Department of Family Medicine

Natasha Withers, D.O.

(MAY 10, 2023) Natasha Withers, D.O., clinical assistant professor of family medicine, will soon start treating depression with a mind-altering drug that’s shown promise in helping people who don’t respond to traditional medicine — despite lingering questions about the drug’s long-term safety and effectiveness — Seven Days reported.

The medication, known as esketamine and sold by Johnson & Johnson under the brand name Spravato, is chemically similar to ketamine, a substance that’s been used in medical settings as an anesthetic, on the streets as a party drug, and, more recently, as an off-label treatment for mood disorders. It must be taken under the supervision of medical professionals because it can cause dizziness, blood pressure spikes, and psychedelic, out-of-body experiences. The U.S. Food & Drug Administration approved esketamine in 2019 as a fast-acting treatment for patients who have failed to find relief from at least two other antidepressants. Esketamine targets a different brain chemical, and it works much faster — sometimes within an hour, instead of the four to six weeks typical of older antidepressants.

Vermont providers say they must weigh the unknown risks against the very real danger of living with untreated depression. An informal survey of the handful of doctors currently certified to offer the drug in Vermont suggests that the 200 or so esketamine patients have had largely positive experiences. Withers said she believes in the FDA and its process for reviewing and approving drugs. “We’re really at the cutting edge of this, so we’re not going to have all the answers … [But] we have to trust the systems that we have in place.”

Over the past year in Chittenden County, about a dozen suicidal people seeking care through the UVM Medical Center Emergency Department have started on the medication.