Every day for the past eight months, someone I love dearly has struggled to find a reason to live.
There is no trauma that caused this, no singular cause that can be fixed, not even a desire to die. The sheer emptiness of it. My loved one has severe depression and being in this world feels like a burden. They wouldn’t want to exist.
About 21 million American adults experience a major depressive episode each year, so I’m not alone. But they feel like they are.
We have tried (and are still trying) therapy. We have tried (and are still trying) anti-depressants. We’ve tried unconditional love and tough love, exercise and eating right. Depression is stubborn and cruel.
Fearing that this would go on for years or, worse, end in suicide, we began to look outside the rigid and exclusionary boxes of mental health care that define our broken care system. That search brought us to ketamine therapy, which my person (who is good at sharing his story) started a few weeks ago.
And then came Matthew Perry and the Los Angeles County Coroner’s Office ruling that the beloved Friends actor’s death was primarily due to the acute effects of ketamine. When I read the headline of this magazine, I couldn’t breathe.
Was I going to find out that the treatment we had turned to with equal measure of desperation and hope was more dangerous than the disease, like one of those big drug commercials with disclaimers so awful they seem absurd?
But after reading the autopsy report and talking to experts and patients who use ketamine, the truth is more complicated than most things in mental health. Perry didn’t die because he used ketamine to treat depression or addiction, and for an effective and only mainstream therapy, it’s important that we get the full facts.
People shouldn’t be scared away from treatment because of this, Dr. John Krystal told me.
He is a professor and director of psychiatry at the Yale School of Medicine. In the 1990s, Krystal began using ketamine to treat depression. Since then, numerous peer-reviewed studies have shown what he sees in his patients daily to improve or control severe depression with ketamine, sometimes overnight.
It’s a wonderful thing to see, he said.
These sometimes fast-acting effects give people the belief that if you stick with treatment, you’ll continue to do well, Krystal said, which can spark a life-saving glimmer of optimism for those who have wandered through the long, dark maze of failed drugs.
A recent study by Harvard researchers and Mass General Brigham, published in the New England Journal of Medicine, found ketamine to be more effective in treating treatment-resistant major depression than electroconvulsive therapy, or ECT, which is still considered the gold standard despite its side effects. and the trauma that the procedure itself causes to some. More than half of those who received ketamine showed improvement, compared to about 41 percent of those who received ECT.
In 2019, the Food and Drug Administration approved a version of ketamine called esketamine (ketamine consists of two isomers or molecules that can be broken down) to treat depression. It’s a nasal spray, and in one study, 70% of people who used it along with an antidepressant got better. Krystal called it a game changer, explaining at the time that it wasn’t a Band-Aid for depression, but a true cure.
When you take ketamine, it triggers reactions in your cerebral cortex that allow brain connections to regrow, he said, meaning ketamine has the potential to help the brain rewire itself rather than just masking symptoms.
Perry had long battled depression and addiction and, like thousands of others, turned to ketamine after other options failed and tried treatment at a Swiss clinic during the COVID-19 pandemic.
It felt like a giant exhalation, Perry wrote in his memoir, Friends, Lovers and the Big Terrible Thing, like being hit on the head with a giant happy shovel.
But not every treatment is right for everyone.
Ketamine wasn’t for me, Perry decided after the first trial, because the hangover was rough and pressed for momentary relief.
We don’t know what brought him back to ketamine, or if his recent experiences were different from his previous ones. It also remains unclear, at least to the public, whether the ketamine he took on the day of his death was prescribed or obtained illegally.
It doesn’t matter in one sense; his death is tragic regardless of the backstory. But in another way, it’s a critical question because, for at least the next decade, Perry’s death will be the first thing people think of when ketamine therapy is mentioned. It links stigma to the importance of treating an illness that is already stigmatized and difficult to treat.
Suicide prevention and crisis counseling resources
If you or someone you know is struggling with suicidal thoughts, seek professional help and call 9-8-8. The US’s first national three-digit mental health crisis hotline, 988, connects callers to trained mental health counselors. Text HOME to 741741 in the US and Canada to access the crisis text line.
But what killed Perry was that he drowned and likely passed out before a dose of ketamine far greater than what would be used therapeutically for depression, levels in his blood more like what an anesthesiologist would use to sedate someone. Ketamine was originally developed in the 1960s as an anesthetic.
The physical impact of that mega-dose was perhaps further exacerbated by the buprenorphine, an opioid addiction treatment, in his system. It can strain the heart and slow down the respiratory system at the same time.
But if he hadn’t been in the water, Perry would still be alive, even with a large amount of ketamine in his blood.
If Perry’s death was the result of a poorly controlled prescription or abuse of legally obtained ketamine, it shines (or should shine) a spotlight on a nascent treatment that, like medical marijuana a few years ago, is both genuinely therapeutic and the Wild West. exploitation. Many legitimate in-person and telehealth professionals offer ketamine, and likely some are more interested in making money than protecting patients.
15 minutes of online time is all it takes to get a ketamine prescription delivered to your door. That could be a good thing, a life saver for some. But it can also just be a quick way for recreational use.
Michael Balaban served two tours in Afghanistan, ending up as a gunner in a Black Hawk helicopter. This military service contributed to his diagnosis of complex post-traumatic stress disorder. He told me that he was so full of unpredictability and anger that by the time of the pandemic he was basically shut down anyway for the safety of others.
I was full of reactivity. Fight and flight were in overdrive, he told me, although the fight usually won. He had tried every anti-depressant and anti-anxiety medication he could get his hands on. They all failed.
One day when she was contemplating suicide, she instead called a local clinic that offered ketamine treatments. Within two months of starting ketamine, her symptoms had reduced so significantly that she felt able to go on vacation to Costa Rica.
It was like I woke up, he said. Now he’s supporting a national nonprofit to help other veterans get off ketamine.
Perry’s death and the still harmful nature of ketamine worry her. She can’t afford the expensive infusions at the clinic, which can cost more than $1,000 each. He relies on a prescription for lozenges that he can take at home and that only cost a few hundred dollars a month.
He fears misinformation about Perry’s death and ketamine could leave him and other veterans without access.
It’s always the people who struggle for access who lose it first, he said. I worry that ketamine infusion and clinic treatments will escape criticism while home ketamine, one of the only affordable methods, will suffer.
The best way to ensure that ketamine is used correctly in the clinic or at home is to provide it through mainstream mental health providers who are insured and understood by both patients and doctors as a safe and effective treatment when used at the correct dose. proper precautions.
Yale doctor Krystal said two reasons why ketamine isn’t more common have more to do with the process than the benefit. Mainstream mental health providers are not set up to offer intervention-based treatments in their facilities, and the field of psychiatry is slowly changing.
I would add that there is little incentive for drug companies to embrace the cheap and fast effect when antidepressants, which people have been taking for years, are a lucrative and growing market.
Despite the obstacles, Krystal said she believes ketamine and esketamine will become antidepressants in the near future, as these drugs are our most effective drugs for major depression.
For me, ketamine was not a magic bullet. But it helps. The first time they did it, I stayed with them in the treatment room with the doctor. After about half an hour, my loved ones did something they had hardly done this year.
They laughed with glee and abandon. A sound like a child’s swing, feeling the rush of the summer air.
This is the real me, they said.
I cried when they giggled because depression is not a solitary endeavor, no matter what it is. Watching my person suffer has dominated my year and left me with every moment of deep anxiety that this would be the day they gave up.
In the days that followed, there was a noticeable difference, a calmness and a greater ability to interact with the world.
Not a cure, but a step.
Heartbreakingly, the ketamine Perry sought help from ultimately led to his death. But Perry was clear that he believed recovery from both depression and addiction was possible, if not for himself, then for others. I didn’t know him, I don’t speak for him, but I believe he wouldn’t want his death to stop others from getting the right help for them.
And he would not want science-backed treatment to be avoided because it is linked to his death.
Any drug can be abused. But ketamine is one that should be available and understandable to those, like my wonderful, beloved person, whose brains have tricked them into believing that sadness is the best that life has to offer.
If you or someone you know is struggling with suicidal thoughts, seek professional help and call 988. The nation’s first three-digit mental health crisis hotline connects callers to trained mental health counselors. Or text HOME to 741741 in the US and Canada to reach Crisis text line.
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