The FDA approval of the drug esketamine is a significant advance in the treatment of depression, a mood disorder. Esketamine is particularly effective for those that have been resistant to conventional treatment or who are at imminent risk of suicide. The drug is a nasal spray that could be self-administered by patients but under the supervision of health care professionals. Esketamine can bring relief to millions of patients all over the world.
Like ketamine, a related drug, esketamine, in addition to its anesthetic effects, is a rapid-acting antidepressant, whose medical use was started in 1997. On February 12, 2019, an independent panel of experts recommended that the Food and Drug Administration (FDA) approve the use of esketamine, as long as it is administered in a clinical setting to ensure patient safety.
Depression has been called a “democratic disease” since it affects people of all social and economic strata. Abraham Lincoln suffered from prolonged periods of depression, which didn’t stop him from becoming one of the most admired presidents in U.S. history.
A study of the first 37 U.S. presidents (1776-1974) by Jonathan Davidson, of Duke University Medical Center and colleagues concluded that half of them had been afflicted by mental illness, and that 24 percent met the criteria for depression, including James Madison, John Quincy Adams, Franklin Pierce, and Calvin Coolidge, in addition to Lincoln.
According to the World Health Organization (WHO) estimates, more than 300 million people were affected by depression worldwide in 2015, equivalent to 4.4 percent of the world’s population. Nearly 50 percent of all people diagnosed with depression are also diagnosed with an anxiety disorder. Depression is also a major contributor to suicide, which numbers approximately 800,000 globally annually. In the U.S., 44,000 people die by suicide every year.
Depression is a state of low mood which can affect a person’s thoughts, behavior, feelings, and sense of well-being. Its symptoms include sadness, inactivity, difficulty in thinking and concentration, and altered appetite and sleep. Many depressed people have feelings of dejection and hopelessness that may drive them to suicide. According to a person’s condition, it may be a short-term or a long-term affliction.
At some point in their lifetime, 15 percent of the adult population will experience depression. At any given year, five percent of the U.S. population experiences seasonal depression. Among women, one in seven experiences post-partum depression; about half of them start experiencing symptoms during pregnancy.
Depression can happen at all ages. It can begin during childhood or during the teenage years. As happens also among adults, girls are more likely to experience depression than boys. Although in the U.S. there has been an increase in teenage depression, there has not been a parallel increase in their treatment. Because symptoms of depression among teens are often missed by their parents and teachers, the American Academy of Pediatrics recommends regular depression screenings for all adolescents and youngsters ages 11 to 21.
Clinical depression among the elderly is also common, affecting 6 million Americans ages 65 and older. Among the elderly, depression is frequently confused with the effects of other illnesses, and the medicines used to treat them. Studies in nursing homes of elderly patients with physical illnesses show that depression substantially increases the risk of dying from those illnesses.
Aside from the effects on health and on people’s well-being, depression exacts a heavy economic toll on individuals, families and on society as a whole. The total economic cost of depression in the U.S. is estimated to be $210 billion annually. That includes decreased productivity, medical expenses, and indirect medical costs.
Although there are known, effective treatments for depression, fewer than half of those affected by it receive such treatments. As depression is on the rise globally, the approval of a drug to treat cases resistant to treatment is most welcome, and necessary, news.