Steven Lippmann, M.D.

There are concerns nation-wide about not having the latest interventional psychiatric treatment options available for clinical prescribing. For just one single example, intranasal esketamine is not uniformly present in some healthcare formularies. There are instances where financial, clinical, and/or other administrative hurdles block this new pharmacotherapy even to hospital emergency medicine departments.

In recent years, there have been scary rates of depression, suicide, and substance abuse. Some of this preceded the COVID-19 outbreak, got worse during the pandemic, and is still an issue. Suicide deaths and gunshot homicide are the two leading causes of death by children; both have some roots in affective disorders. Adults could benefit from treatment too. This matter should be more vigorously addressed by the medical community.

Ketamine has for years been prescribed for a variety of issues and is already long-accepted as effective by emergency services to counter suicidal crises. During 2023, intranasal ketamine was approved for clinical prescribing in similar indications. Intranasal ketamine has proven valuable for patients in a crisis to help diminish overt suicidal thoughts and death wishes, especially in acute situations.

We should be able assist lots of people with depression to avoid self-injury by widely offering esketamine as an established therapeutic modality. To minimize the high cost, government, pharmaceutical industry, and hospital cooperation could lower the price and attenuate some of that prohibition. Most people would favor that.

Intranasal esketamine is easily administered, being quicker and less invasive than intravenous infusions.  Within just hours, it often can rapidly induce dramatic reduction in self-dangerous ideas. It is a life-saving method especially when offered at clinics, in emergency medicine departments, or similar medically supervised places. Repeated administration is productive over extended periods on a recurrent basis to forestall and/or mitigate mood-related relapse. Esketamine is safe and with dosage adjustments is documented with efficacy even for subjects with chronic and/or treatment resistant cases of depression.

Hopefully, we can expand intranasal esketamine availability. Good luck.

Steven Lippmann, M.D. is Emeritus Professor of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky.