The death of beloved "Friends" star Matthew Perry has shocked fans worldwide, especially since it seemed he was on the road to recovery from addiction that haunted him most of his life. However, the report revealing that the cause of death was ketamine has brought attention to this drug and the surrounding controversy regarding its use. Ketamine was originally designated as a medical and veterinary anesthetic before it became a popular and rapid-acting treatment for depression and other severe mental health conditions, according to a report published by the American newspaper "Washington Post."
The Los Angeles County coroner's report stated that Perry's death resulted from the "acute effects" of ketamine use; however, it also noted that other factors contributed to the death, including "drowning," "coronary artery disease," and the effects of "buprenorphine," a drug used to treat opioid addiction. According to the "Washington Post," the last ketamine dose Perry received, who passed away at the age of 54, was about 10 days before his death. The coroner's office clarified that the "high levels of ketamine" in his body "could not be attributed to a therapeutic dose."
**Is Ketamine Safe?**
When used under supervised conditions and with careful patient monitoring, most doctors and health experts consider ketamine treatment to be generally safe, keeping in mind that all medications carry certain risks, particularly when used unsupervised and in unauthorized doses. Consequently, using ketamine without proper oversight may leave harmful effects on mental health, heart rate, and other vital signs. Therefore, it is recommended to use this treatment when there is a possibility for close monitoring of the patient by a healthcare provider, both during and after treatment.
Ketamine is a controlled substance regulated by the U.S. Drug Enforcement Administration, subject to strict safety controls due to its potential for misuse. Doctors state that some accompanying medications may make ketamine treatment risky for certain patients, so reviewing the patient's medical history, particularly concerning mental health, is crucial before starting this treatment. The American Society of Ketamine Physicians and Psychiatrists advises users of this treatment "not to drive, work, care for small children, or engage in strenuous tasks for the remainder of the day after taking the dose."
In October of last year, the U.S. Food and Drug Administration issued a warning regarding compounded ketamine, as compounded drugs are typically customized doses and combinations created by pharmacists and not approved by the FDA. It warned that using compounded ketamine products without monitoring by a healthcare provider for side effects such as drowsiness and changes in vital signs like blood pressure and heart rate could expose patients to severe risks.
In this context, Gerard Sanacora, a professor of psychiatry at Yale School of Medicine, explained that ketamine can be a "life-saving treatment" for some patients, but many questions remain about the range of disorders it may cause, adding, "It is not a miracle treatment for everyone."
**Who Benefits Most from Treatment?**
Ketamine treatment, in general, is intended for individuals suffering from severe mental illnesses who have tried other medications without significant results. It has been widely studied for individuals with treatment-resistant depression and severe suicidal tendencies, and it may also benefit patients with conditions such as post-traumatic stress disorder, obsessive-compulsive disorder, bipolar depression, anxiety, and eating disorders. A study published in the Journal of Clinical Psychiatry involving ketamine users at three clinics in Virginia showed a significant reduction in depression symptoms.
In the same study, an assessment of more than 400 patients revealed that 72% reported an improvement in mood and 38% were symptom-free after ten injections. The use of ketamine for treating mental health conditions is considered "off-label," which means it is legal for a doctor to prescribe the drug, although this indication has not been approved by the FDA. The exception is esketamine, a nasal spray approved by the FDA in 2019, marketed under the name Spravato for the treatment of treatment-resistant depression and severe suicidal thoughts.
**What Evidence Exists for Effective Treatment?**
Numerous studies show that ketamine can act as a rapid-acting antidepressant, alleviating symptoms for many patients within hours or days. While long-term data is not available, some early small studies indicated that ketamine treatment significantly and quickly reduces depression symptoms. Traditional antidepressants typically take four to six weeks to become effective and may sometimes be entirely ineffective. While traditional antidepressants may affect levels of certain brain chemicals related to mood and emotion, ketamine impacts a different neurotransmitter called glutamate, believed to work primarily by making the brain more flexible and receptive to treatment or alternative ways of thinking.
**What Happens During Treatment?**
Ketamine treatment is often delivered through intravenous injections lasting about 40 minutes, which is a low dose compared to its use as an anesthetic. Intramuscular injections and sublingual tablets have also become more widely used, with esketamine nasal spray administered alongside oral antidepressants. Clinically, ketamine patients usually sit in a comfortable chair and listen to music during the treatment session. The number of ketamine sessions varies depending on the patient's condition, but many providers suggest an initial course of six treatments over two to three weeks. Talk therapy, often occurring after the drug's effects wear off, can also be part of the treatment.
Esketamine (Spravato) is administered twice a week in the first month and can be given once a week in the second month. The patient remains under a doctor's supervision for two hours after treatment until any potential side effects dissipate.
**How Does Ketamine Treatment Feel?**
Patients report that therapeutic ketamine can induce feelings of happiness and calm, while others may start to cry uncontrollably or seem visibly anxious. Common side effects may include nausea, drowsiness, dizziness, impaired concentration, and feelings of detachment from reality. An increase in blood pressure may also occur, making monitoring during treatment vital.
