Intranasal esketamine for depression: Not so special K

Intranasal esketamine has been recently approved for the treatment of resistant depression. It is the only form of ketamine approved. The formulation costs around $600 per dose while plain injected ketamine, on which most research has been done, costs less than $20 per dose. Research shows that intranasal esketamine is less effective and has more unwanted effects than injected ketamine, yet the approval means that this intranasal formulation will now be the form used and researched.

While the approval of an inferior treatment mode is understandable from the processes by which medicines are approved, we should think carefully about embracing this particular form of a promising treatment.