Enlarge image

Flowers in memory of Matthew Perry in front of the "Friends" house in New York

Photo: Christina Horsten / picture alliance / dpa

At the end of October, actor Matthew Perry, best known for his role in the series "Friends," was found dead in his hot tub. Now the cause of his death is known.

According to the autopsy report, Perry died primarily from the "acute effects" of ketamine. In addition, other medication and cardiovascular disease probably also contributed to his drowning in the whirlpool. For much of his life, Perry had struggled with addiction issues. His death was now an accident, according to the report.

What kind of substance is ketamine?

Ketamine was developed as an anesthetic in the 1960s and was widely used in American soldiers' operations during the Vietnam War. After that, the remedy was known in low doses for a long time primarily as a drug, and to this day, partygoers use ketamine as a club drug.

In the meantime, ketamine is getting more attention again due to its possible effects on mental illnesses: Chemically prepared, it can have a very rapid antidepressant effect compared to other drugs.

How is ketamine used in medicine?

Due to its side effects, ketamine is almost exclusively used in emergency medicine in Germany to treat pain and stabilize circulation. To a very limited extent, the active ingredient – chemically processed – is now also approved for the treatment of severe, treatment-resistant depression.

In the USA, ketamine-based drugs are also increasingly being used "off label", i.e. without approval, for the treatment of mental illnesses, in addition to depression, anxiety disorders or post-traumatic stress disorders, among others. Some of the drugs are also sold on the Internet in the USA and advertised for self-medication for mental illnesses. This entails enormous risks.

In what context had Perry consumed ketamine?

According to the autopsy report, Perry received therapeutic ketamine infusions. However, the amount that was detected in his body after his death could not be explained by the treatments, the »New York Times« quotes from the autopsy report. The last therapy session was already a week and a half ago at the time of Perry's death.

What are the basic dangers of ketamine?

The U.S. Food and Drug Administration (FDA) also warned medical personnel in October not to treat mental illness at their own risk with ketamine-based agents. The active ingredient is not approved for self-therapy, according to a statement. Nevertheless, ketamine products are marketed for a wide variety of conditions, including depression and anxiety disorders.

After consuming ketamine, according to the FDA, there is a risk of drowsiness as well as changes in vital signs such as blood pressure and heart rate. In addition, there are hallucinations and, at higher concentrations, the feeling of leaving the body, which is often associated with panic.

If the drug is taken without medical supervision, there is a risk of serious side effects, the authority warns. In addition, ketamine can be psychologically addictive.

What effect did ketamine have in the context of Perry's death?

According to the New York Times, Perry's autopsy report states, "The high concentrations of ketamine found in blood samples after death suggest cardiovascular hyperstimulation and reduced breathing as the main causes of death." With such overstimulation, blood pressure and heart rate, among other things, rise dangerously.

The amount of ketamine in Perry's blood was about the same as the concentration that would be used for general anesthesia.

When are ketamine-based remedies approved for the treatment of depression?

Because ketamine in a chemically processed form can help treat depression, doctors and patients accept the possible side effects under certain circumstances. Only one of the two molecules that make up ketamine is used: esketamine.

In both the United States and Europe, a nasal spray containing this active ingredient is approved. The drug is intended for the emergency treatment of patients with severe depression for whom other therapies have failed. In Germany, however, the nasal spray may only be used under medical supervision and may not be given home for self-medication.