“It is the greatest therapeutic novelty that has occurred in the treatment of depression in the last thirty years,” explains Luis Jiménez Treviño, president of the Asturian Psychiatric Society, in relation to Spravato, a new drug that in most of Spain It has already been financed by public health for a few months, but in Asturias it still does not have this coverage. “We do not understand why this happens, when specialists are processing requests for patients who need it and when the drug has already received favorable evaluation from the European and Spanish drug agencies,” says Dr. Jiménez, a psychiatrist who practices in the sector. public (sanitary area IV) and associate professor at the University of Oviedo.
A fast-acting drug
Spravato is a medicine that has intranasal esketamine as its active ingredient. It is indicated for treatment-resistant major depression (DRT). “Esketamine presents, compared to the rest of the known antidepressant drugs, a very important innovation: its rapidity of action”, emphasizes Paz García-Portilla, professor of Psychiatry at the University of Oviedo. Dr. García-Portilla delves into the keys to the aforementioned innovation: “While the rest of the antidepressants need about four weeks for their action to begin on the symptoms of major depression, esketamine only requires a few hours and its effect is consolidating throughout those four weeks in which the traditional antidepressants have not started to act”. This speed of action, emphasize the experts, may be a key factor in patients with suicidal ideation.
The explanation of the Principality
The delay of the Asturian health when approving the public financing of this new drug has reached the General Meeting of the Principality through a written question formulated by the deputy of IU Ovidio Zapico to the regional Government. The response from the Minister of Health, Pablo Fernández Muñiz, says the following: “It must be taken into account that the treatment has been marketed in November 2022, it is very recent, and unfortunately it is not exempt from possible side effects and interactions with other drugs “. And the Counselor adds that “at the moment the evaluation is underway for its inclusion in the Sespa Pharmacotherapeutic Guide to be able to prescribe and dispense this treatment with all the safety guarantees to all those who need it and who can supposedly benefit from it “.
Specialists are processing requests for patients who need it
Paradigm shift
The psychiatrist and professor Manuel Bousoño does numbers. He estimates that the number of resistant depressions in Asturias may move around 2,500, “which means that hundreds of patients will request such treatment.” Dr. Bousoño celebrates the arrival of what he calls “a paradigm shift” to understand and address depression: “Most likely, it will make us understand much better the nature of depressive disorders, the circuits that are involved and how to get closer to really understand how the human brain works. The mechanism that triggers esketamine is based on “a transient increase in the release of glutamate”, which is the most important excitatory neurotransmitter in the brain and increases the stimulation of the AMPA receptor with the consequent increase in brain connections. The consequence is a reestablishment of the brain connections involved in emotional regulation, says Manuel Bousoño. Current approvals call for Spravato to be dispensed from hospital pharmacies and under close medical supervision.
Esketamine only takes a few hours to take effect, and the other drugs four weeks.
Concept
Treatment-resistant major depression is a severe, chronic, and disabling mental disorder for the person who suffers from it. Clinically it is defined as that major depression that does not respond to two different pharmacological treatments, at the correct doses and for the necessary time. This concept has been present in psychiatry since the early years of this 21st century.
prevalence
A recent study led by Víctor Pérez Solá, within the framework of the CIBERSAM scientific consortium, establishes an incidence of almost one case per 1,000 people, which in Spain translates into 44,000 new diagnoses per year with this severe form of depression.
We are on our way to a much better understanding of the nature of depressive disorder.
Costs and savings
As is well known, the cost of new drugs is high. However, Paz García-Portilla points out some complementary data in this regard: “The benefit of Spravato is not only personal, but also social. I would describe it as immense by reducing three types of costs that this mental disorder implies.” The professor lists the savings headings. On the one hand, the direct health costs of DRT: hospitalizations, drugs, psychotherapies and other approved biological treatments, as well as somatic comorbidities and their treatments. Secondly, the indirect social burden of the disease derived from temporary or absolute work disabilities, presenteeism, family overload and negligence in caring for family members in need of them, but above all the costs derived from premature death. And third, the personal costs derived from the disability, the loss of quality of life and the rejection or social stigma associated with mental disorders.