What is ketamine infusion therapy?

Among the details that emerged Thursday about the death of actor Matthew Perry is that the Friends star had been receiving ketamine treatment.

The investigator concluded that the treatment – offered in both the US and the UK – he was innocent of Perry’s death from ketamine, which prosecutors say was illegally administered.

Five people including two doctors, Perry’s assistant and a suspected drug dealer they were charged by providing medicine outside of his treatment plan.

Perry, 54, has been open about his history of drug abuse, and prosecutors say the defendant profited from his addiction.

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

However, it also has dissociative effects – meaning it can distort visual perception, sound and time, as well as produce soothing and relaxing effects. This means that it is also being used illegally.

According to the addiction advice service, Talk to Frank, Ketamine can increase a person’s heart rate and blood pressure, and can leave users confused and disoriented – potentially causing them to harm themselves without realizing it.

Chronic ketamine use has been linked to liver damage, as well which causes bladder problems such as impotence.

Ketamine is used to treat depression in cases where traditional anti-depressants have failed.

“At a biological level, it probably shuts down the area of ​​the brain involved in depression,” said Prof Rupert McShane, an Oxford University psychiatrist 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 who also runs the Save Minds clinic, ketamine infusion therapy, told the BBC that the patients he treats have long-term depression and often try at least seven different medications without realizing it. development.

“These are people who have tried everything in life, [are] to kill themselves – and given the chance, they will.”

The treatment was also used by high-class people. Along with Perry, billionaire entrepreneur Elon Musk said he was prescribed ketamine to treat depression.

In an interview with CNN in March, the owner of X and Tesla said that the drug is “helpful to get someone out of a bad mood”.

Ketamine infusion therapy works by giving the drug in smaller doses than those used for anesthesia.

“With depression, you’re using a lower dose than you use for chronic pain, a really lower dose than what patients are receiving as anesthetics,” said Dr Mario Juruena, a psychiatrist at King’s College London who specializes in treatment-resistant mental disorders.

Ketamine works faster than conventional antidepressants – but its effects wear off quickly.

“It has a short half-life, so the time for patients to be affected is very short in some areas,” Dr Juruena told the BBC, stressing the importance of monitoring patients’ mental state for recovery from depression.

Dr. Yadhu says that, unlike other common anti-depressants, ketamine has been found to affect nerves that use the chemical glutamate to communicate. Glutamate is the most abundant neurotransmitter in the nervous system.

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

“When you’re stressed, brain communication seems to decrease,” Prof McShane told the BBC. “So it’s like in stress, some neurons are like a tree in the winter – and with ketamine, they turn them into a tree in the spring.”

He adds that this drug probably reduces suicidal thoughts and the “bullying cycle” that feeds depression.

Experts are researching why it may help some patients, but not others.

Dr Juruena told the BBC that more than 60% of patients responded well to ketamine treatment – but said this usually happened while taking other anti-depressants or alongside psychotherapy.

Doctors warn that people can still experience side effects from taking ketamine, even when supervised by a medical professional – although Dr Juruena says this happens less often due to the lower dosage.

Dr Yadhu says that although most of his patients’ experiences were positive, some were unpleasant and can bring back bad memories.

Professor McShane comments: “Although ketamine can be very effective for people who have never worked for anything, one of the problems is that you need to keep taking it – and we don’t usually think that’s a good idea.”

Dr Yadhu says he does not treat people who show signs of addiction with ketamine – although some doctors consider it a way to treat drug and alcohol addiction.

Receiving ketamine by “infusion” – that is via an IV drip – is not the only way to treat people with ketamine, however.

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

Experts say that the dose of ketamine given in infusion therapy should be precise and small in order to have antidepressant effects.

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

The medical examiner also found that her last ketamine treatment session took place more than a week before her death – by which time the drug would have worn off.

They said the levels of ketamine in Perry’s body when he died were also very high doses.

Prosecutors said Perry’s assistant had given him at least 27 shots of ketamine four days before his death.