An approval from the NSW Ministry of Health is required to prescribe or supply intranasal esketamine or injectable ketamine for treatment resistant depression (TRD) to:
- a drug dependent person
- a non-drug dependent person for continuous or ongoing treatment of more than two months.
Note: an 'approval' is a reference to an authority under the Poisons and Therapeutic Goods Act 1966. An approval issued to a prescriber by the NSW Ministry of Health is separate to the authority required from Services Australia for a patient to receive a Commonwealth PBS subsidised medicine.
Esketamine and ketamine medicines are to be administered under direct medical supervision, in a healthcare setting which has established administration and patient monitoring procedures and protocols. This setting must be equipped to manage any behavioural and/or medical emergencies.
Who can prescribe or supply esketamine or ketamine
Only Ahpra registered psychiatrists can apply to prescribe or supply intranasal esketamine or injectable ketamine for TRD .
Medical practitioners who are not Ahpra registered psychiatrists must refer the patient to a psychiatrist for prescribing and supply of esketamine or ketamine for TRD.
Esketamine
From 01 April 2025, Ahpra registered psychiatrists are authorised under a 
class authority to prescribe or supply the Australian Register of Therapeutic Goods (ARTG) registered esketamine (Spravato®) nasal spray for the treatment of TRD in a non-drug dependent person over the age of 18 years. The class authority can be used to prescribe up to a maximum daily dose of 84mg.
This means that psychiatrists will not need to apply to the NSW Ministry of Health for an approval for an individual patient in these circumstances.
Psychiatrists must still apply for an individual patient approval to prescribe or supply intranasal esketamine, where required, in all other circumstances.
Ketamine
Ahpra registered psychiatrists must submit an application for an individual patient approval, where required, to prescribe or supply injectable ketamine for the treatment of TRD.
How to apply for an approval
Applications for an approval to prescribe or supply esketamine or ketamine should be submitted by an Ahpra registered psychiatrist via the SafeScript NSW portal.
Applications via SafeScript NSW will provide real-time approval in many cases or a notification if the application needs to be reviewed by the NSW Ministry of Health.
Alternatively, an Application for Approval to Prescribe or Supply a Schedule 8 Medicine – Esketamine or Ketamine for Treatment Resistant Depression may be submitted to Pharmaceutical Services