Ketamine’s promise as an antidepressant is being undermined by its lack of profit

Esketamine, the first new method to treat depression in 25 years, is gaining credibility. Last year, Janssen Pharmaceutical’s ketamine-based drug was approved by the US Food and Drug Administration (FDA) to treat patients with treatment-resistant depression. And on Aug. 3, the FDA followed up with a second approval, allowing doctors to prescribe the tranquilizing drug to patients experiencing suicidal ideation.

But though there’s growing evidence that Janssen’s drug can help those with depression, some psychiatrists question why ketamine, its better-known and cheaper cousin, isn’t being similarly developed.

Ketamine has long been approved in the US as an anaesthetic. That means that though it’s not approved to treat depression, patients can legally use it for this purpose if their doctor provides them with a prescription for so-called “off-label” use. And they do: Medical ketamine clinics have been treating patients in the United States since 2014, and there are now dozens of such clinics across the country.

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