Every day for the past eight months, someone I love very much has been straining to find a reason to live.
There is no trauma that caused it, no single cause that can be cured, not even a desire to actually die. This is just emptiness. My loved one has severe depression, and living in this world feels like a burden. They would prefer not to exist.
There are approximately 21 million American adults who experience a major depressive episode each year, so my person is not alone. But they feel like they are.
We have tried (and continue to try) therapy. We have tried (and continue to try) antidepressants. We’ve tried unconditional love and tough love, exercise and eating right. Depression is stubborn and cruel.
Facing the fear that this would drag on for years, or worse, end in suicide, we began to look outside the rigid and exclusionary boxes of mental health treatment that defined our broken system of care. That search brought us to ketamine therapy, which my guy (who agreed to share his story with me) started a few weeks ago.
And then came Matthew Perry, and the Los Angeles County Coroner’s Office issued a ruling that the beloved Friends actor’s death was primarily caused by the acute effects of ketamine. When I read the headline in this newspaper I couldn’t breathe.
Was I about to find out that the treatment we had turned to with equal amounts of desperation and hope was even more dangerous than the disease itself, like one of those Big Pharma commercials where the disclaimers are so terrifying they seem absurd. Are?
But after reading autopsy reports and talking to experts and patients who have used ketamine, it turns out the truth is more complicated, as are most things involving mental health. Perry did not die because he was using ketamine to treat depression or addiction, and for a therapy that is both effective and just making it into the mainstream, it is important that we get the facts out in full. Receive from.
Dr. John Crystal told me that this is why people should not be afraid of treatment.
He is Professor and Chair of Psychiatry at Yale School of Medicine. In the 1990s, Crystal introduced the use of ketamine to treat depression. Since then, numerous peer-reviewed studies have proven that he sees ketamine treating or controlling severe depression in his patients every day, sometimes overnight.
“It’s a remarkable thing to see,” he said.
Sometimes the fast-acting effects lead people to believe that if you stick to treatment, you’ll continue to do well, Crystal said, potentially igniting a life-saving flicker of optimism for those who have failed medications. Have wandered through the long, dark maze of.
A recent study by researchers at Harvard and Mass General Brigham, published in the New England Journal of Medicine, found that ketamine is more effective at fighting treatment-resistant major depression than electroconvulsive therapy, or ECT, despite its side effects. Despite this it is still considered the gold standard. And this process causes trauma for some people. More than half of those given ketamine showed improvement, compared with about 41% of those who received ECT.
In 2019, the Food and Drug Administration approved a version of ketamine (ketamine is made up of two isomers, or molecules, that can be separated) called esketamine to treat depression. It’s a nasal spray, and in one study, 70% of people who used it with antidepressants saw improvement. Crystal called it a game changer and explained at the time that it was not a Band-Aid on depression, but a true cure.
When you take ketamine, it triggers responses in your cortex that enable brain connections to re-grow, he said, meaning that ketamine causes the brain to reorganize itself rather than just masking symptoms. Has the ability to help.
Perry had long struggled with depression and addiction, and like thousands of others, turned to ketamine after other options failed, and sought treatment at a Swiss clinic during the COVID-19 pandemic. of.
It felt like a huge exhale, like being hit over the head with a giant shovel, Perry wrote in her memoir, Friends, Lovers and the Big Terrible Thing.
But not every treatment works for every person.
Ketamine wasn’t for me, Perry decided after that initial trial, because, well, the hangover was tough and worth more than momentary relief.
We don’t know what brought him back to ketamine, or whether his latest experiences were different from previous ones. It is also not clear, at least to the public, whether the ketamine he took on the day he died was prescribed, or obtained illegally.
In one sense it doesn’t matter; His death is tragic, no matter what the backstory. But in another way, it’s a serious question because for at least the next decade, Perry’s death will be the first thing people think of when ketamine therapy is mentioned. This adds stigma to an important treatment for a disease 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 help from a professional and call 9-8-8. The United States’ first nationwide three-digit mental health crisis hotline, 988, will connect callers to trained mental health counselors. Text HOME to 741741 in the US and Canada to reach the crisis text line.
But the thing that took Perry’s life was that he drowned, possibly taking a dose of ketamine far higher than what is used medically for depression before he died, the level in his blood an anesthesiologist said. It was similar to the level used by the US to render someone unconscious. Ketamine was originally developed as an anesthetic in the 1960s.
The physical effects of that mega-dose were probably further heightened by the presence of buprenorphine, which treats opioid addiction, in his system. This can put stress on the heart as well as slow down the respiratory system.
But if he had not been in the water, Perry would still be alive, even though he had high amounts of ketamine in his blood.
If Perry’s death was the result of a poorly monitored prescription or the abuse of legally obtained ketamine, it would (or should) focus attention on a nascent treatment that, like medical marijuana a few years ago, was actually therapeutic. And the Wild West is both. Exploitation. There are many legitimate in-person and telehealth professionals who provide ketamine, and likely some who are more interested in making money than keeping patients safe.
A 15-minute online appointment is all it takes to get a ketamine prescription delivered to your door. This can be a good thing, a lifesaver for some people. But it can also be a quick route to recreational abuse.
Michael Balaban served two tours in Afghanistan, and eventually served as a gunner on a Black Hawk helicopter. That military service contributed to his diagnosis of complex post-traumatic stress disorder. He told me he was so full of unpredictability and anger that by the time the pandemic hit, he was basically stuck at home for the safety of others.
I was filled with reactivity. Fight and flight were in full swing, he told me, although the fight usually resulted in victory. She had tried every antidepressant and anti-anxiety medication she could get her hands on. They all failed.
On the day he was feeling suicidal, he called a local clinic that offered ketamine treatment. Within two months of starting ketamine, his symptoms had diminished so much that he felt able to go on vacation to Costa Rica.
He said, it felt like I had woken up. Now, he advocates for a national nonprofit to help other veterans access ketamine.
However, Perry’s death, and the still marginal nature of ketamine, worries him. He can’t afford the expensive infusions at a clinic, which can cost more than $1,000 each. He relies on a prescription of lozenges that he can take at home, which costs less than a few hundred dollars per month.
They fear that Perry’s death and misinformation about ketamine more generally could deny them and other veterans access.
He said those who are fighting for access are always the first to lose. My concern is that ketamine infusions and in-clinic treatments will escape criticism, while at-home ketamine, one of the only affordable methods, will suffer.
The best way to ensure that ketamine is used appropriately whether in the clinic or at home is to make it available through mainstream mental health providers, be covered by insurance, and when used at the correct dosage, to patients’ and Deemed by both doctors as a safe and effective treatment. Correct precautions.
Crystal, the Yale doctor, said there are two reasons why ketamine is not more common, which have more to do with the process than the benefits. Mainstream mental health providers are unwilling to offer procedure-based treatment in their facilities, and change in the field of psychiatry has been slow.
I would also add that there is little incentive for pharmaceutical companies to pursue a drug that is cheap and quick-acting, whereas antidepressants, which people sometimes take for years, are a lucrative and growing market.
Despite the obstacles, Crystal said he thinks ketamine and esketamine will become an easy treatment for depression in the near future because these drugs are the most effective medications we have for fighting severe depression.
For me, ketamine was not a magic pill. But this is helping. The first time he did this, I stayed with him in the treatment room with the medical provider. In about half an hour, my loved one did something he had barely done this year.
They laughed with joy and abandon. Such a sound as if a child sitting on a swing is feeling the breeze of summer breeze.
He said, this is the real me.
I cried while they laughed because depression is not a lonely endeavor, no matter how it feels. Watching my personality suffer ruled my entire year, leaving me deeply worried every moment that this would be the day they gave up.
In the days that followed, there appeared to be a noticeable difference, peace and a greater ability to interact with the world.
Not a cure, just a step.
It is heartbreaking that ketamine, which Perry sought help from, ultimately led to his death. But Perry was clear that she believes recovery from both depression and addiction is possible, if not for herself, then for others. I didn’t know him, I don’t speak for him, but I believe he would not want his death to prevent others from getting the help that is right for them.
And he would not want a scientifically supported treatment to be rejected because it is linked to his death.
Any drug can be abused. But ketamine is what should be available and understood to people like my dear, beloved man whose minds have tricked them into believing that suffering is the best life can be.
If you or someone you know is struggling with suicidal thoughts, seek help from a professional and call 988. The first nationwide three-digit mental health crisis hotline will connect callers to trained mental health counselors. Or text HOME to 741741 to reach US and Canada crisis text line,
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