The recent tragic death of beloved actor Matthew Perry has spurred a number of questions and legitimate concerns from healthcare providers, patients, their families, and the media about whether ketamine is safe and appropriate to use as a treatment option for managing certain mental health conditions.
As one of the earliest, largest, and most respected psychiatric practices for administering ketamine for the management of treatment-resistant depression (TRD), we sat down with Michael Banov, MD, the Medical Director at Psych Atlanta, a Hightop Health clinic, and a well-known, highly-regarded industry expert. Given Dr. Banov’s significant experience successfully treating depression with ketamine, we reached out for his opinion on this important topic.
To start, what is ketamine and its intended use?
Ketamine is a dissociative anesthetic that is accompanied by hallucinogenic effects. Often referred to as a “dissociative anesthetic hallucinogen,” ketamine can induce a state of sedation, making users feel calm, relaxed, and even detached from their pain and environment.
Developed in the 1960s, the Food and Drug Administration (FDA) approved ketamine as medication for anesthesia and pain management. The antidepressant benefits were observed early in its use, but much of the research for the use of ketamine for psychiatric disorders were stopped in the wake of the Controlled Substances Act of 1970s> This was due to increasing concerns about abuse potential, especially during a time where hallucinogenic drug use, such as lysergic acid diethylamide (LSD), phenylcyclohexyl piperidine (PCP), and psilocybin, were growing.
Despite the large body of scientifically rigorous studies conducted at reputable university research centers showing that it is indeed effective to treat depression, ketamine does not have formal FDA approval to treat any mental health conditions. However, in the last decade, ketamine has been given by psychiatrists and other healthcare professionals for “off-label” use for several treatment-resistant mental health concerns.
What is the connection between ketamine and Matthew Perry?
Recent reports in the press suggest that ketamine abuse may have been associated with the death of the well-known and beloved actor, Matthew Perry. While he was receiving ketamine for depression at a medically-supervised clinic, he was also obtaining additional vials of the medication illicitly, and was self-administering at home without medical oversight.
It’s also been reported that several people who helped him obtain large amounts of ketamine outside of his medically-supervised treatments have been charged in connection with Perry’s fatal overdose, since it was clear they were providing him dosages that were in excess of those that would be considered safe and appropriate for management of a psychiatric condition.
How would this have been made possible and so easily accessible?
In recent years, there have been a proliferation of “ketamine clinics” that do not offer any other mental health treatment options, nor do they have appropriately trained mental health practitioners as an integral part of their assessment and treatment team. And while some of these clinics are overseen by Physicians or Nurse Practitioners (NPs) who may be very skilled in ketamine administration, that does not necessarily equate to being sufficiently trained to assess, diagnose, and treat complicated psychiatric conditions.
Additionally, there has been an influx of clinics that provide an array of non-mental health services, such as weight loss programs, spa treatments, and cosmetic procedures, that are now adding intravenous (IV) ketamine, primarily as an additional revenue-generating procedure. Unfortunately, the clinicians in these types of clinics may not have the most experience in determining who can actually benefit from ketamine treatment.
More so, online ketamine clinics are a new phenomenon that emerged with the loosening of restrictions during COVID-19. Previously, healthcare professionals could only prescribe highly-controlled and potentially-misused medicines, such as stimulants and opiates, through face-to-face assessments.
With less constraints in place as of late, these sites offer cursory telehealth assessments from prescribers who may or may not be sufficiently trained in the diagnosis and treatment of severe cases of depression and anxiety.
For a subscription fee, these companies typically send patients oral ketamine made at a local pharmacy, without the oversight that pharmaceutical companies go through when they are manufacturing medications. Typically administered via intravenous and intramuscular (IM) injections, oral ketamine has been shown to not give consistent results, as oral absorption is very unpredictable. Despite this knowledge, patients self-administer the ketamine they receive in the mail at home, without any onsite medical supervision.
In some cases these clinics can serve as a valuable function in making ketamine accessible to those suffering from treatment-resistant depression who live in areas where access to ketamine prescribers may be limited, or they cannot travel to clinics with onsite supervision. However, oftentimes there are clinics that are poorly managed and do not provide close, online monitoring during administration of the medication.
In addition, TRD is a very complicated medical condition that requires a high level of training to appropriately diagnose and manage. Often, the time spent during these online assessments and the training of those conducting these visits is inadequate to make a determination that ketamine is the best course of action.
This amalgam of limited expertise and supervision easily allows for patients to accidentally (or even intentionally) take too much, share the medication with others, or experience dangerous effects, such as severe dissociation, loss of consciousness, or life-threatening blood pressure spikes – all with no immediate medical professional to manage those conditions, should they arise.
What is your professional opinion on what happened with Matthew Perry?
While the full details remain unknown, in my opinion, ketamine was most likely not the direct cause of his death. While Perry was indeed receiving ketamine treatment for depression at a supervised medical clinic, at the time of his death the medication he was using was obtained through illicit means and not being appropriately monitored by trained mental health care professionals in a clinical setting.
His last medically-supervised administration was over a week prior to his passing and the amount of ketamine in his system was more than eight times the dose typically used for treating depression. This suggests that he was clearly taking far more than the recommended dose, and all without monitoring.
Therefore, from my perspective, Perry clearly was abusing ketamine, and having other medications and over the counter products in his system only exacerbated the risks. Based on this, I believe he lost consciousness and subsequently drowned in his hot tub.
What would you recommend for those interested in learning more about ketamine treatment?
Going to a clinic that only provides ketamine, and more concerning, does not have experienced mental health professionals as active and integral members of the treatment team, is highly discouraged.
Not only could that put patients at risk for improper administration and allow for unsupervised usage in conditions where it may not be helpful (or possibly even dangerous), it also presents a high likelihood of recurrence of depressive symptoms, even if someone does have an initial positive response. Instead, those seeking out ketamine treatments should look for a reputable, educated provider with proven results.
Psych Atlanta, a Hightop Health clinic, is an experienced clinical practice, research, and teaching facility, where top-tier clinicians utilize only the most groundbreaking, interventional treatments available.
We specialize in providing Ketamine Therapy Services as part of our continuum of offerings available to patients seeking help breaking through complex mental health barriers. As such, we have observed the best, safest, and most effective use of ketamine for the management of mental health disorders and we recognize it’s only successful when it is part of a comprehensive psychiatric treatment program that includes lifestyle changes, medication, and counseling.
Regardless of the practice you choose when exploring ketamine treatments, be sure it is only administered in the presence of trained healthcare professionals and solely in those individuals who have not responded or tolerated approved treatments prior.
If you have any other additional questions regarding the safe and effective use of ketamine for you or someone you care about, please feel free to contact us and we can answer any of your questions or concerns.