4 min readDec 16, 2023 02:28 PM IST
First published on: Dec 16, 2023 at 01:40 PM IST
News reports say that Friends star Matthew Perry died because of the “acute effects” of ketamine, a drug that is used in anaesthesia and in certain antidepressants. And those into substance abuse have been known to use it as a psychedelic party drug.
According to reports, Perry was undergoing ketamine infusion therapy for depression every other day for a period of time but had reduced that intake more recently, and his last known infusion was a week-and-a half before his death. Possibly a ketamine overdose caused “cardiovascular overstimulation and respiratory depression,” the Los Angeles County medical examiner was quoted as saying in the report. Perry had diabetes and chronic obstructive pulmonary disease and the drug might have complicated airflow blockage and breathing problems.
“It is a Schedule X drug in India, which means it is tightly controlled and even monitored on a case-specific basis by the prescribing doctor. As a therapeutic intervention, it is safe. The risk is only with unauthorised use,” says Dr Shaunak Ajinkya, Consultant, Psychiatrist, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
WHAT IS KETAMINE?
American chemist Calvin L Stevens synthesised it in his lab in 1962, which was used as an animal and human anaesthetic in the late 1960s and then in surgeries during the Vietnam war. Derived from a hallucinogenic drug Phencyclidine (PCP), it works by blocking the NMDA receptor in the brain and spinal cord, and increases a brain chemical or neurotransmitter called glutamate. This, in layman’s terms, halts transmission of pain in the spinal cord and activates reward pathways of the brain. Hence ketamine began to be used in pain management. Then, over the last decade or so, it was found as a promising new treatment for severe depression because of its euphoric quality and began to be prescribed to pull patients out of their troughs.
WHY IS IT PRONE TO SUBSTANCE ABUSE?
The drug has a “dissociative” effect that causes someone to hallucinate in an altered reality, a sort of high. This experience is called a “K-hole.” Since it is a clear liquid and can’t be detected, and even the white powder can be dissolved easily, it began to be used as a date rape drug. Now it is also available as nasal sprays.
HOW DOES KETAMINE OVERDOSE IMPACT THE HEART AND OTHER ORGANS?
Since it is a relaxant, it can complicate breathing, which becomes shallow as the lung too collapses. This increases demands on the heart. It speeds up your heart rate and blood pressure but if your arteries are compromised, then they don’t have the ability to keep pace and get stressed, leading to a sudden cardiac arrest. It is toxic for the urinary bladder and liver. Unregulated high doses can cause schizophrenia and lead to drug dependence. Fatalities are more likely when ketamine is mixed with alcohol, which probably happened in Perry’s case.
HOW IS KETAMINE EFFECTIVE IN DEPRESSION?
In 2006, researchers at the National Institutes of Health found that an intravenous dose of ketamine could relieve severe depression in a matter of hours, compared to other remedies. In 2019, the US Food and Drug Administration (FDA) approved a nasal spray and the first antidepressant based on ketamine.
According to reports, Perry was undergoing ketamine infusion therapy for depression every other day for a period of time but had reduced that intake more recently, and his last known infusion was a week-and-a half before his death. (Reuters) 
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