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Why low-cost ketamine is still inaccessible to many with severe depression

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A case study on ketamine reveals systemic barriers that prevent repurposing existing low-cost drugs like ketamine for treatment-resistant depression.

Why low-cost ketamine is still inaccessible to many with severe depression

 

UNSW Sydney

A case study on ketamine reveals systemic barriers that prevent repurposing existing low-cost drugs like ketamine for treatment-resistant depression.

Patients with treatment-resistant depression are missing out on potentially life-changing treatment with ketamine because systemic barriers in the public health system have made it unaffordable.

In an article published recently in the Australian & New Zealand Journal of Psychiatry, a multidisciplinary team of medical researchers, including UNSW SydneyBlack Dog Institute and The George Institute for Global Health, provided insights into why affordable, effective treatments are being eclipsed by novel more expensive alternatives that aren’t necessarily better. They discussed the challenges that are limiting access to affordable treatments and proposed solutions to overcome these barriers.

The researchers drew attention to the fact that it is now more than 20 years since the first indications that generic ketamine was effective, but public funding to support research and patient access has been slow, uncoordinated and underfunded. They also say there have been insufficient commercial incentives to conduct the research and development of generic ketamine, nor any schemes promoting public-private partnerships.

There is now a stark disparity in the accessibility and cost of ketamine-based depression treatments. The patented, intranasal s-enantiomeric ketamine formulation, Spravato, is priced at around $500 to $900 per dose, whereas generic ketamine stands at about $5 to 20 per dose. This high cost has led to Spravato being rejected for public reimbursement three times and thus it remains largely inaccessible for Australian patients.

On the other hand, generic ketamine, despite also being effective at a fraction of the cost, remains unapproved and underutilised due to regulatory and financial barriers. One such barrier is the cost of care of patients who must be monitored for at least two hours after receiving each dose – whether an injection with generic ketamine or nasal spray with Spravato – and as ongoing doses are needed for the treatment to be effective, the mounting costs can become prohibitive for many.

This narrative is not unique to ketamine, as the article foresees a similar fate for upcoming psychedelic-assisted psychotherapy treatments, which are on the verge of entering the mental health treatment arena. The article suggests that without systemic interventions, the cycle of underutilising low-cost effective solutions is set to continue, leaving patients unable to access treatments while threatening to blow out health care costs.

A case study on ketamine reveals systemic barriers that prevent repurposing existing low-cost drugs like ketamine for treatment-resistant depression.

A case study on ketamine reveals systemic barriers that prevent repurposing existing low-cost drugs like ketamine for treatment-resistant depression.

Professor Anthony Rodgers from The George Institute, which is affiliated with UNSW Sydney, says he and his fellow colleagues propose a range of solutions including:

  • providing better commercial incentives
  • boosting funding for integrated and translational research
  • reducing regulatory hurdles
  • optimising clinical trial procedures, and
  • fostering broader collaboration across sectors and borders

He calls on stakeholders across the board to rally towards creating a conducive ecosystem for repurposing off-patent medicines.

“Our findings accentuate an urgent need for structural reforms. It’s imperative that we harness collective efforts to ensure the affordable becomes accessible, ushering in a new era of mental healthcare that is both effective and economically sustainable,” Prof. Rodgers says.

Co-author Professor Colleen Loo, who is a clinical psychiatrist with the UNSW-affiliated Black Dog Institute, says she has witnessed remarkable results over the last 12 years using low-cost ketamine to treat severe depression that has not responded to other treatments.

“To make this treatment accessible to patients, Medicare funding of the treatment process is required, but the process is blocked by systemic barriers as explained in this paper,” Prof. Loo says.

“As there is no commercial gain for pharmaceutical companies in supporting a listing of low-cost, off-patent ketamine as a treatment for depression, the drug is not listed by the TGA for such use, and thus cannot attract Medicare funding for the treatment.

“This is despite all parties recognising that repurposing of existing, low-cost, off-patent drugs for new uses, is in society’s interest. We need government to intervene, to shift these barriers.”

The authors and their respective institutions are planning an application to Medicare to have ketamine treatment for severe depression supported by the government health system.

 

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Whooping Cough and Pneumonia Cases Surge in NSW, Posing Significant Risk to Children

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Whooping Cough and Pneumonia

Whooping Cough and Pneumonia Cases Surge in NSW, Posing Significant Risk to Children

 

Whooping cough rates have surged to their highest levels in nearly a decade in New South Wales (NSW), and the number of young children hospitalised with pneumonia has more than doubled compared to the same period last year, according to state health data.

Pertussis Cases Reach Alarming Levels

The latest NSW Health respiratory surveillance report reveals that there have been 103.1 notifications of pertussis, commonly known as whooping cough, per 100,000 people in the state so far this year. The last time figures were this high was in 2016, with a rate of 139.6 per 100,000.

Professor Robert Booy, an infectious diseases paediatrician at the University of Sydney, attributes the rise to several viruses and bacteria, including pertussis and mycoplasma, actively spreading, particularly among primary school-aged children.

“Both [pertussis and mycoplasma] are causing pneumonia, leading to hospital admissions, emergency department presentations, and the need for antibiotic treatment,” said Professor Booy.

Public Health Advisory

NSW Health advises individuals to stay home if unwell and to wear a mask if going out is necessary, in an effort to reduce the spread of these respiratory illnesses.

Young People Particularly at Risk

Health data indicates that pneumonia rates among children aged zero to 16 are “unseasonably high” and exceed levels recorded in the past five years. In early June this year, nearly 140 children under the age of four presented to emergency departments with pneumonia, compared to fewer than 60 at the same time last year. For children aged five to 16, the number was 400, up from fewer than 50 last year.

The increase is attributed to a specific strain of pneumonia, commonly referred to as “walking pneumonia.” The report states that Mycoplasma pneumoniae is a frequent cause of pneumonia in school-aged children, with epidemics occurring every three to five years. The last epidemic in NSW occurred before the COVID-19 pandemic.

Expert Insights

Dr. Rebekah Hoffman, chair of the NSW and ACT branch of the Royal Australian College of General Practitioners, noted that while most individuals contracting Mycoplasma pneumoniae would remain “quite well,” they might suffer from a persistent cough for several weeks or months. “For some kids, especially if they are immunocompromised or have other respiratory problems, they might get really sick and need hospitalization,” Dr. Hoffman said.

Both Dr. Hoffman and Professor Booy highlighted that social distancing during the COVID-19 pandemic, particularly in 2020 and 2021, resulted in children not being exposed to other respiratory illnesses, such as whooping cough and pneumonia. Professor Booy explained that the absence of exposure created a group of susceptible young children who are now developing and spreading whooping cough in school and other settings.

Resurgence Patterns

Whooping cough typically surges every three to six years, but due to the pandemic, this interval has now stretched to six to eight years. Dr. Hoffman noted that the spike in respiratory illnesses reflects young people “catching up” on infections they missed in previous years. She expressed surprise at the significant increase in whooping cough rates.

Professor Booy emphasized the seriousness of whooping cough for certain groups, particularly newborn babies. “The children at most risk are the very young… they need protection from their mother being vaccinated during pregnancy to develop antibodies which pass to the baby before it’s even born,” he said.

The health department data also indicated that COVID-19 cases remain “high” in the state.

Conclusion

The surge in whooping cough and pneumonia cases in NSW is a significant public health concern, particularly for young children. Continued vigilance, vaccination, and adherence to public health guidelines are essential to manage and mitigate the spread of these illnesses.

 

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Mental Well-Being Crucial for Healthy Aging, New Study Reveals

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Mental Well-Being HEALTHY AGING

Mental Well-Being Crucial for Healthy Aging, New Study Reveals

 

A recent study published in the journal Nature Human Behaviour has established the significant impact of mental well-being on healthy aging. The research evaluated the causal effects of mental well-being on genetically independent aging phenotypes (aging GIP), providing new insights into the relationship between mental health and aging.

Key Findings:

  • Human Longevity and Challenges: While human life expectancy has increased over time, the aging population poses challenges for both individuals and society. Mental well-being is known to correlate with lifestyle behaviours and morbidity and is linked to physical health and increased survival.
  • Socioeconomic Status (SES) Connection: Socioeconomic status (SES) is interlinked with both aging and mental well-being, but a direct causal relationship between mental well-being and healthy aging had yet to be established until now.

Study Overview:

Researchers utilised Mendelian randomisation (MR) to assess the effects of mental well-being on aging phenotypes. Summary-level genome-wide association study (GWAS) data from people of European descent were used. The exposures included various well-being traits such as life satisfaction, neuroticism, depressive symptoms, and positive affect. SES indicators—education, occupation, and income—were also considered.

A total of 106 candidate mediators were screened, including lifestyle factors, physical function traits, diseases, and behaviours. These mediators were selected based on their causal association with aging GIP and the well-being spectrum.

Methodology:

  • Linkage Disequilibrium Score Regression: This was used to examine genetic correlations between mental well-being traits, aging phenotypes, and SES indicators.
  • Univariable and Multivariable MR Analyses: These analyses were performed to assess the causal effects of mediators and mental well-being traits on aging phenotypes and to investigate the impact of SES indicators on mental well-being traits.
  • Two-Step MR Analysis: This tested the mediating effects between the well-being spectrum and aging GIP.

Results:

  • Genetic Correlations: Positive genetic correlations were observed between all mental well-being traits and aging GIP components (except for longevity). The well-being spectrum was linked to increased aging GIP, resilience, health span, parental lifespan, and self-rated health.
  • Positive and Negative Associations: Positive affect and life satisfaction were positively associated with aging phenotypes, while depressive symptoms and neuroticism were inversely associated.
  • SES and Well-Being: Higher income, education, and occupation were causally linked to improved mental well-being. The well-being spectrum independently correlated with higher aging GIP, even after adjusting for SES indicators.

Mediators:

Out of 106 candidate mediators, 33 met the criteria for inclusion. Key findings included:

  • Unhealthier Lifestyle Factors: These were associated with lower aging GIP.
  • Positive Influences: Factors such as later smoking initiation age, higher cheese consumption, appendicular lean mass (ALM), cognitive performance, high-density lipoprotein cholesterol (HDL-C), and fresh fruit intake were associated with higher aging GIP.
  • Significant Diseases: Heart failure, hypertension, stroke, and coronary heart disease had the highest effect sizes on aging GIP.

Several factors, including antihypertensive medication, smoking initiation age, and television watching time, mediated at least 7% of the effect of the well-being spectrum on aging GIP. Other mediators, such as non-steroidal anti-inflammatory drugs, waist-to-hip ratio, and fresh fruit intake, also played significant roles.

Conclusion

The study illustrated the causal effects of mental well-being on aging phenotypes independent of SES. Better mental well-being was linked to improved aging GIP, with the causal effect partly explained by various mediators, including lifestyle factors, physical functions, diseases, and behaviours. These findings underscore the importance of prioritising mental well-being to promote healthy aging.

 

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Beyond Blue champions peer support for men’s mental health

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men's mental health Beyond Blue

Beyond Blue champions peer support for men’s mental health

 

Beyond Blue is encouraging men to check-in with peers online for early mental health support as part of Men’s Health Week.

The annual week’s theme for 2024 is ‘men’s health checks’, with a focus on encouraging men to adopt new, healthier habits to improve physical and mental wellbeing.

Beyond Blue Clinical Spokesperson Dr Luke Martin said men are less likely than women to seek support for mental health issues and there remains a stigma which can stop them seeking support.

“Many men like to be self-reliant and often try to handle problems on their own and can be reluctant to confide in friends and family about how they are feeling,” Dr Martin said.

“Unfortunately, this can lead to unhealthy coping behaviours, which can result in problems snowballing. Taking steps to get support early on can really help people feel better sooner and anonymous online forums can provide that safe and less confronting option that some men need to open up.”

Research reports the effectiveness of digital peer support models, which provide people with a safe and supportive environment to discuss their issues.

In the digital age, online forums, like Beyond Blue’s Forums are a valuable platform, providing people with a free, accessible, anonymous, welcoming place to discuss their mental wellbeing with those who understand because they have had or are having similar experiences.

Beyond Blue Forums are moderated by trained professionals, together with experienced volunteers known as Community Champions, who ensure the Beyond Blue Forums remain a safe and supportive place, and that everyone who posts a question is heard and responded to.

Now in his mid-70s, Community Champion Mark Davis volunteers approximately 20 hours a week to support others through the Forums.

“In Australia, we’ve been brought up in a culture where men don’t complain, they have traditionally needed to be the strong, stoic ones; and they just want to fix the problems,” Mr Davis said.

“The forums offer anonymity and discretion, allowing men in particular to express themselves openly without fear of judgment or stigma.”

Mr Davis often helps young men to navigate relationship break ups and study stress, and supports mature-age men experiencing depression, relationship problems, are single parents, or worried about family member’s mental health.

“I have Post Traumatic Stress Disorder (PTSD), depression, anxiety and was suicidal, and about 10 years ago, I wanted to see how other people handled the same thing,” he said.

“I had medical support, but I was battling my issues in isolation, so I joined the Beyond Blue Forums, to just look at them; I had no intention of writing anything – and I had no intention of ever using my real name; I simply wanted to see how others were coping with similar mental health issues.”

Dr Martin says getting support early, means you get well sooner and stay well.

“Latest research shows that 40 per cent of users of the service are men; but we encourage more men to reach out to our Forums; whether it’s to take that first step to ask for help, or to complement existing treatment, our team is available whenever you need them.

“By destigmatising mental health conversations and promoting peer support initiatives, we can create a culture where men feel comfortable seeking the support they need to get back on track – no problem is too big or too small to ask for help,” Dr Martin said.

Beyond Blue’s Peer Support Forums average 150,000 visits to the forums every month.

The content is monitored by moderators 24 hours/7 days a week.

Men can also check-up on their mental health using Beyond Blue’s online checklist, and receive recommendations tailored to their need. Beyond Blue Forums. For people who need more immediate support, the Beyond Blue Support Service provides 24/7 free counselling, advice and referrals via phone 1300 22 4636, webchat or email.

 

 

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