January 20, 2025
SINGAPORE – Once primarily known as an anesthetic for horses or a recreational substance, ketamine has emerged as a groundbreaking treatment for severe depression in Singapore over the past four years. This transformation has offered hope to countless patients struggling with treatment-resistant mental health conditions.
Medical professionals report remarkable success rates. Four out of five psychiatrists noted that most of their patients achieved remission or significant recovery. One doctor recorded a one-third remission rate among his 16 patients, with half experiencing a 50% reduction in symptoms. Consultant psychiatrist Christopher Chan remarked, “This is high, relative to other options.”
Spravato, a ketamine-based nasal spray developed by Johnson & Johnson, has transitioned from an alternative treatment to a mainstream solution for treatment-resistant depression.It is now frequently recommended in clinical guidelines.Globally, Spravato is available at approximately 2,800 treatment centers as of late 2024, though specific numbers for Singapore remain undisclosed.
Described as a “neuroscience darling,” Spravato is specifically reserved for individuals who have not responded to at least two other medications or are at risk of suicide. Its rapid effects and non-invasive management have made it a preferred choice.Senior consultant psychiatrist Victor Kwok, who began offering Spravato in December 2020, shared, “It’s very fast-acting. Some get better within two sessions.”
At Dr.Kwok’s clinic, Private Space Medical, patients self-administer the nasal spray under medical supervision in serene, dove-gray rooms. Post-administration, the environment is tailored for relaxation, with dimmed lights and personal music choices. Patients rest for about 90 minutes, with periodic check-ins by doctors until the effects subside.
The initial induction phase can be challenging, with some patients experiencing dissociation, dizziness, nausea, or elevated blood pressure. However, by the fourth or fifth session, most enter the maintenance phase, where side effects diminish. As Dr. Kwok explained, “By then, they know what to do, some can read books, answer e-mails, and shop for groceries.”
Ketamine’s therapeutic benefits stem from its ability to increase glutamate levels in the brain, a neurotransmitter often overlooked by customary antidepressants. This mechanism sets it apart, offering a unique approach to mood enhancement between sessions. Dr. Kwok added, “It’s like my secret weapon – it should work and when it doesn’t, I relook the diagnosis.”
Despite its efficacy,Spravato’s high cost remains a barrier. each session averages $1,000, and treatment durations can stretch from eight weeks to several years. Neuropsychiatry Associates medical director Poon Shi Hui noted that one of her patients has been on Spravato for over two years. Insurance coverage is limited, adding to the financial strain. A 27-year-old marketing executive, Ms. K, shared, “My first month alone, it cost $12,000. that’s three times my salary.”
While a more affordable intravenous ketamine alternative is available at the Institute of Mental Health, it is indeed restricted to public facilities. Despite the cost, Spravato’s benefits frequently enough outweigh those of alternatives like electroconvulsive therapy or psychiatric admission, which carry their own set of challenges, including stigma and loss of freedom.
For Ms. K,the investment has been life-changing. After years of ineffective treatments and a suicide attempt in December 2022, she turned to Spravato. “It’s given me the energy to build my resources and my life back to where I can live again,” she said. “Spravato works, but always in conjunction with therapy.”
How effective is ketamine compared to traditional antidepressants for treating treatment-resistant depression?
Interview wiht Dr. Christopher Chan: The Rise of Ketamine in Treating Severe Depression
January 20, 2025
Archyde News: Dr. Chan, thank you for joining us today. Over the past four years, ketamine has gone from being a niche substance to a mainstream treatment for severe depression in Singapore. Can you tell us how this transformation came about?
Dr. Christopher Chan: Thank you for having me. The transformation has been remarkable. Initially, ketamine was used as an anesthetic, primarily for animals, and later gained notoriety as a recreational drug. However, research in the early 2000s revealed its profound potential in treating treatment-resistant depression. By 2021, we began to see its request in clinical settings, and over the past four years, the results have been nothing short of revolutionary.
Archyde News: What makes ketamine so effective for treatment-resistant depression compared to traditional antidepressants?
Dr. Chan: Traditional antidepressants typically target serotonin, dopamine, or norepinephrine pathways, which can take weeks or even months to show results. Ketamine, on the other hand, works on the glutamate system, specifically the NMDA receptors. This mechanism allows it to rapidly restore synaptic connections in the brain, often within hours or days.For patients who have tried multiple treatments without success, this speed and efficacy are life-changing.
Archyde News: You mentioned that four out of five psychiatrists in Singapore have noted significant success with ketamine. What kind of outcomes are we seeing in your practice?
Dr. Chan: The outcomes have been very encouraging. In my practice, about one-third of my patients achieved full remission, meaning their depressive symptoms were completely alleviated. Another half experienced a 50% reduction in symptoms, which considerably improved their quality of life. This is a high success rate compared to other treatment options available today.
Archyde news: Spravato, the ketamine-based nasal spray developed by Johnson & Johnson, has become a go-to solution for many psychiatrists. What are the advantages of this formulation?
Dr. Chan: Spravato offers several advantages. First, its nasal spray delivery is non-invasive and easy to administer, making it more accessible for patients. Second, it has been rigorously tested and approved by regulatory bodies, ensuring its safety and efficacy. it allows for consistent dosing, which is critical for maintaining the balance between therapeutic benefits and minimizing side effects.
Archyde News: Are ther any risks or challenges associated with ketamine treatment that patients should be aware of?
Dr.Chan: Like any medication, ketamine does come with risks. Some patients experience dissociative effects, which can be unsettling, though these are usually short-lived. There’s also the potential for abuse, which is why it’s crucial that treatment is administered under strict medical supervision. We carefully screen patients and monitor them closely to ensure their safety.
Archyde News: what does the future hold for ketamine in mental health treatment? Do you see its use expanding beyond depression?
Dr. Chan: Absolutely. While ketamine’s role in treating depression is well-established, ongoing research is exploring its potential for other conditions, such as PTSD, anxiety, and chronic pain. I believe we’re only scratching the surface of what ketamine can do. As we continue to refine its use and develop new formulations,it could become a cornerstone of mental health treatment worldwide.
Archyde News: what message would you like to share with patients who are struggling with treatment-resistant depression?
Dr. Chan: My message is one of hope. If you’ve tried multiple treatments without success, don’t give up. Ketamine has brought relief to countless patients who felt they had nowhere else to turn. Reach out to a mental health professional to explore whether this treatment might be right for you. There is light at the end of the tunnel.
Archyde News: Thank you, Dr. Chan, for sharing your insights and expertise with us today.
Dr. chan: Thank you for the prospect to discuss this crucial topic.
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This interview has been edited for clarity and length. For more facts on ketamine treatment and mental health resources, visit our website.
