ketamine infusion treatment (copy)

Dr. Richard Bowen of the Charleston Ketamine Center checks on patient Jacinda Standley during her ketamine infusion treatment on Monday, March 11, 2019. Ketamine treatments are given largely through infusions. They are viewed as a last resort when patients with depression have tried other treatments with no success. File/Brad Nettles/Staff

President Donald Trump announced at a press conference this week he has ordered his administration to buy large quantities of a powerful new stimulant by Johnson & Johnson to address high veteran suicide rates. 

Johnson & Johnson confirmed via email that the "stimulant" the president was likely referring to is Spravato — or esketamine — a depression treatment that a Johnson & Johnson spokeswoman said has not yet been specifically approved for treating major depression symptoms among patients who have active suicidal thoughts with intent.

"We have completed clinical studies for this second indication; however, the medicine is not approved or indicated for use in these patients at this time," said Johnson & Johnson spokesperson Kaitlin Meiser via email. 

National suicide rates among the veteran population are more than 10 points higher than the rates of the civilian population, according to the Department of Veterans Affairs. In South Carolina, a similar gap in suicide rates between veterans and civilians exists. 

In June, the Trump administration launched a veteran suicide prevention task force to address the issue. This week, when a reporter questioned Trump on his administration's plans, the president brought up the unnamed stimulant.

"I've instructed the head of the (Department of Veteran Affairs) to go out and buy a lot of it, and we are buying a lot of it," Trump said at the press conference. "Hopefully, we're getting it at a very good cost." 

While the treatment has been studied and approved to be used with an oral antidepressant among patients with treatment-resistant depression, research is still being done on its effectiveness with suicidal ideations. 

The Post and Courier reported earlier this year that the Food and Drug Administration had approved the use of the nasal spray esketamine treatment. The drug was celebrated for it's rapid treatment of depression symptoms. 

It's comparable to a similar drug for depression called ketamine, a historically common anesthetic and one that is currently used as a pediatric anesthetic. The main difference between esketamine and ketamine is that esketamine is more potent. 

Neither treatments are available over the counter. They are given to patients who are closely monitored by a physician. Ketamine treatments are given largely through infusions. They are looked at as a last resort when patients with depression have tried other treatments with no success. 

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Esketamine is treated similarly. It was approved in March to mixed reviews, with physicians citing cost and dangers of the drug being abused as cons to treatment. In the '80s, ketamine was a popular party drug referred to as "Special K."  

In the '90s, Yale researchers discovered that it could be used for treating depression. In an interview with The Post and Courier earlier this year, Dr. Robert Malcolm, a psychiatrist at MUSC, said some of the fear associated with esketamine nasal spray involves its portability and potential for abuse.

This comes after drugmakers and the VA received scrutiny for allegedly targeting veterans as recipients for highly addictive opioids for pain. The Post and Courier published an investigation this month that found a mail-order pharmacy run by the Department of Veterans Affairs in North Charleston shipped more addictive opioid painkillers between 2006 and 2012 than any other pharmacy in the country.

Today, Spravato is currently available for it's FDA-approved use to veterans at the VA who are enrolled in an individualized care plan. Veterans who have not responded to other major depression treatments qualify for the drug. 

Erin Curran, a spokeswoman for the Ralph H. Johnson VA Medical Center in Charleston, said the VA says will closely monitor the use of esketamine in veterans to better understand "its relative safety and effectiveness as compared to other available treatments."

Reach Jerrel Floyd at 843-937-5558. Follow him on Twitter @jfloyd134.

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