Nearly a year after actor Matthew Perry, best known for his role as Chandler Bing on the TV show Friends, died from a ketamine overdose and drowning in his hot tub at home, news broke Thursday that five people had been indicted in connection with Perry’s death, including two doctors, Perry’s assistant, and a woman accused of being a drug dealer.
The actor was undergoing ketamine infusion therapy, Depression and anxiety,but, Becoming more dependent Take medicine towards the end of his lifeAccording to law enforcement officials.
Ketamine has long been known as the “Special K” party drug, but when administered in appropriate doses, it has also been established as an effective treatment for depression.
Below, experts tell us what you need to know about ketamine therapy and when it can become dangerous.
Ketamine therapy is effective for treatment-resistant depression.
Ketamine is prescribed to people with “treatment-resistant depressive symptoms.” Dr. John CrystalChairman of the Department of Psychiatry at Yale University School of Medicine in Connecticut.
“In other words, patients have tried multiple antidepressants and still haven’t seen the clinical response they need,” said Crystal, one of the early researchers of ketamine treatment for depression.
The two most common types of depression medications are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Drugs like Lexapro, Zoloft, and Prozac fall into the SSRI category, while Cymbalta and Pristiq fall into the SNRI category.
These drugs “all work through the same general mechanism, targeting systems in the brain such as norepinephrine and serotonin,” Crystal said. Serotonin and norepinephrine are neurotransmitters. Known for its connection with Mood, memory, and sleep-wake cycles.
about 6–8 weeks for These drugs It builds up in the body before the patient begins to feel better.
“Ketamine targets another chemical system in the brain called the glutamatergic system, which provides an information highway to networks in the brain involved in regulating mood and cognition,” Crystal said.
Ketamine works differently, Get faster results For some people, it works better than SSRIs or SNRIs.
It is most commonly given intravenously or as a nasal spray.
Ketamine can be administered in a variety of ways, but only one drug, in the form of a nasal spray called esketamine, has been approved by the Food and Drug Administration to treat depression, specifically “treatment-resistant depression and major depressive disorder with suicidal thoughts and behaviors,” he said. Dr. Paul KimHe is director of the Johns Hopkins Treatment-Resistant Esketamine Antidepressant Targeting (TREAT) Depression Clinic in Baltimore.
“Esketamine is highly regulated. It is a Schedule III drug, a controlled substance, and both patients and clinics must enroll in a program called ‘Esketamine.’ REMS Program“REMS stands for Risk Evaluation and Mitigation Strategies,” Kim explains. Certain drugs that have the potential for abuse or serious side effects must be included in a REMS program, Kim adds. Esketamine is taken under the supervision of a clinic.
Ketamine can also be administered intravenously, but intravenous ketamine is FDA-approved as an anesthetic, Kim explained. It’s also used off-label for treatment-resistant depression.
Intravenous ketamine is not approved by the FDA as a mental health treatment, so it does not have the same level of regulation for this use. However, that does not mean that medical clinics are not administering the drug properly and safely. Intravenous ketamine treatments are available at many major medical clinics across the country.
Kim said that IV ketamine and esketamine are both effective treatments for depression. Unlike drugs such as Zoloft and Prozac, ketamine and esketamine are not administered daily. Instead, they are typically administered a few times a week at first, decreasing in frequency as treatment progresses. Additionally, ketamine therapy is often prescribed in addition to a daily antidepressant medication.
It can be dangerous if not administered in a medical setting under proper supervision.
Kim said ketamine can also be compounded into tablets to be taken orally, and several online companies now offer the treatment. But both Crystal and Kim stressed that no matter what form of ketamine therapy patients receive, it’s important that they are monitored in a clinic.
“One thing is clear: oral ketamine is not necessarily safer or more effective than intravenous ketamine or intranasal esketamine when administered in a clinic. However, fluctuations in blood levels could raise safety and efficacy concerns if blood levels are not adequately monitored and doses adjusted,” Crystal said. “Safety concerns would be heightened if patients were to take oral ketamine at home without proper clinical supervision.”
The amount of ketamine in Perry’s system What is given during general anesthesia? — much less than doctors use to treat depression. And he was given the medication at home, not in a medical setting.
“While some companies are exploring safer ways to administer ketamine at home, the Matthew Perry case highlights something extremely important: if patients have more ketamine at home than they need, they run the risk of misuse,” Crystal said. “In fact, A study of ketamine use at home We found that many of these patients were misusing ketamine.”
Ketamine is safe when administered appropriately.
Crystal and Kim said esketamine and intravenous ketamine are safe when taken in a medical setting and under proper supervision. Ketamine and esketamine are also life-saving drugs that have been shown to reduce the risk of suicide for many people, Crystal said.
“People have been using ketamine as an anesthetic for a long time, and we know it’s safe, but only in hospitals,” Kim said. “If ketamine is misused, it’s always going to be deadly.”
When ketamine is used properly, the time between treatment sessions can become longer and longer, Crystal said.
But, Crystal says, “Ketamine abusers take more and more ketamine over time. When used infrequently, as in therapeutic use, ketamine stimulates the regeneration of synaptic connections between neurons in brain circuits involved in emotion.” When used recreationally or outside of a clinical setting, Can lead to addictionAt the same time, “it can be harmful to brain connections and contribute to symptoms of depression,” Crystal said.
Please consult a professional before undergoing ketamine treatment.
Ketamine and esketamine can be life-changing medications for many people who feel like they have no control over their depression.
“I can’t speak for all the clinics out there, but my recommendation to readers is to talk to your psychiatrist about ketamine treatment, preferably one who has experience referring patients to that particular clinic,” Kim says. “Often these clinics are run by psychiatrists or have a psychiatrist on staff in some capacity.”
It’s also worth checking with major health systems in your area to see if they offer ketamine therapy. Be wary of places like “pop-up clinics run by people who aren’t mental health professionals,” because anesthesiologists can administer ketamine, and there are plenty of doctors who can administer it intravenously, Kim says.
Because it’s not FDA-approved, IV ketamine requires copays and can be expensive. Kim said FDA-approved esketamine has essentially the same efficacy for mental health treatment.
“At the end of treatment, there is little difference in the effectiveness of IV ketamine and esketamine,” Kim added.
And it’s important to remember that this type of treatment is just one piece of a larger puzzle.
“Esketamine and IV ketamine are not treatments, right? They’re not going to cure depression after one treatment or multiple treatments,” Kim said. “They just improve symptoms, whereas oral antidepressants… [like] Prozac and Zoloft are medications that are expected to prolong or maintain the beneficial effects.”
It’s also important to continue seeing a psychiatrist who can monitor your symptoms, treatment, and overall mental health to make sure you’re on the best path.
Need help with a substance use disorder or mental health issue? In the US, call 800-662-HELP (4357). SAMHSA National Helpline.
Call, text or chat with us on 988 988 Lifeline For mental health support, please see the links below, as well as local mental health and crisis resources. Police websiteIf you are outside the United States, International Association for Suicide Prevention.
