Latest / Connect Call / EP05 - Revolutionizing Mental Health: The Power of Ketamine with Jonathan Lowe

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EP05 - Revolutionizing Mental Health: The Power of Ketamine with Jonathan Lowe · Connect Call

0:00
[SPEAKER_01]: Hi, you've reached the voicemail of Hannah Brett with Connect Call, just leave a message and I'll get back to you soon as I can.
0:06
[SPEAKER_03]: Thanks one for more options.
0:09
[SPEAKER_00]: Hey Hannah, we met through a friend of ours recently and I think I told you, I'm very concerned about my sister.
0:18
[SPEAKER_00]: She's been struggling with depression for a very long time and she self-medicated for many years but then she got sober, she's been in treatment a couple times for depression, inpatient unfortunately a couple times and
0:32
[SPEAKER_00]: They just keep trying to change the anti-depressants.
0:36
[SPEAKER_00]: They tried ACT, nothing's really working.
0:40
[SPEAKER_00]: We're looking at TMS next, but I don't know.
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[SPEAKER_00]: I was wondering if you had any other options or recommendations.
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[SPEAKER_00]: If you didn't get back to me, that'd be great.
0:48
[SPEAKER_00]: Thank you.
0:49
[SPEAKER_00]: Hey Hannah, we met through a fr...
0:52
[SPEAKER_02]: Hi, this is Hannah Bright, and on our latest episode of Connect Call, well, first of all, I like to say that I do not have a clinical background, but I do have a PhD for picking up the phone with families in crisis.
1:03
[SPEAKER_02]: And after 20 years of kind of doing this, again, I wanted to do an episode on a topic that I think is very relevant.
1:12
[SPEAKER_02]: And a lot of people have questions about and there's a lot of myths.
1:15
[SPEAKER_02]: and false information out there.
1:17
[SPEAKER_02]: Typically, as you all know, I talk about a caller on these episodes, but today I'm going to actually talk about myself and my own journey with my mental health and why this subject matters really important to discuss.
1:29
[SPEAKER_02]: Well, first, let me introduce, I've got Jonathan Lowe as our guest today.
1:35
[SPEAKER_02]: He is, I used to work with him at a treatment center.
1:38
[SPEAKER_02]: Jonathan, you were like our executive director, right?
1:42
[SPEAKER_02]: Yes, and we used to call him J-Lo, and he is the shit, and I also wanted to bring him on this for this episode because in my experience of the 20 years I'd been out there and listening to different providers and experts, Jonathan, you have been probably my best teacher, like you really explain things to people like myself that don't have a clinical background probably better than anybody I've ever worked with.
2:10
[SPEAKER_02]: So I used to hang on his words when he was spoke and miss you dearly working with you, but So the subject matter we're going to talk about is Well, I got sober 23 years ago And with that it was very black and white, you know, this is sobriety these are the 12 steps Ploboboboblaw and and back in the day even in some some of the
2:36
[SPEAKER_02]: the old old school of AA, which isn't the case anymore.
2:39
[SPEAKER_02]: You know, they were anti-anti-depressants.
2:41
[SPEAKER_02]: You know, they were just like not wanting you on any medication.
2:44
[SPEAKER_02]: And so kind of with my journey is, you know, I went to treatment, got sober, more meetings, more meetings, more meetings.
2:53
[SPEAKER_02]: I think I was on like one anti-depressant that was gonna treat my depression and anxiety.
2:59
[SPEAKER_02]: and kind of what I've learned over these years is all that addiction really is, is mental health and trauma untreated.
3:05
[SPEAKER_02]: So if you're not treating that mental health piece, you're just gonna self-medicate.
3:09
[SPEAKER_02]: And about eight years or 10 years into my sobriety, my depression took such a tank.
3:17
[SPEAKER_02]: Like it just, I went down real fast.
3:19
[SPEAKER_02]: And I had the kind of depression where, I think I'm gonna say now, I'm fortunate, because it wasn't a functional depression.
3:29
[SPEAKER_02]: took me out.
3:30
[SPEAKER_02]: I couldn't bathe, I couldn't sleep, I was in darkness, suicidal ideation, and, you know, for the longest time, I was just trying to figure out where this was coming from, you know, was this something from my reproductive cycle, you know, or like was this something trauma-undreated that I wasn't discussing, but at the end of the day I was running in a like this hamster wheel of
3:56
[SPEAKER_02]: trying all different types of anxiety presence.
3:58
[SPEAKER_02]: I also knew at this time to ask for help.
4:02
[SPEAKER_02]: And I went for like three weeks to a treatment center to get assessed with my mental health.
4:08
[SPEAKER_02]: Didn't really work.
4:09
[SPEAKER_02]: It wasn't enough time.
4:10
[SPEAKER_02]: And also,
4:12
[SPEAKER_02]: Um, I kept having, that's what we'll talk about that in another episode, but when you do insurance driven treatment, sometimes you have a bunch of doctors, so you don't have one person kind of attending to you.
4:24
[SPEAKER_02]: So finally, it got so bad that I was like, all right, well, I want to go to the best in the country.
4:30
[SPEAKER_02]: And at the time, I thought, um, McLean Hospital, which is the teaching hospital for Harvard, um, the guy who ran the addiction unit over there
4:41
[SPEAKER_02]: And I said, whatever I need to do to get in front of Rocco, I want to work with him and see if he can help me.
4:46
[SPEAKER_02]: Maybe put me on a different medication and all that.
4:49
[SPEAKER_02]: This has been 30 days with this amazing doctor.
4:53
[SPEAKER_02]: And after trying a couple more different antidepressants, he came to me.
4:58
[SPEAKER_02]: and said, okay, we have two choices right now, Hannah.
5:02
[SPEAKER_02]: You kind of treatment resistant, and we'll talk more about that.
5:05
[SPEAKER_02]: So I'm going to either recommend, oh, and we will talk about this on another episode, why wasn't a good candidate for TMS at the time, but he recommended either ECT, which is
5:21
[SPEAKER_02]: or he said, you know, recently we've been doing more and more studies.
5:25
[SPEAKER_02]: This was like 10 years ago, yeah, on the ketamine infusions.
5:30
[SPEAKER_02]: And we think you'd be a great candidate to do a ketamine infusion, and like a lot of people out there who weren't informed on ketamine, I immediately went to this place of, no, that's a party drug.
5:42
[SPEAKER_02]: I don't want to go into a k-hole, you know what I mean?
5:45
[SPEAKER_02]: And I was like, oh no, I'm sober.
5:49
[SPEAKER_02]: Give me the ECT, I'd love to do a lecture shock therapy.
5:52
[SPEAKER_02]: And unfortunately, I wasn't a good candidate for ECT.
5:56
[SPEAKER_02]: Didn't do anything for me for some people.
5:58
[SPEAKER_02]: It really works.
5:59
[SPEAKER_02]: But for me, I just lost two years of my memory.
6:02
[SPEAKER_02]: And I circled back to Rocco after a year or two and said, OK, I'm desperate.
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[SPEAKER_02]: I'll do anything.
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[SPEAKER_02]: Just tell me who to go to, who is the best provider to be assessed, to get one of these infusions.
6:16
[SPEAKER_02]: And I felt and I wanted to have Jonathan on this episode and really discuss this topic because in the work that I do today, there's just so much like I said misinformation on these treatments and a big part of why I'm doing this podcast is I don't know everything on everything, but I do know because of my journey.
6:38
[SPEAKER_02]: and watching other people, but more importantly, just dealing with myself, I've tried everything, and I have seen how effective these infusions have been for myself and others.
6:50
[SPEAKER_02]: And so I thought it was the responsible thing to do to put an episode out there to really educate people,
6:57
[SPEAKER_02]: really on what ketamine is, how it's used.
7:00
[SPEAKER_02]: And so, like I said, you are the best teacher that I've had in explaining things.
7:05
[SPEAKER_02]: And so, and I know you do a lot of work today and you're working Tahoe in California with ketamine and Spurvada, the No Spray.
7:14
[SPEAKER_02]: So I guess let's just start from the beginning and keep it real basic.
7:18
[SPEAKER_02]: Like can you explain really what originally these ketamine treatments are and how they're used to treat for depression and how more importantly they are different than an antidepressant that we are trying.
7:30
[SPEAKER_03]: Yeah, um, so great to be on.
7:33
[SPEAKER_03]: It's good to see you guys.
7:34
[SPEAKER_03]: Thank you for having me.
7:35
[SPEAKER_03]: Yeah, hi, by the way.
7:37
[SPEAKER_03]: Um, yeah, so traditionally we have been a trained depression with medications like M.A.O.I.s, T.C.A.s, um, S.S.R.I.S.R.I.s that really focus, typically I'm like one,
7:53
[SPEAKER_03]: It's one small part of the brain, focusing on serotonin, right?
7:58
[SPEAKER_03]: It's focusing on dopamine, focusing on more at the nephrine.
8:03
[SPEAKER_03]: And these are medications when people take them, they quote a quote feels happy.
8:07
[SPEAKER_03]: And we'll get in maybe talk about that a little bit more and where ketamine might pose some difficulties in terms of the research and studies and what we see with it.
8:17
[SPEAKER_03]: or I think of like, you know, medications like, I don't know, benzodiazepines, lexanics, or out of then, other drugs like alcohol, stimulant medications.
8:30
[SPEAKER_03]: These are medications when given to somebody.
8:32
[SPEAKER_03]: They can listen to the feeling.
8:33
[SPEAKER_03]: So if I were giving somebody up to brushing, let's say, one of these drugs and subversals and added to present, they would maybe have this feeling of this sense of like happiness, where we're not truly draining the depression.
8:46
[SPEAKER_03]: Right, we're just causing this shift in this experience, going back to what you were saying about trauma, untruthy trauma, untruthy depression, untruthy mental health issues leading to substance abuse.
8:58
[SPEAKER_03]: I mean, that's 99% of the time when I'm working with patients who struggle with substance use.
9:04
[SPEAKER_03]: So they're just looking not to feel like shit and who wouldn't want
9:09
[SPEAKER_03]: that experience, right?
9:11
[SPEAKER_03]: And if there are these medications that aren't treating the depression, but helping us to not feel depressed in the moment or have that cognitive shift, it's understandable why people would seek those out.
9:22
[SPEAKER_03]: Whereas our traditional antidepressants, they that take maybe weeks to start functioning, really have been leaving a huge part of the population,
9:34
[SPEAKER_03]: it's untreated, you're not treated at all.
9:38
[SPEAKER_03]: So ketamine is interesting, psychedelics in general are interesting.
9:41
[SPEAKER_03]: So when we use the term psychedelics, it's like a broad umbrella, right?
9:46
[SPEAKER_03]: Right.
9:47
[SPEAKER_03]: The broad umbrella might, you know, it has maybe three basic paths.
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[SPEAKER_03]: We have hallucinogens, like LSD, psilocybin, or what some people call magic mushrooms, with empathics, like MDNA, what people call ecstasy, and then we have dissociatives.
10:02
[SPEAKER_03]: And dissociatives is where ketamine and S ketamine land.
10:06
[SPEAKER_03]: And ketamine was really the child of PCP.
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[SPEAKER_03]: PCP was a drug that was meant to be a field analgesic.
10:14
[SPEAKER_03]: We needed something to give outside of the operating room outside the medical equipment to keep respiratory rates.
10:20
[SPEAKER_03]: We needed something that wasn't going to depress the breathing so much, but that we could use to our pain for procedures.
10:28
[SPEAKER_03]: And then the HECP worked really well for some, right?
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[SPEAKER_03]: The problem with PCP was there was a large portion of the human population being treated.
10:40
[SPEAKER_03]: They would have this like very aggressive response to it.
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[SPEAKER_03]: We still use PCP to this day in like veterinary medicine, especially on big cats or big animals, right?
10:50
[SPEAKER_03]: Like you can give some PCP to maybe a big gorilla and they'll stare off into the distance why you you stitch up a small wound, right?
10:58
[SPEAKER_03]: Without having to put them under general anesthesia,
11:02
[SPEAKER_03]: But PCP was really not a great medication for what we wanted it to be, right?
11:09
[SPEAKER_03]: And so in 1960s we have then the child of PCP which is ketamine.
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[SPEAKER_03]: And ketamine worked and is still a fabulous medication for our purpose and still FDA approved for that reason.
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[SPEAKER_03]: decades later, we see, you know, somehow I'm a seasonologist really starts to take an interest in this medication and maybe some of the facts that they didn't expect.
11:34
[SPEAKER_03]: For patients who struggle with depression, receiving ketamine for procedures, depression is going down.
11:40
[SPEAKER_03]: And so was this question of, well, what could this be about?
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[SPEAKER_03]: Why is this helping?
11:46
[SPEAKER_03]: and these patients with depression are not just in the moment, but lasting effects with depression.
11:52
[SPEAKER_03]: And what it comes down to is a couple of things.
11:56
[SPEAKER_03]: One, when we go back to the traditional antidepressant medications and their focus, the reason why these antidepressants potentially may take weeks to work, right?
12:08
[SPEAKER_03]: We typically hear this like forward to see six
12:12
[SPEAKER_03]: Yeah, see this, I have to feel it.
12:14
[SPEAKER_03]: And that's, you know, probably because there was this downstream effect on what are called glutamate receptors or these neurobiological changes that take place that have to do with more than just blocking the re-uptake of serotonin blocking the re-uptake of NARP an effort because if it was just about serotonin and NARP an effort blocker or dopamine blocker,
12:37
[SPEAKER_03]: Then theoretically, we should start seeing results in a couple of days after taking that to depressing for so many patients, that's not true.
12:46
[SPEAKER_03]: Not to say it.
12:48
[SPEAKER_03]: I mean, that does happen from time to time.
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[SPEAKER_03]: I'll have these responders where I prescribe a, you know, a loft in a few days.
12:55
[SPEAKER_03]: They start feeling better, which is great.
12:56
[SPEAKER_03]: And maybe tells me something about serotonins involved.
12:59
[SPEAKER_03]: They're like a process.
13:00
[SPEAKER_03]: They're lucky, right?
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[SPEAKER_03]: And what, you know, the big difference for ketamine and S ketamine is this Potentiation of what's called glutamate.
13:16
[SPEAKER_03]: Now glutamate is the number one excitatory repairative restorative neurotransmitter in our brain.
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[SPEAKER_03]: Think of it like miracle grow for the brain.
13:25
[SPEAKER_03]: okay, it's very fast acting right and and that you know plus a couple of other pieces is it's probably really where we're getting this rapid antidepressant effect from right that and I will say again the
13:42
[SPEAKER_03]: the psychedelic effect, right, or that shift in consciousness effect that is very different from taking traditional answer to presence.
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[SPEAKER_03]: That can help clear symptoms faster because you're having a very different experience and relationship with these medications than you've had with
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[SPEAKER_03]: the prosax of the world or the lots of the world or the, you know, effects of the world.
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[SPEAKER_03]: So that's where it really sets itself apart is just this kind of miracle growth process for your neurotransmitters, you know,
14:26
[SPEAKER_03]: the year neurons along with that speeding up the connection and repairing those broken connections that we often see when we're working with patients who have depression.
14:36
[SPEAKER_02]: Can I ask a question because one thing that I thought, and I'll tell you about my experience a little bit with the infusion, everyone's different, right?
14:45
[SPEAKER_02]: And originally it was
14:48
[SPEAKER_02]: given to me, or they were going to try it on me, because I was having suicidal ideation.
14:54
[SPEAKER_02]: And because it was such a rapid change in hopefully feeling better, right?
15:00
[SPEAKER_02]: And so where I thought it was effective for me was,
15:03
[SPEAKER_02]: and tell me if this actually.
15:05
[SPEAKER_02]: So when doctors give out antidepressants and I used to be a medsales rep and farm a rep and what we would like to see is, you know, sometimes it's brushing or let me.
15:15
[SPEAKER_02]: Now we have gene site where you can swab the mouth and hopefully get a class of drugs that work for you.
15:20
[SPEAKER_02]: But typically when you're dying, when you're giving an antidepressant to somebody, you're going based on, okay, well, Zoloft is done well with all of my patients.
15:27
[SPEAKER_02]: So I'm going to
15:31
[SPEAKER_02]: While I was on my like sixth anti-depressant, they were trying on me, and while I was waiting for that shift for four to six weeks, I was like really depressed, and so where the infusions helped me is for the meantime to get me kind of okay as they're trying out a new med, but my here's the confusion is so
15:54
[SPEAKER_02]: There's like a cycle, I think of like six weeks.
15:56
[SPEAKER_02]: I was on my second one and I remember for myself, waking up the next day and that shift that doctors talk about with the antidepressant, I think I felt with the infusion, like someone just turned my brain on.
16:10
[SPEAKER_02]: Like I remember distinctly waking up and someone said, how did it make you feel like afterwards?
16:15
[SPEAKER_02]: And I said, two days later, it's like I woke up and I was like, all right, I wanna make a healthy breakfast for myself.
16:21
[SPEAKER_02]: I want to go work out.
16:22
[SPEAKER_02]: I actually want to put makeup on today.
16:25
[SPEAKER_02]: It wasn't like I woke up and I was like, yeah, I'm so happy.
16:28
[SPEAKER_02]: But I felt like, oh, there's Hannah.
16:30
[SPEAKER_02]: She just came back.
16:32
[SPEAKER_02]: You know, it was like they just turned that light bulb on.
16:34
[SPEAKER_02]: And that's what was so amazing and still is for me.
16:37
[SPEAKER_02]: My question is, if you're doing that the way I was doing it, how do you know if that anti-depressant is working or if it's just the infusions?
16:45
[SPEAKER_03]: You mean like by doing them together?
16:47
[SPEAKER_02]: Kind of, yeah, because like some people do that while they're trying on a new antidepressant, just to get them through.
16:54
[SPEAKER_03]: Yeah, well, your story, of course, is the story of so many patients.
16:57
[SPEAKER_03]: We have this wonderful study, this metanauts, is called StarD, that it has been reinterpreted since, I think, like 2020, if you guys are 23, also, we kind of re-explored.
17:13
[SPEAKER_03]: StarD was a real important guide in psychiatry and how we prescribe antidepressants.
17:20
[SPEAKER_03]: Right.
17:21
[SPEAKER_03]: And it first, the picture was a lot brighter than the picture is now with the updated interpretation of this study, meaning that if I have a patient who has depression, I'm following kind of gold standard treatments outpatient, looking for something successful for them, I mean, I mean, Jonathan for the first time and I diagnosed with major depression disorder and I prescribe him any number.
17:44
[SPEAKER_03]: of answered to presence based on maybe poor man's genetics like his mom took a fixer and did really well so maybe a fixer or maybe I'm looking more often than not I might be looking to minimize certain side effects that would just be a non-starter for that patient and maybe that's helping me to choose the medication.
18:04
[SPEAKER_03]: pathway.
18:05
[SPEAKER_03]: Not first medication, you can flip a coin on the option, the odds are a little bit less than 50, 50 that that is actually going to go for them.
18:12
[SPEAKER_03]: And by work, I mean, having a response, a response is seeing a 50% reduction in whatever tool that we're using, whether it's a pH cure or a matter, something that the patient reports or the during clinical interview, we kind of mark the symptoms of depression.
18:29
[SPEAKER_03]: We're looking for 50% reduction
18:33
[SPEAKER_03]: Now let's say that that first antidepressant, you know, the patient takes it for the nine 12 weeks, which would be ideal, but a lot of people don't even make it that long, if there's any side effects.
18:45
[SPEAKER_03]: But let's say they take it for that amount of time, and we're not seeing that response.
18:50
[SPEAKER_03]: And we're certainly not getting into remission, which is a step above response, right where the symptoms are clear into the point where I wouldn't be able to diagnose this
19:03
[SPEAKER_03]: you know say that they were in the long office right.
19:07
[SPEAKER_03]: So if I try that second one right that first one was a failure.
19:11
[SPEAKER_03]: Now I'm going to drop the odds down.
19:13
[SPEAKER_03]: There's diminishing returns and this is what the star D data shows that's really important.
19:18
[SPEAKER_03]: If I try that second anti-depressant, I'm going to drop it down probably somewhere in the low 30s or mid 20s right that they're you know, you're going to take this every day and here's the transit we're going to have
19:31
[SPEAKER_03]: Right.
19:32
[SPEAKER_03]: If I have a 23rd, you know, we're probably talking about 12% right really low odds and to hear that from a medical provider and probably not hearing this from your medical providers saying, Hey, Jonathan, I'm sorry, these first two didn't work for whatever reason.
19:49
[SPEAKER_03]: If you try this third option, then take this every day, I will give you a,
19:57
[SPEAKER_03]: 12% chance that you're going to feel better, you know, as patients understandably, like what do you have?
20:02
[SPEAKER_03]: What else do you have?
20:04
[SPEAKER_03]: And that's where these other treatments, like you mentioned, ECT, TMS, other medications that we've used in an adjuncting, whether it's Lotus Antislicotics, like a Bill of Fire, Lithium.
20:15
[SPEAKER_03]: It's a great adjunctive answer to present as well.
20:17
[SPEAKER_03]: Become important, but those are also not right for everybody.
20:21
[SPEAKER_03]: So when the StarD data first came out, the rule of fun was basically from that is that if we if we work this algorithm about two thirds of patients will get responses to their answer to presence right the updated interpretation of these studies it's one third.
20:41
[SPEAKER_03]: Right.
20:42
[SPEAKER_03]: Um, so it's it's not, uh, you know, to say like a one third of patients by following the saga rhythm right to, you know, get these, you know, achieve these goals that we're looking for.
20:52
[SPEAKER_03]: Right.
20:52
[SPEAKER_03]: It's just not great.
20:54
[SPEAKER_03]: And we, we have better medicines out there arguably.
20:59
[SPEAKER_03]: It's just finding the right medicine for the right patient or the right treatment for the right patient.
21:03
[SPEAKER_03]: And
21:04
[SPEAKER_03]: when, you know, with ketamine and S ketamine or and the exploration of other psychedelic treatments that are on the verge of being approved for these types of disorders, the benefit is one is a radical and a radically different experience than you've had with your oral answer to presence, right?
21:30
[SPEAKER_03]: Can I interrupt and we're going to go on with more questions here?
21:34
[SPEAKER_02]: Let me know in this everything you're saying is brilliant, but when do you know?
21:40
[SPEAKER_02]: when you're treating a patient, right?
21:42
[SPEAKER_02]: You're gonna give them one anti-depressant, maybe it's not working.
21:45
[SPEAKER_02]: They're suffering and struggling.
21:47
[SPEAKER_02]: And I gotta tell you some of these struggles with depression and the way I did, every day, felt like a year.
21:53
[SPEAKER_02]: When do you say, you know what?
21:56
[SPEAKER_02]: It's time to try some, you know, an infusion, where we're gonna talk about the, the Spurvada, which is the no spray of, of like a ketamist.
22:05
[SPEAKER_02]: I'm gonna say the word wrong.
22:06
[SPEAKER_02]: But treatment, like when do you know,
22:09
[SPEAKER_02]: this is a treatment resistant person or this is somebody that would be a good candidate.
22:14
[SPEAKER_03]: So treatment resistant, there's no one definition.
22:17
[SPEAKER_03]: Right.
22:17
[SPEAKER_03]: Every insurance company has their own definition for what they've, they consider treatment resistant.
22:23
[SPEAKER_03]: Right.
22:24
[SPEAKER_03]: The bottom line across all all studies and all use of the language of insurance companies is a trial and failure, but at least two active
22:34
[SPEAKER_03]: right now some insurance companies will say no it actually needs to be three or it needs to be two of different types and or it needs to be right an SSRI with an SNRI or an SSRI with an adjunct event icycotic an appropriate dose for appropriate amount of time that can be different where i start to think about these interventions is at the after that second trial
22:59
[SPEAKER_03]: Now, in many of the studies that were done with ketamine and us ketamine, patients were more likely to respond to the treatment if they had tried and failed.
23:12
[SPEAKER_03]: multiple answer depressive.
23:14
[SPEAKER_03]: So two, three answer depressants, rather than the patient who may be only tried and failed with one.
23:19
[SPEAKER_03]: Right.
23:20
[SPEAKER_03]: So, you know, for me, what it comes down to is what makes sense for the patient, we can talk about like, what good patient profile, like who's a good candidate for this, and maybe who's not?
23:31
[SPEAKER_03]: that will be a question.
23:32
[SPEAKER_03]: Thank you.
23:33
[SPEAKER_03]: Okay, Gold.
23:34
[SPEAKER_03]: Um, so because again, if I'm being prescribed another pill, right, and I'm already coming from a place where like this stuff's not working.
23:42
[SPEAKER_03]: I'm already coming from a place of kind of losing hope.
23:45
[SPEAKER_03]: Right.
23:46
[SPEAKER_03]: Um, I'm praying.
23:49
[SPEAKER_03]: Yeah.
23:51
[SPEAKER_03]: And where I like these alternative treatments, whether it's TMS or ECT or ketamine or S ketamine or other psychedelic treatments, is that it radically changes your relationship with how you're engaging with your treatment.
24:06
[SPEAKER_03]: It's a very different experience than taking a pillow every day.
24:10
[SPEAKER_03]: It is.
24:11
[SPEAKER_03]: And I think that a lot of, there's a lot of benefit to that when I've kind of been in these bad relationships with medicines over and over again to really shift that relationship in a meaningful way.
24:27
[SPEAKER_03]: Right.
24:28
[SPEAKER_03]: And then there's this whole other piece of these treatments when it comes to ketamine and S ketamine and other psychedelic treatments where we see this, you know,
24:41
[SPEAKER_03]: this boundlessness, right, this shift in cognition that is typically very, very positive where we feel much more, not just connected to ourselves, but connected to something bigger than us, because depression is a very lonely place to be, right?
24:58
[SPEAKER_03]: We could be in a,
25:01
[SPEAKER_03]: a group therapy treatment with ten other people with depression, and we all feel utterly alone.
25:06
[SPEAKER_03]: Right.
25:07
[SPEAKER_03]: And to have medicines that not only treat the depression on a neurobiological level, right, and that neurochemistry, but also have this amazing ability for many patients to help them just feel connected to their life again, like you said, getting up and like wanting to make myself a healthy breakfast.
25:25
[SPEAKER_03]: and just to engage, it's so, so important, and these treatments offer a very, really, really fast and effective pathway to that.
25:35
[SPEAKER_02]: I think, you know, something I definitely want to talk about now is because it was, it's sad, but, you know,
25:41
[SPEAKER_02]: as a treatment specialist helper, as you may call the shame I felt for some reason of me just struggling with my mental health.
25:50
[SPEAKER_02]: I mean, now today I know like it makes me a better me, makes me better at my job, makes me better for helping people because I have walked that walk with these people.
25:59
[SPEAKER_02]: I know when people are struggling, what that feels like.
26:03
[SPEAKER_02]: I think what was frustrating and still is, and it's still very rampant out there, is in our industry, or those who are sober, right, you know, or NAA, and I come across this, this shame of and misinformation of what these, what the treatments are.
26:21
[SPEAKER_02]: So I remember when
26:23
[SPEAKER_02]: Um, we were recommending somebody at my old job for an infusion.
26:29
[SPEAKER_02]: Some of my colleagues are like, oh, they're going to go into a cable, you know, or like, hey, why don't we just set up people just a fucking trip?
26:36
[SPEAKER_02]: And I'm like, you're so not informed.
26:39
[SPEAKER_02]: You still have no idea what you're talking about.
26:41
[SPEAKER_02]: I think also, with all due respect, just like purple fall with Michael Jackson, you know, we still use purple fall, although that was his babe, he called it his milk and he was addicted to it.
26:51
[SPEAKER_02]: And he, you know, for those of you who don't know purple fall is, it's a really nice night time kind of not anesthesia, but it kind of puts you out for a baby nap and brings you back up when you're doing like minor surgeries.
27:02
[SPEAKER_02]: But that was addictive for him and just like that, you know, we got these stories about Matthew Perry, you know, and and I remember when they came out about him, you know, unfortunately he died and a part of what they found in the system was ketamine, I knew.
27:20
[SPEAKER_02]: that he had vials and vials prescribed to him by a doctor who his assistant was just shooting up, right?
27:28
[SPEAKER_02]: I, I knew he was a, we all knew he was abusing it, but I think at the time what was just so like frustrating.
27:37
[SPEAKER_02]: as someone who sees the benefits of these infusions is a kind of kid ketamine a really bad name for a second.
27:42
[SPEAKER_02]: And so, or, you know, you should be the horse tranquilizer.
27:46
[SPEAKER_02]: So I guess, like, can you separate some myths out there from some facts?
27:51
[SPEAKER_02]: Because I feel like people don't really under, like, the myths out there are that it's just going to be addictive.
27:59
[SPEAKER_02]: You know, or and I will say as somebody who has that brain when I'm going in for my infusion when I leave it does not turn on that let's go more let's do more it really doesn't for me.
28:13
[SPEAKER_03]: Right.
28:13
[SPEAKER_03]: And yeah, it's good.
28:16
[SPEAKER_03]: And that's what so many patients report.
28:18
[SPEAKER_03]: And in fact, newer forms of ketamine that are on the cusp of being approved for medical use by the FDA are focused purely on addictive disorders.
28:30
[SPEAKER_03]: We know that these types of medicines have shown a long time, a lot of benefit for rapid response and helping with addiction.
28:40
[SPEAKER_03]: Now, we have studies, and then we have real-world studies, right, where we track populations over time once the medication is out, kind of being used in the real-world, and there's some differences between those.
28:51
[SPEAKER_03]: But when it comes down to the abuse potential, you can abuse a whole lot of things when you're lost.
28:58
[SPEAKER_02]: I take out a tent, and I can take the bottle and go crazy, probably.
29:02
[SPEAKER_03]: We can be, yeah, in a grocery store or in our home, on our kitchen under our sink, there's plenty of things around that can be abused when we're using them for purposes that they weren't intended for, right?
29:15
[SPEAKER_03]: Right.
29:15
[SPEAKER_03]: Use becoming an addiction when the focus on the use about substance is so high that it's taking precedent over other activities in our daily life.
29:25
[SPEAKER_03]: Right.
29:27
[SPEAKER_03]: you know, it's impairing our ability to be a partner or go to work, go to school, it's taking that much of our focus where now it is an addiction.
29:34
[SPEAKER_03]: And when it comes to ketamine, the first thing to understand is that the data that we have out there is that ketamine related deaths are extremely extremely low, right?
29:49
[SPEAKER_03]: So there are, you know, there was a meta-analysis down in the UK that's spanned
29:55
[SPEAKER_03]: I think like almost a decade from the late 90s or mid 90s to almost a like 2017, where there was four deaths attributed to ketamine.
30:07
[SPEAKER_03]: And then it doesn't even know ketamine was listed as this may be the singular drug fund in their system that still unclear did the ketamine cause that person to die.
30:17
[SPEAKER_03]: is you have to take a lot of ketamine for ketamine to depress your breathing so much or to cause an event that is so severe that that is the thing that makes you pass away, right?
30:28
[SPEAKER_02]: He also had other drugs in his system too.
30:30
[SPEAKER_03]: Well, here's the thing, right?
30:32
[SPEAKER_03]: It's that most ketamine deaths are attributed to accidents that are related to things that happened while the person was on ketamine, right?
30:41
[SPEAKER_03]: So when somebody is driving and toxicated from alcohol and dyes and motor vehicle accident,
30:49
[SPEAKER_03]: We don't say that they died because they had an alcohol overdose.
30:53
[SPEAKER_03]: Right.
30:54
[SPEAKER_03]: Alcohol was involved in a huge piece of that.
30:57
[SPEAKER_03]: Right.
30:58
[SPEAKER_03]: The same thing was like I think of Matthew Perry.
31:01
[SPEAKER_03]: It was drugs.
31:03
[SPEAKER_03]: Unfortunately, it was left alone on a variety of substances including ketamine and drowned.
31:11
[SPEAKER_03]: Right.
31:13
[SPEAKER_03]: And he was put in a, you know, a really, really unsafe environment, right, with a high dose of the lot of things, right.
31:23
[SPEAKER_03]: The high dose.
31:24
[SPEAKER_03]: So when we're talking about the clinical use, there is no research out there to show that there is an addictive or dependency quality to the use of ketamine when used appropriately in these clinical settings.
31:37
[SPEAKER_03]: Right, pedamine abuse usually involves a use of a gram or more right of ketamine daily right for our kind of our ketamine abusers and it's all about access.
31:49
[SPEAKER_02]: That's a lot.
31:51
[SPEAKER_03]: So PCP is pretty easy to make, right?
31:53
[SPEAKER_03]: I'm not going to give you the recipe, but it is not that difficult to kind of set up shop and make PCP at home.
32:00
[SPEAKER_03]: Chetamine is very difficult, right?
32:03
[SPEAKER_03]: So the ketamine that we see on the streets, one is that sometimes it's not ketamine, outtations to believe that they have been using ketamine in a party and we test their urine, meat centered off for advanced testing, and it is not ketamine.
32:17
[SPEAKER_03]: Right.
32:18
[SPEAKER_03]: We see higher rates of ketamine abuse in like Asia where we have a lot of the manufacturers of the world's ketamine because there's a lot of, you know, there's just more available to them.
32:32
[SPEAKER_03]: Right.
32:32
[SPEAKER_03]: Right.
32:32
[SPEAKER_03]: Right.
32:32
[SPEAKER_03]: Right.
32:33
[SPEAKER_03]: Here in the US, we just don't have it widely available.
32:36
[SPEAKER_03]: It's either being diverted from, oh, yeah, go ahead.
32:40
[SPEAKER_02]: Well, no, I was going to say, actually, what I saw, and I think you saw too, and that's a whole another subject is, and I tried it because I was in the UK and I was stuck and they were behind and they didn't have the infusions.
32:53
[SPEAKER_02]: During COVID, we started this whole influx of,
32:58
[SPEAKER_02]: you can go online and be assessed by these doctors.
33:01
[SPEAKER_02]: And if you work and did it, then you got the trotchase or you got, you know, things sent to you and trotchase like a, like a, it's like a coffee trotchase.
33:09
[SPEAKER_03]: Yeah.
33:09
[SPEAKER_03]: Yeah.
33:10
[SPEAKER_03]: Yeah.
33:10
[SPEAKER_03]: Good.
33:10
[SPEAKER_02]: Well, I don't see your tongue.
33:12
[SPEAKER_02]: To me, I will say, it, it, it,
33:15
[SPEAKER_02]: it didn't hold a candle to the infusions.
33:19
[SPEAKER_02]: But it really gave access to a lot of people that wouldn't give access to a lot of people.
33:25
[SPEAKER_03]: And there are some, I think dangers into that home style treatment, where we're now sending, like you said, Losgis or tropeys, or even some detainees and jackions of Academy now to patients in the home.
33:42
[SPEAKER_02]: There are sending injections of ketamine to people now.
33:45
[SPEAKER_03]: They are.
33:48
[SPEAKER_03]: And I'm not going to say, I mean, to the right patient, the right circumstance, like, right.
33:52
[SPEAKER_03]: I think as long as somebody is getting to help if they need, I think that's the most important thing.
33:58
[SPEAKER_03]: And it's all about access.
33:59
[SPEAKER_02]: But for me, if you were, I was stuck in Europe during COVID.
34:04
[SPEAKER_02]: And again, literally, I think there was one doctor in London who was
34:12
[SPEAKER_02]: And just to speak to him was like $1,200 for getting on the occasion, but I needed in that moment in case of an emergency or I was going down that I had something right, but and I think that's that's also leading to the next question is, you know, and I do want you to.
34:30
[SPEAKER_02]: I want you to explain the difference to the infusion and also this pervato, which you do.
34:36
[SPEAKER_02]: But before that, here's where there's been a lot of debate.
34:40
[SPEAKER_02]: So we both work to Detreatment Center where we focused on adolescents and young adults, right?
34:46
[SPEAKER_02]: And
34:47
[SPEAKER_02]: Do you feel, I guess the rule still apply for adolescents in young adults if they've tried two or three treatments of antidepressants and it's not working?
34:56
[SPEAKER_02]: It's a case by case, right?
34:58
[SPEAKER_02]: And I think what I'm seeing in the treatment world, which I think is good and people are freaking out, but I think it is good, is some programs now are offering those infusions as part of the treatment.
35:11
[SPEAKER_02]: And I think for certain people that really struggle with depression and I say this because, you know, and I do get really defensive now because it's like unless you've walked in the shoes of wanting to die like you have no idea and
35:26
[SPEAKER_02]: People like me were so desperate just to feel normal.
35:30
[SPEAKER_02]: I didn't want to get high.
35:31
[SPEAKER_02]: I didn't want to dissociate.
35:34
[SPEAKER_02]: I just wanted me back.
35:36
[SPEAKER_02]: And so I was then open, I mean, I would have done high-oast got, I would have done anything just to feel normal.
35:42
[SPEAKER_02]: And part of also why I do this podcast is to talk about, like there's not one way to recover.
35:47
[SPEAKER_02]: There's not one way to,
35:51
[SPEAKER_02]: give yourself the best life.
35:53
[SPEAKER_02]: And so I want to expose our viewers and listeners to all different types of treatments.
36:00
[SPEAKER_02]: With that, can you explain, because I do infusions, but some people do the no spray, which you treat with.
36:06
[SPEAKER_02]: Can you explain the difference?
36:09
[SPEAKER_03]: Yeah, so ketamine is a mixture of both what's called S ketamine and R ketamine, and what we've done, or what we've done, what Jansen is done, is that they have, so ketamine, like you said, it can be very expensive because it's not FDA-proof training mental health purposes, right, go to these ketamine clinics, whether it's online or in person, right, it's really that what is the market supporting in terms of cost, right, and access.
36:35
[SPEAKER_03]: And so now we have S Academy and the brand name is Spurvado and it is only FDA approved for mental health treatment.
36:44
[SPEAKER_03]: It's FDA approved for treatment resistant depression as we discussed like there's different definitions from different insurance companies.
36:52
[SPEAKER_03]: And it's also improved for major compressor with acute suicidal ideation.
36:58
[SPEAKER_03]: And it has ketamine in its studies is one of only really three psychiatric drugs that have shown to help with suicidal ideation.
37:05
[SPEAKER_03]: We have us ketamine, we have lithium.
37:08
[SPEAKER_03]: And then we have an anti-psychotic called closed pain, but that's a very narrow population that we're seeing that drug for, right, to help with suicidal ideation.
37:18
[SPEAKER_03]: Um, and it's it's as a factor of those ECT.
37:21
[SPEAKER_03]: I mean, that's job.
37:22
[SPEAKER_03]: Yeah.
37:23
[SPEAKER_03]: So, yes.
37:24
[SPEAKER_03]: Good job, right?
37:25
[SPEAKER_03]: Yeah.
37:26
[SPEAKER_03]: So, so ask Catamine basically just takes a part, right?
37:32
[SPEAKER_03]: Um, just like a half of what makes up Catamine.
37:36
[SPEAKER_03]: When we do this with some drugs, when we kind of split them, we can create drugs that are more quoting quote potent, or maybe have a more of an affinity for their mechanism of action, like a higher stronger mechanism of action.
37:50
[SPEAKER_03]: So that's what we have found with us ketamine, is that I can now give, you know, 56 or 84 milligrams of the two doses,
38:02
[SPEAKER_03]: outpatient, and the beauty of it is it's covered by insurance.
38:05
[SPEAKER_03]: So for me, it's not that I prefer one over the other.
38:09
[SPEAKER_03]: Yes, it's right.
38:09
[SPEAKER_03]: What's right for the patient?
38:11
[SPEAKER_03]: What can the access?
38:12
[SPEAKER_03]: A lot of my patients are on, and our state's Medicaid, right, or Medicare, and to ask them to spend a few thousand dollars on infusion treatments at our local infusion plant.
38:25
[SPEAKER_03]: It's right, outrageous and impossible, and so I wouldn't want to suggest something that they wouldn't be able
38:32
[SPEAKER_02]: I spent $350 injection or infusion, but now my doctor is able to kind of bill it for insurance, but I remember for those, I just hadn't tried this provider than this, right?
38:44
[SPEAKER_02]: But I remember the selling point was, it's just like the infusion you have to do in the doctor's office, but the insurance will pay for it, which is so infuriable paperwork.
38:52
[SPEAKER_03]: Yes, yeah.
38:53
[SPEAKER_03]: So same thing kind of like as the infusion where my patients are under my care and recovery for at least two hours, they're monitored and wow, you know.
39:04
[SPEAKER_03]: in my office.
39:05
[SPEAKER_03]: But the efficacy rates, right?
39:09
[SPEAKER_03]: I think it depends on who you talk to.
39:11
[SPEAKER_03]: If you try to ketamine clinics, they might point to one study and there are studies out there that say like IV ketamine is the gold standard and that's why it's worth the few thousand dollars that we're going to ask for this, right?
39:22
[SPEAKER_03]: Right.
39:23
[SPEAKER_03]: Right.
39:23
[SPEAKER_03]: And IV ketamine can be awesome, but again, very expensive.
39:27
[SPEAKER_03]: Yes, however, if we look at all of the studies broadly, there's really not a significant difference in terms of the effectiveness of S ketamine versus IV ketamine.
39:39
[SPEAKER_02]: That's good to know.
39:40
[SPEAKER_03]: It's just a huge, cost difference in accuracy difference.
39:43
[SPEAKER_03]: Right.
39:45
[SPEAKER_03]: And some of the studies that were done because most of them were done with just these like real world patient trials is we have to remember that the patients that are receiving IV ketamine are probably patients at least have means enough to where they can afford that and we know that patients who aren't
40:04
[SPEAKER_03]: financially struggling right have better rates of their depression clearing than say my patients who are State assistance or like state one Insurance right So we've been looking at data Yeah, we all when we look at the data.
40:21
[SPEAKER_03]: It's just I think basically what I tell patients is that there's not one that's better than the other It's which one is right for you in your current right
40:30
[SPEAKER_02]: And when I started, there was no no spray and I always say to people, you know, it is crazy how much money I do spend on my mental health.
40:39
[SPEAKER_02]: But I say there is no price tag on my sanity, you know, like when you're feeling like you're wanting to die, yeah, I'll drop a thousand on my credit card, just help me feel better, you know, and I mean, and I think, yeah.
40:52
[SPEAKER_02]: And unfortunately, that's a whole other conversation because trust me, I have fought with many insurance companies who thought I wasn't depressed enough, where I hadn't tried enough treatments, which is a joke.
41:05
[SPEAKER_02]: But also, I think it's important, and I can speak on this too, but talk on the nose, very what do patients typically feel when they're getting the treatment?
41:12
[SPEAKER_02]: Like, what goes down?
41:14
[SPEAKER_03]: Yeah, so it can be a whole variety of things.
41:18
[SPEAKER_03]: Again, this is a dissociative that kind of has chemical psychedelic treatment.
41:23
[SPEAKER_03]: So, or psychedelic, I won't say it goes quite so far as to say psychedelic, that like kind of lighter experience, and it can be everything from
41:35
[SPEAKER_03]: I don't think there was anything in this no spray today because I didn't feel quote unquote anything right to these very mystical and spiritual experiences yes what we know from the researchers regardless of the experience even for patients who come in and they don't quote unquote feel anything for the medication that doesn't That doesn't diminish the effects of the antidepressant qualities would I like my patients to feel more connected to
42:04
[SPEAKER_03]: a higher power or to humanity or to themselves.
42:08
[SPEAKER_03]: Of course, I want them to have wonderful experiences.
42:12
[SPEAKER_03]: But I know that that is not a requirement for the treatment itself.
42:17
[SPEAKER_03]: So the overall effect would be that they come in, we take their blood pressure, we check their O2 saturation, we kind of do our little pre-screener, we lay them down, and a comfy comfy chair, and I mask because having your eyes closed,
42:39
[SPEAKER_03]: ketamine is not a drug at these doses where your eyes were open.
42:44
[SPEAKER_03]: It would be causing an individual hallucinations, but when your eyes are closed, you certainly will travel.
42:49
[SPEAKER_03]: I've had patients end up hiking in Vermont from their chair.
42:54
[SPEAKER_03]: I've had patients end up in boats surrounded by myers, lendons, and powdered sugar.
43:00
[SPEAKER_03]: A lot of patients will end up in outer space or some reason ketamine and us ketamine seem very connected to space.
43:06
[SPEAKER_02]: Right.
43:07
[SPEAKER_02]: I came up with the name of this podcast on an infusion to be honest with you.
43:11
[SPEAKER_02]: I literally was an infusion and I got myself in crisis.
43:14
[SPEAKER_02]: People make a call at call and I'm going to do a connect call and I came out going, yes, I got the name.
43:20
[SPEAKER_02]: That's it.
43:21
[SPEAKER_03]: I got it.
43:21
[SPEAKER_03]: Right.
43:21
[SPEAKER_03]: Yeah, it's it's fascinating what we can experience when you're under the
43:26
[SPEAKER_03]: kind of guided and purposeful and intentional use of these types of substances for these purposes.
43:33
[SPEAKER_03]: Right.
43:33
[SPEAKER_03]: It's really cool.
43:34
[SPEAKER_03]: I've worked with a lot of cancer patients.
43:38
[SPEAKER_03]: So these are regions with digger on palliative care and the life.
43:44
[SPEAKER_03]: Right.
43:44
[SPEAKER_03]: And I can't
43:46
[SPEAKER_03]: I mean, I've got multiple patients where they've been taking traditional acid depressants, right?
43:52
[SPEAKER_03]: And not seeing any benefit and going to hours and hours of therapy.
43:57
[SPEAKER_03]: And they will come in for one S ketamine treatment, even though there's usually it's a set of 12, right, that we do to start off with.
44:05
[SPEAKER_03]: And they will come out having this huge breakthrough.
44:09
[SPEAKER_03]: All right, I've had a young man who,
44:13
[SPEAKER_03]: was so afraid that he hadn't even told his parents and his loved ones that he was dying of cancer.
44:20
[SPEAKER_03]: He just wouldn't talk about it.
44:22
[SPEAKER_03]: He wouldn't talk about it.
44:22
[SPEAKER_03]: Therapy wouldn't talk about it.
44:24
[SPEAKER_03]: Anybody, but then after this experience and what he felt was this connection and kind of an understanding of what happens to us after we die, right?
44:36
[SPEAKER_03]: That happens for a lot of people.
44:39
[SPEAKER_03]: that it was completely transformative.
44:42
[SPEAKER_03]: He's been able to talk about it openly, except that he was going to die and come from a place that was really genuine, like it's just drugged because the drug itself is not in our system for very long, right?
44:55
[SPEAKER_03]: So we know it's not that drugged experience by itself that is the fix.
45:00
[SPEAKER_03]: It's a miracle grow on the brain and what happens after in the days, the months after we have this treatment.
45:08
[SPEAKER_03]: We just want to try and create a support of environment to help patients with in any way that we can have an experience that means something more than just ingesting the drug itself.
45:22
[SPEAKER_02]: I'm glad you brought that up because, you know, my mother, unfortunately, passed away four years ago from terminal cancer.
45:28
[SPEAKER_02]: And this was, you know, she was very growing up, very British English, they didn't take pills.
45:34
[SPEAKER_02]: It was okay if I did therapy and took pills, but my mom was like, not a pill, polka, and she just wouldn't do anything.
45:40
[SPEAKER_02]: And I remember her white knuckling, my whole life, anxiety and depression.
45:45
[SPEAKER_02]: And when we found out she was
45:48
[SPEAKER_02]: terminal.
45:48
[SPEAKER_02]: I literally said I can watch you physically decline.
45:52
[SPEAKER_02]: I can't watch you mentally decline in that for the love of God.
45:56
[SPEAKER_02]: I beg of you.
45:57
[SPEAKER_02]: Let's just do a little antidepressant.
45:59
[SPEAKER_02]: But I remember at the time I said to the doctor, I wish you guys would do an infusion with her.
46:03
[SPEAKER_02]: Like we have nothing to lose and everything to gain.
46:07
[SPEAKER_02]: And again, we were in the UK.
46:09
[SPEAKER_02]: It was still very behind on things.
46:12
[SPEAKER_02]: But just on my own experience with these infusions, I will say this because when people are like, what is it like?
46:17
[SPEAKER_02]: I go, it's honestly like the best, because I'm the same thing.
46:21
[SPEAKER_02]: I'm putting this like real comfy lounger.
46:23
[SPEAKER_02]: I get a little fleece blanket in a pillow and I mask.
46:26
[SPEAKER_02]: I also bring my own playlist.
46:29
[SPEAKER_02]: That brings me just to this call for someone like me who's non-stop in my head and just like ADHD and It slows me the fuck down and it literally just I sometimes go in with intention But it literally just brings you to the subconscious place kind of of and many things have happened I'm gonna have seen my mom in an infusion, but I'm not high.
46:54
[SPEAKER_02]: It's weird.
46:55
[SPEAKER_02]: You know, but I think
46:58
[SPEAKER_02]: You know, I tell people like it's just like a really good just like if to me if it's meditation if I could do if I could meditate, you know, it just takes me to such a different calm place.
47:12
[SPEAKER_02]: the next question I am going to ask is just because I know with me, I've had, so I'll say this, I'll get an infusion at 9 a.m. and I'll start working at 12.
47:22
[SPEAKER_02]: Like it's out of my system, I'm not driving, but I'm ready to work.
47:25
[SPEAKER_02]: You know what I mean?
47:26
[SPEAKER_02]: So it doesn't take me out for the whole day.
47:28
[SPEAKER_02]: What I have noticed, it do sometimes with side effects is sometimes it'll make me hungry.
47:34
[SPEAKER_02]: It's weird.
47:35
[SPEAKER_02]: Sometimes
47:37
[SPEAKER_02]: I'll do an infusion and I'll be really tired, but sometimes it just wakes me up.
47:44
[SPEAKER_02]: But another thing that I found out about is it really, like, which is they ask you to use the restaurant before you go because it can really kick up your bladder.
47:53
[SPEAKER_03]: Yes.
47:53
[SPEAKER_02]: And so I've had an infusion where it was just like I kept walking to the bathroom because it was just I felt like it just had to go all the time.
48:02
[SPEAKER_02]: So that found that really interesting.
48:04
[SPEAKER_02]: But do you have do you know of any side effects from your patients or anything they they found uncomfortable or not have like to me there's nothing compared to a bad side effect of an antidepressant and I don't feel any of that with the ketamine.
48:20
[SPEAKER_03]: Yeah, and the nice thing about ketamine and S ketamine is that the half life is so short, right?
48:25
[SPEAKER_03]: And any negative side effects that you will experience are going to dissipate within hours, right?
48:31
[SPEAKER_03]: Right.
48:32
[SPEAKER_03]: So, you know, when we're talking about high dose ketamine or ketamine abuse,
48:37
[SPEAKER_03]: or we know that those can cause serious problems with our bladder, right, long-term.
48:42
[SPEAKER_03]: Like really serious problems with our bladder, used in appropriate doses like with infusions or if that's how to mean an intranazile spray, it doesn't cause, we've got, with that's how to mean a lung, right?
48:55
[SPEAKER_03]: We are monitoring this drug so closely in the outcomes.
48:58
[SPEAKER_03]: We've got a well over six years of data that
49:01
[SPEAKER_03]: that prove, yeah, that absolutely show that there are no long-term negative effects that you see with Academy of Use, the progress of the facts, right?
49:13
[SPEAKER_03]: The dissociation that comes with it, right?
49:16
[SPEAKER_03]: It's expected, right at some point, but you might experience that your feelings are dissociated.
49:22
[SPEAKER_03]: And the way I kind of like to help patients who never experience this room before understand it and understand dissociation is I use the following analogy if I go to an art museum and I can look at a piece of art on the wall and it can bring you to tears.
49:39
[SPEAKER_03]: or I can look at another piece of art and it can make me feel existential terror or another piece of art that makes me feel joy and happiness.
49:47
[SPEAKER_03]: But the feeling that it's being elicited, it's not the same thing as being scept into the painting.
49:52
[SPEAKER_03]: It's not the same thing as being depressed.
49:54
[SPEAKER_03]: Right?
49:55
[SPEAKER_03]: The painting is on the wall and viewing it.
49:57
[SPEAKER_03]: But when we are in the dissociative space, we're still allowed to feel things and see things.
50:03
[SPEAKER_03]: But we have this distance between us.
50:05
[SPEAKER_03]: Right?
50:05
[SPEAKER_03]: Um, that's what the dissociation does, right?
50:08
[SPEAKER_03]: It could just treat some space.
50:10
[SPEAKER_03]: The medication itself becomes an art house curator.
50:14
[SPEAKER_03]: So even if I go into the experience with the intention that I want to look at things that just make me happy.
50:24
[SPEAKER_03]: Right, the drum kind of decides like, no, I want you to look at this and I want to look at that, but it's right now you're going to look at this and you're going to look at this for what might feel like an attorney, even though the effects, it's really only 30 minutes it might feel like you'd been here forever.
50:42
[SPEAKER_03]: Right.
50:42
[SPEAKER_03]: Right.
50:43
[SPEAKER_03]: And that's that's the effect of the medication.
50:46
[SPEAKER_03]: The so for for patients in terms of the side effects.
50:50
[SPEAKER_03]: Yes, that increased frequency of your nation.
50:54
[SPEAKER_03]: So yeah, we ask patients not to eat anything two hours right treatment or drink anything half hour.
51:00
[SPEAKER_03]: Again, it's not because this isn't surgery, I just want them to be comfortable and if they're in a deep state of self exploration.
51:07
[SPEAKER_03]: I don't want to have them get up and pee.
51:09
[SPEAKER_02]: And that's rare that that's happened to me, like maybe one or twice in all my years.
51:14
[SPEAKER_02]: And I just have to say, you're analogy with, this is why I adore you because you do these like, I just wish you taught everything like you really need to do your own podcast too.
51:29
[SPEAKER_02]: And I'll use that analogy.
51:31
[SPEAKER_02]: You set an analogy.
51:32
[SPEAKER_03]: Yeah, yeah, figure free.
51:33
[SPEAKER_03]: It's yours.
51:34
[SPEAKER_03]: Yeah.
51:36
[SPEAKER_03]: And so where can be really difficult those side effects of dissociation?
51:40
[SPEAKER_03]: Where I'm really doing a lot of exploration, you know, prior to treatment to make sure it's the right treatment for somebody.
51:47
[SPEAKER_03]: Right.
51:48
[SPEAKER_03]: Somebody who we're dissociating, you know, having that drug to feeling or being dissociated, right, is going to affect them negatively.
51:58
[SPEAKER_03]: in the research that was done prior to the medications being used in the market, there didn't seem to be any response to difference between patients who had what's called bareline personality disorder and might have dissociation from that itself.
52:13
[SPEAKER_03]: But in practice, that is a patient population.
52:16
[SPEAKER_03]: You need to be very cautious of because there can be some potential negative effects for that population with the use of this medication.
52:23
[SPEAKER_02]: Can I ask on that so part of, you know, my journey in helping people, I've helped, you know, some families and some children who have survived school shootings.
52:34
[SPEAKER_02]: And I was working with this one child who still in my life and I adore her, who was telling me she survived Parkland.
52:42
[SPEAKER_02]: And she was in one of the classrooms where most a lot of
52:47
[SPEAKER_02]: three to four kids, I think were killed in front of her.
52:50
[SPEAKER_02]: And one of the treatments they tried for the PTSD was she went to Yale to do a trial with treating her PTSD with the ketamine.
52:59
[SPEAKER_02]: For her, it wasn't effective, but what was the goal in that?
53:02
[SPEAKER_02]: Like, like, you talk anything on that because that was interesting to me with treating PTSD.
53:08
[SPEAKER_03]: Yes, it's like about some general, there's been a big interest in treating PTSD.
53:13
[SPEAKER_03]: If we think about the M.D.M.A.
53:15
[SPEAKER_03]: trials, I think about the use of psilocybin, right now being used in treatment centers in Oregon and Colorado, for example, which is awesome.
53:24
[SPEAKER_03]: So psychedelics, I think it, you know, kind of is a blanket, right, can help with trauma and have certainly seen as ketamine and ketamine help with trauma with my patients, and even patients who, it becomes like a, like a therapy booster, right, so then that glutamate burst.
53:43
[SPEAKER_03]: write that article, grow on the brain.
53:46
[SPEAKER_03]: What I explain to patients, it's not the drug itself that is that fix, because if it were, and I had to be on a steady bloodstream of ketamine in order for this to be affected every day of my life, this wouldn't be realistic treatment.
54:00
[SPEAKER_03]: Right.
54:00
[SPEAKER_03]: Getting the medicine in, so it can help that glutamate first, letting the medicine go, and then understanding what to do with that miracle grow.
54:09
[SPEAKER_03]: So if I've got miracle grow on a garden,
54:11
[SPEAKER_03]: it doesn't matter if I didn't plant the right seeds or if I don't tend to my garden.
54:16
[SPEAKER_03]: So for patients who are having struggles with maybe traditional EMDR treatments or treatments for therapy treatments, top therapy treatments for PTSD, these medications can really help them break through and I've seen that multiple.
54:33
[SPEAKER_03]: Right.
54:33
[SPEAKER_03]: Oh, like
54:34
[SPEAKER_03]: I have multiple examples of and I found some treatments that something we haven't really talked about.
54:40
[SPEAKER_02]: Sorry.
54:40
[SPEAKER_02]: But yeah, no.
54:42
[SPEAKER_02]: Is something people have done and this is part of it too.
54:45
[SPEAKER_02]: We call it cap therapy, where it's where basically you're doing the infusion, you're going to this place subconsciously.
54:53
[SPEAKER_02]: And there's a therapist in the room who is interacting with you to kind of like you said, like all those other traditional treatments didn't take that wall down.
55:03
[SPEAKER_03]: and it allows or it or it's didn't take that wall down because these are walls that we build up to protect ourselves right and youngy and psychology we have this idea of like what's called the shadow cell like things about my life or my experiences that I push off into the shadows that I don't want to bring light to because I have to function I have to go to work I have to be right to go to school I kind of have to get through and so I don't want to
55:30
[SPEAKER_03]: bring this out of the shallows.
55:32
[SPEAKER_03]: I just want to stick this.
55:33
[SPEAKER_03]: When we take these medicines back to that art house curator, oftentimes they will just come right out into the light.
55:40
[SPEAKER_03]: And so again, for my patients who have done cap types of therapies, it's amazing what they will share.
55:48
[SPEAKER_03]: And again, this isn't
55:49
[SPEAKER_03]: like you're in like blackout drank and like I can't believe I said that I can't remember it's not my experience whatsoever.
55:56
[SPEAKER_03]: It's by allowing that safe dissociation between the memory and the emotional experience.
56:02
[SPEAKER_03]: Right.
56:03
[SPEAKER_03]: I can now a note and talk about these things, but in a way that feels a lot safer.
56:08
[SPEAKER_03]: Yeah.
56:09
[SPEAKER_03]: And it is genuine.
56:10
[SPEAKER_03]: It is not a, oh, I'm just said that because I
56:16
[SPEAKER_02]: So for a patient like you were describing, it makes sense that they would try something like this if other treatments had shown more effective right so I also I'm part of why I do this podcast is at the end obviously I'm going to be leaving information about Jonathan Lodgello so you know if you are in the state of California right because you're licensed just in California anywhere California Nevada
56:41
[SPEAKER_02]: In Nevada, you know, realize the services, but also, I guess what I want to leave people with is like, how do people access or even get assessed for the no spray or the infusion, like, what steps do people need to take who are like, I want to do this.
56:59
[SPEAKER_02]: I'm going to try this, this, you know, might be good for me.
57:02
[SPEAKER_03]: So the Spurvada website will, you'll be able to type in your location where you're looking for providers and we'll have that in the notes and we'll have a perfect.
57:15
[SPEAKER_03]: Now, they'll just have like a list and here are all the providers in your area that are using Spurvada.
57:20
[SPEAKER_03]: Now those services again, the assessment itself and the treatment will be covered by insurance if you meet clinical criteria.
57:32
[SPEAKER_03]: I mean, it goes just, they're kind of everywhere now.
57:35
[SPEAKER_03]: Yeah, they are.
57:36
[SPEAKER_03]: For me, you know, but again, when it comes to access, right?
57:41
[SPEAKER_03]: It's just about cost.
57:42
[SPEAKER_03]: And then like you mentioned, there are online providers, an example would be like, say, like mind, when they're right, it's a famous online provider.
57:51
[SPEAKER_03]: Where insurance will often cover the,
57:54
[SPEAKER_03]: evaluation sitting down talking with a licensed clinician to see if you meet criteria, but the medication itself, not being at the approved, there will be a cost to it.
58:04
[SPEAKER_03]: Right.
58:05
[SPEAKER_03]: Right.
58:05
[SPEAKER_03]: And that's until these newer medicines are FDA approved.
58:09
[SPEAKER_03]: Again, a really good.
58:12
[SPEAKER_03]: To give you a good idea about where psychiatry is heading in the treatment of multiple disorders.
58:17
[SPEAKER_03]: I know we've been focused on the pressure for addiction, who CD, trauma, anxiety, all sorts of things is that you can go to a website called psychedelic alpha.
58:32
[SPEAKER_03]: and they have a bullseye chart and they have an updated bullseye chart that shows you what stages all of these different psychiatric drugs that are being studied or and and how closely they are to like full FDA approval and it's remarkable what it's being studied out there what is coming down the road right that might be you know really helpful for patients
58:56
[SPEAKER_03]: I know we couldn't get into even like half of what we could talk about today, but again, per person.
59:01
[SPEAKER_02]: We've technically really a 45 minutes and we've totally gone over, but here's the old thing.
59:05
[SPEAKER_02]: Don't we can totally turn this back on this podcast?
59:08
[SPEAKER_03]: Oh, we should.
59:08
[SPEAKER_03]: We should, because then we could dive more into the addiction, because I can tell you in terms of treating
59:13
[SPEAKER_03]: folks who struggle with addiction in my experience and in the studies what we see is oftentimes this is what's happening is that I have patients who are coming in who have been relying on other substances to get just kind of get by with their symptoms.
59:27
[SPEAKER_03]: And once they start these treatments, they stop using other substances.
59:33
[SPEAKER_03]: And it's remarkable how fast and how naturally they
59:39
[SPEAKER_03]: decrease.
59:39
[SPEAKER_03]: And we've seen this across the board since the 1960s with psychedelic treatments in terms of their potential to really help rewrite the brain and the disfunctions in the brain happen with things like addictive disorders.
59:51
[SPEAKER_02]: And I'm so glad you're talking about this and we're saying that's because there are so many people still in the addiction world who are like we need to do more you know sessions and talks about how these psychedelics are addictive and I'm like yo get with the program and the way I feel and what I'm excited because of someone listen.
1:00:11
[SPEAKER_02]: someone who has struggled for years and who had been resistant to the traditional antidepressant, let's say, you know, it is exciting that there are options out there now today and that can really, really, really help people and rapidly.
1:00:28
[SPEAKER_02]: You know, it's a nicely a mouthful key.
1:00:30
[SPEAKER_02]: That's the key.
1:00:31
[SPEAKER_02]: It's rapid and the way I'm looking at it is for those who are anti, whatever.
1:00:35
[SPEAKER_02]: I'm like, get on the train.
1:00:36
[SPEAKER_02]: This is kind of like how people were back in the day with the anti depressants.
1:00:39
[SPEAKER_02]: I'm like, I don't know about that.
1:00:41
[SPEAKER_01]: Yeah.
1:00:42
[SPEAKER_02]: And I think that like in all of this are going to be part of the norm and I love that.
1:00:48
[SPEAKER_03]: They will be part of the norm.
1:00:49
[SPEAKER_03]: I think that the next year, at least couple of decades in psychiatry, if everything goes the way it has been going, we're going to focus on psychedelics and electricity in terms of really how to better treat patients.
1:01:01
[SPEAKER_03]: It's all going to be, like this is an electrochemical organ.
1:01:04
[SPEAKER_03]: We're going to be focused just because of the outcomes of what we're seeing and the research and
1:01:12
[SPEAKER_03]: I keep little stickers of Bill in the fourth dimension, you know, for my folks at our recovery that are nervous about these treatments.
1:01:19
[SPEAKER_03]: Right.
1:01:19
[SPEAKER_03]: And we just, we just talk about how psychedelics are nothing new to the recovery community.
1:01:25
[SPEAKER_03]: And in fact, it's been helping a lot of people, including some of the founders of recovery as we know it.
1:01:32
[SPEAKER_03]: Yeah, we just space where they feel much better.
1:01:35
[SPEAKER_03]: Again, it's about working with the right person.
1:01:37
[SPEAKER_03]: I don't want to say, like, hey,
1:01:41
[SPEAKER_03]: Right.
1:01:41
[SPEAKER_03]: Absolutely.
1:01:42
[SPEAKER_02]: Like all these things have their potential downsides and, and, but for people like me, there's just there's always been this shame, you know, like I'll go and tonight and I'm not going to share on this, you know, and I mean because I feel like there's.
1:01:55
[SPEAKER_03]: Yeah, like alternative groups like psychedelics and recovery, where you have that population that understands, like, okay, you know, we kind of see where this is going and how this has been helpful and this is it anything new, it's just that what what is old is new again, because of the stop and research for these these medications.
1:02:17
[SPEAKER_02]: The way I look at it also is like, if I go on for surgery and my doctor, you know, prescribes me a week of percussive, I take as prescribed.
1:02:25
[SPEAKER_02]: It's no different than being prescribed a psychedelic and I just people like yourself.
1:02:30
[SPEAKER_02]: There's other people in the industry.
1:02:31
[SPEAKER_02]: I know that are coming back around and they're starting clinics as well.
1:02:35
[SPEAKER_02]: And it's just exciting stuff.
1:02:37
[SPEAKER_02]: You know, because anything that we can help more people with, who are we to judge, you know, and I always say step into my shoes, you know, when you want to die, like I was like telling me what to do, I will also say this because I'll always say these on these episodes.
1:02:53
[SPEAKER_02]: There is no magic pill, there's no magic shot, there's no magic injection, you know, spray, you have to do a bunch of other things.
1:03:00
[SPEAKER_02]: You have to do, you know, go to the gym, you have to eat well, like do all those DBT skills, all of that, it's at home expag, but what these new treatments are not new treatments, what these treatments are helping us do is being able to do those things.
1:03:14
[SPEAKER_03]: You know, for instance, I actually do those things.
1:03:16
[SPEAKER_03]: Yeah, 1000% where the depression, you know, that dark, dark depression is preventing us from waking up and and being able to make that breath.
1:03:24
[SPEAKER_03]: That's right.
1:03:25
[SPEAKER_03]: Go and exercise or just to, you know, just to engage with the world.
1:03:30
[SPEAKER_03]: But yeah, you still have to engage with the world.
1:03:32
[SPEAKER_03]: And for these treatments, so work.
1:03:34
[SPEAKER_02]: I just want to, I want to, because we have to wrap up.
1:03:36
[SPEAKER_02]: I want to say thank you.
1:03:37
[SPEAKER_02]: I also am already asking you to come back on the show because I think you love to because well-fledged knowledge.
1:03:43
[SPEAKER_03]: We talked about maybe 10% of what I was talking about next.
1:03:47
[SPEAKER_02]: Next show is on you like whatever you want to talk about and you know the notes we're going to be leaving again.
1:03:52
[SPEAKER_02]: Some of these websites we talked about you know some of the notes that we talked about bullet points on like facts versus fiction and also jails information Jonathan
1:04:04
[SPEAKER_02]: Well, thanks.
1:04:05
[SPEAKER_02]: Well, thanks.
1:04:07
[SPEAKER_02]: But thank you, thank you for being on the show.
1:04:09
[SPEAKER_02]: And can we just see you again?
1:04:13
[SPEAKER_02]: Thank you so much for having me.
1:04:15
[SPEAKER_01]: Thank you for tuning into this episode of Connect Call.
1:04:17
[SPEAKER_01]: As we conclude, remember that Insight Shared are intended for informational and educational purposes only and should not substitute professional medical advice, diagnosis, or treatment.
1:04:28
[SPEAKER_01]: We strongly recommend consulting a qualified medical health professional or health care provider for personalized advice tailored to your unique needs.
1:04:36
[SPEAKER_01]: Your mental health journey is important and having the right support is essential.
1:04:40
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1:04:49
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1:04:54
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1:05:00
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