After it was approved in 2019, Spravato, a depression treatment derived from the club drug ketamine, was looking like a dud. But recently it has taken off, and it surpassed $1 billion in annual sales last year for its maker, Johnson and Johnson. Further Listening: -A Lawyer Says He Doesn't Need Help for Psychosis. His Family Disagrees. -America's Maternal Mental Health Crisis Further Reading: -J&J’s Ketamine-Derived Drug Is Taking Off -Big Pharma Walked Away From Mental Health. Why Some Are Coming Back. Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: Who is Sean Fury and how does depression impact his life?
My name is Sean Fury. I'm a writer in Fort Worth, Texas. I'm 36 years old.
And I'm seeing some, like a very interesting background there for you. You've got a poster. You've got, is that Creature from the Black Lagoon?
It is. That's my favorite.
Sean loves movies, but he doesn't just love to watch them. He makes them too.
Horror is my go-to. We just finished the first leg of a shoot of a horror thriller. It's a vampire film.
Why did you want to make this film?
You know, to kind of work through my own issues with that depression, anxiety, PTSD. And I chose a vampire type story because I feel like there are times where I felt really low, where I just feel like I'm sucking the life out of my family, my wife. Yeah. So I decided to make that literal and explore it through a vampire film.
Sean says depression has been part of his life for as long as he can remember. At times, he says, it's been debilitating.
There are days where my wife has to physically help me out of bed. I just can't get up. I can't really bear to face the day. What kind of treatments have you tried over time? Pretty much anything that came onto the market physically. I tried and it is hard because you start taking it and you don't notice if it works or not for a couple of weeks.
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Chapter 2: What is Spravato and how has it affected Sean Fury?
And then by that point, you have to kind of wean yourself off of it to try something new. And in the meantime, those antidepressants can have several side effects on your body, which are frustrating as well.
Sean has what's called treatment-resistant depression. And a few years ago, he found out about a new kind of treatment that might help him. It's called Spravato, and it's made by Johnson & Johnson. And Spravato is unique because it's a derivative of ketamine, best known as an illicit club drug. What impact has Spravato had on your life? How would you describe that?
Oh, man. I still have outlier days, but I am so much more positive and so much able to better roll with the punches just of life. People notice that you walk in a little more confident. You're a little bit taller. I think just more ready to go versus being depressed and just kind of floating from room to room, you know?
Patients with results like Sean's have propelled sales of Spravato. Last year, it exceeded a billion dollars in sales worldwide, becoming a blockbuster drug for J&J. For the pharmaceutical industry, it's amplifying the potential of psychedelics as a treatment for mental health. Welcome to The Journal, our show about money, business, and power. I'm Jessica Mendoza. It's Friday, March 21st.
Chapter 3: How did Spravato become a successful treatment for depression?
Coming up on the show, how a ketamine-derived treatment for depression became a hit for Johnson & Johnson.
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Nearly 30% of adults in the U.S. say they've been diagnosed with depression at some point in their lives, according to a Gallup survey. But even though depression is so prevalent, and in recent years more widely discussed, the way we treat it hasn't evolved for years.
Chapter 4: Why is depression challenging to treat effectively?
Why is depression so hard to treat? Yeah, I think that's a very good question. So in contrast to some what we might call physical illnesses, illnesses of the brain and the mind are less well understood.
Dr. Hosseini Manji is a neuroscientist and professor of psychiatry at Oxford University. And for years, he worked at J&J coming up with treatments for depression.
Depression is unfortunately one of the most disabling conditions there is. And although we've had a number of treatments, many people don't respond to them. So there's a real need to come up with improved treatments.
In the late 80s and early 90s, the pharmaceutical industry made some breakthroughs in the field of mental health treatment with the success of Prozac.
Prozac Weekly is here. Ask your doctor if it's right for you.
And Zoloft.
Zoloft. When you know more about what's wrong, you can help make it right.
These drugs are called SSRIs, and they boost serotonin levels in the brain. They're some of the most common treatments for depression, and they're effective, but results vary.
One of the things that sometimes surprises people is that almost all our existing antidepressants, even when they work, take about four to six weeks to work. And that led many people, including myself, to think maybe we're hitting the wrong target, that just increasing levels of serotonin is a starting point.
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Chapter 5: How does ketamine play a role in treating depression?
Ultimately, you need to bring about other changes, which results in people getting better.
Hosseini wanted a medicine that worked quickly and could help people with treatment-resistant depression. Instead of boosting serotonin levels, he thought a better strategy for dealing with depression was to help the brain cells create new connections. So Hosseini went looking for a substance that could do that. And he found a good option. Ketamine. Ketamine is best known as a psychedelic.
It's often used illegally at clubs and is popular for its hallucinogenic effects. It can make people feel detached from reality and kind of spacey.
Ketamine, known on the streets as Special K, Vitamin K, or Cat Valium, a street drug police say is starting to resurface.
It is usually snorted or swallowed. The desired effect is euphoria, a dreamlike state. Ketamine is a controlled substance, which comes with a risk of addiction and abuse. but it has also been used legally for decades as an anesthetic.
So I was involved in some of the earlier studies using intravenous ketamine, and those studies really showed remarkable effects. So we were looking at patients who are sometimes called treatment-resistant depressed patients, And in those patients, we saw that within 24 hours, 70% of those patients were classified as responders.
And what was interesting was that although the drug, the ketamine, is gone from your system within two to four hours, people remained well for at least four days.
In 2008, Hosseini was hired to become the new global head of neuroscience at J&J. He started working to create an effective medication for treatment-resistant depression. Hosseini believed ketamine could provide a breakthrough. But first, he needed to convince J&J.
When I first brought up the idea, I think understandably people had some reservations because ketamine has sometimes been used as a club drug. So I had to really sort of walk through a lot of the reasons why I thought this would be successful.
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Chapter 6: What are the side effects and challenges of using Spravato?
— All new tonight, a controversial new treatment for depression. The FDA approved the antidepressant this week, and it's a nasal spray.
— Spravato is the first new type of depression treatment since Prozac was okayed back in 1987. — At the time, J&J put the list price for Spravato between $590 and $885 per treatment session.
For Hosseini and his team, the FDA approval was a huge breakthrough.
You know, we got the call while the whole team was together, and obviously we celebrated right after.
Were you popping champagne?
Okay.
But Spravato got off to a shaky start. Because it had to be taken in a clinic under supervision, doctors and patients had more of a learning curve than typical medication. And then the pandemic made that sort of in-person treatment even harder. How Spravato turned into a blockbuster is next. When you first heard about a ketamine treatment for depression, what did you think?
I associated it, ketamine, with like microdosing LSD, which I was very nervous, hesitant to try. And I could not find any research about it online or reviews or testimonials of people who have actually undergone that treatment, which was very worrisome.
Sean Fury, who we heard from earlier, was encouraged to try Spravato by his psychiatrist because he was continuing to struggle with his depression. What changed your mind?
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