Highlights

Well there’s a lot [of unmet needs]. So for one thing, the medications that we currently use, with the exception maybe of Janssen’s Spravato drug, but for the majority of the medications they work too slow. I mean it takes weeks and weeks for them to have an effect. Side effects is another problem. I mean the most popular classes, like the SSRIs and the SNRIs, have sexual dysfunction side effects which can be, in some studies, 30 to 40% of people and in some other studies can be even higher than that. That’s a big problem. Efficacy is a problem. I mean with the typical antidepressant the response rate is something like 70% and the response is defined as a 50% decrease in the depression rating scale, but if you use a higher criteria remission which means basically that the patient’s symptoms are not different than somebody who’s not ever been depressed, then the rates go down to about 30 or 40%. And then the other thing I would say is that, with the exception of Janssen’s drug Spravato, every antidepressant that’s on the market in the United States is in some way, shape or form related to the monoamine hypothesis of depression.

In my hospital they opened up a Spravato clinic on January 1st, it took almost two years to get it going, so actually in my mind the pandemic has been the least of the problems. The problem has been it’s not a big money maker for the facility that’s giving it. The reimbursement rates were not that good. My hospital was very concerned about financial risk, in terms of the buying of the medication and so forth, and it took a lot of time to convince the financial people that we could do this. I mean it’s just a tremendous hassle to get this set up. I mean as a researcher it was great, but in the clinic, when you start having all these financial concerns, it was problematic. So we’re doing it. There’s unlimited demand for it. I mean my phone and other doctors’ phones ring off the hook with people wanting to get it and it’s understandable. These people with treatment-resistant depression, there are not a lot of options. But we, as a facility, have been limiting the number of people we can give it to, just for financial and manpower reasons.

Well yes, that’s even worse because in the case of Zulresso you’re talking about actually having to admit the lady to the hospital for the infusion. That’s number one. Number two, you need an infusion center – you need a place to do it and most infusion centers and hospitals are set up for oncology. We’ve been able to set it up in our OB division, so when they do an infusion it’s in the recovery room of the labor and delivery. But the other big difference with Zulresso is, it has competition. I mean right now, Spravato has some competition but the other competitors are, like TMS or ECT, also expensive. There it’s more patient preference, but in the case of Zulresso their competition is generic sertraline and that’s a big difference. So there’s some issues there with cost.