How Special K Evolved: From Club Drug to FDA- Approved Antidepressant

By Jacqueline Katz

Depression is an American epidemic. Even many who seek treatment, not to mention those whose cries for help are unanswered, go without remedy. But, the FDA approved what could be a sort of mental health magic bullet at the end of last month. Derived from the anesthetic ketamine, esketamine is a fast-acting, nasal spray antidepressant.

But, how did Special K get from the club to the clinic? The truth is, we still don’t really know. Ketamine’s antidepressant properties are ill-understood. And, more daunting than the underlying question of how it works, the drug comes with a potential for abuse.

But, these unknowns are insignificant in the face of crippling, untreatable depression. This newly approved drug offers hope of recovery for those who have been previously resistant to antidepressants and behavioral therapy. And, while the drug only slightly outperformed the placebo treatment in a series of trials, researchers found that, among those who saw significant mood improvements on esketamine, far fewer subjects relapsed than those receiving the placebo nasal spray.

Earlier studies of ketamine suggest that this drug has broader benefits beyond depression and has proven to be effective in treating other behavioral and mood disorders, such as anxiety and anhedonia.

The study of ketamine-based compounds for depression treatment is in its infancy. We still do not understand why esketamine may be less effective in adults over fifty, know how esketamine compares to intravenous ketamine, nor can we determine what it is about the ketamine molecule that makes it a seemingly effective antidepressant.  


Benedict Carey. (2019, March 5). Fast-Acting Depression Drug, Newly Approved, Could Help Millions. The New York Times. Retrieved March 7, 2019 from