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Editor's Note: The Chasing Life podcast with Dr. Sanjay Gupta explores the medical science behind some of life's mysteries, big and small. You can listen to episodes. over here.
() — Matthew Perry 2023 death from what Los Angeles County Medical Examiner's Office The drug, which was gaining popularity as a treatment for depression and other mental health conditions, was shadowed by the “devastating effects of ketamine.”
(The report listed drowning as a contributing factor; Perry was found slumped in a hot tub at his home.)
The actor's death has raised questions about how Katie is being used, and possibly abused, in a largely unregulated landscape that some critics have described as “Wild West” due to the expansion of clinics across the country. Perry, who had struggled with drug addiction for years, was open to receiving ketogenic treatment for depression.
“Matthew Perry went to a local clinic seeking treatment for depression and anxiety and became addicted to intravenous ketamine,” Drug Enforcement Administration Administrator Anne Milgram said in a recent press release. “When the clinic's doctors refused to increase the dosage, Perry turned to unscrupulous doctors who saw it as a way to make a quick buck.”
There is an underground network of prosecutors Drug dealers and suppliers – including two doctors – were responsible for spreading the Katy who killed Perry. Five people have been charged in connection with the “Friends” actor's death. The three are cooperating with prosecutors and two have pleaded not guilty to charges of falsifying medical records and conspiracy to distribute others.
To be clear, ketamine is only approved by the US Food and Drug Administration as an anesthetic and not as a treatment for any mental illness. (FDA approved A related drug, esketamine, marketed as Spravato, is available in 2019 for people with treatment-resistant depression.)
But the Scientific evidence Showing that Ketin can be useful in patients Treatment-resistant depression And Suicidal ideation Strong and back At least 20 years.
Still, the circumstances surrounding Perry's death have brought scrutiny to the relatively new and somewhat misunderstood practice.
“Ketamine is a different type of treatment than traditional treatments, not just for depression, but in medicine in general,” says psychiatrist Dr. David Pfeffer. Kadima Neuropsychiatric InstituteA private clinic in San Diego that provides ketamine therapy to patients recently spoke to Chief Medical Correspondent Dr. Sanjay Gupta on the podcast Changing Life.
“One of the main differences is that the correct position and the patient's state of mind at the time of treatment play a major role in the outcome of the treatment.”
You can listen to the entire episode of the podcast over here
Pfeffer, a professor of psychiatry at California's San Diego School of Medicine, was one of the first doctors to use ketamine off-label to treat depression at the school's Center for Advanced Treatment for Mood and Anxiety Disorders. An article In the Lancet magazine.
Unlike traditional antidepressants that target the neurotransmitters serotonin and/or norepinephrine, ketamine targets glutamate — the brain's most abundant chemical messenger, Pfeffer said. It also appears Improving neuroplasticityStimulating new connections or pathways in the brain.
Ketamine was first discovered in the 1960s as A Anesthesia – An application still in use today. (It's on the World Health Organization. Model list of essential drugs.)
But Feifel said the medicine dissociative and hallucinogenic Properties – what made it such a popular party drug – may hold the key to why it helps some people with depression and other mental health disorders.
“Ketamine treatment is associated with an altered state of mind, a psychedelic-like state of mind, for a short period of time. “There's a lot of evidence that this is part of the treatment effect,” Pfeiffer said. “This psychedelic-like experience allows people to see things through a different lens that seems to improve them.”
But, Feifel noted, it can be emotional and unpleasant for some — and can make patients vulnerable to treatment because they can't fully control their senses. Therefore, it is important to make proper preparations and follow up, he said.
Pfeffer said he started treating patients with ketamine because of existing treatments. Don't work for everyone.
“One of the motivations when I started in psychiatry was the realization that mental illness is an incredible scourge of society. The statistics are incredible in terms of depression, anxiety, PTSD (post-traumatic stress disorder) and suicide – and they're not getting better,” he said. “After 50 years of medicine, they really haven't gotten better.” So there is a lot of demand.
Here's what Feifel wants people to know about Katie, especially if they or someone they know is interested in trying it.
Ketamine can be a lifeline for some people who have not responded to conventional treatments for depression, such as medication and various forms of psychotherapy.
“(This is) probably the biggest medical advance in mental health in decades,” Pfeffer said.
“It's very effective when conventional[treatments]don't work,” he said. “And the immediate effectiveness against suicidal thoughts is really important. We've never had anything like this where we can give it to someone … and it makes their suicidal thoughts evaporate.”
And when taken under proper medical supervision, ketamine is safe.
“It is almost impossible to die from an overdose of ketamine alone” because it does not reduce the rate of respiration, “it is very unusual for anesthesia” and has a wide therapeutic range.
Pfeffer pointed out that Perry's death did not occur at a medical clinic. “There was no medical supervision,” he said. “This is not given in anything resembling a medical context.”
If you're looking to try ketamine for depression or another mental health condition, do your homework.
“If anyone is considering[ketamine treatment]they have to be a little bit cautious,” Pfeiffer said, because it's a very, very unregulated landscape right now, let's say, with a lot of providers (using) under high standards. And then it can be dangerous.”
To find the right provider or clinic, start by asking your psychiatrist. “Even if they don't practice with ketamine themselves,[they]know their local colleagues and people with good reputations who do it,” he said.
Find a clinic run by a mental health professional.
“The problem is that many of these providers are not good,” Pfeiffer said. You wouldn't go to a urology clinic run by a psychiatrist, he said, so why would you go to a cath clinic run by a urologist?
“In general, the clinics are mostly run by mental health professionals, not psychiatrists.”
Pfeffer: Some clinics may do a good job, but many do not. “They don't have the background,” he said, referring to a psychiatrist's years of residency and specialty training, not to mention a deeper understanding of complex drug systems.
“People who come to this treatment remember that the most resistant forms of depression, the most complex, are often associated with other mental illnesses,” he said.
Look for a clinic that includes psychotherapy as part of the treatment plan.
“The highest level is to do ketogenic treatments in a special psychiatric setting called ketogenic psychotherapy,” Pfeiffer said. “A provider with a multidisciplinary team that includes trained licensed therapists—that's a barometer of a very high commitment to best practices in Katy.”
He said you don't want to go to a clinic, get an injection and then be sent on your way without proper follow-up support.
When the epidemic happened, the rules about the order Controlled medications such as attention deficit hyperactivity disorder were relaxed. To continue the treatment process. This flexibility in prescribing rules can be problematic for someone receiving ketogenic therapy via telehealth.
“There are companies that allow patients to have instant telemedicine consultations with a nurse practitioner. ” said Feifel. That's actually part of the problem: doing it on your own, unsupervised (and) thinking, 'Oh, this is good.'
At least initially, people should stay away from home ketamine, he said. “I think it's a recipe for disaster,” he said.
Pfeiffer said he believes the public can distinguish what happened to Perry from the promise of ketamine therapy.
“There are people who deal drugs and unfortunately become addicted to drugs, even addictions to drugs as low as ketamine,” he said. This is not a medical service.
Listen to the whole episode over here. Starting next week, new episodes of the Chasing Life podcast will be released on Fridays.