Understanding Ketamine and Esketamine (Spravato®) Treatments: Safety, Benefits, and Responsible Care From a Board-Certified Psychiatrist’s Point of View

A board-certified psychiatrist explains what ketamine therapy is, who can benefit from it, and how to administer it safely in light of the recent, tragic death of Matthew Perry.

On August 15, 2024, news broke that five individuals, including two doctors, were charged in connection with actor Matthew Perry’s tragic drug overdose. Among those charged were Perry’s assistant and the doctors who allegedly provided him with the ketamine that led to his accidental overdose in 2023. This incident has sparked a wave of media coverage, with many headlines questioning the safety of ketamine treatments and, in some cases, portraying ketamine as a dangerous recreational drug. Unfortunately, this type of media portrayal can contribute to the stigma surrounding mental health, making it even more challenging for those battling mental health disorders to seek the help they need.

Matthew Perry’s death was undeniably tragic, and it is crucial that those responsible are held accountable, but it is equally important to differentiate the irresponsible drug distribution and use that led to his death from the safe, responsible use of ketamine and esketamine (Spravato®) in medical treatment. The FDA has published warnings and guidance discouraging at-home use of compounded oral or injected ketamine. As a psychiatrist who has integrated ketamine and esketamine (Spravato®) into my practice, I want to call attention to the significant benefits patients can realize from ketamine and esketamine (Spravato®) treatment when used correctly and under professional supervision.

Ketamine: A Revolutionary Treatment for Treatment Resistant Depression

I began incorporating ketamine into my practice in 2017 to treat patients with treatment-resistant depression, and the results have often been transformative. Ketamine, and its derivative esketamine, are not new to the medical field. About 25 years ago, researchers discovered that ketamine had rapid antidepressant effects in patients, which led to further studies and the FDA’s ultimate approval of esketamine (Spravato®) nasal spray. This discovery has revolutionized our understanding of depression and opened up new possibilities for treatment, especially for those who have not responded to traditional therapies. Intranasal esketamine (Spravato®) is FDA approved for treatment resistant depression and major depressive disorder in patients with suicidal ideation. This offers another promising option for those who have not found relief with other treatments.

We are currently facing a mental health crisis, with rates of depression higher than ever, exacerbated by the COVID-19 pandemic. The reality is stark: for many young people, suicide is now one of the leading causes of death. We really are in a crisis, and we have to act. It is imperative to explore all available treatment options, including those that may offer rapid relief and have a favorable side effect profile.

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Safety and Responsible Care in Ketamine and Esketamine (Spravato®) Treatment

At LifeStance, we are committed to providing with the highest standards of safety and have developed a protocol we refer to as “responsible care.” Responsible care requires a thorough assessment that includes screening for potential contraindications, such as previous or active substance use disorders, cardiovascular disease, history of stroke, aneurysm, mania, psychosis, interstitial cystitis, and pregnancy. Every candidate for ketamine and esketamine (Spravato®) treatment undergoes a comprehensive evaluation to identify potential risks associated with the contemplated treatment. This evaluation includes validated screening scales and a thorough clinical interview to assess psychiatric history, co-occurring mental and physical health disorders, medication use, and any history of hospitalization or suicide attempts.

We also screen for undiagnosed bipolar disorder and substance use disorders, as well as physical health conditions, such as hypertension, that could increase risks during treatment. For example, if a patient has high blood pressure, we collaborate with their other healthcare providers to manage this condition before starting ketamine or esketamine (Spravato®) therapy.

Our patients are advised that medications they are taking might interact with ketamine or esketamine (Spravato®), and we may advise them to pause certain medications on the day of treatment to enhance safety. We also recommend that all patients receiving ketamine or esketamine (Spravato®) therapy participate in concurrent psychotherapy to maximize the benefits of treatment.

Each ketamine or esketamine (Spravato®) administration session takes place onsite at one of our clinics and is supervised by a licensed psychiatrist, with the support of a care team that may include nurse practitioners and physician assistants. All such care team members are certified in Basic Life Support (BLS) and trained to respond to emergencies and monitor treatment recipients for respiratory depression and falls. Clinics that offer ketamine or esketamine (Spravato®) treatments are equipped with adjustable beds, pulse oximetry, and emergency equipment so that we can respond promptly to any issues that arise during treatment. For added safety, patients are monitored via live video (not recorded or maintained) during treatment, and they have access to a call button for immediate assistance.

Staying Safe and Informed

As ketamine and esketamine (Spravato®) continue to gain recognition for their effectiveness in treating depression, it is important for patients and their families to seek care from qualified professionals who adhere to rigorous safety standards. Evidence-based, safe, and responsible ketamine and esketamine (Spravato®) treatment involves in-office treatment under medical supervision, using appropriate protocols and best practice guidelines regarding dosing and monitoring.

While much of the recent media coverage surrounding ketamine has been negative, the safe, responsible application of ketamine or esketamine (Spravato®) in a clinical setting can be an effective, relatively low-risk treatment for patients with treatment-resistant depression. If you or a loved one is struggling with depression, I encourage you to explore all treatment options and seek out providers who prioritize safety and evidence-based care. When used appropriately, ketamine and esketamine (Spravato®) have the potential to save lives and can offer hope to those who need it most.

Find out if Ketamine Therapy or Spravato® Therapy is offered at your LifeStance location.

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Key Takeaways Key Takeaways

  • When used correctly, Ketamine has shown transformative results for some patients with treatment-resistant depression. It can offer rapid relief and a favorable side effect profile, making it an important option for those who have not responded to traditional therapies.

  • Safe ketamine treatment relies on thorough patient evaluations, collaboration with other healthcare providers, and in-office administration under medical supervision. This approach enables ketamine to be used effectively while minimizing potential risks.

  • An alternative to ketamine infusion, intranasal esketamine (Spravato®), is FDA-approved and covered by many insurance plans for treatment-resistant depression and major depressive disorder in patients with suicidal ideation. This highlights the growing recognition of ketamine and Spravato’s efficacy, but the importance of seeking qualified professionals who adhere to best practices in the administration of these medications is paramount.

Authored By 

Rachel Dalthorp, MD
Head of Specialty Services

Rachel Dalthorp, MD, is the Executive Medical Director of Specialty Services at LifeStance Health, where she leads clinical programming and innovation in reproductive psychiatry, interventional psychiatry and the treatment of complex mental health needs. She is a board-certified psychiatrist through...

Reviewed By

Melanie Barrett, MD
Dr. Melanie Barrett received her medical degree from the University of Oklahoma College of Medicine following undergraduate studies in Psychology at Texas A&M University in College Station, Texas. She completed her psychiatry residency at the University of North Carolina Hospitals, Chapel Hill, where she served as Chief Resident. She maintains board certification through the American Board of Psychiatry & Neurology. Dr. Barrett specializes in interventional treatments including Zulresso (brexanolone) for postpartum depression as well as Spravato (esketamine) and ketamine IV therapy for treatment resistant depression. She regularly provides teaching and consultations to medical professionals interested in learning about postpartum depression and Zulresso.

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