Here’s What You Should Know About Ketamine As A Depression Treatment

It’s been nearly a year since actor Matthew Perry, best known for playing Chandler Bing on “Friends,” died from a ketamine overdose and drowning in his hot tub. News emerged on Thursday that five people have been charged in his death, including two doctors, Perry’s assistant and a woman accused of selling drugs.

The actor had used ketamine therapy for depression and anxiety, but it appears he became more dependent on the drug toward the end of his life, according to law enforcement officials.

Although ketamine has long been known as Special K, a party drug, it has also been established as an effective treatment for depression, with appropriate dosages.

Below, experts share what you need to know about ketamine treatment and when it may turn out to be unsafe.

Ketamine is prescribed to people with “treatment-resistant depression symptoms,” according to Dr. John Krystal, chairman of the Department of Psychiatry at Yale School of Medicine in Connecticut.

“In other words, they’ve tried more than one antidepressant and still haven’t gotten the clinical response they need,” said Krystal, one of the lead researchers. about ketamine treatment for depression.

The two most common types of antidepressants are serotonin reuptake inhibitors, or SSRIs, and serotonin and norepinephrine reuptake inhibitors, or SNRIs. Medications such as Lexapro, Zoloft and Prozac fall into the SSRI class, while Cymbalta and Pristiq are in the SNRI class.

These drugs “all work through the same general mechanisms to target processes in the brain, such as norepinephrine and serotonin,” Krystal said. Serotonin and norepinephrine are neurotransmitters known for their links to mood, memory and the sleep cycle.

It can take about six to eight weeks for these drugs to build up in a person’s system before the patient starts to feel better.

“Ketamine targets a different chemical system in the brain, called the glutamate system, which provides a major information pathway for brain networks involved in emotion regulation and cognition,” Krystal said. said.

Because ketamine works in a different way, it may produce faster effects than SSRIs and SNRIs in some people.

There are different ways that ketamine can be administered, but it has only been approved by the Food and Drug Administration as a treatment for depression in its nasal spray form, with a treatment known as esketamine. In particular, it is approved for “treatment-resistant depression and major depressive disorder with suicidal thoughts and behavior,” said Dr. Paul Kim, director of the Johns Hopkins Treatment Resistant Esketamine Antidepressant Targeted (TREAT) Depression Clinic in Baltimore.

“Esketamine … is highly regulated. It is a Schedule III drug, a controlled substance, and both the patient and the clinic must enroll in this program called the REMS program. ‘REMS’ stands for ‘risk assessment and risk mitigation strategy,’” explained Kim. Other drugs with potential for abuse or serious side effects need to be on the REMS program, Kim added. Esketamine is taken under clinical supervision.

Ketamine can also be administered intravenously, but IV ketamine is FDA-approved as an anesthetic drug, Kim explained. It is also used as an off-label medication for treatment-resistant depression.

Since IV ketamine is not approved by the FDA as a mental health treatment, it does not have the same regulatory standards for this use. That’s not to say that medical clinics don’t administer medications correctly and safely; You can get intravenous ketamine treatment at many major medical clinics across the country.

Both IV ketamine and esketamine are effective treatments for depression, Kim said. Unlike medications like Zoloft and Prozac, ketamine and esketamine are not prescribed daily. Instead, they are usually given a few times a week at first, and more often as the person progresses through treatment. In addition, ketamine therapy is often prescribed in addition to a daily antidepressant.

Ketamine can also be compounded into an oral pill, according to Kim, and some online companies now offer this treatment. But both Krystal and Kim stressed that it’s important for patients to be monitored in the clinic as they receive any form of ketamine treatment.

“One thing that is clear is that oral ketamine is not necessarily safer or less effective than IV ketamine or intranasal esketamine when brought to the clinic. However, if the level of monitoring of blood levels and correction of dose is not used, then different blood levels can cause safety or efficacy issues,” Krystal said. “Concerns about safety issues would increase if patients were to take oral ketamine at home without adequate medical supervision.”

The amount of ketamine in Perry’s system was equivalent to that given for general anesthesia – not the amount doctors use for the treatment of depression, which is much less. And he was at home when he was given the medicine, not in a medical facility.

“There are companies trying to find ways to make ketamine safe for home administration, but Matthew Perry’s story highlights something very important, which is that when patients have too much ketamine in their more than they need at home, there will be a risk of abuse,” said Kristal. And, in fact, a study of ketamine use at home found that a large percentage of patients use ketamine see badly.

When taken under proper medical supervision, esketamine and IV ketamine are safe, Krystal and Kim said. Ketamine and esketamine are also life-saving medications that have been shown to reduce the risk of suicide in many people, according to Krystal.

“People have been using ketamine as a drug for a long time, and they know it’s safe — but again, in a hospital setting,” Kim said. If misused, there is always the possibility that it can be fatal.

When ketamine is used correctly, treatment sessions become more spaced out, Krystal said.

But Krystal said “people who abuse ketamine take more ketamine as time goes by. When used rarely, as we do in therapy, ketamine stimulates the regrowth of synaptic connections between nerve cells in brain circuits involved in emotions. ” When used recreationally and outside of clinical settings, it can lead to addiction, while being “toxic to those brain connections and can even produce symptoms of depression,” Krystal said.

Ketamine and esketamine can be life-changing medications for many people who feel like they can’t manage their depression.

“I can’t speak to all the clinics out there, but I think my recommendation to readers would be that, of course, they should talk to their psychiatrist about ketamine treatment, and hopefully they have experience in referring patients to certain clinics,” said Kim. “Most of the time those clinics have to be run by a psychiatrist, or somehow have a psychiatrist on staff.”

It is also important to research the major health systems in your area to see if they offer ketamine treatment. Be wary of places that are “psychologist-run pop-up clinics. Because … anesthesiologists can give it, and there are all kinds of doctors who can give IV ketamine,” Kim said.

Because it is not approved by the FDA, IV ketamine may require an out-of-pocket payment, which can be expensive. Kim says the FDA-approved esketamine has a similar effect as a mental health treatment.

“At the end of treatment, there’s really no difference in the effectiveness of IV ketamine over esketamine,” Kim added.

And you should remember that this type of treatment is only one part of a bigger game.

“Esketamine and IV ketamine, it’s not a cure, is it? It’s not like you’re going to get one treatment, or multiple treatments, and they’re going to get better from depression,” Kim said. “It’s just improving the symptoms, and it’s an anti-depressant. stress – [like] Prozac and Zoloft – these are the ones that hope to sustain or maintain the beneficial effects.”

It is also important to continue to see a psychiatrist who can monitor your symptoms, treatment and mental health to make sure you are on the right track moving forward.

Do you need help with a substance abuse or mental health problem? In the US, call 800-662-HELP (4357) for SAMHSA National Helpline.

Call or text 988 or visit 988lifeline.org for mental health support. Additionally, you can find mental health and crisis resources at dontcallthepolice.com. Outside the US, please visit the International Association for Suicide Prevention.