December 16, 2023

expert reaction to news reports that Matthew Perry’s accidental death was partly from acute effects of ketamine

It was reported that Matthew Perry’s death was partly caused by acute effects of ketamine. Matthew Perry had previously received ketamine infusion therapy for depression and anxiety which is not related to his cause of death.

Prof Allan Young, Director, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, said:
“Ketamine is a licensed anaesthetic agent which is also used off-licence as a treatment for severe depression. In both settings, it should only be given under medical supervision. Patients should be carefully observed until fully recovered from the effects of the medicine. If ketamine is taken in non-health care settings tragic accidents can happen especially due to the anaesthetic effects but there is also a significant risk of other severe adverse effects such as urinary tract toxicity. Esketamine is licensed, as a nasally administered medicine, for treatment resistant depression but again should only be given under supervision in health care settings.”

Dr Paul Keedwell, Consultant Psychiatrist and Fellow of the Royal College of Psychiatrists, said:

“Treatment resistant depression is a leading cause of disability worldwide. Ketamine infusions can provide rapid relief from depression (within hours or days) where no other treatment helped.

“In the U.K., infusions are only given in a few research centres, but the treatment is much more widespread in the US. It is also increasingly prescribed as a nasal spray, called Spravato, which is licensed for the management of treatment resistant depression in Scotland and the US but not in England and Wales.

“Its mode of action is different to more established antidepressants. Although the relief from depression is rapid, improvements in mood are rarely maintained without repeated doses. It does not work for everyone, and research is ongoing to determine clinical and demographic predictors of response. 

“It is a safe treatment but like all drugs it can have side effects, which include dissociation (common and transient) nausea and vomiting (uncommon) and a brief spike in blood pressure (even less common). Although concerns about addiction are largely unfounded, the question of when to stop the treatment, if ever, is a vexed one.”  

*https://news.sky.com/story/friends-star-matthew-perrys-death-was-accidental-from-acute-effects-of-ketamine-los-angeles-officials-say-13031116

Declared interests

Prof Allan Young:
Employed by King’s College London; Honorary Consultant South London and Maudsley NHS Foundation Trust (NHS UK)
Editor of Journal of Psychopharmacology and Deputy Editor, BJPsych Open,
Paid lectures and advisory boards for the following companies with drugs used in affective and related disorders: Flow Neuroscience, Novartis, Roche, Janssen, Takeda, Noema pharma, Compass,
Astrazenaca, Boehringer Ingelheim, Eli Lilly, LivaNova, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, Sage, Neurocentrx

Principal Investigator in the Restore-Life VNS registry study funded by LivaNova.
Principal Investigator on ESKETINTRD3004: “An Open-label, Long-term, Safety and Efficacy Study of Intranasal Esketamine in Treatment-resistant Depression.”
Principal Investigator on “The Effects of Psilocybin on Cognitive Function in Healthy Participants”
Principal Investigator on “The Safety and Efficacy of Psilocybin in Participants with Treatment-Resistant Depression (P-TRD)”
Principal Investigator on ‘’A Double-Blind, Randomized, Parallel-Group Study with Quetiapine Extended Release as Comparator to Evaluate the Efficacy and Safety of Seltorexant 20 mg as Adjunctive Therapy to Antidepressants in Adult and Elderly Patients with Major Depressive Disorder with Insomnia Symptoms Who Have Responded Inadequately to Antidepressant Therapy.’’ (Janssen)
Principal Investigator on ‘’ An Open-label, Long-term, Safety and Efficacy Study of Aticaprant as Adjunctive Therapy in Adult and Elderly Participants with Major Depressive Disorder (MDD).’’ (Janssen)
Principal Investigator on ‘’A Randomized, Double-blind, Multicentre, Parallel-group, Placebo-controlled Study to Evaluate the Efficacy, Safety, and Tolerability of Aticaprant 10 mg as Adjunctive Therapy in Adult Participants with Major Depressive Disorder (MDD) with Moderate-to-severe Anhedonia and Inadequate Response to Current Antidepressant Therapy.’’
Principal Investigator on ‘’ A Study of Disease Characteristics and Real-life Standard of Care Effectiveness in Patients with Major Depressive Disorder (MDD) With Anhedonia and Inadequate Response to Current Antidepressant Therapy Including an SSRI or SNR.’’ (Janssen)
UK Chief Investigator for Compass; COMP006 & COMP007 studies
UK Chief Investigator for Novartis MDD study MIJ821A12201
Grant funding (past and present): NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK). Janssen (UK) EU Horizon 2020
No shareholdings in pharmaceutical companies

Dr Paul Keedwell: No conflicts