Australians suffering from major depressive disorder (MDD) may soon be able to access a new treatment in the form of a nasal spray.
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According to University of Melbourne and Ramsay Health Care psychiatry professor Mal Hopwood, the new nasal spray SPRAVATO may provide an option to those with MDD who do not respond to traditional treatments.
"Major depression is a severe illness that affects many Australians and, sadly, our current treatments don't work for everyone," Professor Hopwood said.
"About 30 to 40 per cent of people (don't respond) to the first two treatments."
The professor said these people meet the definition of treatment resistant depression - a subset of depression associated with more disability and worse outcomes - and are ideal candidates for SPRAVATO.
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While not yet available to the public, the Pharmaceutical Benefits Advisory Committee (PBAC) is currently receiving submissions regarding the effectiveness of the spray.
However, this is not the only step to SPRAVATO being on the public market.
To be affordable, the professor said the nasal therapy would need to be reimbursed on the Pharmaceutical Benefits Scheme (PBS) as well.
"(SPRAVATO) operates via a new mechanism of action in the brain targeting the glutamate system that we've never really targeted before in treatment," professor Hopwood said.
"And, most importantly, the evidence from trials and overseas use of this drug - in over 20 countries - suggest it's going to be a really useful addition."
This is particularly good news given the relatively few advances in the area in the last decade or two, however, the professor said there is still work to be done to ensure all Australians could access this medication.
"I absolutely acknowledge we've got good data that says rates of depression, and most likely treatment resistant depression, are higher rurally than in the metro regions," he said.
With new treatments like this, that require supervision in a treatment center, we really need to ensure equity of access, if it becomes freely available.
- Mal Hopwood
"So I hope that if the drug is refunded by the PBAC in Australia that we'd see treatment centers open in regional cities like Bendigo in the relatively near future."
The challenges of distance, economic disadvantage, a lack of access to specialist mental health care are some of the factors behind the higher rates of MDD in rural and regional areas, and Professor Hopwood said these need to be addressed.
"SPRAVATO is a self administered nasal spray, but you need to do it in a treatment center where you can be observed for an hour or so post dose to look out for side effects," he said.
"Initially, treatment is twice a week for four weeks, and if successful, would then continue for a maintenance period of up to six months initially weekly, and then fortnightly."
Many people with depression will respond to first-line defences such as lifestyle intervention in diet and exercise therapy, as well as conventional antidepressant medication.
SPRAVATO is recommended to be used in those who fail to respond to these initial treatments.
Professor Hopwood said it's important to know there are new options becoming available and that people should seek help if they are experiencing the symptoms of depression.
"No drug works for everyone and we get about a 50 per cent response rate with SPRAVATO, which is pretty good, given the (patient) has already failed to respond to the first line treatments," he said.
"Even if this didn't work for you, it's important to know, there will almost certainly be other options available."
People should seek professional medical help if they are experiencing symptoms of major depression such as:
- persistent low mood;
- loss of enjoyment or pleasure;
- problems with sleep, appetite, concentration or motivation;
- hopelessness;
- suicidal ideation
Those struggling can also contact Lifeline on 13 11 14.
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