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Health News

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.
Norco Agrisolutions

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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Health News

Specialist mental health service for new parents opens in Lismore

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CEO Gidget Foundation Australia Arabella Gibson, NSW Minister for Mental Health Rose Jackson, Lismore MP Janelle Saffin, Gidget Angel Kaiden Powell and Tresillian operations manager Rachael McLean at the opening of Gidget House in Lismore.
Norco Agrisolutions

Specialist mental health service for new parents opens in Lismore

 

By Sarah Waters

New and expecting parents in the Northern Rivers will now have access to free specialised mental health care as they navigate their journey through parenthood.

Last Friday, Gidget House officially opened at Tresillian Lismore Family Care Centre to support parents struggling with perinatal depression and anxiety.

Gidget House provides year-long, free individual psychological counselling services and holistic care delivered face-to face and via telehealth.

New data from Gidget Foundation Australia reveals one in two parents living in regional NSW lack both emotional and practical support from their family and friends.

A quarter of parents in regional NSW also needed the most support between 3-12 months after the birth of their child.

While one in three felt a loss of identity in most aspects of their life after having a baby.

NSW Minister for Mental Health Rose Jackson officially opened Gidget House and welcomed the service for expectant and new parents to the area.

CEO Gidget Foundation Australia Arabella Gibson, NSW Minister for Mental Health Rose Jackson, Lismore MP Janelle Saffin, Gidget Angel Kaiden Powell and Tresillian operations manager Rachael McLean at the opening of Gidget House in Lismore.

CEO Gidget Foundation Australia Arabella Gibson, NSW Minister for Mental Health Rose Jackson, Lismore MP Janelle Saffin, Gidget Angel Kaiden Powell and Tresillian operations manager Rachael McLean at the opening of Gidget House in Lismore.

Ms Jackson said families across the Northern Rivers had experienced unparalleled challenges over recent years with floods and threats of fires, whilst still navigating adjusting to early parenthood.

“This is why providing mental health support in regional communities such as Lismore and the surrounds is a top priority of ours,” she said.

“It’s important for expectant and new parents to have access to quality services like Gidget Foundation Australia in times of need and know that help is never too far away.”

Gidget Foundation Australia CEO Arabella Gibson said the expansion of face-to-face services across the state will provide much needed support for parents in regional locations.

“With half of parents in regional NSW reporting a lack of emotional and practical support after having a baby, it’s necessary for us to expand our services to reach more mums and dads who may be struggling,” Ms Gibson said.

“As part of our valued commitment to support the emotional wellbeing of expectant and new parents across the country, we’re hopeful our expansion to Lismore will provide a safe space for open conversations with perinatal specialist clinicians.”

It is estimated that perinatal depression and anxiety affect almost 100,000 expectant and new parents in Australia each year.

 

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Virtual reality is helping brain injury survivors regain use of their arms and hands

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Neuromersiv has created the Ulysses VR Upper Limb Therapy System Virtual reality (VR) to help people come back from brian ijuries.
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Virtual reality is helping brain injury survivors regain use of their arms and hands

 

Survivors of brain injuries caused by stroke and other serious events can lose function in their arms and hands. An Australian company is creating a virtual reality therapy system to help survivors regain the use of these limbs.

Making brain injury therapy more engaging

Getting better after brain injury is hard work. Survivors need therapy to help the brain to heal. But therapy can be boring and repetitive. This means survivors don’t always do as much therapy as they need.

To make therapy more engaging, Australian company Neuromersiv has created the Ulysses VR Upper Limb Therapy System. Using a wireless virtual reality (VR) headset, brain injury survivors can do therapy by performing rewards-based, gamified activities in realistic environments.

An immersive environment

‘As soon as the person puts on the headset, they are totally immersed,’ CEO Anshul Dayal enthuses. ‘Like with gamers, dopamine kicks in and they want to keep going. So VR creates the motivation to keep doing your therapy. That can lead to better function recovery.’

The Ulysses VR software is available to buy in Australia and Britain. ‘I am proud we’ve taken this to market. We’re seeing people use it and give us positive feedback,’ Anshul says.

Wearable glove

As part of the Ulysses therapy system, Neuromersiv has also developed a hand and arm wearable glove. The glove helps users activate their muscles and receive real-time sensory feedback from VR environments. It combines two therapy modes with the VR software.

Functional electrical stimulation (FES) therapy helps brain injury survivors activate muscles they can’t move. Electrodes in the glove send small electrical currents through key points on the forearm muscles to stimulate extension and flexion.

New neural pathways

‘If the survivor is trying to brush their teeth in virtual reality but they just can’t grab the virtual toothbrush, the FES can assist with the grabbing action by stimulating flexion of the wrist and fingers,’ Anshul explains.

‘This stimulation creates a feedback loop that can be a catalyst for the brain to form new neural pathways to recover lost function. This is often referred to as brain neuroplasticity and is the key to long-term functional recovery.’

Neuromersiv has created the Ulysses VR Upper Limb Therapy System Virtual reality (VR) to help people come back from brian ijuries.

To make therapy more engaging, Australian company Neuromersiv has created the Ulysses VR Upper Limb Therapy System.

Sensory feedback

The team is also combining tactile feedback, or haptics, with the glove. For example, when users brush their teeth in virtual reality, they get a vibration effect on their fingers.

‘The goal is to enhance the sensory feedback because that helps the brain start to recognise the end of the fingertips, Anshul tells us. ‘When the person stops doing that task, they still feel tingling on the fingertips. That helps reactivate those neural connections.’

‘We are building a system that has multiple layers. Combining the visual and sensory aspects could improve functional recovery,’ Anshul concludes.

‘We think we are the first company in the world to combine FES, haptics and virtual reality.’

Technical challenges

The team had to overcome technical challenges to achieve this. Cameras on the virtual reality headset track users’ hands as they do therapy. The team’s first prototype had an exoskeleton design that impeded the hand tracking and overall usability. This was refined through user testing and design modifications.

‘For the FES, we created a sleeve with adjustable electrodes to wrap on the forearm,’ Anshul says. ‘For the haptics, we created a unique system of finger caps connected by soft & thin wires. It goes on top of the hand and doesn’t interfere with the tracking.

‘The next challenge was creating a wireless control unit for the glove that was compact and lightweight.’

Approval to sell the glove in Australia

Neuromersiv is planning a pivotal clinical trial to develop further clinical evidence on the safety and efficacy of the glove. With this evidence they will seek regulatory approval from the Therapeutic Goods Administration to commercialise the glove in Australia.

‘When you work with people in their homes and clinics, it can be confronting see the challenges they can face after the brain injury. That inspires me to help people through this Ulysses solution,’ Anshul says.

‘I have seen proof that when they use the system, they feel motivated and excited. They feel this can really help their therapy, and that’s quite rewarding.’

The MRFF-funded MTPConnect Biomedtech Horizons program funded Ulysses with $994,000.

 

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Health News

Think Twice About Asbestos

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asbestos in a roof. National Asbestos Awareness week
Norco Agrisolutions

Think Twice About Asbestos

 

It’s easy to forget that asbestos is still present in millions of Australian properties, but it’s a fact, that if a house was built or renovated before 1990, there’s a good chance it contains asbestos.

“National Asbestos Awareness week (20 -26 Nov) is a good opportunity to remind everyone to ‘Think Twice About Asbestos’ when planning any renovations, repairs or other work on buildings that may contain asbestos” said Karen Rudkin, Project Coordinator at North East Waste.

“Although many people know that asbestos cement sheeting was used for walls and roofs they often don’t realise that asbestos was used in thousands of other building products including vinyl floor tiles, adhesives, paints, textured coatings and insulation’ Ms Rudkin said.

North East Waste and councils across the Northern Rivers are working together with the NSW Environmental Protection Authority to help reduce the risk of exposure to asbestos by supporting the safe management and disposal of asbestos containing materials.

Bathroom reno with asbestos being removed.

To keep yourself and your family safe around asbestos, take these simple steps:

  1. Get in the know – plan ahead before starting any renovations and find out where asbestos is likely to be in your home.
  2. Take it slow – to avoid damaging or disturbing asbestos materials.
  3. Get a pro – know your limits. Contact a licensed asbestos professional for advice on where it might be located, and on how to manage or remove it.

As part of a regional scheme aimed at reducing the unsafe disturbance or removal of asbestos by home renovators, all Northern Rivers councils offer subsidised ‘Household Asbestos Testing’ (HAT) kits.

The kits include easy step-by-step instructions on how to take samples safely and send to a certified testing laboratory. The results are then emailed back to residents. If asbestos is identified and requires removal, residents are urged to use a licensed removal contractor to remove and dispose of it safely.

It is illegal to dispose of asbestos waste in any domestic or commercial bin and doing so can incur very heavy fines.  Asbestos waste should always be disposed of at a landfill licensed to accept it.

For further information about managing or disposing of household asbestos or obtaining a ‘Household Asbestos Testing (HAT) kit, contact your local council or visit the website here.

 For more information on asbestos safety and National Asbestos Awareness week, visit https://www.asbestos.nsw.gov.au

 

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