Latest / Voyage Clinics Podcast / Ketamine Therapy Explained | Preparation, Integration, and Finding the Right Clinic

Transcript

Ketamine Therapy Explained | Preparation, Integration, and Finding the Right Clinic · Voyage Clinics Podcast

• 0:10
  Speaker 1: Hello, welcome to the Voyage Clinics Podcast. I'm your host, Dr.
• 0:12
  Speaker 1: John Sanders, family physician and friend of the community.
• 0:15
  Speaker 2: As usual, we're here just talking about educational tidbits for
• 0:20
  Speaker 2: the community. One thing that's extremely popular is ketamine. And
• 0:24
  Speaker 2: I just wanted to talk about ketamine, what it is,
• 0:27
  Speaker 2: what it's not. And I brought in a couple of really,
• 0:29
  Speaker 2: really great friends of mine and good experts on the subject.
• 0:33
  Speaker 2: And I just wanted to introduce them to our team.
• 0:36
  Speaker 2: Thank you guys for joining us.
• 0:37
  Speaker 1: Dr. Reed Robinson, psychiatrist, and Dr. Steve Thayer.
• 0:40
  Speaker 2: He's a psychologist and a PhD in that space as well.
• 0:43
  Speaker 1: So welcome to the podcast, guys. Thanks, John.
• 0:46
  Speaker 3: Thanks for having us.
• 0:48
  Speaker 1: Well, I wanted to kind of kick things off with ketamine.
• 0:52
  Speaker 1: It's very popular.
• 0:54
  Speaker 2: There's a lot of people doing ketamine sessions for help
• 0:59
  Speaker 2: in the psychiatric spaces. And I just wanted you guys
• 1:02
  Speaker 2: to kind of kick it off as far as– kind
• 1:04
  Speaker 2: of what one could do to kind of understand what
• 1:08
  Speaker 2: it is and what is not, and then also maybe
• 1:11
  Speaker 2: to prepare for a ketamine session, what one might do there. So, yeah,
• 1:15
  Speaker 2: let's kick things off. Farid, talk to us a little
• 1:17
  Speaker 2: bit about ketamine. Why is it used so broadly? What
• 1:22
  Speaker 2: are its applications and where we might be able to
• 1:25
  Speaker 2: utilize it in our clinics?
• 1:26
  Speaker 4: Yeah, I remember when it started entering psychiatry. It's been
• 1:30
  Speaker 4: around in anesthesia for quite a while. But when it
• 1:34
  Speaker 4: started coming into psychiatry, this is like 15 years ago
• 1:38
  Speaker 4: or so, was my first ketamine study. And it was pre-spravato.
• 1:44
  Speaker 4: It was in clinical trials for depression. And I was
• 1:47
  Speaker 4: doing studies of other medicines and starting to get a
• 1:49
  Speaker 4: bit discouraged, to be honest, of the antidepressant response. So
• 1:54
  Speaker 4: it came along in this study of treatment-resistant depression, those
• 1:58
  Speaker 4: who hadn't responded to at least two other antidepressants. And
• 2:01
  Speaker 4: I sat with like every single one of the people
• 2:04
  Speaker 4: through their whole session as we did that study and
• 2:07
  Speaker 4: was blown away at seeing depression lift like in real time,
• 2:12
  Speaker 4: like the first rapid antidepressant I'd encountered. And since then,
• 2:18
  Speaker 4: I think that's one of the reasons behind its rising popularity,
• 2:23
  Speaker 4: like you mentioned, of people are suffering depression now. sucks
• 2:29
  Speaker 4: like to be quite honest it's it's something that can
• 2:32
  Speaker 4: just kind of take the color out of your life
• 2:34
  Speaker 4: or drain the life out of you and to have
• 2:37
  Speaker 4: a tool that helps you come up for air see
• 2:40
  Speaker 4: some hope and engage in some other things to uh
• 2:44
  Speaker 4: reclaim your your life is uh was you know long
• 2:49
  Speaker 4: overdue and so welcome to the field that we've kind
• 2:53
  Speaker 4: of been figuring out how to use it since and
• 2:55
  Speaker 4: uh happy to chat with you about it, but that's
• 2:58
  Speaker 4: kind of context of how it came to be and
• 3:00
  Speaker 4: why it's been so interesting in mental health.
• 3:05
  Speaker 2: I am grateful for pioneers like you guys who have
• 3:08
  Speaker 2: pushed this into the clinical space where we can use
• 3:12
  Speaker 2: it in our clinics. And I'm a family physician and
• 3:15
  Speaker 2: we treat a ton of depression and we're kind of
• 3:18
  Speaker 2: like the first line to some of those access points.
• 3:21
  Speaker 2: And and kind of like first responders to some of
• 3:25
  Speaker 2: the suicidalities and some of those, those higher level situations. And, um,
• 3:30
  Speaker 2: in my clinic, we've integrated ketamine for more than a
• 3:32
  Speaker 2: year and a half now, two years probably. And, um,
• 3:35
  Speaker 2: it has been remarkable, like you say, like, like actually healing.
• 3:39
  Speaker 2: And it's, it's not hard to find people who have
• 3:41
  Speaker 2: failed more than.
• 3:42
  Speaker 1: Two of these antidepressant medicines. It's underwhelming.
• 3:45
  Speaker 2: It's, it's really underwhelming as far as the relief that
• 3:48
  Speaker 2: they provide, maybe just a bandaid, maybe just lifting temporarily, um,
• 3:52
  Speaker 2: But the deeper spaces in the ketamine healing that happens
• 3:56
  Speaker 2: is lovely. I'd say in the past 12 months, we've
• 4:00
  Speaker 2: helped three people avoid hospitalization from just suicidality, as this
• 4:05
  Speaker 2: is one of the FDA indications for it. And we're
• 4:08
  Speaker 2: very strict about integration and using it appropriately and all that.
• 4:12
  Speaker 2: And so I wanted to hear from Steve a little
• 4:14
  Speaker 2: bit about what you have seen from your perspective, kind
• 4:18
  Speaker 2: of unique in the ketamine space as far as the
• 4:20
  Speaker 2: healing journey for folks.
• 4:22
  Speaker 5: Yeah, so I'm coming at this as a clinical psychologist,
• 4:24
  Speaker 5: so somebody who's not a physician, somebody who doesn't prescribe medicines,
• 4:28
  Speaker 5: a psychotherapist. And so for me, one of the things
• 4:31
  Speaker 5: that makes ketamine really stand out as a prescribable medicine
• 4:34
  Speaker 5: that might help with depression symptoms is, in addition to
• 4:37
  Speaker 5: what it does neurologically to help provide people some relief
• 4:42
  Speaker 5: from their depression symptoms, it can also give them a
• 4:46
  Speaker 5: unique lived experience that they can mine for insight and
• 4:51
  Speaker 5: for transformational change. You mentioned the term integration. Like when
• 4:55
  Speaker 5: we have an experience that ketamine can provide, there's an
• 4:59
  Speaker 5: opportunity to sort of build on that experience. Like I said,
• 5:02
  Speaker 5: mine that experience for pattern-changing insights and integrating those insights
• 5:08
  Speaker 5: into our daily life, actually make changes. And so what
• 5:12
  Speaker 5: is this experience that I'm talking about? Sometimes people will
• 5:14
  Speaker 5: lump ketamine into this broad category of even a psychedelic medicine.
• 5:18
  Speaker 5: And when people think about psychedelics, they think about things
• 5:21
  Speaker 5: like psilocybin, magic mushrooms, or LSD or something like that.
• 5:26
  Speaker 5: These drugs, these compounds, these plant medicines that provide these
• 5:30
  Speaker 5: altered states of consciousness that, again, a person can mine
• 5:35
  Speaker 5: and integrate into their daily life.
• 5:37
  Speaker 1: Ketamine, it's debatable.
• 5:39
  Speaker 5: Sometimes people don't like to put it in that psychedelic
• 5:41
  Speaker 5: bucket because it's not a phenethylamine or tryptamine and it
• 5:47
  Speaker 5: doesn't act on the serotonin receptors in the same way
• 5:48
  Speaker 5: that some of those do.
• 5:49
  Speaker 1: It's a totally different mechanism of action, yeah.
• 5:51
  Speaker 5: But I kind of like it in that bucket of psychedelic.
• 5:55
  Speaker 5: Like the term psychedelic being mind manifesting or sort of
• 5:58
  Speaker 5: wandering in the mind or the soul. It does at
• 6:01
  Speaker 5: certain doses, depending on the route of administration, or can
• 6:05
  Speaker 5: provide a dreamlike psychedelic trip or a journey. And so
• 6:10
  Speaker 5: I think that's one of the things that really distinguishes
• 6:12
  Speaker 5: it from the antidepressants that you're talking about and potentially
• 6:16
  Speaker 5: is one of the reasons why where it might be
• 6:18
  Speaker 5: helpful for some folks where Zoloft or Prozac might not
• 6:22
  Speaker 5: have been helpful because you have this potentially, not everybody
• 6:26
  Speaker 5: experiences this, but potentially like really novel and revelatory and
• 6:31
  Speaker 5: relieving lived experience to then work with.
• 6:35
  Speaker 1: I love what you said, Justin.
• 6:37
  Speaker 2: Having an experience that they can mine for, for understanding
• 6:40
  Speaker 2: and different growth, um, trajectories. Have you noticed, I mean,
• 6:44
  Speaker 2: mechanism of action, uh, basically the end point of that,
• 6:48
  Speaker 2: I'll skip over some of the technical free, but the
• 6:51
  Speaker 2: end point is really kind of a, a spike in
• 6:54
  Speaker 2: neuroplasticity and an ability to change your thinking and change
• 6:58
  Speaker 2: your mind. And, and, and maybe during the session is
• 7:01
  Speaker 2: pretty forceful kind of shutting off of like thinking and
• 7:04
  Speaker 2: default mode networks. Um, And then arriving at this kind
• 7:08
  Speaker 2: of therapeutic spike of brain-derived neurotrophic factor or like a
• 7:14
  Speaker 2: neuroplastic spike that occurs for maybe three days after a
• 7:17
  Speaker 2: ketamine session. Have you noticed in the therapy space that
• 7:20
  Speaker 2: that creating more therapeutic outcomes in that space?
• 7:26
  Speaker 5: Yeah, I really have.
• 7:27
  Speaker 1: You know, the sort of.
• 7:30
  Speaker 5: Psychological phenomenology of neuroplasticity is psychological flexibility. Like when our,
• 7:36
  Speaker 5: when our neurological pathways are more flexible, it helps us, um,
• 7:40
  Speaker 5: have more or sort of more plastic. It helps us
• 7:42
  Speaker 5: have more flexibility in the way that we think in
• 7:45
  Speaker 5: the patterns that we find ourselves stuck in that we
• 7:48
  Speaker 5: often attribute our suffering to when we have a psychiatric
• 7:51
  Speaker 5: condition like depression, especially treatment, so-called treatment resistant depression. But
• 7:55
  Speaker 5: especially with some of these more what we might call
• 7:57
  Speaker 5: over control phenotypes like obsessive compulsive disorder or eating disorders
• 8:01
  Speaker 5: where people are tortured by these patterns that are unrelenting.
• 8:06
  Speaker 5: Like even some of these, the nerdy term is ego dystonic,
• 8:10
  Speaker 5: meaning that they know that these patterns don't really fit.
• 8:13
  Speaker 5: They know that they're often irrational or illogical, but they
• 8:16
  Speaker 5: can't help but continue to think and feel in this way.
• 8:19
  Speaker 5: So I've had a few clients where, you know, thinking of,
• 8:23
  Speaker 5: I'll speak in more categorically, folks with obsessive compulsive disorder, OCD,
• 8:27
  Speaker 5: where during their ketamine treatment, during their ketamine experience was
• 8:30
  Speaker 5: the first time they experienced a relaxation around the tyranny
• 8:35
  Speaker 5: of their obsessive thoughts. And, you know, you mentioned that
• 8:38
  Speaker 5: the neuroplastic window is not forever, that oftentimes it only
• 8:41
  Speaker 5: lasts a few days, but they will never have not
• 8:44
  Speaker 5: had that experience now where they got to actually not
• 8:47
  Speaker 5: only think about it, imagine it cognitively, like, yeah, doc,
• 8:50
  Speaker 5: I know that It doesn't make sense that I need
• 8:52
  Speaker 5: to wash my hands in this particular way in order
• 8:54
  Speaker 5: to feel relief. But now they have an actual lived experience,
• 8:58
  Speaker 5: like I was saying before, of, oh, I actually felt
• 9:00
  Speaker 5: what it was like to have that part of my
• 9:02
  Speaker 5: mind relaxed and to actually believe and feel the implications
• 9:06
  Speaker 5: of that belief that I don't have to continue engaging
• 9:08
  Speaker 5: in this pattern in order to feel safe and secure. So,
• 9:13
  Speaker 5: and it's really interesting to me the routes that people
• 9:15
  Speaker 5: take in the ketamine mind space to get to some
• 9:17
  Speaker 5: of these insights. Because it's not always just, you know,
• 9:20
  Speaker 5: you see God and God reveals to you the.
• 9:22
  Speaker 1: Truth, metaphorically or whatever.
• 9:24
  Speaker 5: Sometimes it's like with other so-called psychedelics, it's sort of
• 9:28
  Speaker 5: a bizarre, I mentioned dreamlike experience. But I remember one
• 9:32
  Speaker 5: story in particular where a person saw in their dreamlike
• 9:37
  Speaker 5: ketamine experience the connection of this psychological burden. In this case,
• 9:42
  Speaker 5: it was an eating disorder passed down from grandmother to
• 9:45
  Speaker 5: mother to them. And they saw their daughter on the
• 9:48
  Speaker 5: other side of them. And they felt a dissolving of
• 9:50
  Speaker 5: this chain that had been passed down from generations and
• 9:54
  Speaker 5: their ability to not pass this down and came out
• 9:57
  Speaker 5: with that insight. And it was still hard work afterwards.
• 10:00
  Speaker 5: You know, these parts that get relaxed under the influence
• 10:02
  Speaker 5: of ketamine can sometimes come back. Um, they don't feel
• 10:06
  Speaker 5: comfortable having been relaxed and they want to sort of
• 10:10
  Speaker 5: try to recapture the security. They felt like they were
• 10:12
  Speaker 5: building by being rigid, but again, she will never have
• 10:16
  Speaker 5: not had that experience. And now it sort of refreshes
• 10:18
  Speaker 5: the commitment to work on this conditions. It's can be
• 10:21
  Speaker 5: pretty magical.
• 10:22
  Speaker 1: That's really cool.
• 10:23
  Speaker 2: So many of what I see is anxiety, depression, OCD
• 10:29
  Speaker 2: come from that kind of ruminating kind of ant and
• 10:33
  Speaker 2: the elephant, the ego or the ant, like sitting on
• 10:35
  Speaker 2: top of the elephant. That's a, that's a book at reference,
• 10:39
  Speaker 2: but like, And just ruminating and just constantly needling us
• 10:43
  Speaker 2: and telling us we need to do this or we
• 10:44
  Speaker 2: need to do that. And you feel it in your bones,
• 10:46
  Speaker 2: compulsivity toward this hand washing or this whatever that is.
• 10:51
  Speaker 2: Or stuck in a ruminating thought process of.
• 10:53
  Speaker 1: You know, oh my gosh, what if? Or, you know, anxiety.
• 10:55
  Speaker 2: And being free from that, even momentarily, maybe even creating
• 10:59
  Speaker 2: pathways back to that.
• 11:01
  Speaker 1: Never not.
• 11:02
  Speaker 2: I love the double negative things because one of my
• 11:04
  Speaker 2: professors in med school always did it.
• 11:06
  Speaker 5: And I'm like, oh.
• 11:06
  Speaker 1: Having not had that experience yet. Yeah.
• 11:10
  Speaker 2: But yeah, I think it's beautiful and maybe providing release temporarily,
• 11:13
  Speaker 2: but then also understanding around, oh my gosh, that's how
• 11:17
  Speaker 2: that feels like.
• 11:18
  Speaker 1: And that's really relieving.
• 11:19
  Speaker 4: There's a lot of hope there, right? There's a lot
• 11:22
  Speaker 4: of things there, right? That lived experience. But you see, feel,
• 11:26
  Speaker 4: experience what's possible, even if it isn't forever. And that's
• 11:30
  Speaker 4: one of the things that comes out of some of
• 11:32
  Speaker 4: the psychedelic literature, even recently, even in conditions like you mentioned,
• 11:38
  Speaker 4: anorexia is like, coming out of that, there might be
• 11:41
  Speaker 4: more motivation to change, and that's huge.
• 11:46
  Speaker 2: With that neuroflexibility, I mean, being able to change some
• 11:51
  Speaker 2: of those spaces permanently, I mean, the data, there's like,
• 11:55
  Speaker 2: you know, a ketamine session on average is what, like
• 11:57
  Speaker 2: an hour long, and then the neuroplastic spike being two
• 12:01
  Speaker 2: to three days after, kind of a therapeutic window for
• 12:05
  Speaker 2: integration and maybe some psychotherapy moving of things.
• 12:09
  Speaker 1: Heavier tectonic plate.
• 12:11
  Speaker 2: I mean, you can, and the openness creating a vulnerability
• 12:15
  Speaker 2: to where they might access spaces that they maybe.
• 12:18
  Speaker 1: Weren't able to before.
• 12:19
  Speaker 2: Yeah, I think it's a beautiful phenomenon that kind of
• 12:24
  Speaker 2: happens therapeutically for folks. And I was seeing a lot
• 12:29
  Speaker 2: of ketamine shops coming up and I was unsure about,
• 12:34
  Speaker 2: I was just a mixed bag of what was coming
• 12:36
  Speaker 2: to me. And so I wanted to briefly just talk
• 12:38
  Speaker 2: about like, what are some things that you guys look
• 12:41
  Speaker 2: for to find someplace that might be a reputable shop
• 12:44
  Speaker 2: that's doing it right? I mean, some folks are just
• 12:46
  Speaker 2: chasing the K hole or they're chasing this thing or, um,
• 12:50
  Speaker 2: and I don't know, I've seen, I've personally seen like
• 12:53
  Speaker 2: some really tough cases where I don't know that they're
• 12:57
  Speaker 2: getting the integration. I don't know that they're getting the
• 12:59
  Speaker 2: best therapeutic dosing. And, and, um, that's why I brought
• 13:02
  Speaker 2: it in house, frankly, it was cause I was like,
• 13:04
  Speaker 2: I know that I'll do it right. And so I'm
• 13:06
  Speaker 2: just going to do it this way. Um, So can
• 13:08
  Speaker 2: you guys give us some guidelines? If somebody's seeking ketamine therapy,
• 13:11
  Speaker 2: what are some things that we.
• 13:12
  Speaker 1: Should be looking for?
• 13:13
  Speaker 2: What are some red flags or things like that?
• 13:16
  Speaker 1: Is there best practices there?
• 13:17
  Speaker 4: I think it's an important question and brings up the
• 13:22
  Speaker 4: point that ketamine is not for everyone.
• 13:24
  Speaker 3: It can be a very beautifully.
• 13:27
  Speaker 4: Helpful tool in the right individual, but there are people
• 13:32
  Speaker 4: who um, become addicted to ketamine who misuse it or
• 13:37
  Speaker 4: who have even some kind of medical or, uh, psychiatric
• 13:42
  Speaker 4: safety issues. So I think, uh, to answer your initial
• 13:45
  Speaker 4: question is, um, any clinic should be getting to know
• 13:50
  Speaker 4: the individual and screening for those, um, contraindications, if you will. And, uh,
• 13:56
  Speaker 4: ketamine is kind of the wild west out there, uh,
• 14:00
  Speaker 4: And you'll see it offered in so many different ways
• 14:03
  Speaker 4: and formats and popping up in surprising places even.
• 14:08
  Speaker 3: So I think our.
• 14:10
  Speaker 4: Bias, and I'll let Steve chime in here, is that
• 14:13
  Speaker 4: there should be good mental health support and awareness included
• 14:17
  Speaker 4: in that, whether it's a collaboration with your psychotherapist or
• 14:21
  Speaker 4: the mental health providers in-house or that experience and awareness
• 14:28
  Speaker 4: that We need to be careful and be aware of
• 14:33
  Speaker 4: the starting place and guide people carefully through this unknown
• 14:38
  Speaker 4: territory for them and make sure they have supports along
• 14:41
  Speaker 4: the way.
• 14:43
  Speaker 1: Steve, do you have any thoughts on that space?
• 14:45
  Speaker 5: Yeah, probably too many thoughts. I mean, we use the
• 14:48
  Speaker 5: word term bias, and my bias as a psychotherapist is
• 14:51
  Speaker 5: I think if we're going to give people a medicine
• 14:53
  Speaker 5: that can shake the snow globe a little bit, who
• 14:56
  Speaker 5: have already sort of shaky snow in there to begin
• 14:59
  Speaker 5: with psychologically that they, like Reed said, need a lot
• 15:02
  Speaker 5: of mental health support. So some of these ketamine clinics
• 15:06
  Speaker 5: popping up, I not so affectionately refer to as like
• 15:09
  Speaker 5: ketamine mills where you're just going in there. Maybe they
• 15:12
  Speaker 5: do a little bit of screening. Maybe they give you
• 15:13
  Speaker 5: like a one page handout. Um, but they're just hooking
• 15:17
  Speaker 5: you up to IV and maybe you listen to some
• 15:19
  Speaker 5: music and then they wish you well. And certainly people
• 15:22
  Speaker 5: can be helped by just what I call the psychiatric
• 15:25
  Speaker 5: approach to ketamine, meaning you have a mental illness, we
• 15:28
  Speaker 5: have a drug that might help for that, here you go,
• 15:30
  Speaker 5: try it, hopefully that helps. So some people could be
• 15:32
  Speaker 5: helped by that, but I think you're leaving a lot
• 15:35
  Speaker 5: on the table when you don't provide some kind of
• 15:38
  Speaker 5: mental health support like Reid was saying. So my preference
• 15:41
  Speaker 5: is a licensed psychotherapist that's providing multiple sessions of preparation,
• 15:46
  Speaker 5: somebody who knows you, can get to know you well,
• 15:48
  Speaker 5: somebody that you trust. to help not only get a
• 15:51
  Speaker 5: sense for what your challenges are and how we might
• 15:53
  Speaker 5: best use ketamine to help address those challenges, but can
• 15:57
  Speaker 5: educate you on how to navigate that space and help
• 16:00
  Speaker 5: you feel safe. Because a ketamine experience can be unnerving.
• 16:04
  Speaker 5: It can be scary for some people. You mentioned access
• 16:08
  Speaker 5: to certain kinds of healing. Sometimes the access that is
• 16:11
  Speaker 5: granted is because we have psychological structures that are preventing
• 16:15
  Speaker 5: us from going certain places. You think of PTSD in particular,
• 16:18
  Speaker 5: like I don't want to approach this memory because it's
• 16:20
  Speaker 5: too scary, can relax some of those protections and allow
• 16:25
  Speaker 5: us access. But when they come back to sober space
• 16:29
  Speaker 5: and they visited that place and their snow globe has
• 16:32
  Speaker 5: been shaken and they don't have proper, the term you've
• 16:35
  Speaker 5: been using is integration support, then that can re-traumatize people, frankly.
• 16:40
  Speaker 5: So yeah, my bias is to have a lot of
• 16:41
  Speaker 5: good psychological preparation. I would love for a therapist or
• 16:47
  Speaker 5: somebody to be in there with this person as they're
• 16:49
  Speaker 5: having their academy experience in case they need extra support
• 16:52
  Speaker 5: and guidance. And then to have several sessions of integration
• 16:55
  Speaker 5: where they're going through, how do I, like we were
• 16:57
  Speaker 5: talking about before, mind this experience or make sense of
• 17:00
  Speaker 5: this experience and to help educate people and dispel some
• 17:03
  Speaker 5: of the myths that sometimes people bring in. Like I
• 17:05
  Speaker 5: need to understand what all this means now in order
• 17:09
  Speaker 5: for it to be helpful.
• 17:10
  Speaker 2: Yeah.
• 17:10
  Speaker 3: Right.
• 17:11
  Speaker 5: Like a good therapist can help dispel some of those.
• 17:13
  Speaker 2: I love this holistic approach toward it.
• 17:16
  Speaker 1: Um, I love that.
• 17:18
  Speaker 2: I mean, my clinic, we're not an outward facing ketamine
• 17:22
  Speaker 2: offering service. We really bring it internally. And my practice
• 17:26
  Speaker 2: model is really direct primary care. It's taking good care
• 17:29
  Speaker 2: of these families that we have engaged with for years often.
• 17:32
  Speaker 2: And we know their family, we know their kids, we
• 17:34
  Speaker 2: know the name of their dogs. I mean, we are
• 17:36
  Speaker 2: very integrated into their overall health and wellness. And seeing
• 17:40
  Speaker 2: it as an instrument in some of their lives, where
• 17:43
  Speaker 2: some of them are like, yeah, actually I had some
• 17:45
  Speaker 2: pretty bad trauma and I still don't know that I
• 17:47
  Speaker 2: put it in the right spot and I get dysregulated
• 17:50
  Speaker 2: easily and I get triggered about these things. And being
• 17:53
  Speaker 2: able to just have another tool to say, here's an
• 17:57
  Speaker 2: idea and let's do it right. But coming from that
• 18:01
  Speaker 2: trust foundation, it just makes it so powerful as far
• 18:04
  Speaker 2: as a therapeutic. And it would be my, I guess,
• 18:07
  Speaker 2: my invitation to some of my colleagues in the family
• 18:10
  Speaker 2: medicine space to consider it as integrating it into their
• 18:13
  Speaker 2: clinics and integrating.
• 18:15
  Speaker 1: Psychotherapy as well.
• 18:16
  Speaker 2: So you can do it appropriately and right in, on
• 18:19
  Speaker 2: the multi-pronged way that it kind of needs to be administered.
• 18:22
  Speaker 5: And I'll say to the docs out there, like you don't,
• 18:24
  Speaker 5: that doesn't mean you have to hire a bunch of therapists.
• 18:26
  Speaker 5: Like if, if you have people coming in and you
• 18:28
  Speaker 5: think ketamine might be helpful, you know, try to ensure
• 18:32
  Speaker 5: or refer them to therapists that understand ketamine, understand the space.
• 18:36
  Speaker 5: Like if they can have somebody on board that's even
• 18:38
  Speaker 5: not in your clinic, that's doing some preparation that can
• 18:41
  Speaker 5: at least meet with them afterward for integration.
• 18:43
  Speaker 3: I think that's a lovely way to do it.
• 18:45
  Speaker 1: Yeah. I started out that way.
• 18:46
  Speaker 2: I mostly said, make sure that you have therapy within
• 18:49
  Speaker 2: the next 48 hours and have somebody out there that, that,
• 18:52
  Speaker 2: and I didn't really, and then I brought someone in
• 18:54
  Speaker 2: house and then I had, now I have kind of
• 18:57
  Speaker 2: more resources, but yeah, absolutely. As long as they're getting
• 19:00
  Speaker 2: integration with somebody who's familiar in the space and, um,
• 19:03
  Speaker 2: it's been lovely to move the needle for folks permanently
• 19:07
  Speaker 2: and wean them off of some of their antidepressants and
• 19:10
  Speaker 2: change lives and their, you know, sexual relationships are much
• 19:13
  Speaker 2: better and all the things, you know, and so, yeah,
• 19:15
  Speaker 2: it's been really cool.
• 19:17
  Speaker 3: Yeah, that's amazing. It's really neat to hear.
• 19:21
  Speaker 2: I wanted to talk, read just a little bit about,
• 19:24
  Speaker 2: I think a lot of folks are just thinking it's,
• 19:27
  Speaker 2: it's just, I wanted you to dive in just a
• 19:29
  Speaker 2: little bit more into the therapeutic space of it and,
• 19:34
  Speaker 2: Six sessions, where the data is on a lasting change
• 19:37
  Speaker 2: and with integration, obviously, and where's the science there?
• 19:41
  Speaker 3: Okay.
• 19:43
  Speaker 4: I like this question, and there's a lot of unanswered
• 19:47
  Speaker 4: questions still, I'll say.
• 19:49
  Speaker 3: Is the ketamine.
• 19:50
  Speaker 4: like I was saying, came into mental health by these
• 19:52
  Speaker 4: studies in the early 2000s that there was one at
• 19:56
  Speaker 4: Yale and one at the NIH that did two or
• 20:00
  Speaker 4: three sessions a week for three weeks or so. You
• 20:05
  Speaker 4: might get six sessions, and it was the same dose.
• 20:09
  Speaker 3: It was always IV.
• 20:10
  Speaker 4: It was 0.5 milligrams per kilogram, IV over 40 minutes.
• 20:14
  Speaker 4: And since then, that was a long time ago. And
• 20:16
  Speaker 4: since then, there have been a lot of studies published,
• 20:21
  Speaker 4: but I'll say not many big randomized controlled trials. There
• 20:25
  Speaker 4: is that Johnson & Johnson one that I mentioned that
• 20:28
  Speaker 4: I worked on back before they brought Spervato to market.
• 20:33
  Speaker 4: but none of them had psychotherapy with it. So the
• 20:36
  Speaker 4: psychotherapy part of the equation is a mostly unanswered question
• 20:42
  Speaker 4: as far as the research goes of like how much
• 20:44
  Speaker 4: is it adding and viewed by the field as this opportunity,
• 20:49
  Speaker 4: like a golden opportunity, because we have this general consensus
• 20:54
  Speaker 4: that most prescribers and therapists would hold that, you know,
• 21:00
  Speaker 4: meds plus therapy is in general better than meds alone, right?
• 21:05
  Speaker 3: The more support.
• 21:06
  Speaker 4: And like Steve's mentioned, there are so many things that
• 21:08
  Speaker 4: come up and so many potential insights to explore or
• 21:15
  Speaker 4: those trailheads to go down in psychotherapy when you do
• 21:19
  Speaker 4: have this psychological flexibility that are golden opportunities, but we
• 21:26
  Speaker 4: can't say much about like the evidence for ketamine-assisted psychotherapy
• 21:32
  Speaker 4: until someone does a randomized controlled trial, and they might not, right?
• 21:37
  Speaker 4: So we're left to kind of keep doing it clinically
• 21:41
  Speaker 4: and sharing and publishing the reports. But the other part
• 21:45
  Speaker 4: of your question, I think, was about the durability of it.
• 21:48
  Speaker 4: And that's one thing about ketamine. It is known to
• 21:52
  Speaker 4: be temporary, and it's variable for each individual. But say
• 21:56
  Speaker 4: you do a session or two a week over several weeks, three,
• 22:00
  Speaker 4: four weeks. Um, there's usually in most people, uh, antidepressant response,
• 22:06
  Speaker 4: like some relief by the next day. And whether it's
• 22:11
  Speaker 4: that initial course or a single session, it might, it
• 22:15
  Speaker 4: might only last days or weeks, sometimes longer. Sometimes it
• 22:19
  Speaker 4: pulls you out of an episode and that's, you're out
• 22:21
  Speaker 4: of the episode and you're working on, um, What do
• 22:25
  Speaker 4: you need to do in the meantime? How do we
• 22:26
  Speaker 4: prevent the recurrence of that? How do we keep things
• 22:28
  Speaker 4: at bay? But that's kind of one of the known
• 22:34
  Speaker 4: issues with it is that we need to be aware
• 22:37
  Speaker 4: of things potentially coming back and do all the work
• 22:40
  Speaker 4: we can to support people. And sometimes it's a bridge
• 22:43
  Speaker 4: to the next thing or sometimes it's an opportunity to
• 22:47
  Speaker 4: do that deep work. But what would you say, Steve?
• 22:51
  Speaker 3: Other things to add?
• 22:53
  Speaker 5: Yeah, I mean, I would love to see research done on,
• 22:58
  Speaker 5: like Reid's saying, sort of a randomized controlled trial approach
• 23:02
  Speaker 5: to ketamine by itself and ketamine with psychotherapy. Because while
• 23:05
  Speaker 5: the neurological effects are transient and the relief that somebody
• 23:08
  Speaker 5: gets from receptor modulation might be transient, what my guess
• 23:12
  Speaker 5: is is not transient are those insights I was talking about.
• 23:15
  Speaker 5: And so perhaps with the help of a therapist, somebody
• 23:18
  Speaker 5: takes advantage of that neuroplastic window and keeps the momentum there.
• 23:22
  Speaker 5: that Reed was mentioning with like sort of launching out
• 23:24
  Speaker 5: of a depressive episode by collaborating with a therapist that
• 23:28
  Speaker 5: they trust and feel safe with. So again, that's my
• 23:31
  Speaker 5: hunch and my bias as a therapist that does it
• 23:33
  Speaker 5: this way. It'd be interesting to see if the research
• 23:35
  Speaker 5: actually bears that out.
• 23:37
  Speaker 1: Sure. Can we talk about applications?
• 23:40
  Speaker 2: Like what, if I'm a person curious about ketamine, like
• 23:44
  Speaker 2: want to talk to someone about it, what are the
• 23:46
  Speaker 2: things that we can apply ketamine to as far as
• 23:49
  Speaker 2: emotional wellness?
• 23:51
  Speaker 4: So, I want to point out that ketamine, kind of
• 23:56
  Speaker 4: tied into what we were just talking about, ketamine has
• 23:58
  Speaker 4: some psychopharmacologic benefit of its own. And in its glutamate
• 24:04
  Speaker 4: and neuroplasticity effects, there's a rapid antidepressant response there for
• 24:11
  Speaker 4: a significant percentage of people, even if it doesn't last forever,
• 24:17
  Speaker 4: regardless of what else is going on.
• 24:20
  Speaker 3: In a safe and.
• 24:20
  Speaker 4: Supported environment, of course, like a good therapeutic container.
• 24:24
  Speaker 3: To deliver it.
• 24:26
  Speaker 4: But then, what would it be used for? We know
• 24:30
  Speaker 4: it has antidepressant responses. There are all these other studies,
• 24:34
  Speaker 4: like Steve mentioned some of them, OCD, anorexia, other eating disorders,
• 24:41
  Speaker 4: generalized anxiety. In fact, most people, when they study it
• 24:44
  Speaker 4: for depression, they'll measure anxiety symptoms. We've published a lot
• 24:47
  Speaker 4: of studies from the clinics we used to work at
• 24:51
  Speaker 4: and oversee, the Cedar Psychiatry clinics, of what happened in
• 24:55
  Speaker 4: the real world to people's depression and anxiety on the
• 24:58
  Speaker 4: GAD-7 for anxiety, the PHQ-9 for depression, and what happened
• 25:03
  Speaker 4: over time. And you see benefits for most people in
• 25:07
  Speaker 4: both categories. And then beyond that, I'll say if you're
• 25:11
  Speaker 4: going into PTSD work, That suggests being more cautious about
• 25:17
  Speaker 4: the support around it and one's readiness and resourcing on
• 25:22
  Speaker 4: board to do the deep trauma work. Because sometimes in
• 25:26
  Speaker 4: trauma work, you feel worse before you feel better. You're
• 25:29
  Speaker 4: bringing things up and sometimes you don't know what's going
• 25:33
  Speaker 4: to come up and how it's going to feel. And
• 25:37
  Speaker 4: then last thing I'll just point out is a few
• 25:39
  Speaker 4: of the things. to be extremely cautious about is, and
• 25:43
  Speaker 4: most people will not give ketamine for bipolar because of
• 25:48
  Speaker 4: a risk. Most people, like there are some pilot studies
• 25:53
  Speaker 4: for bipolar depression that can be done in a safe way,
• 25:55
  Speaker 4: but because there's a risk of potentially unearthing a manic
• 25:59
  Speaker 4: episode or in same goes for any like history of psychosis,
• 26:06
  Speaker 4: you know, that's an extreme caution with ketamine because, you know,
• 26:10
  Speaker 4: the fear is that it could precipitate something like that
• 26:12
  Speaker 4: or an episode. And then other kind of medical considerations,
• 26:17
  Speaker 4: there is a transient increase, as you know, in senior
• 26:20
  Speaker 4: clinic and heart rate, blood pressure, but not more than
• 26:23
  Speaker 4: someone's brisk walk.
• 26:26
  Speaker 3: But you got to be aware of.
• 26:27
  Speaker 4: Their general kind of medical health as well as their psychiatric,
• 26:31
  Speaker 4: but I'll let you speak to that more.
• 26:33
  Speaker 1: Yeah, yeah.
• 26:34
  Speaker 2: We're careful about that with blood pressures and monitoring and
• 26:36
  Speaker 2: making sure that people are safe and Yeah, that's all
• 26:40
  Speaker 2: really cool. I just asked because staying abreast of the
• 26:44
  Speaker 2: latest research on the utilization of ketamine and its indices
• 26:48
  Speaker 2: and FDA approvals and all that, you guys are more
• 26:51
  Speaker 2: in that space than I am.
• 26:52
  Speaker 4: Yeah. So one thing to add that that reminds me
• 26:55
  Speaker 4: of is S-ketamine, brand name Spravato, did get FDA approved
• 27:01
  Speaker 4: in 2019 for treatment-resistant depression at first. And then like
• 27:04
  Speaker 4: you alluded to for depression with suicidal ideation as its
• 27:09
  Speaker 4: next indication. And so when we were working in these clinics,
• 27:13
  Speaker 4: we offered both, like ketamine therapy first, and then when
• 27:18
  Speaker 4: Spravato came out, we made the decision to start giving
• 27:21
  Speaker 4: that as well because when it's FDA approved, that often
• 27:26
  Speaker 4: translates into potential insurance approval for people who meet the indication,
• 27:32
  Speaker 4: like in this case, treatment-resistant depression. But so ketamine, when
• 27:36
  Speaker 4: it's given, is given off-label for anything mental health.
• 27:41
  Speaker 2: Can we speak to this bravado briefly? I think a
• 27:44
  Speaker 2: lot of folks are curious about that, and it is
• 27:46
  Speaker 2: not something that I prescribe. We're just in the infusion space.
• 27:51
  Speaker 2: And so can you speak to that and how that works?
• 27:54
  Speaker 2: And it's quite different than a true ketamine infusion experience, correct?
• 28:00
  Speaker 4: Yeah, quite different experience. For most people, yeah, it's a
• 28:07
  Speaker 4: nasal spray. But it is one of the two enantiomers
• 28:12
  Speaker 4: of the ketamine mix. In ketamine, you have the right-handed,
• 28:15
  Speaker 4: left-handed enantiomer that makes up that chemical soup. And then
• 28:20
  Speaker 4: in S-ketamine, it's just one of them. But it's interesting,
• 28:23
  Speaker 4: that study that I mentioned, my first ketamine study ever, 2011,
• 28:27
  Speaker 4: I was like, what is Johnson & Johnson doing studying
• 28:31
  Speaker 4: a generic medicine?
• 28:32
  Speaker 3: But.
• 28:33
  Speaker 4: They had this brilliant psychiatrist named Jas Singh who left
• 28:38
  Speaker 4: the NIMH.
• 28:39
  Speaker 3: He went over.
• 28:39
  Speaker 4: To there and he had this vision, this like 10-year plan.
• 28:43
  Speaker 3: And he did it.
• 28:43
  Speaker 4: He took ketamine, studied it first to make sure, okay,
• 28:48
  Speaker 4: does it work? Can we replicate that it works? And
• 28:51
  Speaker 4: at this dose, IV. And can we show that it
• 28:54
  Speaker 4: works twice a week and not three times a week?
• 28:56
  Speaker 1: Yes.
• 28:57
  Speaker 4: And then they made S-ketamine and showed that that would
• 29:01
  Speaker 4: work and tried. tried to figure out the answer to
• 29:03
  Speaker 4: the question of how could it be delivered in mental
• 29:05
  Speaker 4: health clinics where psychiatrists don't do IVs usually, or they're
• 29:11
  Speaker 4: super rusty in that department. And it's just different delivery mechanisms.
• 29:15
  Speaker 4: So they're like, okay, if we put esketamine into a
• 29:18
  Speaker 4: nasal spray, what's the dose that would be the equivalent
• 29:21
  Speaker 4: receptor occupancy and antidepressant response? And then they studied that.
• 29:26
  Speaker 4: And then fast forward until 2019, you have it approved
• 29:29
  Speaker 4: in a nasal spray. For people who have failed past antidepressants,
• 29:34
  Speaker 4: two or more could get authorized in this REM system.
• 29:40
  Speaker 4: like some other meds that many prescribers are familiar with have,
• 29:46
  Speaker 4: that where we have to register the patient, and it's
• 29:48
  Speaker 4: only given in clinics. They come in, and the nasal
• 29:51
  Speaker 4: spray is there, sent to the prescriber, and they deliver it.
• 29:55
  Speaker 4: The patient actually self-administers, and then the sessions are 90 minutes,
• 29:58
  Speaker 4: but It's a dose that feels, I would say, less
• 30:02
  Speaker 4: psychedelic on average than ketamine because it is kind of
• 30:07
  Speaker 4: limited to these Fervato doses and through that nasal administration
• 30:13
  Speaker 4: and bioavailability, but it does have good data. So less
• 30:17
  Speaker 4: of a dissociative psychedelic type experience, but good data on depression.
• 30:22
  Speaker 3: And we saw that play out.
• 30:24
  Speaker 4: At first, we weren't sure how it would go because
• 30:26
  Speaker 4: it was a new medicine, but we had a number
• 30:29
  Speaker 4: of people adopted in part because they could get it
• 30:32
  Speaker 4: paid for.
• 30:33
  Speaker 3: And, and that can be a burden.
• 30:35
  Speaker 4: Even if you found ketamine helpful to, for some, like
• 30:39
  Speaker 4: to keep the depression at bay. And we saw that
• 30:43
  Speaker 4: it was accessible and helpful and safe and easy to administer.
• 30:47
  Speaker 4: And so we were all in, and it is an
• 30:49
  Speaker 4: option with those constraints. You know, when, especially when there's
• 30:54
  Speaker 4: insurance involved, because if not, it's just really expensive.
• 30:58
  Speaker 5: Yeah.
• 30:59
  Speaker 2: Is it an ongoing treatment or is it like six sessions,
• 31:01
  Speaker 2: kind of like the IMID space?
• 31:03
  Speaker 4: So the protocol is really spelled out. Like if you
• 31:06
  Speaker 4: get approved by, registered in the REMS and authorized by
• 31:11
  Speaker 4: your insurance to get it, it would be twice a
• 31:14
  Speaker 4: week for the first month, once a week for the
• 31:16
  Speaker 4: next month, and then an individualized maintenance period. regimen if
• 31:20
  Speaker 4: it applies. And I'd say most people lately do find
• 31:25
  Speaker 4: some kind of way to go, okay, what's the right frequency?
• 31:28
  Speaker 4: Another month like that, or once every two weeks, once
• 31:31
  Speaker 4: a month. And then there's usually an end in sight
• 31:36
  Speaker 4: of the number of approved sessions. And then you're evaluating
• 31:39
  Speaker 4: every step of the way, how's the depression doing? And
• 31:46
  Speaker 4: getting approved for some maintenance strategy, but it's always in-clinic
• 31:50
  Speaker 4: and a nasal spray.
• 31:53
  Speaker 3: And that's how Spravato works.
• 31:54
  Speaker 2: Okay.
• 31:55
  Speaker 1: Okay. Okay.
• 31:57
  Speaker 2: At the end, I want to circle back on the
• 31:58
  Speaker 2: addiction space because you mentioned that and if ketamine can
• 32:02
  Speaker 2: kind of drive that. So we'll circle back on that
• 32:05
  Speaker 2: towards the end. But next, I want Steve to talk
• 32:08
  Speaker 2: a little bit about preparation. So what can we do
• 32:12
  Speaker 2: maybe like emotionally and things that we can do to
• 32:15
  Speaker 2: prepare for I've been contemplating it. We've kind of got,
• 32:18
  Speaker 2: went through the process of like choosing a reasonable person
• 32:21
  Speaker 2: to go to get ketamine at. Now I'm, I'm into
• 32:23
  Speaker 2: the ketamine sesh and I'm like, okay, I'm ready. I've
• 32:26
  Speaker 2: met with them. We've done the pre, pre ketamine consults
• 32:29
  Speaker 2: and all the things. And now preparing for ketamine. Let's
• 32:32
  Speaker 2: talk about that space. Go ahead.
• 32:34
  Speaker 5: I think good preparation starts with good psychoeducation. So I
• 32:39
  Speaker 5: like to educate my clients on what this thing is like, what,
• 32:43
  Speaker 5: What does ketamine? So sort of a layman's appropriate explanation
• 32:47
  Speaker 5: of what this drug is. And then what might your
• 32:49
  Speaker 5: experience be like? And you notice when I talk about this,
• 32:52
  Speaker 5: I use a lot of hedge words like what might
• 32:53
  Speaker 5: your experience be like? Because one thing I want to
• 32:58
  Speaker 5: caution my clients against is having really rigid expectations, either
• 33:03
  Speaker 5: about the kind of experience they're going to have or
• 33:06
  Speaker 5: the kind of outcome they expect. Of course, people aren't
• 33:08
  Speaker 5: going to do this if they don't have some kind
• 33:10
  Speaker 5: of expectation that it's going to be helpful. but let's
• 33:13
  Speaker 5: get open and curious about what direction that help can
• 33:16
  Speaker 5: come from, because it can come from surprising directions when
• 33:19
  Speaker 5: you're wandering in the mind with a medicine that's going
• 33:22
  Speaker 5: to alter your consciousness. So a little bit of education
• 33:25
  Speaker 5: about what ketamine is, and then how you might navigate
• 33:29
  Speaker 5: that experience. So sometimes back at Cedar, we used to
• 33:32
  Speaker 5: give this pre-flight instructions, this handout that would describe, you know,
• 33:36
  Speaker 5: how do we best prepare and how do we navigate
• 33:38
  Speaker 5: and then integrate this experience? So Um, so some education
• 33:42
  Speaker 5: and then talking to them about how to navigate. And
• 33:45
  Speaker 5: that would include things like mantras. They can repeat to themselves,
• 33:48
  Speaker 5: these slogans that help remind them of the most helpful
• 33:52
  Speaker 5: attitude they could have to go through an altered consciousness experience.
• 33:56
  Speaker 5: So things like surrender, let go, be open, be curious,
• 34:02
  Speaker 5: ask for help if you need it, those kinds of things. Cool.
• 34:05
  Speaker 5: And this comes a little bit from our training in
• 34:06
  Speaker 5: the psychedelic medicine space. Um, these are common, um, I guess,
• 34:12
  Speaker 5: ways of thinking about how to navigate other psychedelic medicine spaces.
• 34:15
  Speaker 5: But they are inspired by this idea that sometimes people
• 34:19
  Speaker 5: in the psychedelic world will talk about bad trips, so-called
• 34:22
  Speaker 5: bad trips. And that can result from a lot of
• 34:25
  Speaker 5: different reasons. But one of them, we think, is people
• 34:27
  Speaker 5: who are trying to control the experience too tightly. Like,
• 34:30
  Speaker 5: let's say you're having your ketamine experience and you're wandering
• 34:33
  Speaker 5: through your mind and you're encountering some difficult content. And
• 34:37
  Speaker 5: your first instinct is, no, I don't want to experience that.
• 34:40
  Speaker 5: And that leads to this sort of power struggle with
• 34:44
  Speaker 5: your psyche. And then we found that simply, I mean,
• 34:46
  Speaker 5: it's not so simple, but simply relaxing into opening up
• 34:49
  Speaker 5: to and surrendering to what's showing up often pays dividends.
• 34:53
  Speaker 5: Like you get to see what's on the other end
• 34:55
  Speaker 5: of that struggle. So, and then we'll talk about other
• 34:58
  Speaker 5: ways that I can support them if they need, you know,
• 35:01
  Speaker 5: me to guide them through some deep breathing as they
• 35:03
  Speaker 5: navigate that can often help folks. We're all holding these
• 35:07
  Speaker 5: little sort of uh, whittled totems that Dr. John made.
• 35:10
  Speaker 5: And I was telling him on the way in here that, uh,
• 35:13
  Speaker 5: you know, some of my clients have things like this
• 35:14
  Speaker 5: of their own. They have a crystal, they have a stone,
• 35:16
  Speaker 5: they have some kind of totem. And if, um, they
• 35:18
  Speaker 5: want to bring that with them, we'll practice in preparation,
• 35:21
  Speaker 5: those breathing exercises with something tactile in their hand as
• 35:25
  Speaker 5: another sensory input. When they're in this space, read, use
• 35:27
  Speaker 5: the word dissociative a second ago. Ketamine can sometimes be
• 35:31
  Speaker 5: a bit dissociating, meaning you feel a disconnection from self,
• 35:34
  Speaker 5: from the concept of self, from time, from the body.
• 35:37
  Speaker 5: And so having something to anchor that you've practiced with
• 35:39
  Speaker 5: can be grounding as you're navigating this. So sometimes we'll
• 35:43
  Speaker 5: even practice with things like that. So talking about the
• 35:47
  Speaker 5: kinds of sources of support that are available to them
• 35:50
  Speaker 5: is often pretty helpful in preparation. And the last thing
• 35:52
  Speaker 5: I'll say is I think it's often helpful to talk
• 35:55
  Speaker 5: about a guiding purpose or an intention or what I
• 36:00
  Speaker 5: sometimes refer to as a loosely held hope for what
• 36:03
  Speaker 5: your ketamine experience is going to give you. I contrast
• 36:07
  Speaker 5: this with expectations. Like I mentioned before, we want to
• 36:09
  Speaker 5: hold these hopes loosely, meaning we're here for it. We're
• 36:14
  Speaker 5: here for whatever the ketamine experience has for us. But
• 36:18
  Speaker 5: an intention can be also sort of a rudder in
• 36:21
  Speaker 5: the stream of consciousness. So an intention might be something like,
• 36:24
  Speaker 5: you know, help me understand my trauma better or help
• 36:27
  Speaker 5: me reconnect with joy because I've felt no joy because
• 36:30
  Speaker 5: I'm so depressed and show me what's in my way.
• 36:33
  Speaker 5: Things like that. Sort of these simple, rudders that help
• 36:36
  Speaker 5: us navigate that space.
• 36:38
  Speaker 2: One of my favorite intentions i heard from one of
• 36:40
  Speaker 2: my clients was i just want to stop being so
• 36:45
  Speaker 2: mad all the time and she was this she was
• 36:49
  Speaker 2: like 35 mama bunch of kids and just struggling you
• 36:55
  Speaker 2: know and she was just showing up poorly for her
• 36:58
  Speaker 2: family a little bit and just man she's just mad
• 37:01
  Speaker 2: yeah and i don't think we could peel back into
• 37:05
  Speaker 2: the secondary tertiary emotions but the anger was the primary
• 37:09
  Speaker 2: just right out in front and I said that sounds
• 37:12
  Speaker 2: great let's look at that let's explore that space and
• 37:16
  Speaker 2: so she's her healing journey was so beautiful and how
• 37:20
  Speaker 2: she just changed so much and processed some heavy stuff
• 37:25
  Speaker 2: that that came to the surface that she didn't know
• 37:28
  Speaker 2: was there and and and how that just kind of
• 37:32
  Speaker 2: helped her show up better for her family for her
• 37:35
  Speaker 2: kids and I don't know that she was feeling anything
• 37:38
  Speaker 2: super depressive or super anything that way. And I just
• 37:42
  Speaker 2: knew that there were triggers there that were probably deeper and,
• 37:46
  Speaker 2: and that exploring those spaces with this were just so
• 37:50
  Speaker 2: healing for her and her family.
• 37:51
  Speaker 1: Super cool.
• 37:52
  Speaker 2: Yeah.
• 37:53
  Speaker 5: Well, you mentioned triggers, Reed mentioned, um, trailheads earlier. And
• 37:58
  Speaker 5: I think that's another helpful thing to talk about in
• 38:00
  Speaker 5: preparation when you're, when we're using slogans like let go
• 38:03
  Speaker 5: or be open or surrender is it, People will set
• 38:06
  Speaker 5: an intention like, you know, help me deal with this anger.
• 38:08
  Speaker 5: And they might expect what ketamine will do is dissolve it.
• 38:12
  Speaker 3: Right?
• 38:12
  Speaker 5: Like I won't feel anger anymore. But the help you
• 38:15
  Speaker 5: might get with anger is allowing you to move right
• 38:17
  Speaker 5: into it. Understand it better. Process, like you said, what's
• 38:21
  Speaker 5: behind it. What's contributing to that anger. So treating those
• 38:26
  Speaker 5: triggers as they come up as opportunities instead of things
• 38:29
  Speaker 5: to avoid or dissolve. Let's treat them as trailheads. Follow
• 38:33
  Speaker 5: them to where they might lead.
• 38:34
  Speaker 1: I love that.
• 38:35
  Speaker 4: Like we said the other week on a recording here together,
• 38:39
  Speaker 4: triggers are friends to follow.
• 38:41
  Speaker 3: They show you the work. Yeah.
• 38:43
  Speaker 4: Um, and sometimes the only way out is through.
• 38:46
  Speaker 1: Yeah. I love that. Triggers are trailheads. Triggers are friends
• 38:50
  Speaker 1: to follow. Yeah. These are bumper stickers, guys. We're going to,
• 38:54
  Speaker 1: we're doing it. We're doing it. Um, okay.
• 38:57
  Speaker 2: So we talked a little bit about, um, preparation, getting
• 39:00
  Speaker 2: in there. Um, what to expect kind of during the session.
• 39:04
  Speaker 2: And then even after the session, maybe we can talk
• 39:08
  Speaker 2: a little bit about post session, what to expect, and
• 39:11
  Speaker 2: then kind of ways to integrate that, that initial time
• 39:16
  Speaker 2: after the session. And then that, that initial, maybe three
• 39:18
  Speaker 2: days after session too. I'll just throw a.
• 39:21
  Speaker 4: Few simple things in and then bump it over to Steve.
• 39:25
  Speaker 4: Sometimes integration might sound boring, involving a lot of good self-care,
• 39:32
  Speaker 4: a lot of good making space for things to settle
• 39:36
  Speaker 4: and making time and space to process and think and
• 39:41
  Speaker 4: write and sleep and rest.
• 39:44
  Speaker 3: But it's like if you go.
• 39:47
  Speaker 4: On a world trip you know, backpack across the world
• 39:52
  Speaker 4: and come right back and try to jump into work
• 39:55
  Speaker 4: the next morning after a red eye. It could be,
• 39:57
  Speaker 4: you know, it could be destabilizing or you got to
• 40:01
  Speaker 4: kind of be aware of your landing and the conditions
• 40:05
  Speaker 4: of it and what you're going to be facing in
• 40:09
  Speaker 4: this vulnerable, sensitive state. In addition to that, using that
• 40:14
  Speaker 4: opportunity wisely to do productive, meaningful work, but But yeah,
• 40:19
  Speaker 4: integration thoughts, Steve?
• 40:21
  Speaker 5: Yeah, I think treat it like you've come out of surgery.
• 40:26
  Speaker 5: You're going to be tender. You might be emotionally raw.
• 40:30
  Speaker 5: Try not to go right back to work the next
• 40:31
  Speaker 5: day if you can do that. Some people don't have
• 40:33
  Speaker 5: that option, but you might need some gentleness in your
• 40:37
  Speaker 5: life to give yourself time and space to do this integration.
• 40:41
  Speaker 5: And I would also say take the pressure off of
• 40:44
  Speaker 5: yourself too to make sense of everything. Some people do have,
• 40:49
  Speaker 5: like we were describing, these very revelatory, interesting, what I've
• 40:52
  Speaker 5: been calling dreamlike experiences. Some people don't. They just sort
• 40:56
  Speaker 5: of float in the void. I remember when I was
• 40:57
  Speaker 5: first studying ketamine, like being trained on how to use it,
• 41:00
  Speaker 5: I was talking to a doctor who said, yeah, I
• 41:04
  Speaker 5: tried ketamine. It just felt like a boring space mountain ride.
• 41:07
  Speaker 5: He was like, that's interesting.
• 41:08
  Speaker 1: Yeah.
• 41:09
  Speaker 5: And then I actually got some ketamine treatments myself. I
• 41:12
  Speaker 5: was dealing with some depression. And I did have one
• 41:14
  Speaker 5: experience that just felt like floating through space. I feel
• 41:16
  Speaker 5: like I was in the hangar bay of a giant
• 41:18
  Speaker 5: alien spaceship. And there wasn't a whole lot that was
• 41:20
  Speaker 5: revelatory to me in that particular experience. So loosening expectations
• 41:25
  Speaker 5: a bit and then taking some of the pressure off
• 41:27
  Speaker 5: of yourself to make sure that I make sense of
• 41:29
  Speaker 5: all this. But some of the things Reid alluded to,
• 41:33
  Speaker 5: you know, these are the standard things that a good
• 41:35
  Speaker 5: doctor like John would say to do. You know, make
• 41:37
  Speaker 5: sure you get enough sleep. Make sure you're treating your
• 41:39
  Speaker 5: body well with good movement that your body can handle.
• 41:42
  Speaker 5: Make sure that you're in connection with the people that
• 41:44
  Speaker 5: you love. Make sure that you're eating nutritious food and hydrating.
• 41:47
  Speaker 5: All these things will support the integration process. And then
• 41:52
  Speaker 5: as you do come upon some insights about patterns that
• 41:55
  Speaker 5: have been self-defeating, try little experiments within this neuroplastic, psychologically
• 42:01
  Speaker 5: flexible window that are doing things a little bit differently
• 42:05
  Speaker 5: than you would do them before.
• 42:06
  Speaker 2: Mm-hmm.
• 42:07
  Speaker 5: If you come out of your ketamine experience feeling a
• 42:09
  Speaker 5: little bit emboldened to try some of these things, act
• 42:13
  Speaker 5: on that. Strike while that iron is hot, while it's malleable.
• 42:16
  Speaker 5: So with support, have some courage and try some new things.
• 42:21
  Speaker 1: I love it.
• 42:22
  Speaker 2: Journaling immediately after, is that helpful?
• 42:24
  Speaker 1: Or is that.
• 42:26
  Speaker 2: Like in the next few days? And then also just
• 42:29
  Speaker 2: like using life as integration, like talking, sharing. obviously with
• 42:36
  Speaker 2: a therapist as well, doing the psychotherapy, doing some of
• 42:38
  Speaker 2: the heavy lifting spaces, especially if you're dealing with some
• 42:40
  Speaker 2: of the heavier traumas and things like that. But give
• 42:43
  Speaker 2: us some pearls and some of those, sprinkle some sauce
• 42:45
  Speaker 2: into that.
• 42:46
  Speaker 5: Yeah, I would say journal if it sounds good to you, right?
• 42:51
  Speaker 5: None of these things are requirements, right? Some people, journaling
• 42:54
  Speaker 5: isn't helpful for some folks. Journaling is rumination and journaling
• 42:58
  Speaker 5: is sort of obsessively grinding on the negativity in their life.
• 43:03
  Speaker 5: Like their dear diaries are just a tome of lament.
• 43:07
  Speaker 5: So for some folks, journaling is awesome. It's the way
• 43:11
  Speaker 5: that they think and they process. For some folks who
• 43:14
  Speaker 5: don't like to write, sometimes I'll encourage them just to
• 43:15
  Speaker 5: do voice memos. Oh, cool. I know some people that
• 43:18
  Speaker 5: have some trusted friends in the Marco Polo app where
• 43:21
  Speaker 5: you're kind of just sending little voice and video notes
• 43:23
  Speaker 5: to each other. And so that's when they've had experiences,
• 43:26
  Speaker 5: they'll Marco Polo back to each other. Yeah, certainly journaling
• 43:29
  Speaker 5: can be helpful. Time for quiet reflection. If you're a meditator,
• 43:34
  Speaker 5: It's a great time to meditate. If you're not a meditator,
• 43:36
  Speaker 5: it's a great time to experiment with it. Sharing with
• 43:39
  Speaker 5: other people. So ideally, you'll have a therapist to process
• 43:42
  Speaker 5: this with. I often caution my clients about sharing too
• 43:47
  Speaker 5: much with too many people during that plastic phase. You
• 43:51
  Speaker 5: might feel eager to, but also a little emotionally raw.
• 43:57
  Speaker 5: So be judicious, I guess, about who you share some
• 44:01
  Speaker 5: of those things with.
• 44:02
  Speaker 1: Sure, sure.
• 44:03
  Speaker 2: And folks, might just think you're crazy because he just
• 44:07
  Speaker 2: went to crazyville and some of this stuff doesn't make
• 44:10
  Speaker 2: any sense and so so yeah being really cautious about
• 44:13
  Speaker 2: who you discuss that with and integrate that with if
• 44:15
  Speaker 2: they haven't if they're unfamiliar or whatever they might there
• 44:18
  Speaker 2: might be some wonky thinking.
• 44:19
  Speaker 4: God knows what to do with your mystical experience right
• 44:23
  Speaker 4: not everybody knows they bring it up at the family
• 44:25
  Speaker 4: dinner table it might prompt some triggering drama who.
• 44:29
  Speaker 5: Knows you tried that horse tranquilizer what are you doing dude.
• 44:34
  Speaker 2: Um caffeine, stimulants, some folks are on Adderall or concomitant medicines.
• 44:39
  Speaker 2: Are there certain things that we should hold the day before?
• 44:41
  Speaker 1: Reid, what are your thoughts?
• 44:42
  Speaker 4: So we have this kind of lens of having done
• 44:46
  Speaker 4: this in studies with ketamine and related things and psychedelics.
• 44:51
  Speaker 4: I think the general approach is that a lot of
• 44:53
  Speaker 4: things can coexist as, you know, you could be on
• 44:56
  Speaker 4: other medicines like antidepressants or a stimulant prescription for ADHD
• 45:01
  Speaker 4: or whatever. But in general, we'll will pause very stimulating
• 45:07
  Speaker 4: things for that dose unless it's going to cause a
• 45:12
  Speaker 4: distracting withdrawal. Like if skipping a caffeine that morning means
• 45:16
  Speaker 4: you're going to have a severe headache mid-ketamine session, that's
• 45:20
  Speaker 4: not ideal. So we would say a lesser dose of
• 45:22
  Speaker 4: caffeine perhaps. But just aware of your nervous system's activation
• 45:25
  Speaker 4: and creating a state of calm is kind of the
• 45:29
  Speaker 4: spirit of it and checking vitals with your doctor and
• 45:32
  Speaker 4: your blood pressure beforehand because you look at this bravado literature,
• 45:35
  Speaker 4: there's guidance. They leave it up to the clinic, but
• 45:38
  Speaker 4: there's guidance that says like, you're going to have your parameters,
• 45:42
  Speaker 4: but if your blood pressure is over 140, over 90
• 45:45
  Speaker 4: or something like that, um, clinic dependent, uh, maybe don't
• 45:50
  Speaker 4: dose or, uh, you know, address that.
• 45:53
  Speaker 1: Yeah. I like it.
• 45:55
  Speaker 2: Um, lastly, thank you so much. The wealth of understanding.
• 45:59
  Speaker 2: I hope this helps all of our clients and all
• 46:00
  Speaker 2: their community people.
• 46:01
  Speaker 1: This is so good. I want to talk about a fear.
• 46:04
  Speaker 2: I mean, in our neck of the woods, and a
• 46:07
  Speaker 2: lot of people are afraid of things like this, and
• 46:09
  Speaker 2: they're afraid of addiction, they're afraid of dependence, they're afraid
• 46:11
  Speaker 2: of those kinds of things. And can we speak to
• 46:13
  Speaker 2: that just a little bit? Maybe why would this be addicting?
• 46:16
  Speaker 2: Maybe why it's less addicting than other things? And kind
• 46:19
  Speaker 2: of speak in those spaces.
• 46:20
  Speaker 4: Ketamine's interesting in that it started out in anesthesia, but
• 46:25
  Speaker 4: also became a drug of abuse along the way and
• 46:28
  Speaker 4: has been for decades. a club drug, some call it.
• 46:31
  Speaker 4: And there are people, as I mentioned earlier, who have
• 46:35
  Speaker 4: gotten into big trouble with addictive patterns and ketamine. And
• 46:40
  Speaker 4: there's kind of an individual susceptibility, probably a combination of
• 46:45
  Speaker 4: your wiring and where you're at in life and your
• 46:48
  Speaker 4: supports and susceptibility to escapism and things like that. But
• 46:53
  Speaker 4: we've used it really, really cautiously for that reason by
• 46:58
  Speaker 4: doing the careful screening and preparation. And like you said,
• 47:01
  Speaker 4: you know the people you're working with. And so you
• 47:05
  Speaker 4: know that if there are concerns in a certain area,
• 47:08
  Speaker 4: like if someone has an out-of-control drinking problem, it's a
• 47:13
  Speaker 4: good reason to get things to a certain place, like not,
• 47:18
  Speaker 4: you know, acutely intoxicated or risk of withdrawing. But then ketamine, interestingly,
• 47:25
  Speaker 4: has some anti-addictive properties and anti- addictive evidence in studies
• 47:31
  Speaker 4: that have come out for alcohol use disorder and other substances,
• 47:36
  Speaker 4: even cocaine, like using ketamine as a tool. So it's
• 47:39
  Speaker 4: this really interesting paradox where you have a tool that
• 47:41
  Speaker 4: if used wisely can help some people with their addictive patterns,
• 47:46
  Speaker 4: but if unchecked can become a problematic kind of rabbit
• 47:51
  Speaker 4: hole of its own. And there are extra dangers of
• 47:55
  Speaker 4: safety in the street use of ketamine including bladder problems
• 48:00
  Speaker 4: and whatnot that weren't seen in the Spravato safety data,
• 48:05
  Speaker 4: even long-term, if used in appropriate ways. But there are
• 48:08
  Speaker 4: other concerns from the illicit use and definitely something we
• 48:13
  Speaker 4: want to keep people far away from. And so there
• 48:17
  Speaker 4: are some companies out there that will send lozenges to
• 48:19
  Speaker 4: your home and observe people on ketamine. And I'm not
• 48:24
  Speaker 4: suggesting a stance on home ketamine at all, but I'd
• 48:28
  Speaker 4: say if we ever went into those territories with clients,
• 48:31
  Speaker 4: it was people we knew very well, had a known
• 48:34
  Speaker 4: support system, and there was maybe a barrier to accessing
• 48:38
  Speaker 4: an important maintenance treatment where we could say, okay, we
• 48:41
  Speaker 4: might prescribe these lozenges or this nasal spray at home
• 48:44
  Speaker 4: to be taken on this day with your spouse or
• 48:48
  Speaker 4: other support person who we've involved in this process. helping
• 48:52
  Speaker 4: you out and then we've been able to navigate kind
• 48:55
  Speaker 4: of the access that way without kind of turning a
• 48:58
  Speaker 4: blind eye to the real world needs out there and
• 49:01
  Speaker 4: that not everyone who like most people who experience ketamine
• 49:05
  Speaker 4: don't end up with a problem with it but there
• 49:07
  Speaker 4: are some who do and it can be.
• 49:09
  Speaker 2: Scary would you say it's more mostly like you said
• 49:12
  Speaker 2: multifactorial sequence of events that maybe leads to an addiction
• 49:16
  Speaker 2: to this is it more the escapism addiction i mean,
• 49:20
  Speaker 2: because it doesn't really have a mu receptor agonist property
• 49:22
  Speaker 2: to it. And mu receptor, I mean, for our listeners,
• 49:25
  Speaker 2: it's like the opiates or like cocaine or some of
• 49:27
  Speaker 2: these major turn on. And mu receptor in our brain
• 49:31
  Speaker 2: is like this euphoria type sense. And so, yeah, tell
• 49:35
  Speaker 2: me your thoughts on that.
• 49:36
  Speaker 4: Today, Steve was pointing out that I... There was a
• 49:40
  Speaker 4: new article that came out on the structure of ketamine
• 49:43
  Speaker 4: and the mu opioid receptor. There's been this question for
• 49:48
  Speaker 4: a while of does it have mu opioid activity. We
• 49:51
  Speaker 4: know how it behaves, ketamine, in the street use and
• 49:56
  Speaker 4: in the clinic use in terms of its potential addictive
• 50:00
  Speaker 4: properties and potential anti-addictive properties. But there is some mu
• 50:05
  Speaker 4: opioid receptor from a June 2026, what journal?
• 50:08
  Speaker 1: Nature.
• 50:08
  Speaker 3: Nature.
• 50:09
  Speaker 1: Is that right? Thank you, nerdy Steve.
• 50:13
  Speaker 4: Yeah, and so, but it's been a question and concern
• 50:17
  Speaker 4: even from previous studies. And this just kind of adds
• 50:19
  Speaker 4: a little structure of ketamine, adds a little bit to
• 50:24
  Speaker 4: that puzzle. But we do know that ketamine and just
• 50:30
  Speaker 4: like Spravato, if used appropriately, Like we have kind of
• 50:37
  Speaker 4: given and supervised thousands of dosing sessions with both ketamine
• 50:41
  Speaker 4: and Servato in these CDER and then numinous clinics across
• 50:45
  Speaker 4: Utah and have been able to avoid those with the
• 50:51
  Speaker 4: right kind of safeguards in place, avoid those kind of
• 50:54
  Speaker 4: problematic patterns like with Servato, you're only getting it in
• 50:57
  Speaker 4: the clinic and you don't even have it at home.
• 51:00
  Speaker 4: And that's something that helps it. Stay in the lane
• 51:03
  Speaker 4: of being a helpful tool.
• 51:04
  Speaker 1: Yeah, I like that. Just put up some safeguards for folks.
• 51:07
  Speaker 5: Yeah.
• 51:08
  Speaker 1: That's smart. That's smart. Steve, do you have some thoughts? Yeah,
• 51:10
  Speaker 1: just a few.
• 51:11
  Speaker 5: You know, you mentioned sort of the pattern we see
• 51:14
  Speaker 5: in some folks who fall prey to addiction being one
• 51:16
  Speaker 5: of avoidance, like escape. In addiction medicine, we talk about,
• 51:21
  Speaker 5: you know, when somebody has an addiction, an unhealthy relationship
• 51:25
  Speaker 5: to a substance or a pattern of behavior, don't ask
• 51:27
  Speaker 5: why the substance or why the pattern of behavior.
• 51:29
  Speaker 1: Ask why the pain.
• 51:31
  Speaker 5: Like, what is it that they're trying to alleviate through
• 51:34
  Speaker 5: engaging with this substance? So, sure, there might be something
• 51:37
  Speaker 5: going on neurologically with this new research, even at the
• 51:39
  Speaker 5: opioid receptor sites, that might make a drug more than
• 51:43
  Speaker 5: less likely to be a drug of abuse. You know,
• 51:47
  Speaker 5: people talk about how psychedelics don't tend to lead to
• 51:51
  Speaker 5: misuse in the sense that people are doing mushrooms every
• 51:53
  Speaker 5: day because they don't just reliably produce anything but euphoria
• 51:57
  Speaker 5: like something like cocaine or these more dopaminergic drugs might cause.
• 52:00
  Speaker 5: So yeah, there might be a chemical hook. But there's,
• 52:03
  Speaker 5: you mentioned, I think, did you use the term K-hole earlier?
• 52:06
  Speaker 5: So it's this colloquial term that people use to describe
• 52:10
  Speaker 5: the oblivion that can sometimes be blissful oblivion that people
• 52:14
  Speaker 5: reach at higher doses of ketamine. So if somebody has
• 52:17
  Speaker 5: a lot of pain in their life, you know, a
• 52:19
  Speaker 5: lot of dissatisfaction with their life, it doesn't take a
• 52:22
  Speaker 5: huge stretch of the imagination to think why might they
• 52:24
  Speaker 5: enjoy a period of oblivion, right?
• 52:27
  Speaker 1: Of just escape.
• 52:28
  Speaker 5: So with the things Reed was talking about, sort of
• 52:31
  Speaker 5: the guidelines and structure around the way it's prescribed, the
• 52:34
  Speaker 5: screening about who it's prescribed to, I think you can
• 52:37
  Speaker 5: avoid a lot of those problems. But it certainly is
• 52:39
  Speaker 5: the case that ketamine can be a drug of abuse
• 52:42
  Speaker 5: for some people.
• 52:44
  Speaker 2: Well, thank you guys for hashing that out with me
• 52:46
  Speaker 2: and talking about, you know, our emotional journeys on this
• 52:50
  Speaker 2: earth are so vast and so diverse. And from one
• 52:55
  Speaker 2: person to the next, from one family to the next, from...
• 52:58
  Speaker 2: Just the multitude of genetics and patterns in our families
• 53:03
  Speaker 2: and generational stuff, it's complicated. I love what we talked
• 53:10
  Speaker 2: about today in having curiosity and having grace to yourself
• 53:15
  Speaker 2: and just kind of navigating these spaces. And if you're
• 53:22
  Speaker 2: thinking about ketamine out there and you're curious about it,
• 53:25
  Speaker 2: talk to some trusted healthcare professionals. professionals and talk it
• 53:29
  Speaker 2: through if it's a reasonable option for you. Any closing
• 53:34
  Speaker 2: advice you guys might have for folks kind of navigating
• 53:36
  Speaker 2: some of these waters?
• 53:38
  Speaker 4: One thing that is coming to mind is when we
• 53:41
  Speaker 4: were talking about integration, I just kept thinking that because
• 53:46
  Speaker 4: life is one big trip and we do have these varied,
• 53:49
  Speaker 4: sometimes difficult experiences, I'd say all the things we're talking
• 53:54
  Speaker 4: about apply to even the non psychedelic experiences that are
• 54:00
  Speaker 4: out of the ordinary, we go through and because life
• 54:02
  Speaker 4: is one big trip, integrate as you go and, and, uh,
• 54:06
  Speaker 4: make the space for introspection and being gentle with yourself and, um, and,
• 54:14
  Speaker 4: you know, whatever it is, a, a, a mystical moment
• 54:17
  Speaker 4: on the mountain by yourself or a very enraging and triggering,
• 54:23
  Speaker 4: you know, debate you had with someone, but just, you know,
• 54:26
  Speaker 4: apply an integration to that. Cool.
• 54:29
  Speaker 5: Yeah. I guess one closing thought is, you know, we're
• 54:32
  Speaker 5: clearly excited about the potential of this medicine. It can
• 54:34
  Speaker 5: be a long lever for folks, but there's no such
• 54:36
  Speaker 5: thing as a magic bullet for what it means to
• 54:39
  Speaker 5: be a person for humanity. Wherever you go, there you are.
• 54:43
  Speaker 5: So while a medicine like this or some of the
• 54:45
  Speaker 5: medicines that Reid and I study at our clinic might
• 54:48
  Speaker 5: be really, really helpful, like you've been describing, John, the preparation,
• 54:53
  Speaker 5: the integration is key. So it is up to you
• 54:57
  Speaker 5: to sort of use and explore and apply what you
• 55:02
  Speaker 5: learn from an experience like this. But I'm really grateful
• 55:05
  Speaker 5: that science continues to unveil these long levers to help
• 55:09
  Speaker 5: people who suffer.
• 55:11
  Speaker 2: Just lastly, in closing, I'll just share a brief example.
• 55:13
  Speaker 2: I had a client a couple months ago. He lost
• 55:19
  Speaker 2: a 23-year-old son to suicide a few years back and
• 55:24
  Speaker 2: just wasn't he just struggled with it, processing it from
• 55:29
  Speaker 2: all the angles. And it was very, very hard for
• 55:32
  Speaker 2: he and his wife and his family and just a
• 55:35
  Speaker 2: giant hearted man and just, just struggled with sleep, struggled
• 55:39
  Speaker 2: with depression. And it was just quite dysregulating for him. Um,
• 55:45
  Speaker 2: we talked about ketamine as an option. We, we discussed,
• 55:48
  Speaker 2: you know, intentions and talked about, you know, what this
• 55:52
  Speaker 2: might help him with processing and, made sure he had
• 55:55
  Speaker 2: a trusted psychotherapist that he worked with on it as well.
• 55:58
  Speaker 2: And man, I think he did five or six sessions
• 56:03
  Speaker 2: with integration each time. And the changes that I saw
• 56:07
  Speaker 2: from day one to the end of his sessions were
• 56:10
  Speaker 2: just magnanimous. And he didn't start any new medicines or anything.
• 56:15
  Speaker 2: And he's been, I mean, several months now off of it.
• 56:19
  Speaker 2: And I guess it's more than two months ago.
• 56:22
  Speaker 1: But he's been several months.
• 56:24
  Speaker 2: away from the ketamine sessions and he's doing awesome. And
• 56:27
  Speaker 2: he's just integrated and reworked. I think sometimes traumatic things
• 56:32
  Speaker 2: happen to us or difficult things happen to us and
• 56:34
  Speaker 2: we're not sure where to put them. And we've got
• 56:36
  Speaker 2: to put them somewhere here and in our mind and
• 56:39
  Speaker 2: in our hearts. And sometimes they don't fit in both places.
• 56:41
  Speaker 2: We don't have the skills to put them into both places. And,
• 56:44
  Speaker 2: and it's, it's wonky and it can really hurt us
• 56:47
  Speaker 2: and create all kinds of mental, non-wellness. And, um, And
• 56:54
  Speaker 2: so he was suffering, and it was wonderful to see
• 56:57
  Speaker 2: him not just find relief, but find a path to healing,
• 57:02
  Speaker 2: like truly healing. And that's the beauty of these psychedelic spaces.
• 57:06
  Speaker 2: I think they're just incredible.
• 57:08
  Speaker 1: Yeah.
• 57:09
  Speaker 4: Well, thanks for sharing, and thanks for the brave work
• 57:11
  Speaker 4: you're doing and the important.
• 57:14
  Speaker 3: Tools you bring to people when they need the most.
• 57:17
  Speaker 1: Thanks, Dr.
• 57:17
  Speaker 3: Reed.
• 57:17
  Speaker 1: Thank you, Dr.
• 57:18
  Speaker 2: Reed.
• 57:19
  Speaker 1: Thank you, guys.
• 57:19
  Speaker 2: I want to appreciate you again just for coming on
• 57:22
  Speaker 2: and sharing your wisdom and your experiences and your sweet
• 57:25
  Speaker 2: brain cells with us. And for our listeners, hope this
• 57:28
  Speaker 2: helped you. Don't forget to like and subscribe or just
• 57:31
  Speaker 2: go outside and hunt mushrooms and enjoy nature.
• 57:34
  Speaker 1: Thanks, guys. Thanks. Thank you.