An antidepressant containing a form of the drug ketamine has been added to the Pharmaceutical Benefits Scheme (PBS), making it much cheaper for the estimated 30,000 Australians with treatment-resistant depression. This is when a patient has tried multiple forms of treatment for major depression – usually at least two antidepressant medications – without any improvement.

From May 1, a dose of Spravato (also known as esketamine hydrochloride) will cost $A31.60 and $7.70 for concession card holders.

However, unlike oral antidepressants, Spravato can’t be taken at home. Here’s how it works, and who it’s expected to help.

What is Spravato?

The chemical ketamine is used as an anaesthetic. In this formulation it combines both the right-handed (designated “R”) and left-handed (called “S”) forms of the molecule.

This means they are mirror images of each other, similar to how your left hand is a mirror image of your right hand. The left- and right-hand forms can have different effects in the body.

Spravato contains only the left-handed version, giving the drug its generic name esketamine.

Spravato works by increasing the levels of glutamate in the brain. Glutamate is a key chemical messenger molecule that excites brain nerve cells, lifting and improving mood. It also plays a role in learning and forming memories.

How is it taken?

Spravato cannot be taken at home.

A patient can self-administer, but it must be done at a registered treatment facility, such as a hospital, under the supervision of medical staff so they can look out for blood pressure changes and monitor potential side effects.

The drug is provided as a single-use nasal spray. This application means it’s absorbed directly through the nasal lining into the brain, so it starts to work within minutes.

Spravato must also be taken alongside an oral antidepressant. This will be a new one the patient hasn’t tried before. In clinical trials, it was usually an SNRI or SSRI medication.

When a patient first starts on Spravato, they are given the spray twice a week in the first month. It is then administered once a week for the second month, and then weekly or fortnightly after that.

Once there are signs the medicine is working, treatment is continued for at least six months.

How effective is it?

Spravato was approved for sale in Australia based on clinical trial data from more than 1,600 patients who were administered the drug for a period of four weeks. Each was given either Spravato, or a nasal placebo, and an oral antidepressant.

Patients were given a starting dose of either 28 or 56mg, which could be then increased up to 84mg by their doctor.

By the end of the four weeks, a greater percentage of patients who were given Spravato were found to have had a meaningful response to the treatment when compared with patients who received the placebo. Patients who were taking Spravato were also found to relapse at a lower rate. For those who did relapse, it took the Spravato patients longer to relapse when compared with patients who took the placebo.

It is expected Spravato will benefit a wide range of patients. The clinical trials demonstrated effectiveness for men and women, people aged 18 to 64, and those from a range of different ethnic backgrounds.

Potential side effects

As with any medicine, Spravato may cause side effects, some of which can be serious. The most common include:

• dissociation (feeling disconnected from yourself or what is around you)
• dizziness
• nausea and vomiting
• drowsiness
• headache
• change in taste
• vertigo.

Because Spravato can potentially increase blood pressure, medical staff will monitor a patient before and after it is administered.

Usually, blood pressure spikes around 40 minutes after taking the drug, so a reading is taken around this time. After taking Spravato, if their blood pressure has stayed low, or it’s dropping, the patient is given the all-clear to go home.

Due to the potential for this and other serious side effects, Spravato carries a black triangle warning. This means medical staff are encouraged to report any problem or side effect to the Therapeutic Goods Administration. A black triangle warning is generally used for new medicines or medicines that are being used in a new way.

Who will be eligible?

To be eligible for a prescription, a patient will need to have been diagnosed with treatment-resistant depression. In practice, this means they will have unsuccessfully tried at least two other antidepressant drugs first.

Australia’s Therapeutic Goods Administration approved Spravato for use in Australia in 2021, meaning it was available but not subsidised. Since then, the sponsoring company, Janssen-Cilag (an Australian subsidiary of the multinational Johnson & Johnson), applied to have it added to the PBS four times.

In December 2024, the Pharmaceutical Benefits Advisory Committee recommended a PBS listing.

The new PBS listing, capping the price of a single treatment at $31.60, is a significant price drop. In 2023, single doses of branded Spravato were reported to cost anywhere between $500 and $900.

However, patients may still have to pay hundreds of dollars for appointments at private clinics where Spravato can be administered. Public places are available but limited.

Spravato may be suitable for you if you’ve tried different antidepressants without success. If it is suitable for you, then your doctor can discuss the next steps.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Nial Wheate, Professor, School of Natural Sciences, Macquarie University and Shoohb Alassadi, Associate Lecturer and Registered Pharmacist, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Aged-care workers will receive a significant pay increase after the Fair Work Commission ruled they deserved substantial wage rises of up to 28%. The federal government has committed to the increases, but is yet to announce when they will start.

But while wage rises for aged-care workers are welcome, this measure alone will not fix all workforce problems in the sector. The number of people over 80 is expected to triple over the next 40 years, driving an increase in the number of aged care workers needed.

How did we get here?

The Royal Commission into Aged Care Quality and Safety, which delivered its final report in March 2021, identified a litany of tragic failures in the regulation and delivery of aged care.

The former Liberal government was dragged reluctantly to accept that a total revamp of the aged-care system was needed. But its weak response left the heavy lifting to the incoming Labor government.

The current government’s response started well, with a significant injection of funding and a promising regulatory response. But it too has failed to pursue a visionary response to the problems identified by the Royal Commission.

Action was needed on four fronts:

• ensuring enough staff to provide care
• building a functioning regulatory system to encourage good care and weed out bad providers
• designing and introducing a fair payment system to distribute funds to providers and
• implementing a financing system to pay for it all and achieve intergenerational equity.

A government taskforce which proposed a timid response to the fourth challenge – an equitable financing system – was released at the start of last week.

Consultation closed on a very poorly designed new regulatory regime the week before.

But the big news came at end of the week when the Fair Work Commission handed down a further determination on what aged-care workers should be paid, confirming and going beyond a previous interim determination.

What did the Fair Work Commission find?

Essentially, the commission determined that work in industries with a high proportion of women workers has been traditionally undervalued in wage-setting. This had consequences for both care workers in the aged-care industry (nurses and Certificate III-qualified personal-care workers) and indirect care workers (cleaners, food services assistants).

Aged-care staff will now get significant pay increases – 18–28% increase for personal care workers employed under the Aged Care Award, inclusive of the increase awarded in the interim decision.

Indirect care workers were awarded a general increase of 3%. Laundry hands, cleaners and food services assistants will receive a further 3.96% on the grounds they “interact with residents significantly more regularly than other indirect care employees”.

The final increases for registered and enrolled nurses will be determined in the next few months.

How has the sector responded?

There has been no push-back from employer groups or conservative politicians. This suggests the uplift is accepted as fair by all concerned.

The interim increases of up to 15% probably facilitated this acceptance, with the recognition of the community that care workers should be paid more than fast food workers.

There was no criticism from aged-care providers either. This is probably because they are facing difficulty in recruiting staff at current wage rates. And because government payments to providers reflect the actual cost of aged care, increased payments will automatically flow to providers.

When the increases will flow has yet to be determined. The government is due to give its recommendations for staging implementation by mid-April.

Is the workforce problem fixed?

An increase in wages is necessary, but alone is not sufficient to solve workforce shortages.

The health- and social-care workforce is predicted to grow faster than any other sector over the next decade. The “care economy” will grow from around 8% to around 15% of GDP over the next 40 years.

This means a greater proportion of school-leavers will need to be attracted to the aged-care sector. Aged care will also need to attract and retrain workers displaced from industries in decline and attract suitably skilled migrants and refugees with appropriate language skills.

The caps on university and college enrolments imposed by the previous government, coupled with weak student demand for places in key professions (such as nursing), has meant workforce shortages will continue for a few more years, despite the allure of increased wages.

A significant increase in intakes into university and vocational education college courses preparing students for health and social care is still required. Better pay will help to increase student demand, but funding to expand place numbers will ensure there are enough qualified staff for the aged-care system of the future.

Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.