The news of Matthew Perry’s passing due to the “acute effects of ketamine” highlighted the safety concerns that at-home ketamine poses as a mental health treatment. Yet in the wild west of ketamine administration, many startups purport that at-home ketamine is safe to use in non-medical settings. As a mental health clinic specializing in treatment-resistant depression, with multiple ketamine therapies offered, we felt compelled to dispel some of the myths about at-home ketamine and provide better insight from our own experience treating thousands of patients about how one can recover from depression effectively. In this blog, we'll delve into the reasons why you should think twice before embarking on a DIY ketamine journey at home.
Is At-Home Ketamine Safe?
Ketamine dangers during treatment
When it comes to any medical intervention, safety should always be a top priority. At-home ketamine administration lacks the crucial element of professional oversight that clinics provide. Although rare, here are some things that we have seen happen to our patients during treatment:
- Hypoxia: Hypoxia is when oxygen is unavailable in sufficient amounts at the tissue level to maintain adequate homeostasis; this can result from inadequate oxygen delivery to the tissues due to low blood supply or low oxygen content in the blood. These patients have been quickly rescued with oxygen that we keep in the clinic for emergencies.
- Nausea and extreme vomiting: Many people have some form of nausea during treatment. While rare, some patients have thrown up so much that we have had to rehydrate them with IV fluids.
- High blood pressure: Ketamine can elevate blood pressure, but in some cases, the pressure can be so high that it is dangerous, and people need to be treated with rescue medication.
Other safety issues with at-home ketamine
While addiction is rare and titrating off ketamine has fewer side effects than other drugs, it is possible to become psychologically dependent on ketamine. Without professional oversight, there is no way to prevent a person from taking too much of the drug, as was the case in Matthew Perry’s death. The ketamine found in his system was widely reported to be an anesthetic dose rather than a therapeutic dose, which results in far less sedation.
Many people think that ketamine works because of the disassociation that comes with the initial treatments. However, disassociation is considered a negative side-effect of ketamine, not the mechanism by which the brain heals from depression and anxiety. Much in the same way that taking medications like Adderall or antidepressants does not result in an altered state, ketamine does not necessarily need to create an altered state to be effective. Most of the effectiveness of ketamine is in its ability to create new synapses that help the brain’s regions associated with logic and emotion communicate more effectively. Disassociation may or may not happen simultaneously, but that has no real impact on the treatment.
What we have found is that some people put so much emphasis on disassociation that they feel that they need higher and higher doses to “recover” from depression. The reality is that this mindset may actually be counterproductive as they are looking to disassociate from reality so much that they cannot make real changes in their lives that can help them truly heal from depression and anxiety. In a clinical setting, trained medical professionals monitor not only your vitals and respond promptly to any adverse reactions, but they also adjust your dose and are closely watching for signs of psychological or physical addiction.
Is At-Home Ketamine More Affordable Than In-Clinic Ketamine?
At-Home Ketamine is Not Covered by Insurance
While the idea of administering ketamine at home may seem like a cost-effective solution, it is important to consider that no at-home ketamine programs are covered by insurance, including the intake process. Many claim that the dose is so low that you do not need any supervision whatsoever as there is no “psychedelic” experience, however from experience, we can tell you that it’s impossible to know how any individual will respond to ketamine. Other times a ketamine prescription is provided for 30 days or less. There simply isn’t enough clinical data for any insurance company to take the risk of covering these “treatments” when other ketamine treatments have been clinically studied to be safe and effective.
DIY treatments may also lead to unforeseen complications, resulting in additional medical bills that could have been avoided with proper supervision. For instance, addiction or high blood pressure.
In-Clinic Ketamine is Covered by Most Insurance, Including Medicaid
Intention and Setting Are Critical Drivers to Healing
Ketamine treatment is just one piece of the mental health puzzle. Some researchers believe that social context is important for ketamine treatment to be the most effective, or “intent and setting.” This is why going to an in-person clinic has vastly different outcomes than snorting ketamine at a rave. Where you choose to go for ketamine treatment is as important as why you go, if healing is any part of your expectation. It’s also not unusual to see that “home” is actually one of a patient’s triggers, and finding a place to rest outside of the home becomes critical for healing.
Mental Health is More than Meds
In-clinic settings provide a holistic approach to mental wellness by offering access to additional supportive treatment modalities like psychotherapy and nutritional psychiatry or additional treatments like TMS (Transcranial Magnetic Stimulation). These complementary services can enhance the effectiveness of your treatment, addressing the root causes of mental health concerns rather than simply alleviating symptoms.
A personalized and comprehensive treatment plan tailored to where you are on your unique journey, your lifestyle, and your goals, co-created with an empathetic and informed mental health professional, can make a significant difference in your overall well-being. Providers can do more than just prescribe meds; in fact, we developed an entire social prescribing program because we recognized the interdependence between social connections and mental health. By helping people to reconnect with the world, we are helping them forge long-term methods of self-soothing rather than relying on just medication to keep them in remission. This may come in the form of free tickets to the botanical gardens with a therapeutic assignment to "take a friend" or dance classes to reignite a former passion. Sparking positive synaptic growth and new habits, rather than masking symptoms should be the goal of any holistic mental health plan.
Community Connection and Understanding
Embarking on a mental health journey can be a lonely road, but in-clinic experiences foster a sense of community and understanding. Sharing your experiences with others going through similar challenges can be incredibly empowering and healing. Our patient, Megan, consented to share her story, and we shared her video with another patient who was having a particularly rough treatment. One day, the two of them met in the waiting room of our clinic, and the patient shared with Megan that her video inspired her to keep going to treatment and recover. We all erupted in tears.
Even when patients don’t meet each other serendipitously, they support each other through our clinic notebooks where patients leave words of encouragement and understanding to each other. In contrast, at-home ketamine treatment isolates you from the supportive network that clinics can provide. Being part of a community that values your mental health journey can be a source of strength and resilience, even if you don’t meet other patients.
In-Clinic Ketamine is the Safer and Affordable Choice
In conclusion, while at-home ketamine may seem like a convenient option, the risks and limitations far outweigh the perceived benefits. We can only speculate on how Matthew Perry acquired the ketamine found in his system and in his stomach prior to his death. While there have been no reports of deaths from ketamine use in clinical settings, the same cannot be said about at-home ketamine. Mental health is complicated, expensive and is hell to endure. No one should have to go through it alone. Choosing in-clinic care ensures safety, affordability, and access to a comprehensive support system—key elements in a journey towards lasting mental wellness. Your mental health deserves the highest level of care, guidance, and understanding that only a professional clinical setting can provide.