Psychedelic substances and therapy have made headlines once again, following the tragic death of actor Matthew Perry in October 2023. Known and beloved for his portrayal of Chandler Bing in Friends, Perry’s sudden passing at age 54 sparked renewed interest in psychedelics, particularly ketamine.
According to court documents, authorities are charging two doctors, a supposed dealer, a middleman, and Perry’s personal assistant with conspiracy to distribute ketamine.
The documents reveal that Perry received several illegal injections of the drug on the day of his death, leading to his passing due to “acute effects of ketamine,” as confirmed by the Los Angeles County medical examiner. Perry had legally received ketamine infusions for depression and anxiety management, but he also began to rely on illegally sourced ketamine, according to The New York Times.
On the day he died, Perry’s request for multiple doses of ketamine came in close succession. Around 8:30 a.m., he asked his assistant for an injection, then requested another one close to noon, and yet another dose a mere 40 minutes later, instructing his assistant to “shoot me up with a big one.”
Tragically, later that afternoon, the assistant discovered Perry face down in his hot tub. The circumstances of Perry’s death underscore questions about ketamine and other psychedelics: how they can be used safely, their therapeutic potential, and the risks associated with misuse.
Although ketamine and other psychedelics are being studied for their potential in treating conditions like depression and PTSD, the risks remain significant, especially without strict medical supervision.
The Rise of Psychedelic Therapy in Mental Health Care
Psychedelics have emerged as a promising approach to treat mental health issues such as depression, PTSD, and addiction. According to research, ketamine, in particular, has shown potential for people with treatment-resistant depression, where traditional antidepressants are ineffective.
In 2019, the U.S. Food and Drug Administration (FDA) approved esketamine, a derivative of ketamine, to be used with antidepressants for major depressive disorder.
Boris Heifets, MD, PhD, of Stanford University, highlights the double-edged nature of ketamine: “This is a real therapy that has helped many people, and it is capable of doing good things. But just as it’s capable of good, it’s also capable of harm.”
This therapeutic promise has led to both increased interest and a rise in misinformation, as noted by Jerrold F. Rosenbaum, MD, director of the Center for Neuroscience of Psychedelics at Massachusetts General Hospital.
Here, Rosenbaum and other experts help clarify some of the most persistent myths surrounding psychedelics, providing insights into both the benefits and the risks.
- Myth: Psychedelics Are Highly Addictive
While many drugs lead to compulsive usage patterns and physiological dependence, psychedelics generally do not fall into this category.
According to Itai Danovitch, MD, of Cedars-Sinai Medical Center, “Psychedelics do not generally lead to a compulsive pattern of use, which is the hallmark of addiction.”
Psychedelics are different in that they often lack the addiction triggers seen in substances like alcohol or opioids, such as craving and withdrawal symptoms.
Instead, studies, like a pilot study published in The Journal of Psychopharmacology in 2014, suggest that psychedelics may actually help people overcome addictions to substances like nicotine and alcohol.
Still, ketamine represents a unique case. While ketamine dependence is not typical for most patients, Dr. Heifets acknowledges that misuse patterns do emerge among some users.
He explains, “I think one of the increasingly appreciated issues with ketamine is that a segment of patients who are introduced to ketamine in therapeutic settings will go on to develop abuse, misuse, or overuse patterns outside the bounds of therapy.”
Tolerance, a common hallmark of addiction, can also develop with certain psychedelics like LSD, according to the National Institute on Drug Abuse (NIDA), requiring users to take higher doses over time, which increases risks of unpredictable effects.
- Myth: There’s Limited Research on Psychedelics
Despite popular belief, psychedelics are among the most researched substances in psychiatry. Scientific interest in their therapeutic effects dates back to the 1950s, and recent years have seen renewed focus and rigorous study.
Dr. Danovitch notes, “Renewed interest in the therapeutic effects of psychedelics spawned a resurgence, and over the last decade, there has been a groundswell of rigorous research demonstrating benefits of specific psychedelic agents for certain mental health conditions.”
Several studies exemplify the benefits psychedelics can offer:
- A 2022 study in The Journal of Affective Disorders found that among 537 patients receiving intravenous ketamine, over half experienced improvement in symptoms, with 30% achieving remission.
- Research in Nature Medicine (2021) showed that 67% of patients with PTSD no longer met the diagnostic criteria for the disorder after receiving MDMA-assisted therapy.
- A 2020 study published in JAMA Psychiatry demonstrated that psilocybin-assisted therapy significantly alleviated major depressive disorder symptoms.
- Researchers published a study in 2016 in the Journal of Psychopharmacology that found high doses of psilocybin, when administered by medical professionals under supportive psychological conditions, significantly improved anxiety and depression symptoms in patients facing life-threatening cancer diagnoses.
- A small pilot study in 2014, featured in the Journal of Nervous and Mental Disease, indicated that combining LSD with psychotherapy helped reduce anxiety in individuals with terminal illnesses.
- Myth: Psychedelic Therapy Is Safe for Everyone Under Clinician Supervision
Even under medical supervision, psychedelic therapy may not be suitable for everyone. People with conditions like schizophrenia, mania, severe heart disease, or epilepsy are often advised against pursuing such therapies.
The Translational Psychedelic Research Program at the University of California highlights the importance of disclosing all current medications before trying psychedelics. Recreational use, though increasingly common, differs vastly from a medically controlled psychedelic session, and unmonitored use carries increased risks.
Dr. Rosenbaum points out that although psychedelic therapy holds promise, it is not a universal solution.
“The idea that these are a cure-all or a universal solvent is way overstated,” he says. He emphasizes the importance of managing expectations and understanding that psychedelics might be effective for some patients but not universally effective.
- Myth: Psychedelics Will Cause Permanent Mental Distress
One of the most persistent misconceptions about psychedelics is that they can permanently disrupt mental stability. While psychedelics induce hallucinations, these effects generally subside once the drug has left the system.
Dr. Danovitch explains, “Intoxication with psychedelics can cause people to feel like they are losing their minds. In most cases, after the psychedelic agent is metabolized or eliminated from the body, the intoxication syndrome resolves, and a clear sense of reality returns.”
However, those with certain mental health vulnerabilities can experience prolonged psychotic symptoms, as NIDA points out, making this myth partially rooted in fact. For individuals at risk of psychosis, psychedelics can exacerbate symptoms.
- Myth: Psychedelics Cause Permanent Brain Damage
Psychedelics interact with the brain in complex ways, leading to short-term changes but not permanent brain damage. Research published in Cell (2017) found that LSD can temporarily bind to serotonin receptors in the brain, explaining the drug’s prolonged effects.
However, these changes do not last permanently. Dr. Rosenbaum explains that psychedelics create a “window of neuroplasticity,” which enhances the brain’s ability to form new connections.
He clarifies, “It’s probably a window of days or maybe hours where you have an enhanced ability to learn or to think about things and change things.”
This effect may be one reason for the success of psychedelics in therapeutic settings, as patients may be more open to new perspectives or insights during this time.
- Myth: Psychedelics Are Only for Recreational Use
Psychedelics are often mischaracterized as party drugs, but their true therapeutic potential emerges in controlled, clinical settings. In these environments, psychedelic drugs are given in specific doses, accompanied by therapeutic guidance to help patients process and integrate their experiences.
This integration therapy is critical for achieving meaningful change. Dr. Danovitch explains, “The therapeutic benefits of psychedelic drugs appear to depend on psychotherapy, which helps patients process the experience, develop insights, and pursue meaningful change.”
- Myth: Psychedelics Have No Risks
While psychedelics can be safe under controlled conditions, they remain powerful substances with real risks. According to NIDA, adverse effects can include increased heart rate, nausea, paranoia, and psychosis.
Dr. Danovitch stresses the need for ongoing research to identify when and how these substances can be used safely and effectively, particularly for adolescents, who may be more susceptible to potential side effects.
- Myth: Psychedelics Are the Endgame for Mental Health
Although psychedelics represent a fascinating frontier in psychiatry, many scientists view them as a stepping stone rather than a final solution. Dr. Rosenbaum, for instance, hopes that current research will lead to new, non-hallucinogenic therapies inspired by psychedelics.
“For me, the biggest hope for these drugs is that they will lead us to explore a new generation of therapeutics,” he says.
Researchers are exploring how psychedelics might offer benefits without the need for an intense hallucinogenic experience.
Dr. Danovitch echoes this sentiment, noting that “what we know about psychedelics is just the tip of the iceberg.”
Current research may pave the way for future medications that retain the therapeutic effects of psychedelics but minimize risks and side effects, offering hope to those seeking new treatment options.
Recommended For You
