Evidence to Support Use of Ketamine in Treatment Course for Severe Depression in Singapore
Ministry of HealthSpeakers
Summary
This question concerns the efficacy and regulation of ketamine nasal spray for severe depression, as raised by Dr Wan Rizal and Mr Yip Hon Weng. Senior Minister of State for Health Dr Janil Puthucheary noted that the Health Sciences Authority approved the treatment in 2020 for patients unresponsive to standard therapies. He detailed strict safeguards, including its classification as a controlled drug and mandatory administration under specialist psychiatric supervision to ensure patient safety and prevent misuse. Addressing affordability and stigma, the Senior Minister explained that cost-benefit analyses are conducted and clinical providers offer personalized counseling to patients and their families. He concluded that the current framework prioritizes clinical indications and medical oversight to manage the drug’s potential risks while providing necessary therapeutic benefits.
Transcript
16 Dr Wan Rizal asked the Minister for Health (a) what steps are being taken to regulate and ensure the safe use of ketamine as a treatment course for severe depression in Singapore; (b) how is the effectiveness of such a treatment being monitored; and (c) what safeguards are in place to prevent any potential misuse of the controlled drug.
17 Mr Yip Hon Weng asked the Minister for Health (a) what evidence supports the efficacy and safety of ketamine as treatment for severe depression compared to other therapies; (b) whether there are plans to monitor long-term outcomes for patients using this treatment; and (c) what regulatory frameworks will be put in place to govern the distribution and use of ketamine for medical purpose while ensuring tight control to prevent diversion for recreational use.
The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mr Speaker, may I have your permission to answer Question Nos 16 and 17 on today's Order Paper?
Mr Speaker: Please proceed.
Dr Janil Puthucheary: Sir, ketamine in the form of a nasal spray was approved in October 2020 by the Health Sciences Authority (HSA). It is to be administered together with other oral anti-depressant therapy for the treatment of depression.
Clinical trials have demonstrated that the use of ketamine nasal spray resulted in improvements in symptoms of major depression with mild side effects and minimal addictive potential. Overall, the benefits of ketamine nasal spray outweigh its risks.
There are several safeguards in place to ensure the safe use of ketamine for severe depression. It is classified as a controlled drug under the Misuse of Drugs Regulations, which means that the product must be kept under lock and key with stringent records of the product inventory. Further, it can only be supplied to hospitals and clinics providing specialist services for psychiatry, and prescribed for use by a registered psychiatrist. It is administered strictly under nursing supervision with resuscitation equipment and doctors on standby. Patients are continuously monitored during and after the treatment for adverse effects before they leave the clinical setting. Specialists also review patients regularly to assess treatment effectiveness.
Mr Speaker: Dr Wan Rizal. Keep it short because we are running out of time.
Dr Wan Rizal (Jalan Besar): Sir, I thank the Senior Minister of State for his reply. I can hear that ketamine is indeed effective. So, how can we extend this usage of ketamine, knowing that it is actually quite costly, to make it affordable for patients across the board?
Mr Speaker: Senior Minister of State Janil. Keep it short, too, because Mr Yip has a supplementary question to ask.
Dr Janil Puthucheary: Sir, I thank Dr Wan Rizal for the supplementary question. The use of ketamine is not a substitute for all the other treatments that are available for depression and other psychiatric treatment. It should only be used when indicated and for those situations where the other treatments are not effective. So, we will continue to study its effectiveness, analyse the cost benefit analysis and make sure it is available for those patients who need it.
Mr Speaker: Mr Yip.
Mr Yip Hon Weng (Yio Chu Kang): Thank you, Mr Speaker, and I thank the Senior Minister of State for his response. Considering the potential stigma and misconceptions associated with ketamine due to its history as a recreational drug, what initiatives will the Ministry undertake to educate the public and healthcare professionals about its therapeutic use in depression? And how will these efforts help in mitigating societal concerns and promoting informed acceptance?
Dr Janil Puthucheary: Sir, the number of patients that could potentially benefit from this is relatively small. The education and counselling is done for those patients and their families on a one-to-one basis by the clinical providers, and I think that is probably the correct approach for now.
There are many drugs with serious side effects or potential abuse and misuse, where use in a controlled setting is possible. This is something that we have been doing for, for example, opioid agents, anesthetic agents and many other controlled drugs and substances, where there is a public protection and it is a drug of abuse outside this controlled setting, and then, appropriate counselling for the patient and the family when there is an indication and there is a benefit.
1.00 pm
Mr Speaker: Order. End of Question Time. The Clerk will now proceed to read the Notice of Motion.
[Pursuant to Standing Order No 22(3), provided that Members had not asked for questions standing in their names to be postponed to a later Sitting day or withdrawn, written answers to questions not reached by the end of Question Time are reproduced in the Appendix.]