As Johnson & Johnson prepares to launch its $32,400 esketamine drug for treatment-resistant depression, a prolonged shortage of the cheaper generic ketamine has left clinics treating the same condition scrambling for solutions.

Spravato, developed by J&J's Janssen Pharmaceuticals Inc., became the first U.S. Food and Drug Administration-approved medicine for treatment-resistant depression since 2009. Other treatment options for this type of depression include electroconvulsive therapy, which carries significant adverse events and procedure complications.

Generic ketamine, approved in the 1970s as an anesthetic, has been used off-label for difficult-to-treat conditions, including treatment-resistant depression and post-traumatic stress disorder. Leveraging medications for conditions other than their FDA-approved use, called "off-label use," is legal in the U.S., and can occur when a lack of other treatment options exists.

Prior to Spravato's approval, ketamine clinics had sprouted up across the U.S. in an effort to address the large unmet need for patients with these neurological conditions. Because the drug is generic, it costs about one-tenth of Spravato.

"One might think that the increased demand would be met with increased supply, but ketamine is an inexpensive, generic drug," ketamine clinic founder and Ketamine Consulting president Roman Langston said. "So perhaps there is minimal profit to be made from selling it."

Story: Cost of J&J's Spravato casts shadow amid shortage of cheaper, generic ketamine

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