NICE is unable to make a recommendation about the use in the NHS of esketamine for treating major depressive disorder in adults at imminent risk of suicide. This is because Janssen has confirmed that it does not intend to make an evidence submission for the appraisal at this time. Janssen considers that there is unlikely to be enough evidence that the technology is a cost-effective use of NHS resources for this population.


If NHS organisations wish to consider esketamine for this indication, they should follow the advice on rational local decision making in the NHS Constitution for England and the NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012. This outlines the approach that should be taken when there is no NICE guidance.

NICE will review the position if the company decides that it wants to make an evidence submission.

ISBN: 978-1-4731-5238-0

  • National Institute for Health and Care Excellence (NICE)