What is ketamine infusion therapy?

Among the details that emerged Thursday about actor Matthew Perry’s death was that the Friends star was undergoing ketamine infusion therapy.

The coroner concluded that the treatment, offered in both the US and the UK, he was not responsible for Perry’s death due to ketamine, which prosecutors say was supplied to him illegally.

Five people including two doctors, Perry’s assistant and an alleged drug dealer they were accused for administering the drug outside of its therapeutic regimen.

Perry, 54, had been open about his history of substance abuse and prosecutors say the defendant had profited from his addictive tendencies.

Ketamine is an anesthetic that can be used to treat depression, anxiety, and pain in medical settings.

However, it also has dissociative effects, meaning it can distort the perception of sight, sound and time, as well as producing calming and relaxing effects. This means it is also used illicitly.

According to addiction counseling service Talk to Frank, ketamine can increase heart rate and blood pressure and can leave users feeling confused and agitated, which could lead to them harming themselves without realizing it.

Chronic use of ketamine has been linked to liver damage, as well as causing bladder problems like incontinence.

Ketamine is used to treat depression in cases where traditional antidepressants have not been effective.

“Biologically, it probably switches off the area of ​​the brain involved in disappointment,” says Prof Rupert McShane, a psychiatrist at the University of Oxford who runs an NHS ketamine treatment clinic. “That area is probably involved in depression.”

Dr Rajalingam Yadhu, a consultant at the Royal Free Hospital in London and director of Save Minds, a ketamine infusion clinic, told the BBC that the patients he treats suffer from chronic depression and have typically tried at least seven different drugs without seeing any improvement.

“These are people who have actually tried everything in life, [are] extremely suicidal and, if given the chance, would kill himself.”

The treatment has also been used by high-profile figures. In addition to Perry, billionaire entrepreneur Elon Musk has said he has taken ketamine to treat depression.

In an interview with CNN in March, the X and Tesla owner said the drug was “helpful for getting out of a negative mood.”

Ketamine infusion therapy works by administering the drug intravenously in doses lower than those used for anesthesia.

“For depression, you use a lower dose than you use for chronic pain, a much lower dose than patients receive in the form of anaesthetics,” says Dr Mario Juruena, a psychiatrist at King’s College London who specializes in treatment-resistant mental disorders.

Ketamine works more quickly than traditional antidepressants, but its effects also wear off more quickly.

“It has a short half-life, so the time that patients feel the effects is sometimes quite short,” Dr Juruena told the BBC, stressing the importance of monitoring patients’ mental state to avoid relapses into depression.

Dr. Yadhu says that unlike other traditional antidepressants, ketamine has been found to work on nerves that use the chemical glutamate to interact. Glutamate is the most abundant neurotransmitter in the nervous system.

Some studies suggest that ketamine may also help reverse synaptic pruning, or the removal of neurons, which occurs naturally but can also be associated with chronic stress and depression.

“When you’re depressed, the connections in your brain seem to shrink,” Prof McShane told the BBC. “So it’s almost as if in depression, some of the neurons are like a tree in the winter – and then with ketamine, it turns them even more into a tree in the spring.”

He adds that the drug likely reduces suicidal thoughts and the “rumination cycle” that fuels depression.

Experts are studying why it might help some patients but not others.

Dr Juruena told the BBC that more than 60% of patients responded well to ketamine treatment, but added that this usually occurred in conjunction with other antidepressants or psychotherapy.

Doctors warn that taking ketamine can still cause negative side effects, even when supervised by a doctor, although Dr. Juruena says this happens less often due to the lower dosage.

Dr. Yadhu says that while many of his patients’ experiences have been positive, some have been unpleasant and may bring back bad memories.

Professor McShane notes: “Although ketamine can be very effective for people for whom nothing else has worked, one of the problems is that you have to keep taking it, and we’re not used to thinking of that as a good idea.”

Dr. Yadhu says he does not treat patients with addictive tendencies with ketamine, although some doctors are exploring it as a treatment for drug and alcohol addiction.

However, administering ketamine via “infusion,” or drip, is not the only way to treat ketamine patients.

Dr. Juruena says it can also be given as an injection, nasal spray, or capsule.

Experts say the dosage of ketamine administered via infusion must be precise and in small amounts to have antidepressant effects.

But a post-mortem examination revealed that Perry’s blood contained a high concentration of ketamine and that he had died from the “acute effects” of the drug.

The medical examiner also found that his last ketamine infusion therapy session had been more than a week before his death, by which time the drug had worn off.

They said the levels of ketamine in Perry’s system at the time of his death were of a much higher dosage.

Investigators said Perry’s assistant had given him at least 27 injections of ketamine in the four days before his death.