Matthew Perry’s Passing: Understanding the Dangers of Ketamine Overdose

Recent reports suggest the passing of Friends star Matthew Perry resulted from the “acute effects” of ketamine—a drug utilized in anesthesia and specific antidepressants. Perry, engaged in ketamine infusion therapy for depression, reduced intake before his demise, with the last infusion a week and a half prior. The Los Angeles County medical examiner speculated a potential ketamine overdose causing “cardiovascular overstimulation and respiratory depression.” Perry’s existing health conditions, including diabetes and chronic obstructive pulmonary disease, might have complicated matters, impacting airflow and respiratory function.

In India, classified as a Schedule X drug, ketamine is subject to stringent control and careful monitoring by prescribing doctors. Dr. Shaunak Ajinkya, Psychiatrist at Kokilaben Dhirubhai Ambani Hospital, Mumbai, emphasizes its safety in therapeutic contexts, highlighting that the risk lies primarily in unauthorized usage.

Ketamine, synthesized by American chemist Calvin L Stevens in 1962, initially served as an animal and human anaesthetic in the late 1960s and during the Vietnam War surgeries. Derived from the hallucinogenic drug Phencyclidine (PCP), it functions by blocking the NMDA receptor, increasing the neurotransmitter glutamate, and halting pain transmission in the spinal cord while activating reward pathways in the brain. Evolving from pain management, ketamine has emerged as a promising treatment for severe depression over the last decade, owing to its euphoric qualities and prescription for uplifting patients from their depressive states.

What makes ketamine susceptible to substance abuse is its “dissociative” effect, inducing hallucinations and an altered reality, commonly known as a “K-hole.” Its clear liquid form and easy solubility, even as a white powder, make it difficult to detect. This characteristic led to its misuse as a date rape drug. Additionally, the drug is now accessible in nasal spray forms, contributing to its potential for abuse.

Ketamine overdose impacts the heart and organs as it acts as a relaxant, compromising breathing and leading to shallow breaths and lung collapse. This places increased stress on the heart, causing elevated heart rate and blood pressure. However, compromised arteries may struggle to cope, potentially resulting in sudden cardiac arrest. Ketamine’s toxicity extends to the urinary bladder and liver, and unregulated high doses can induce schizophrenia and foster drug dependence. Fatalities are more probable when ketamine is combined with alcohol, as might have occurred in Perry’s case.

In the realm of depression treatment, researchers at the National Institutes of Health discovered in 2006 that an intravenous ketamine dose could rapidly alleviate severe depression, outperforming other remedies. Recognizing its efficacy, the US Food and Drug Administration (FDA) approved a nasal spray as the first antidepressant based on ketamine in 2019.

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