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Newcastle Herald
Newcastle Herald
Health
Damon Cronshaw

'It saved my life': Push to list esketamine on PBS for depression

Matthew Craig speaking about esketamine treatment for depression at Parliament in Canberra on Wednesday. Picture supplied

Matthew Craig says the drug esketamine helped him overcome severe depression after other treatments failed.

"It's been a life-saving and life-changing experience," said Mr Craig, a University of Newcastle academic.

Mr Craig shared his story with federal MPs at an event in Parliament House in Canberra on Wednesday.

In an emotional speech, he talked about living with a mental illness that made him suicidal.

The event called for esketamine, sold in Australia under the brand name Spravato, to be made available on the Pharmaceutical Benefits Scheme (PBS).

Mr Craig joined clinicians and other patients in Canberra to call for the next Pharmaceutical Benefits Advisory Committee meeting in July to be the third - and final time - that Spravato will be reviewed for a PBS listing.

Last July, the committee rejected a PBS listing for Spravato, citing "unresolved issues" such as "when it would be appropriate to reduce or discontinue treatment".

The drug is approved in Australia for treatment resistant depression in adults who have not responded adequately to at least two different antidepressants. Sold by pharmaceutical company Janssen, Spravato costs about $11,000 over four months.

Mr Craig said he would "never have been able to afford it if I wasn't put on the early access program" in January last year through Newcastle psychiatrist Dr Stuart Saker.

Mr Craig said the treatment should be "accessible to everybody".

He began his esketamine program with two sessions a week.

"You spray it up your nose, wear noise-cancelling headphones and eyeshades with a mental health nurse observing in a super-safe environment," he said.

"At the start, you set an intention. You go through the process, debrief afterwards and unpackage what you went through and explored."

His sessions steadily reduced to weekly, fortnightly and now monthly.

"My diagnostic criteria shows I no longer have depression, which is amazing considering I was at the worst end of it."

Mr Craig suffered severe depression after being "subject to significant workplace harassment in a very toxic environment".

"I tried all the normal interventions like SSRIs, electro-convulsive therapy and in-patient treatment without any luck," he said.

Esketamine helped him "unpack" recent trauma and repressed childhood and adolescent memories.

"Esketamine has empowered me to explore these things in a safe and beautiful way, so now I can talk about them. I would never have thought of revisiting the sites of some of the traumatic stuff that happened."

A couple of months after his first treatment, Mr Craig enrolled in university.

He had since completed a graduate diploma in psychology at the University of Newcastle. His results led him to secure a job as a casual academic in the university's School of Psychological Sciences.

The treatment had "brought me back from literally the darkest place".

"It's given me a whole new lease on life, a new perspective, a new mission to make sure no one else can fall into this overwhelming darkness like I did."

Dr Saker says esketamine is an "effective treatment", but not for everyone.

"We treat 14 esketamine patients a day. About half do really well and half discontinue it quickly because they don't like it," Dr Saker said.

"Either you'll get better, or learn quickly you're not going to get better."

As well going through his own mental health challenges, Mr Craig lost his step brother seven years ago to suicide.

He said mental health issues "touch us all".

Mr Craig said it was "very appropriate that the right amount of caution is applied" to esketamine use for depression, but it should be accessible for people who "don't have any other options".

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) stated in a clinical memorandum last July that a meta-analysis of esketamine, which is a derivative of ketamine, "showed significant antidepressant efficacy".

"Ketamine is a complex drug that has strong effects on the mental and physical states of patients. Psychiatrists should ensure they are fully aware of these effects and required precautions when treating patients with ketamine."

The document stated that serious adverse effects had been reported after "repeated ketamine use in the recreational context".

"Serious adverse effects have not been reported where there has been careful monitoring of treatments within clinical trials, with frequency and level of dosing adjusted where necessary."

Lifeline 13 11 14.

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