[copper_think]

So, it's just enantiomerically pure S-ketamine - not really a new drug discovery. The drug is already around as an anesthetic but it is almost finished with the FDA's approval process for treatment-resistant depression. When used as an anesthetic it is administered intravenously, but the anti-depressant formulation is a nasal spray. Cool! That definitely makes it more accessible.

I wonder if J&J got a patent on S-ketamine? The patent system is often abused this way. First you sell the racemic mixture, then when that patent is about to expire, you start selling a new product that is just the active enantiomer. And you can tell customers that it's new and improved: that you only need to take half as much! See Prilosec/Nexium, Celexa/Lexapro, etc.

Although, maybe it's difficult to manufacture just the one enantiomer, at scale?

[pkaye]

Why couldn't someone else jump ahead and patent S-ketamine first while the racemic mixtures is being sold?

[epmaybe]

I thought this was interesting: https://patents.google.com/patent/DE102007009888A1/en?q=s-ke... https://patents.google.com/patent/US20130236573A1/en

Also the racemic intranasal ketamine was already patented: https://patents.google.com/patent/US20070287753A1/en?q=s-ket...

[WalterSear]

It's even more confusing: R-ketamine is the more effective enantiomer, with less dissociative effects.

[civilian]

Sweet, I like that J&J is using S-ketamine then. I think the dissociative effects of ketamine are fantastic and beneficial, even though they can be surprising. At a low dose it likely won't be an issue.

[WalterSear]

Personally, I have no issues with the dissociative effects per se. However, studies have determined that they aren't related to the antidepressant effect. Fwiw, a full clinical dose feels like ~1/4 of a 'rail'. There's no introspective trip here, just slight drunkenness.

(Incidentally, we have some evidence that the metabolite that causes the effect can be blocked via concurrent CBD administration - without reducing the dissociative effect)

The standing appointment to get slightly high for a couple of hours every three days does get inconvenient (though it's not as problematic as the resultant insomnia). I expect esketamine will be more so, for less antidepressant effect. And, being a controlled substance, I'm concerned I'll be unable to increase my dosage to make up the difference.

[rincebrain]

People seem to still be arguing about that - [1] and [2] argue that they're directly correlated in ketamine treatment, and I can't begin to guess what research on {ar,es}ketamine and metabolite efficacy is going to produce when one of these becomes readily available.

[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065787/

[2] - https://www.ncbi.nlm.nih.gov/pubmed/29501990