Hosseini Manji

I think there's no doubt it's opened the door. I would say both, you know, sort of this different type of treatment. And then what Spravato has also been able to do is, you know, sort of normalize to some extent the in-clinic administration. So I think that's one of the things that until Spravato came along, that simply wasn't the case. So I think it certainly has opened the door.

I would say probably it'll depend on the indication. So I would say for treatment-resistant depression, it may be slightly more of a longer-term treatment because it just suggests that they've got bad illness. If they're not on treatment, the illness might come back.

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.

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.

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.

Ultimately, you need to bring about other changes, which results in people getting better.

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.

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.

Yeah, I think it's fair to say that it was done in stages. So, you know, the initial discussions centered around, look, we think this is a good idea. Let's go ahead and generate some of the data.

It's like an inhaler, except it's delivered through the nose. Basically, the person comes into the clinic, their dose is calculated, and they self-administer it. So they administer it in the nose themselves, and then there's no drug left in the device, so you throw away the device.

Sure. So it's basically two side effects. One is that you get a slight increase in blood pressure after you take it. And it's about the blood pressure increase that you or I might have if we ran up a flight of stairs. The second thing is something called dissociation. So what dissociation is, that you might feel that the colors around you are brighter or the sounds are louder, etc.

For almost everyone, you know, it sort of starts within about half an hour. At about one hour, it's gone. Dissociation, is that like tripping? I think so. I think it's a low, low level tripping. Very low level. Very low level tripping.

You know, we got the call while the whole team was together, and obviously we celebrated right after.

Okay.