Trump recently told reporters that he has instructed “top officials” at the VA to order esketamine.
President Donald Trump ordered the Department of Veterans Affairs (VA) to purchase a large amount of a ketamine derivative as a means of combating rising suicide rates among military veterans.
While en route to a veterans’ conference in Kentucky, Trump told reporters that he has instructed “top officials” at the VA to order esketamine, a medically viable variation of ketamine in nasal spray form that has been approved by the Food and Drug Administration (FDA) for treatment of depression.
Trump’s request countered a decision by the VA’s medical board to exclude esketamine from the list of drugs in its hospital system, save for extreme cases without results from any other medication.
Trump told reporters that esketamine—which is marketed under the brand name Spravato by troubled pharmaceutical company Johnson & Johnson—has had a “tremendously positive” effect in tests involving patients with depression.
However, as The Atlantic noted, test results produced a very different result, with just one of three clinical trials showing any benefit. And though approved for use by the FDA, the agency’s support hinged on using the drug with an oral antidepressant, and only in cases of severe depression that have not shown response from other treatments. The FDA even published a report in mid-August 2019—a week before the president’s statement—that viewed esketamine as less reliable than a placebo.
The VA’s Stance
The VA did not comment on its decision to exclude esketamine from its drug supply in 2019, but did note that it would be available for “occasional use” in extreme cases of depression. The president’s comments did not appear to change that stance: spokesperson Susan Carter told The Atlantic that it will “closely monitor” esketamine use in veterans and may consider revising its guidelines “if warranted.”
Ketamine—an anesthesia medication used to assist sedatives and painkillers in cases of surgery or major injuries—is also known as a recreational drug for its hallucinogenic properties. More recently, the drug has been put forward as treatment for a host of mental disorders, including treatment-resistant depression, obsessive-compulsive disorder and post-traumatic stress disorder. Though small clinical trials have yielded some positive results, others have shown that ketamine’s effectiveness as a depression treatment is limited.