Why esketamine will force doctors to rethink office visits for depressed patients

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The Food and Drug Administration approved esketamine (Spravato) for treatment-resistant depression to be administered under physician supervision. It’s a derivative of ketamine, a drug commonly used for anesthesia.

Yet in its approval of esketamine, the FDA overlooked one essential issue: while psychiatrists provide “talk therapy” and others dispense medications, it’s almost unheard of for a doctor to dispense a psychiatric medication and supervise the reaction for up to two hours. In a mental health care system where waitlists are already weeks long, will the system adapt to allow for this additional period to supervise the immediate effect of the medication?

Herein lies the tension with esketamine and for two other psychedelics — MDMA (known on the street as ecstasy or Molly) and psilocybin — that are currently in the pipeline for FDA approval for refractory mental health conditions. Such drugs require a fundamental shift in how psychiatric care is delivered and the amount of time each patient may require with a health provider for a given session. Doctors will need to rethink the role of longer, and more in-depth patient encounters in a system that places a premium on the revolving door of mental health care.

Related article:  Inside the battle to convince insurers that chronic fatigue syndrome is a legitimate illness

Read full, original post: Esketamine and psychedelics will require restructuring mental health care visits

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