Ketamine – My On-Camera Experience with a Treatment That Could Reshape Mental Health Worldwide

0:00:01 – Dr. Jen, thank you for joining me.
0:00:02 – Yeah, thank you.
0:00:03 – I’m so glad to have you here.
0:00:05 – Me too, happy to be here.
0:00:06 – This is gonna be so cool,
0:00:10 because this is such a topic that I find
0:00:14 can be just so polarizing for so many people.
0:00:16 When I first announced on Twitter that I had gone through
0:00:20 and done ketamine therapy, I got druggy,
0:00:23 I got all this hate, I got some people saying congrats,
0:00:25 it’s awesome, glad you treated yourself,
0:00:26 I got other people that reached out to me and said,
0:00:27 hey, I did it too.
0:00:30 It was life changing for me.
0:00:32 But before we get into that, there’s so much to talk about.
0:00:37 I wanna think, I think the most important thing is that,
0:00:39 you know, as I’ve been following these trends,
0:00:42 and I thankfully do a lot to, you know,
0:00:43 Tim Ferriss’ involvement in psychedelics
0:00:45 and trying to push that forward,
0:00:48 I believe I first heard about ketamine treatment via him,
0:00:51 like probably like six years ago or something like that.
0:00:54 And at that point in time, when I was in Portland,
0:00:58 these were like a lot of kind of like fly-by-night operations.
0:00:59 It seems like they were just propped up,
0:01:02 you didn’t talk about it.
0:01:03 But I think the first thing, before we get into this
0:01:06 conversation, what I loved about finding you
0:01:09 was that you’re a legit doctor.
0:01:11 So you go by Dr. Jen, which is super awesome,
0:01:12 ’cause it feels more approachable,
0:01:16 but it’s actually Dr. Jennifer Ellis.
0:01:20 You are a board certified in emergency medicine
0:01:22 based in Los Angeles.
0:01:25 You studied at Princeton University,
0:01:28 University of Rochester School of Medicine,
0:01:32 and the Warren Albert Medical School of Brown University
0:01:35 residency program in emergency medicine at the mouthful
0:01:37 before coming to Los Angeles,
0:01:40 where you’ve been practicing since 2008,
0:01:43 which has gained a lot of extensive experience
0:01:44 in emergency medicine.
0:01:49 Those are, first of all, those are legit places to study.
0:01:52 It’s not like you just like kind of like
0:01:54 phoned it in on your MD.
0:01:59 So emergency room, are you still practicing?
0:02:01 – I occasionally do still practice, yes.
0:02:04 – So you’re seeing all kinds of different stuff.
0:02:07 Prior to starting this clinic that was at your full-time job
0:02:09 was emergency room at medicine.
0:02:13 Okay, so you’ve seen the craziest of the crazy.
0:02:16 – Yeah, I guess you could say that.
0:02:18 The thing about emergency medicine
0:02:20 is it’s the first 30 minutes of everything.
0:02:21 That’s what everyone says.
0:02:26 So it’s kind of, it’s banal things like colds,
0:02:29 but it’s also everybody’s crisis worst day,
0:02:30 life and death kind of situation.
0:02:31 So yes, I guess you could say that.
0:02:33 – So I mean, you’ve seen overdoses I take it,
0:02:37 various compounds, everything from broken limbs
0:02:39 to probably people that have died in front of you,
0:02:41 is that fair to say?
0:02:41 – Unfortunately.
0:02:47 – So when did ketamine hit your radar?
0:02:49 Was that part of medical school?
0:02:52 When was, and then I’m really curious
0:02:55 how that makes its way into the emergency room.
0:02:57 – Okay, so it’s really interesting actually,
0:02:59 ’cause ketamine’s been in use since the 1970s
0:03:01 as an anesthetic, widely used,
0:03:03 most widely used anesthetic on the planet.
0:03:04 – In humans.
0:03:05 – In humans and in animals, yes.
0:03:07 – Because so many people, the first thing,
0:03:10 at least back in the day on this maybe five, six years ago,
0:03:11 people were like, oh, that’s horse tranquilizer.
0:03:14 – Yeah, and you know, I always tell people,
0:03:17 look, my cat takes moxicillin sometimes.
0:03:19 There’s crossovers in medicine, but yes.
0:03:22 – Yeah, my dog takes Gabapentin to relax and stuff,
0:03:23 and they give that to humans for the same thing.
0:03:25 – Right, there’s dogs on Prozac, right?
0:03:26 It doesn’t mean the Prozac works
0:03:29 any less efficiently in humans or anything like that.
0:03:30 So I like to sort of debunk that.
0:03:33 That’s not, it doesn’t, it’s a human drug.
0:03:34 We use it for humans.
0:03:36 – Yeah, ’cause it sounds like when you first hear that,
0:03:39 you’re like, oh, okay, so somebody went online,
0:03:41 they found a vet, they ordered some horse tranquilizer,
0:03:43 and now they’re taking that.
0:03:44 And you’re like, you know what I mean?
0:03:45 Like that can be a real thing.
0:03:45 – Yeah, that sounds terrifying.
0:03:46 – It sounds terrifying.
0:03:48 – Right, and how I usually explain it to folks
0:03:49 is that I trained in this medicine
0:03:51 20 years ago to use in children.
0:03:54 So the emergency medicine residency program I went to
0:03:57 was longer than a lot of emergency medicine programs.
0:03:58 It was four years instead of three.
0:03:59 And one of the reasons it was longer
0:04:03 is because we spent so much time learning on children,
0:04:04 which is important ’cause children’s physiology
0:04:07 is very different from adult physiology.
0:04:09 And so the way I learned to use ketamine
0:04:11 was as an anesthetic for children.
0:04:13 When kids have an emergency, if they break their leg
0:04:16 or something needs, they need emergency sedation.
0:04:19 This is a very, very safe drug to use for children.
0:04:21 – Is that the go-to these days still for sedation?
0:04:22 – It usually is, yeah.
0:04:24 It usually is especially for children, yeah,
0:04:25 because it’s so safe.
0:04:26 So that’s how I train on it.
0:04:29 But now, having said that, I’ve used it in toddlers
0:04:30 all the way up to people in their 90s.
0:04:32 So it’s a safe medication for use in the ER.
0:04:36 And just to be clear, that’s not how we use it in clinics.
0:04:37 The doses in the ER are much higher.
0:04:40 – Yeah, very excited to dive into that.
0:04:43 But when you’re talking about the ER in sedation,
0:04:45 what are your options?
0:04:47 Somebody comes in, they broke their leg.
0:04:51 Let’s just say it’s pretty hardcore,
0:04:53 compound fracture or something,
0:04:55 like something that needs to be like,
0:04:56 well, that would require surgery, right?
0:04:58 So you’re probably going somewhere else there.
0:04:59 Or maybe they pop the hip out or something.
0:05:01 – Whether you need surgery or not,
0:05:02 you could use, they do use ketamine
0:05:04 for anesthesia in surgery sometimes.
0:05:06 – And we use ketamine sometimes to put people in a coma
0:05:07 if we’re going to intubate them
0:05:09 and keep them in a medical coma.
0:05:12 So, and anesthetics come in lots of different flavors,
0:05:14 lots of different doses, we mix them.
0:05:16 And ketamine is generally used, though,
0:05:18 for what we would call moderate sedation, okay?
0:05:20 So which isn’t the same thing as general,
0:05:21 just in case people are wondering.
0:05:24 But any medication, any anesthetic,
0:05:28 if you turn it up enough, can knock you out, right?
0:05:32 – And so when you turn up ketamine to the highest level,
0:05:37 one of the things, you’re going to become unconscious, right?
0:05:38 You lose consciousness.
0:05:40 But unlike other things.
0:05:42 So let’s take Michael Jackson, for example.
0:05:44 – Propofol. – Propofol, right?
0:05:46 – Milk of amnesia, that’s what we call that.
0:05:46 – Milk of amnesia.
0:05:48 – Yes, ’cause it’s white and cloudy, yes.
0:05:51 – So I had that done, you know, I’m at the age now
0:05:53 where they had to do a colonoscopy
0:05:55 to check for cancer and Paul’s stuff.
0:05:57 And they gave me propofol as I was going in.
0:05:58 – Yes.
0:06:00 – And I asked the anesthesiologist,
0:06:03 I asked for what I call, this is so stupid,
0:06:06 I’m telling this, but I asked for what I call
0:06:08 the slow ramp, which is where I said,
0:06:09 hey, don’t give it to me all at once.
0:06:11 I kind of like slow me into it.
0:06:13 ‘Cause I’m just like personally curious
0:06:16 about what Michael Jackson felt when he was there, right?
0:06:18 ‘Cause they kept him in a somewhat conscious state
0:06:20 I have to imagine.
0:06:21 – Propofol is different.
0:06:23 So propofol is very honest. – Does it really knock you out?
0:06:24 – Yeah, you turn it, it’s, you know,
0:06:26 you’re counting back 10, nine, eight,
0:06:27 and then you wake up from your surgery, right?
0:06:29 – Yeah, so when they were pushing it in,
0:06:31 I got this euphoria of like,
0:06:33 I didn’t care if I died or not.
0:06:34 Like it was a very euphoric thing.
0:06:38 And I was like, oh, maybe that’s why he got addicted to that.
0:06:40 – It’s also possible they were using other agents
0:06:42 with propofol, ’cause usually we give something first.
0:06:45 So the euphoria was probably not from the propofol,
0:06:46 it was probably from Madazzle, I’m a first head,
0:06:48 but we can kind of get into that.
0:06:51 But basically like anesthetics, you know,
0:06:55 ketamine is so safe because unlike most other anesthetics,
0:06:59 it doesn’t depress your heart rate or your respirations
0:07:02 or your blood pressure at the right doses, right?
0:07:05 So initially speaking, when you give anyone an anesthetic,
0:07:07 usually their blood pressure and their heart rate will drop.
0:07:09 And that’s actually, blood pressure dropping is way more
0:07:11 dangerous in general, generally speaking,
0:07:13 than blood pressure being too high.
0:07:14 But ketamine’s different.
0:07:16 So when you give someone ketamine, their blood pressure,
0:07:17 most people’s blood pressure and heart rate
0:07:18 will actually go up.
0:07:19 – Oh, interesting.
0:07:21 – But when you give enough ketamine,
0:07:23 enough of any sedative or anesthetic,
0:07:24 you will stop breathing.
0:07:25 – Oh, interesting.
0:07:27 – Any, any, right.
0:07:29 The thing is, is that for ketamine, it’s very transient.
0:07:30 It’s a very on/off.
0:07:32 Once we turn off the medication,
0:07:33 it’s leaving your system very quickly.
0:07:35 – Well, it has like a three or four hour half life,
0:07:36 it doesn’t really matter.
0:07:36 – It does, it does.
0:07:40 But for practically speaking for an emergency situation,
0:07:42 if I can’t figure out if you’ve eaten or not, you know,
0:07:46 if it’s an emergency and I need to sedate you right away,
0:07:48 I can give you this and if something’s going wrong,
0:07:51 I can turn it off and you will very rapidly come back.
0:07:51 – Oh, interesting.
0:07:53 – So it’s safe in that way because if you stop breathing,
0:07:55 and I have seen some providers, you know,
0:07:57 I’ve never done this, but in the emergency room,
0:07:59 you can give ketamine too quickly.
0:08:00 And I’ve seen a couple of providers
0:08:02 where a person will stop breathing.
0:08:03 – Oh, interesting.
0:08:05 – And yes, but it’s transient, it will go away.
0:08:08 And it’s, your heart stops when it happens.
0:08:10 But they will start breathing again
0:08:11 once you turn the medication on.
0:08:13 – But that, like, just so we don’t freak people out.
0:08:16 So compare that dose of what you would have to give
0:08:19 to get people to stop breathing on ketamine
0:08:21 with what you would give someone in the clinic
0:08:22 that is treating depression, anxiety,
0:08:24 all the things that we’ll get into.
0:08:26 – Is it 10x, is it 3x, is it what?
0:08:29 – It’s a, for IV, it’s about 4x.
0:08:31 – 4x, okay. – But it’s not really,
0:08:32 and this is why it’s so complex,
0:08:34 and this is why providers who use ketamine
0:08:36 should be people who are very qualified
0:08:38 in resuscitation and airway management.
0:08:40 Because when you’re dealing with anesthetics,
0:08:42 it’s not just about the dose,
0:08:43 it’s about the rate that you’re giving it,
0:08:44 how quickly you’re giving it.
0:08:47 And also recognizing the different medical things
0:08:50 that can make someone, say, more compromised
0:08:51 on a certain medication.
0:08:53 So it’s a complex thing, but generally speaking, yes,
0:08:56 it’s a much lower dose that we’re giving in clinics.
0:08:57 – Yeah, so I mean, the odds of,
0:08:59 I mean, I’m sure you’ve treated hundreds of patients.
0:09:01 Have you ever seen depressed breathing
0:09:02 or anything like that?
0:09:03 I mean, not at these levels though.
0:09:05 – No, so in the clinic, no, absolutely.
0:09:07 And there’s been, to my knowledge,
0:09:10 no case reports of any bad outcomes in clinics so far
0:09:12 in the United States.
0:09:13 I mean, one of the reasons we use this medication,
0:09:16 like I said, is because it’s so rapid on and rapid off, right?
0:09:17 And we talk about half-life,
0:09:19 but people don’t think in terms of half-lives.
0:09:21 What this means is I turn this medicine off,
0:09:23 and 20 minutes later, you’re coming back.
0:09:24 You’re back, right?
0:09:25 You’re not slurring your speech.
0:09:26 You’re not, right?
0:09:27 – Right, maybe a little, like, funky.
0:09:28 – A little funky, but not, right?
0:09:30 And as the hours go by, every hour,
0:09:32 you’re kind of clear and clear.
0:09:36 So, and when I was using ketamine in the emergency room,
0:09:38 and by the way, so I was using ketamine for 20 years
0:09:40 in the emergency room before I ever heard about using it
0:09:43 from a mood protocol, I loved using it so much
0:09:45 because I sort of, even without knowing any of the literature,
0:09:49 I would see people instantly transformed after one dose.
0:09:51 I loved it so much, this is kind of a funny story,
0:09:54 that I used to sort of volunteer to do it for other doctors,
0:09:55 ’cause it’s a little bit more work.
0:09:57 When you’re setting up for anesthesia,
0:09:59 you have to set the bone, and you have to do the anesthesia.
0:10:02 So it’s more work to do the anesthesia part,
0:10:03 but people would know they would come to me.
0:10:05 They’d be like, oh, are you gonna ketamine someone?
0:10:08 Jen loves doing it, go grab her, you know, the other doctors,
0:10:10 or if a doctor had a problem, the nurse would come get me
0:10:12 and say, they’re kind of not sure how to use this
0:10:13 or whatever, can you help them?
0:10:17 – Because you see, do you see them just smile, relax?
0:10:18 Like, what would you see?
0:10:21 – So, before I knew anything about mood protocol,
0:10:23 I would see the craziest things.
0:10:27 Like, so, I tell this story just because it was so,
0:10:29 it was the first time I really started to think
0:10:32 about this medication as something special.
0:10:34 I had this older Indian woman come in,
0:10:36 and she had her daughter where there was transling.
0:10:38 I can’t remember, I think she dislocated her hip.
0:10:40 – When you say older, you had 70s, 80s, or whatever?
0:10:41 – Yeah, maybe like 70s.
0:10:44 And she had the kind of face that you,
0:10:45 I would only describe it as like,
0:10:47 she’d been frowning for decades.
0:10:52 Like a really weathered, she was just like sad and concerned
0:10:54 and anxious and holding on like this for decades.
0:10:56 And you could see it like written into her face.
0:11:00 Her mouth was like in a permafrown and concern.
0:11:03 And she had her daughter where her daughter was translating.
0:11:05 And so, whenever anyone’s translating for a patient,
0:11:07 you’re always worried that it’s not gonna get fully crossed.
0:11:08 So, I was explaining to her, you know,
0:11:09 we’re gonna give you this medication,
0:11:11 we’re gonna reset your hip.
0:11:12 It might make you feel a little strange.
0:11:15 We gave it to her, she woke up,
0:11:16 and I remember being at her bedside
0:11:18 and her face looked different.
0:11:19 I almost, I was checking the chart,
0:11:21 like am I in the right room?
0:11:23 She looked like a different person.
0:11:26 The facial muscles that she was using were different.
0:11:28 In psychiatry, we would say,
0:11:29 when someone’s depressed, they have blunted facies,
0:11:32 meaning they’re not using even all of their facial muscles.
0:11:33 They’re not making all the expressions.
0:11:35 They don’t have the full range.
0:11:37 She had a blunted facies going in.
0:11:41 Coming out, she looked like a different human being.
0:11:44 And I came to the bedside to say,
0:11:45 you know, are you okay?
0:11:46 How did that go once she’d recovered?
0:11:49 And the daughter said, she wants to tell you,
0:11:50 life is a circus.
0:11:53 And I was like, I thought there was a translation issue.
0:11:55 I’m like, I’m sorry, what?
0:11:57 She said, no, she’s adamant.
0:11:59 She’s really insistent, life is a circus.
0:12:03 And she’s so happy, thank you for giving her that awareness.
0:12:05 And so I was sort of like–
0:12:06 – Wow, I’m like literally getting goosebumps.
0:12:08 – Yeah, yeah, and her face looked totally different.
0:12:09 And the daughter looked mystified.
0:12:11 She was just like, I don’t know what mom’s on about.
0:12:13 And mom, you know, this woman,
0:12:14 not a woman who’d done any recreational drugs
0:12:16 in her life or anything.
0:12:19 And she’s smiling at me and she just said like,
0:12:22 it’s all so important and it’s not important.
0:12:24 And thank you, like I see it now.
0:12:26 And I see that life is a beautiful circus.
0:12:29 And I remember walking away from that thinking,
0:12:32 huh, well, that’s interesting because like, you know, not,
0:12:34 I mean, people say all kinds of things all the time,
0:12:35 right after coming out of anesthesia.
0:12:38 But something about the way her face was transformed,
0:12:39 it really kind of stuck in my head.
0:12:42 And I started paying attention and I would do,
0:12:43 you know, I used to kind of mean a lot
0:12:45 and there are a lot of procedures for which we use that for.
0:12:47 And I would almost always see
0:12:50 some kind of traumatic transformation, even in kids.
0:12:52 And so I started just enjoying doing it.
0:12:54 Like in terms of Mesa, I just would love it.
0:12:55 And so I would just be-
0:12:57 – Like giving you a gift every time you go down and do it.
0:12:58 – People would be about to use Popofal.
0:12:59 I’d be like, you want to use ketamine instead?
0:13:00 They’d be like, why?
0:13:02 I’m like, I’ll do it for you, okay.
0:13:04 You know, the orthopedist would get so mad at me.
0:13:05 They’d be like, nah, we, Popofal.
0:13:07 I’m like, nah, let’s do ketamine instead.
0:13:08 Cause it’s-
0:13:10 – Doesn’t Popofal have a much tighter range too?
0:13:12 Isn’t it more dangerous in terms of like-
0:13:12 – It’s more dangerous
0:13:14 because you can get to a deeper level of sedation
0:13:15 if you don’t know what you’re doing.
0:13:17 Yeah, in that sense.
0:13:19 But anyway, regardless.
0:13:22 So I didn’t even know anything really about Mood Protocol.
0:13:25 It’s not something that would be on my radar as an ER doctor,
0:13:27 even reviewing the literature, does the psychiatric stuff.
0:13:29 – Mood Protocol, what does that mean?
0:13:33 – So in the 1990s, they started doing sort of research
0:13:34 on ketamine and its effects.
0:13:36 And they started seeing in the late 90s
0:13:40 and throughout the 2000s that it has a very rapid
0:13:44 and sometimes long lasting anti-depressant effect
0:13:47 and a rapid anxiolytic effect, breaking down anxiety.
0:13:48 And so they started studying it
0:13:53 and they found that this is one of the few medications we have
0:13:55 that we never say cure,
0:13:59 but can have a long-term remission for people who are depressed,
0:14:00 especially people who are suicidal
0:14:03 or people with what we call treatment resistant depression,
0:14:05 which is a whole discussion in and of itself.
0:14:07 But so I just wasn’t aware of this literature
0:14:08 because I’m not a psychiatrist, right?
0:14:10 I’m an ER doctor.
0:14:12 And I went to a party,
0:14:14 a friend of mine was having a Burmitzva up in Toronto,
0:14:17 where they do a lot of psychedelic,
0:14:19 because they were their looser restrictions
0:14:23 on psychedelic research and on psychedelic use,
0:14:27 they have, you can invest in, I guess, psychedelics, marijuana
0:14:29 on the Toronto and the Canadian stock exchange.
0:14:33 So there’s a lot of finance up there for psychedelic research.
0:14:38 And I happened to be standing next to a finance bro at a party
0:14:40 and he was the CEO of a company
0:14:43 that was rapidly buying up ketamine clinics across Canada
0:14:46 and North America and the United States.
0:14:47 And I knew nothing about this.
0:14:49 And so he said, “Oh yeah, do you hear about this?
0:14:50 “This is what I do.”
0:14:52 And I said, “No, what are you using?
0:14:53 “What do you mean, ketamine clinics?
0:14:54 “What are you using it for?”
0:14:56 And he said, “Oh, for depression.
0:14:57 “You never heard of this?”
0:15:00 And so I was like, “No, I haven’t.”
0:15:00 – But I’ve seen it.
0:15:01 – I’ve seen it, right.
0:15:02 I was really intrigued.
0:15:05 So I went home and I did a deep dive
0:15:07 and I looked through a literature and I was really,
0:15:08 first of all, blown away.
0:15:08 I’d never heard of it.
0:15:11 That was weird to me because the literature is solid.
0:15:15 I mean, there’s stuff out there that we do in medicine
0:15:16 that doesn’t have great evidence,
0:15:20 but this was like really high quality evidence-based research
0:15:24 across the world, replicatable, clinically controlled,
0:15:28 clinical trials that were randomized controlled trials
0:15:29 that showed again and again
0:15:31 this rapid antidepressant effect.
0:15:33 And I think for me,
0:15:35 I actually went to med school to be a psychiatrist.
0:15:37 – Oh, interesting.
0:15:38 Okay, that explains a lot.
0:15:40 So just checking more boxes for you.
0:15:40 – Yeah, yeah.
0:15:44 And during med school, during our rotations,
0:15:46 I just got really frustrated when it came to psychiatry.
0:15:49 I didn’t think that what we had to offer
0:15:50 was really that great.
0:15:52 I mean, I’m not poo-pooing SSRIs.
0:15:53 I’m not poo-pooing therapy,
0:15:56 but it was really heartbreaking to see people
0:15:59 not being helped by my profession from what we had.
0:16:02 It just, so I didn’t go into it
0:16:04 because it didn’t seem like something
0:16:05 that would be fulfilling.
0:16:06 And so when this came around,
0:16:07 I was like, wait,
0:16:09 there’s something here now that can actually help?
0:16:12 That’s, so I kind of just,
0:16:14 it checked that box for me,
0:16:18 but it also after COVID gave me an ability
0:16:21 to kind of reconnect with medicine and why I went into it.
0:16:21 – Well, it’s interesting.
0:16:23 What you said about SSRIs,
0:16:25 the one unique piece about ketamine
0:16:27 that I think is so fascinating is,
0:16:31 oftentimes when people have to change modalities
0:16:32 for depression,
0:16:35 it’s like tapering off of an SSRI
0:16:37 to try something else, right?
0:16:39 And there, correct me if I’m wrong here,
0:16:41 but you don’t have to taper off an SSRI.
0:16:42 These are completely compatible.
0:16:43 You can try them in conjunction
0:16:44 with what you’re already doing.
0:16:46 – And not only that, most of the studies were done
0:16:47 on treatment-resistant depression.
0:16:51 Patients who were on SSRIs, sometimes multiple SSRIs.
0:16:52 – Interesting.
0:16:53 – So we actually don’t recommend tapering
0:16:55 while you’re getting your infusions.
0:16:56 We recommend if you’re gonna taper
0:16:57 to either do it before or after
0:16:58 in conjunction with your psychiatrist,
0:17:00 but you definitely don’t have to.
0:17:03 They work completely different ways, so yeah.
0:17:06 – Is there any drugs that people will be on
0:17:08 and they can’t receive this treatment
0:17:10 because they’re taking something?
0:17:13 – There is, if you’re on MAOI inhibitors,
0:17:14 there’s a relative contraindication there.
0:17:16 You kind of have to think about it.
0:17:17 And then there are some conditions.
0:17:20 See, because ketamine raises your blood pressure
0:17:22 and your heart rate, if you have a really bad heart
0:17:23 or if you have an irregular heart rhythm
0:17:27 or something like that, then you wanna use caution
0:17:30 to make sure, it’s part of the reason why this is a medicine
0:17:33 that you should be administered by a doctor
0:17:34 and not in a recreational setting
0:17:37 and why you should have a doctor look over
0:17:40 your medical history before you begin.
0:17:41 Yes, and there’s some medicines
0:17:44 that we think might dampen the effect of ketamine.
0:17:46 So we will recommend if you are on them
0:17:47 and you actually absolutely have to be on them
0:17:50 that you kind of push your dose out further away.
0:17:53 Some mood stabilizers like lamyctal,
0:17:55 some benzodiazepines like Ativan or Valium,
0:17:57 Xanax, that kind of thing, so.
0:18:01 – Interesting, okay, so that explains why you have
0:18:03 such a rigorous kind of intake form.
0:18:05 And you personally interview every single person before,
0:18:06 which must be a lot of work,
0:18:08 but you actually have a conversation with these people
0:18:10 to make sure they’re a good candidate
0:18:13 before they can just come in and take the treatment.
0:18:16 So let’s talk about, there are so many different ways
0:18:18 that one can do this.
0:18:19 I mean, there’s some places that are like,
0:18:23 now mailing you ketamine in the mail to do,
0:18:27 kind of guided therapy, there’s street usage.
0:18:28 Can you walk me through,
0:18:32 how does this get into the humans’ bodies?
0:18:34 – Okay, well, first of all,
0:18:38 it can be introduced into your bloodstream directly,
0:18:39 and that’s IV.
0:18:41 Okay, so that’s the most effective way
0:18:42 to get it in your bloodstream.
0:18:43 But once it’s in your bloodstream,
0:18:46 it has to cross the blood-brain barrier
0:18:48 to get to your brain where it acts.
0:18:50 So there are multiple ways to get it into your bloodstream.
0:18:52 So you can do an IV,
0:18:54 or you can do an intramuscular injection,
0:18:56 which is like a step down from IV,
0:18:59 where the medicine is injected like a shot,
0:19:00 so it looks like a vaccine,
0:19:00 and it goes into your muscle,
0:19:02 and then it’s released slowly from your muscle,
0:19:03 there it goes through your bloodstream
0:19:05 and crosses the blood-brain barrier.
0:19:06 – Right.
0:19:09 – And you can also, you can snort it, like a powder,
0:19:11 you can spray it into your nostrils,
0:19:13 you can take it into your mouth and swallow it,
0:19:14 and it goes into your stomach,
0:19:16 or you can swish it around in your mouth,
0:19:20 and then it’ll cross the mucous membrane in your mouth.
0:19:24 People also do swish it and put it in their butts.
0:19:25 There are lots of different ways, right?
0:19:27 – I mean, that’s, you can do that with cocaine too.
0:19:28 – Yes, yes.
0:19:28 – Like there’s, yeah, there’s lots of–
0:19:30 – Yes, and that’s because the mucous membrane
0:19:34 in your gastrointestinal system is very rapid transfusion,
0:19:36 so you can get medications across that barrier
0:19:38 and into your bloodstream very quickly.
0:19:39 But what happens right away
0:19:41 is that your liver is rapidly metabolizing the ketamine,
0:19:46 right, so when you drink alcohol, this happens too, right?
0:19:48 Your liver will break down the medicine
0:19:49 into a secondary tertiary,
0:19:52 and sometimes, a quaternary metabolite.
0:19:53 So with ketamine, it’s super efficient.
0:19:55 It’s so efficient at pulling it out of your bloodstream
0:19:58 that it is not recommended that you swallow it.
0:20:00 And so people who are taking lozenges for therapy,
0:20:03 they’re recommended to swish it around and not swallow it,
0:20:04 because as soon as you swallow it,
0:20:07 it goes through what we call first pass hepatic metabolism.
0:20:08 Your liver just pulls it all out
0:20:10 and turns it into norkenamine, okay?
0:20:11 Which is a secondary metabolite
0:20:14 that doesn’t have those effects on your brain, okay?
0:20:17 So when you take it,
0:20:19 there are efficient ways to get it across the bloodstream
0:20:21 barrier, and there are less efficient ways.
0:20:23 And by the way, when you’re taking it orally,
0:20:26 you have to use much, much higher doses of ketamine
0:20:29 in order to get enough to cross the bloodstream barrier.
0:20:32 And when you do, you produce much, much higher amounts
0:20:35 of norkenamine too, which is toxic in and of itself, right?
0:20:38 So just to be clear, there are, and this is true,
0:20:41 this is the pharmacokinetics of any medication you’re giving.
0:20:44 There are ways to do it that are more efficient
0:20:45 than other ways to do it.
0:20:49 And so the IV administration is the most efficient way
0:20:51 to get this medicine across the bloodstream barrier
0:20:53 where it is, where it’s working.
0:20:55 And when you use it in other ways,
0:20:57 the absorption across the bloodstream barrier
0:20:58 is more variable.
0:21:02 So instead of looking like this with IV,
0:21:04 you’re getting like spikes.
0:21:07 And so, you know, that has effects on the trip,
0:21:10 but it also has effects on its utility.
0:21:11 So when you look at studies,
0:21:12 you see that they get the best,
0:21:14 you get the best results when you use,
0:21:15 when you do an IV infusion.
0:21:18 – When we first met and you helped me,
0:21:21 we can get into that experience,
0:21:23 you said to me, it’s about time on brain.
0:21:24 Can you explain what that means?
0:21:26 ‘Cause that would explain some of the spikiness
0:21:27 and why that’s not ideal.
0:21:31 – Right, so we think we know how this medication works, right?
0:21:32 There’s sort of two ways that it works.
0:21:35 One is the neuroplasticity that you get,
0:21:36 and we can kind of get into that.
0:21:37 And we should, I think we should understand that.
0:21:39 And then the other is the trip itself.
0:21:40 And that’s a little bit more of a black box,
0:21:42 but we know that’s also important, right?
0:21:44 So time on brain means this medication
0:21:46 needs to cross the blood membrane barrier
0:21:47 and act on your brain.
0:21:48 And we know from the studies
0:21:50 that the time that it acts on your brain,
0:21:53 the length of the time that it’s there is more effective
0:21:55 if you can get at least a 40 minute infusion,
0:21:57 where you’re spending,
0:21:57 where that’s the amount of time
0:21:59 that your brain is under the influence of this medication.
0:22:01 – Okay, so just to break that down for people,
0:22:03 someone’s laying there in your clinic,
0:22:05 they have done an IV, you have an IV.
0:22:09 The IV is, it’s unlike a traditional bag IV
0:22:10 that you would see, you know,
0:22:13 for someone getting like saline solution or something, right?
0:22:15 You have like a syringe that’s sitting
0:22:16 inside of an automated machine
0:22:19 that’s been pre-programmed to automatically.
0:22:20 So it’s not like someone coming in there
0:22:22 and just choosing how much they wanna do.
0:22:26 It’s slowly and via its programming
0:22:28 pushes that into them over the course of an hour.
0:22:30 So you’re guaranteeing consistency.
0:22:31 – Correct.
0:22:32 – Which is amazing.
0:22:33 – Right.
0:22:35 – And then one, that’s going straight in the bloodstream,
0:22:37 crosses the blood brain barrier.
0:22:42 It’s sitting, that ketamine is circulating in the brain.
0:22:43 And then that’s when you’re getting
0:22:45 the beneficial effects during that time.
0:22:46 – Correct, correct.
0:22:48 – And so because you’re doing that nice,
0:22:52 programmed, automated dispersal of ketamine,
0:22:55 you’re getting the most benefit for bank for your buck
0:22:56 in that particular period.
0:22:57 – Correct, just to be clear though, you could do,
0:22:59 I do it with the machines
0:23:01 because I am a very precise person and I like that.
0:23:03 But many clinics just put in a bag.
0:23:04 – Well, they do.
0:23:06 – You can control the rate of a drip in a bag,
0:23:07 it’s just less precise.
0:23:08 You just sort of judge it eyeball.
0:23:09 Oh, that’s how many drops are in it.
0:23:11 – Yeah, but also, correct me if I’m wrong here,
0:23:13 but like, I mean, for me, I’m thinking like,
0:23:16 you’re in there, you’re sitting down for an hour and a half
0:23:17 before you actually want to get up
0:23:19 and kind of like walk about.
0:23:21 You know, you’re a little unstable.
0:23:24 If I’m getting a bag of saline with my ketamine,
0:23:25 and I have to pee,
0:23:27 I mean, this is a little logistical challenge, right?
0:23:29 – No, it is, it is, right, yeah.
0:23:31 And so they would use maybe a smaller bag,
0:23:33 but yes, it is a logistical challenge, correct.
0:23:35 And so the benefit also of having a machine
0:23:37 is that you can deliver the smallest amount of volume.
0:23:38 – Oh, I see.
0:23:39 Okay. – Right.
0:23:40 – And then how do people think about,
0:23:42 or how do you, as a physician,
0:23:43 think about the difference between
0:23:46 the two most common, the two used in your clinic,
0:23:50 which is intramuscular versus actual IV.
0:23:53 Like, when is one better for a situation?
0:23:54 Is it just, some people don’t like IVs,
0:23:56 and they might want intramuscular?
0:23:57 How do you think about that?
0:23:59 – Well, yeah, I mean, the thing about an IV is,
0:24:00 you know, you put the needle in
0:24:01 and then you take the needle out,
0:24:04 but then you’re attached to an infusion pump.
0:24:07 There’s a sort of, some people don’t like that, right?
0:24:08 They feel like it’s more invasive.
0:24:10 So when you have an intramuscular,
0:24:12 it’s just sort of a shot like a vaccine,
0:24:15 but the absorption is a little more variable.
0:24:18 So what it functionally means is,
0:24:22 you’re kind of deeper when you do an IV infusion.
0:24:25 Now, I could give you enough intramuscularly
0:24:26 where you would be in danger.
0:24:29 And like, for example, what happened with Matthew Perry,
0:24:32 but generally speaking, it’s harder to titrate.
0:24:33 It’s a little bit less precise,
0:24:37 and it’s sort of a slower-on, slower-off sort of experience
0:24:39 when you do intramuscular injection.
0:24:41 But some people like that because they can do therapy.
0:24:43 So you’re not connected to an IV,
0:24:45 you can get intramuscular injection,
0:24:47 you and your therapist can talk.
0:24:50 And we can, you know, it’s a sort of a different thing
0:24:52 that you’re doing than when you get an IV
0:24:56 and you just sort of go deep within your own subconscious
0:24:58 and lie there and not talk to anybody.
0:25:01 – So this is another kind of
0:25:04 way to administer this and that.
0:25:07 It’s not, there’s the dose that takes you to outer space
0:25:09 where you sit back, you put the whole, you know,
0:25:11 goggles on and the goggles.
0:25:11 – Goggles.
0:25:12 – Goggles.
0:25:13 – We should do that.
0:25:16 – Yeah, you should do goggles, the welding mask.
0:25:17 But you put the actual mask on
0:25:19 and then you put the headphones in
0:25:21 and you go in, it’s a very personal thing.
0:25:23 And then, you know, I’ve even seen some therapists
0:25:25 who was one in San Francisco I’d seen a while ago
0:25:27 that was, you know, doing these very almost
0:25:31 like micro-type doses just to hopefully, you know,
0:25:34 obviously not going for that time on brain,
0:25:37 those deep neuroplasticity changes,
0:25:40 but more a loosening of emotions.
0:25:42 And do you think there is benefit
0:25:44 in that kind of like more micro dose version
0:25:47 in coupled with an actual therapist?
0:25:48 – Yeah, I mean, if you look just straight up,
0:25:51 look at the literature, you’ll see that the rates
0:25:55 of improvement for depression, let’s just say depression,
0:25:57 are better with IV administration
0:25:59 than they are with the other modalities.
0:26:01 But the real question you’re asking is,
0:26:02 are we trying to achieve something else
0:26:04 by doing it with a different modality?
0:26:07 And the answer is yes, because I have a few patients
0:26:11 who they do prefer to do IM and talk to someone
0:26:13 because it is accomplishing sort of a different thing.
0:26:16 They can get to a more open space,
0:26:19 they feel a little bit more emotionally accessible
0:26:21 when they’re just getting a little bit of that medication,
0:26:23 either IM or, you know, orally, laws in July’s.
0:26:27 And then they can access and talk in ways
0:26:29 that they can’t normally when they do therapy.
0:26:32 – I actually just talked to a patient today
0:26:35 who had said that he has a very difficult time
0:26:37 talking in therapy, just so he shuts down
0:26:39 whenever he approaches his trauma.
0:26:41 You know, he had something very traumatic happen to him
0:26:44 and he’s tried therapy multiple times,
0:26:46 but he just cannot talk.
0:26:47 And so for something like that,
0:26:50 he says it’s a physical thing, it’s like a blockage.
0:26:51 As soon as it comes up, I’ll start crying,
0:26:53 I can feel the emotion, but I cannot talk.
0:26:54 – Oh, wow.
0:26:56 – I can’t get the words out.
0:26:58 And so that’s, you know, in a case like that,
0:26:59 this would be very helpful.
0:27:00 – Yes.
0:27:01 – Kind of pull down some of those barriers
0:27:04 and let the emotion be more accessible
0:27:05 so that you can communicate.
0:27:07 – Again, this just really, I mean,
0:27:09 triples down on this idea that you need
0:27:11 to seek out a medical professional
0:27:13 to figure out which one of these is right for you.
0:27:15 You know, because there’s so much variance
0:27:16 in what people are trying to do,
0:27:18 whether it’s PTSD or depression or anxiety,
0:27:20 or you name it, you know,
0:27:23 it’s not like it’s a one-size-fits-all solution out there.
0:27:25 You know, I’d love to talk about Matthew Perry.
0:27:28 I mean, obviously a horrible, tragic thing
0:27:30 that has occurred.
0:27:31 New information has come to light
0:27:33 on the more recent side.
0:27:37 You know, there’s a lot of, I would say, polarize.
0:27:38 Like if you go and you read some of the comments
0:27:39 on some of these new sites,
0:27:42 like it’s kind of all over the place, right?
0:27:45 And so what do we know
0:27:48 and what can we talk about to kind of like compare
0:27:50 and contrast what happened to him
0:27:53 versus say what might actually happen in a professional setting?
0:27:56 – Right, well, first thing is that, you know,
0:27:59 this medication is extremely effective,
0:28:01 but it’s also, it’s an anesthetic
0:28:03 and something we use for conscious sedation,
0:28:06 which, you know, I think I’ve said this
0:28:07 probably a million times,
0:28:12 but you never want to be on a sedative
0:28:13 without being monitored.
0:28:15 You never, you don’t want to be, you know,
0:28:18 taking something that’s an anesthetic and not be monitored.
0:28:21 Not to mention he was, ultimately, he drowned.
0:28:21 You know, he was in a hot tub,
0:28:23 so which is even more tragic, right?
0:28:25 And he had buprenorphine in his system as well,
0:28:27 which is also can be sedating.
0:28:28 – What is that?
0:28:29 – It’s used for addiction.
0:28:32 It’s an opiate agonist antagonist,
0:28:35 but it’s used to help with addiction.
0:28:39 So, you know, it’s really tragic for a number of reasons.
0:28:42 The other thing that’s so tragic about it is that,
0:28:44 you know, it sounds like, from what I understand,
0:28:45 he was receiving the kind of, I mean,
0:28:47 both illegally from dealers
0:28:50 and also sort of semi-illegally,
0:28:52 certainly unethically through doctors.
0:28:56 You know what, and apparently one of the doctors
0:28:59 had instructed his assistant to inject him
0:29:02 when the assistant is not a medical professional, right?
0:29:03 And according to the indictment,
0:29:06 he got at least six injections a day
0:29:08 for three days leading up to his death.
0:29:10 – That is just insanity.
0:29:11 – Isn’t it, I mean, you’ve,
0:29:13 if you’ve ever seen someone experience
0:29:17 an intramuscular injection of catamine or an IV infusion,
0:29:19 you almost can’t imagine doing that six times.
0:29:23 – No, I mean, you’ve administered to me via injection
0:29:27 and I will tell you firsthand, like, for the,
0:29:29 so even when you’re done, you leave the clinic
0:29:32 and you go home, there’s no way I’m even getting
0:29:33 in a hot tub off of one injection
0:29:36 because you’re still out of it a little bit, you know?
0:29:39 It’s post-op-ish, you know?
0:29:41 And you kind of want to just take it easy, relax,
0:29:44 like be around friends, put yourself in a healthy environment.
0:29:49 And when you compound and add those on top of each other,
0:29:53 and especially in doses that can state you to the point
0:29:55 where you could drown, I mean, it’s just like,
0:29:58 it just seemed to be a really inappropriate,
0:30:00 I mean, this isn’t really the use
0:30:02 that it would even come close
0:30:03 to what you would do in a clinical setting.
0:30:05 – No, no, absolutely not.
0:30:08 But it does also speak to a more complex issue,
0:30:11 which is that this is a medication that can be addictive.
0:30:15 You know, the biggest tragedy for me is just knowing
0:30:17 that there might be people out there
0:30:20 who will not now seek out or receive this treatment,
0:30:22 who might benefit from it because of this awful tragedy.
0:30:26 And I think also those of us in emergency medicine,
0:30:28 especially since one of them was an ER doctor,
0:30:30 and certainly at the larger medical community,
0:30:33 we’re just sort of disgusted and ashamed
0:30:35 that one of us would do this, you know,
0:30:39 would act so unethically and obviously just take advantage
0:30:42 of his illness because addiction is an illness, right?
0:30:45 They took advantage of his disease to make money off of him
0:30:46 and they caused him great harm
0:30:48 and they ultimately he lost his life because of it.
0:30:53 So yeah, I mean, it’s really tragic on a number of levels,
0:30:56 but to the point about addiction,
0:30:59 I have very mixed feelings about receiving this in the mail
0:31:00 and just using this as a knowledge, right?
0:31:01 – Yes.
0:31:04 – I understand I’ve had a few patients that have flown in
0:31:05 from other parts of the country
0:31:06 where they can’t get this treatment.
0:31:08 And for them, if they need a booster,
0:31:10 then I guess that makes sense for them.
0:31:11 And they can’t, if they can’t access it
0:31:12 without having to fly hundreds of miles.
0:31:16 But barring that, you know, getting it in the mail
0:31:18 and just using it without supervision,
0:31:23 not even potentially even getting a therapeutic dose,
0:31:26 but potentially just incurring addiction,
0:31:28 that’s problematic.
0:31:31 And I think it’s going to be something that, you know,
0:31:32 we as a profession need to look at,
0:31:36 but also I think the FDA and the DEA
0:31:37 are probably going to look at that at some point
0:31:42 and especially if there is another high profile situation
0:31:46 like this, which is, it’s just,
0:31:49 any medication can be misused, right?
0:31:51 But it’s just, it’s just particularly tragic
0:31:52 because this is a medication that’s,
0:31:55 it’s just a emerging modality now.
0:31:55 – Yes.
0:31:59 It was a bummer because it cast this kind of like, you know,
0:32:01 immediately people hit me up and were like,
0:32:03 are you sure this is safe?
0:32:04 What’s going on here?
0:32:06 And it’s like, you have to understand,
0:32:08 there’s the professional use.
0:32:12 Decades of use of this being a very successful compound
0:32:14 in all different types of outcomes and procedures
0:32:15 that you’re still using today,
0:32:18 that every major emergency room is using today.
0:32:20 And then there’s the street use,
0:32:22 which is of course going to carry a ton of risk.
0:32:24 – Right, and I think that that’s really,
0:32:26 most ketamine providers,
0:32:27 we sort of knew this was going to come
0:32:30 because we, because people do abuse ketamine.
0:32:32 And so there was this sort of feeling like
0:32:34 there’s going to be a case like this.
0:32:35 It’s very unfortunate.
0:32:38 I think though, for me, it’s just really important.
0:32:39 I just remind my patients like,
0:32:41 this is a medication that can have life changing benefits
0:32:44 for you and the lesson to learn,
0:32:45 if there is one from this tragic thing,
0:32:49 is that you should not be giving this medicine to yourself.
0:32:51 You should, this is something that should be done
0:32:52 with the doctor, right?
0:32:53 – 100%.
0:32:55 Okay, so yeah, the other notes I had
0:32:58 that was a little confusing is the NIH came out
0:33:03 and said that this is, it can cause amnesia
0:33:06 without the cardiovascular and respiratory depression
0:33:08 associated with common anesthetics.
0:33:11 And then the DEA comes out and says
0:33:13 that in order so ketamine can cause unconscious
0:33:14 and slow breathing.
0:33:18 So like, NIH is saying it doesn’t depress breathing.
0:33:19 DEA says it does.
0:33:23 It sounds like if it’s too much, it does.
0:33:26 – When we first started taking pharmacology in med school,
0:33:28 the first thing they would say to us is the dose,
0:33:30 the dose is the poison.
0:33:33 It’s, any medication can kill you.
0:33:34 You water can kill you.
0:33:36 If you take too much, you med too fast, right?
0:33:39 – I remember like five years ago about that talk show host.
0:33:40 Do you remember that?
0:33:40 – Which talk show?
0:33:43 – Oh, so there was a radio show
0:33:46 and they had like a $1,000 prize or something.
0:33:47 They’re like, who could drink the most water
0:33:48 within a certain amount of time.
0:33:49 – Oh, oh, God.
0:33:51 – And this woman drank too much water
0:33:53 and died from a water overdose.
0:33:54 – Yes, you can.
0:33:55 And we see that actually with schizophrenics.
0:33:56 It’s a very common thing.
0:33:58 They’ll stand in the shower and just drink and drink and drink
0:33:59 until they throw their electrolytes off.
0:34:01 You can die from that and herniate your brain from that.
0:34:03 So yes, the dose is the poison,
0:34:04 like anything you take too much.
0:34:07 And so what you’re picking up on there
0:34:09 is that ketamine at the therapeutic doses
0:34:11 does not depress your respiration,
0:34:12 but if you give it too much or too quickly, it will.
0:34:14 And like I said, I had seen that.
0:34:15 I’ve seen providers give it too quickly
0:34:18 and what we call apnea meaning you stop breathing
0:34:19 but you pick up again quickly.
0:34:22 So yes, that can happen.
0:34:23 You have to know what you’re doing.
0:34:25 This is not child’s play, right?
0:34:26 This is a serious medication.
0:34:27 – That’s why I love that.
0:34:30 It’s funny when I sat down with you
0:34:32 for my first kind of treatment.
0:34:34 I remember you just being like, you know,
0:34:36 like my day job’s like an emergency room doctor.
0:34:38 And I’m like, well, that makes me feel a lot better.
0:34:40 Because if something did go wrong,
0:34:42 you’d be the person I showed up in front of, right?
0:34:44 Which is like really cool.
0:34:48 So what is the, what do you treat with this?
0:34:50 Because I know, well, actually one question,
0:34:53 somebody comes in tonight into an emergency room
0:34:55 and says, I want to kill myself.
0:34:58 I’ve heard that they will sometimes administer ketamine.
0:34:59 Is that not the case?
0:35:01 – No, no, I mean, not no emergency room that I know.
0:35:02 They should, but they don’t.
0:35:03 No, no, generally speaking,
0:35:05 when someone comes in in a crisis like that,
0:35:06 what they’re doing in the emergency room,
0:35:07 the only reason they have to go through
0:35:09 the emergency room is one to make sure
0:35:11 that it’s just a psychiatric, I say just,
0:35:13 but a psychiatric issue and not a medical issue.
0:35:15 Like for example, you don’t have meningitis or something
0:35:16 and that’s why you’re acting like this.
0:35:18 And the second reason to come to the emergency room
0:35:21 is to medically clear you if you need to be committed.
0:35:23 So if you’re holding these to be placed on you.
0:35:24 So I need to make sure you’re safe
0:35:26 to go to a psychiatric hospital,
0:35:28 which is gonna be different than a regular hospital.
0:35:29 So those are the two reasons to go to the emergency room.
0:35:30 So typically speaking,
0:35:33 ketamine is not administered for that purpose,
0:35:36 for mood disorders in ERs.
0:35:37 I think it should be.
0:35:39 It has rapid anti-depressant effects.
0:35:41 And for people who are suicidal,
0:35:42 and this is in the literature,
0:35:43 you can kind of look this up, it’s crazy.
0:35:45 Sometimes 45 minutes after the first infusion,
0:35:46 they’re not suicidal anymore.
0:35:47 That’s crazy.
0:35:48 When I read that, I did not believe it.
0:35:49 I could not believe it.
0:35:51 You take a person that’s suicidal.
0:35:53 This is one of the hardest things in psychiatry.
0:35:55 And 45 minutes after giving them a medication,
0:35:57 they’re not suicidal anymore.
0:36:00 I was reading that and I could not believe it.
0:36:02 And I have now seen it.
0:36:04 So it does work like that.
0:36:07 – I can’t even think outside of an IV antibiotic
0:36:12 for someone that has a blood-based bacteria
0:36:13 that’s about to kill them.
0:36:15 Like what has those rapid effects?
0:36:16 – That level of efficacy, right?
0:36:17 Short of setting a bone,
0:36:19 there’s little in medicine that does.
0:36:21 That’s why it’s so amazing.
0:36:23 But to be clear, and I’m such a Debbie Downer.
0:36:24 I’m so sceptic.
0:36:29 I tell people, this is a miracle drug if it works for you,
0:36:31 but there’s still people whom it does not work for.
0:36:33 So the studies, if you look at them in aggregate,
0:36:35 show anywhere from 60 to 80% of people
0:36:38 with treatment-resistant depression get better,
0:36:39 sometimes long-term remission from treatment,
0:36:40 which is amazing.
0:36:43 And in terms of looking at therapy or SSRIs,
0:36:44 or like you said, even antibiotics,
0:36:46 those are great numbers for medicine,
0:36:47 but it still functionally means,
0:36:48 and I tell every patient this,
0:36:50 if you take 10 people and bring them to me,
0:36:52 there may be two or four of them for whom it won’t work.
0:36:53 And if that’s the case,
0:36:55 it doesn’t mean nothing will work for you.
0:36:57 I don’t want people to lose hope
0:36:59 or feel despairing in that.
0:37:01 There is no medication that works perfectly
0:37:03 for everyone all the time.
0:37:05 – That’s a great thing to say,
0:37:08 because it is promising as it sounds.
0:37:10 There’s still some people.
0:37:12 – For whom it doesn’t work for, right?
0:37:13 – And so what is it, when you say work,
0:37:15 okay, what do you actually,
0:37:17 when someone comes knocking at your door and they say,
0:37:19 okay, I have depression, I have anxiety,
0:37:22 are there any other things that you say,
0:37:23 okay, you’re allowed in?
0:37:25 Is it like, I’d imagine,
0:37:27 have you, I’m sure you’ve treated veterans before
0:37:28 with people with PTSD.
0:37:31 – Yeah, PTSD, yeah, eating disorders.
0:37:32 – Oh, eating disorders?
0:37:34 – Yeah, I’m treating people with,
0:37:36 you know, lots of different mood disorders.
0:37:39 The evidence is the strongest for depression
0:37:41 and secondary to that anxiety,
0:37:43 but there is good evidence for some of those other things.
0:37:46 Well, we also use it for migraines, for chronic pain.
0:37:49 So chronic pain is a really interesting thing
0:37:51 to talk about, because for people with chronic pain,
0:37:56 there is something going on centrally in their brain
0:37:58 in which their signaling is off in terms of the pain,
0:38:01 and that causes them great anguish.
0:38:03 I mean, to be in chronic pain every day is no joke, right?
0:38:05 So these people are often also depressed and anxious,
0:38:08 but that doesn’t mean that we’re saying your pain
0:38:10 is because you’re depressed or you’re like,
0:38:11 oh, you’re still on your head, no.
0:38:13 But it is a complex cocktail,
0:38:15 and we use ketamine also for chronic pain.
0:38:16 – That makes sense to me.
0:38:18 There’s actually, I can’t remember the name of the book,
0:38:20 but Howard Stern came out a long time ago
0:38:22 where he had really severe back pain,
0:38:24 and there was a book around, it wasn’t like hypnosis,
0:38:29 but it was something more around the more psychiatric control
0:38:31 of chronic pain and some strategies.
0:38:33 – The body keeps it’s score, maybe.
0:38:34 – It wasn’t the body keeps it’s score, it was a different one,
0:38:36 but it was interesting because it was the first time
0:38:39 I had heard it wasn’t a pill, it was more like,
0:38:43 can we manage the mind to control the pain?
0:38:45 And it sounds like you’re saying the kind of the same thing,
0:38:48 like the mind can actually be transformed in some way
0:38:50 to help manage the pain and lessen it.
0:38:52 – So there’s two things with that.
0:38:54 One is that ketamine can help with the depression
0:38:56 caused by having chronic pain.
0:38:58 People who are in chronic pain are depressed often,
0:39:01 and often it’s because of the chronic pain
0:39:03 and what they’re going through, not the other way around,
0:39:05 which is important to know, right?
0:39:07 So it can help with that, but we also think it can help
0:39:10 with the central mechanism that’s going on
0:39:13 with chronic pain, which is that there’s ways
0:39:15 in which your brain is gatekeeping signals
0:39:16 that are coming through, right?
0:39:18 And so, I’ll give you an example.
0:39:20 It’s probably easiest to explain with an antidote.
0:39:22 I had a patient come to me.
0:39:25 She was walking on a beach and stepped on a bee
0:39:27 like several years ago, and it stung her on her heel.
0:39:29 No big deal, right?
0:39:30 – Was she allergic to bees?
0:39:33 – No, she stung her on the bottom of her foot.
0:39:34 And it hurt like hell.
0:39:35 – Pulled the stinger out, yeah.
0:39:36 – She pulled the stinger out.
0:39:37 It hurt like hell for a couple of days.
0:39:40 It kind of went, the redness, the swelling went away.
0:39:41 She didn’t get an infection or anything,
0:39:43 but the pain never did.
0:39:45 And it got worse and it got better,
0:39:47 and sometimes it was so bad she couldn’t go walking.
0:39:48 She couldn’t go to the farmer’s market.
0:39:51 She couldn’t go hiking with her other kids.
0:39:53 And she went to doctor after doctor,
0:39:54 and they just kept telling her,
0:39:56 it was kind of like all in her head.
0:39:57 They kept explaining, look,
0:39:58 the bee stinger’s not there anymore.
0:40:00 She’s like, I know it’s not there anymore.
0:40:02 I see, I’ve been stung by bees before.
0:40:03 I don’t know why.
0:40:06 And what had happened was that the brain,
0:40:08 when you injure tissue,
0:40:09 there’s signals being sent to your brain,
0:40:11 and the conscious part of your brain
0:40:13 or the higher up levels past your spinal cord
0:40:15 are deciding sort of what to do with that signal
0:40:18 and whether we need to keep listening too, right?
0:40:20 So in the case of back pain, it’s really interesting
0:40:23 because your back is so central to stabilizing,
0:40:24 that you have to listen, right?
0:40:26 You injure your back, it’s super important
0:40:27 for your brain to be like, no, no,
0:40:30 you need to chill now ’cause we need to heal, right?
0:40:33 Whereas like, if you get a paper cut or something,
0:40:35 it’s maybe not that important.
0:40:36 And so a bee stinger’s kind of in the category
0:40:37 of like a paper cut or something.
0:40:40 So it’s a little bit unusual for her brain to get this thing.
0:40:41 So the tissue is injured.
0:40:43 It’s sending a signal to the brain.
0:40:44 We have injury.
0:40:45 After the injury is healed,
0:40:47 after the inflammation’s gone down,
0:40:49 it’s still sending the signal.
0:40:50 And because of that, there’s parts of your brain
0:40:52 that get sort of, the squalch gets turned up too high.
0:40:55 It starts listening more than it should.
0:40:56 We need to keep listening to that heal.
0:40:59 And so any little thing that touches it,
0:41:00 oh, oh, oh, that must be pain again.
0:41:01 Oh, oh, oh, oh, turn up the signal.
0:41:02 We need to listen, we need to listen.
0:41:06 And so that signaling, that part of your brain
0:41:08 that is responsible for seeing whether or not
0:41:11 we need to listen is what’s dysregulated.
0:41:13 It’s not that there’s actually still injury in the tissue.
0:41:14 – Yeah, of course.
0:41:16 But would you consider that more of an obsessive
0:41:19 or rumination type thing?
0:41:21 – No, I mean, no, actually.
0:41:24 It’s just very, from the research that I’ve seen,
0:41:26 it’s very clearly part of the pain mechanism.
0:41:29 It’s the mechanism where you, it’s not,
0:41:33 I hate conversations where we separate the mind and the body.
0:41:35 ‘Cause it doesn’t really work like that in biology.
0:41:36 There isn’t really that distinction.
0:41:38 But to the extent that you could say no,
0:41:40 it’s not just their OCD person.
0:41:43 She wasn’t the beasting woman.
0:41:46 It’s not that she’s just crazy and like too anxious.
0:41:49 It’s that her brain actually just, it’s malfunctioning.
0:41:52 It’s listening too hard to that part of her body.
0:41:53 And it still is, and giving it the weight
0:41:55 that it shouldn’t, right?
0:41:58 And so they think that ketamine actually can reset that.
0:41:58 – Interesting.
0:42:00 – In and of itself, beyond the antidepressant effects
0:42:02 that it might be working to help reset that signal.
0:42:03 – Did you treat her for that?
0:42:05 – I did, yes.
0:42:08 So with chronic pain though, it is trickier, right?
0:42:10 There’s a lot of other.
0:42:13 Chronic pain is a very difficult thing to treat
0:42:17 because there’s a lot of other comorbid depression
0:42:19 is very often in conjunction with that
0:42:22 just because being in chronic pain will ruin your life.
0:42:23 – Right.
0:42:25 Was that a tricky one for you to treat?
0:42:28 Like, did she walk away pretty in remission?
0:42:30 – It was tricky for me to treat because she didn’t,
0:42:32 she was so nervous about doing it
0:42:34 that she did one session and she didn’t want to come back.
0:42:36 – Oh, interesting.
0:42:38 How often is that the case for you
0:42:40 where people will do a session
0:42:43 and get a little too nervous or?
0:42:46 – I actually don’t know if she was nervous and didn’t come back.
0:42:47 That was my impression,
0:42:50 just based on kind of seeing her go through it.
0:42:52 But maybe it could have been just inconvenient
0:42:53 for her to come back, right?
0:42:54 So it’s not very often,
0:42:57 it’s probably like maybe one out of 20
0:42:58 at times it happens.
0:43:02 But I will say that if you do this treatment right,
0:43:03 you need to do serial infusion.
0:43:05 So that’s a really hard thing to explain to people.
0:43:07 It’s not just one and done.
0:43:10 And so that can be very hard to fit into your life.
0:43:11 You got to kind of like take an afternoon off
0:43:14 and go trip on a Monday afternoon.
0:43:15 So not everyone can do that.
0:43:18 So that’s part of what makes this logistically challenging
0:43:19 is having to do that in series.
0:43:22 – Yeah, so let’s talk about what that takes.
0:43:25 So by the way, is that pretty much the list of things
0:43:27 that you treat with this?
0:43:29 So we’ve got PTSD, we’ve got pain management,
0:43:31 anxiety, depression.
0:43:34 – Another disorder is like bipolar.
0:43:36 It doesn’t work for personality disorders.
0:43:37 So we don’t, if someone comes to me.
0:43:39 – Eating disorders, things like that?
0:43:41 – Eating disorders, yes, we treat for that.
0:43:46 Migraines, there are people and there’s a lot of research
0:43:49 now being done for autism.
0:43:54 But that’s, it’s also problematic because the phenotypic
0:43:56 expression of autism is very complex.
0:44:00 So, but yes, autism also, so aside all the end of life,
0:44:03 sometimes people who are facing death will use this for
0:44:06 to help them kind of with the anxiety and the fear
0:44:07 around death.
0:44:10 – And so when you think about those different buckets,
0:44:12 I know when depression, you know,
0:44:15 Hubertman talked about this, like a lot of the studies
0:44:18 have been at six infusions, you know,
0:44:22 and you typically do six, what, like two a week?
0:44:24 – So this is how I explain it to people.
0:44:27 So the protocols are six, eight or 10 infusions
0:44:29 for treatment resistant depression initially.
0:44:32 And how I explain to people is that it,
0:44:34 the way it’s working, it’s working in two ways
0:44:35 as far as we know.
0:44:37 So the first way is the trip itself.
0:44:39 – Yes, you said trip a few times.
0:44:41 We need to explain to people what trip it is.
0:44:44 – Okay, so when you’re under, under, I say under,
0:44:46 when you’re experiencing a psychedelic,
0:44:48 what’s happening to you is there’s a part of your brain
0:44:50 that’s shut off.
0:44:51 – Hold on a second, you said psychedelic.
0:44:54 Now we’ve called this anesthesia before,
0:44:56 we’ve yet to say it’s psychedelic.
0:44:58 What makes it a psychedelic?
0:45:00 – So that’s a good distinction.
0:45:02 It’s actually a dissociative amnestic, technically,
0:45:04 if you’re looking at the categories,
0:45:07 but it has psychedelic effects.
0:45:09 – Okay, so let’s say dissociative,
0:45:10 let’s define each of these.
0:45:13 Dissociative just means when I’m receiving it,
0:45:16 I feel like I’m potentially could be not in my body.
0:45:17 Is that the best way to describe it?
0:45:19 – Yes, it’s a very difficult thing to describe actually,
0:45:20 dissociation.
0:45:23 It’s used in, the word is used in pop culture
0:45:24 to mean lots of different things.
0:45:26 But what it functionally means is that you sort of feel
0:45:28 like you’re maybe either floating
0:45:29 or that your body’s like moving in ways
0:45:31 that you’re not actually moving in.
0:45:33 So you may feel like your hands are doing this
0:45:33 when they’re not, right? – Oh my God,
0:45:34 I felt that so many times.
0:45:36 So I felt like when we were doing the sessions,
0:45:39 I felt like my whole body was twisting in the chair
0:45:40 and like turning sideways.
0:45:42 And obviously I wasn’t moving at all,
0:45:44 but I could have sworn with 100% certainty
0:45:45 that that was what was happening.
0:45:47 – Yeah, so that’s the dissociation part,
0:45:48 but it also has a dissociative,
0:45:50 it’s not just physical dissociation.
0:45:53 You can sometimes dissociate from your feelings
0:45:54 and your emotions or your memories for PTSD
0:45:56 is particularly important.
0:45:58 Like what happened to you that caused the trauma?
0:46:00 You can see it from a different perspective,
0:46:02 almost like you’re seeing it from somebody else’s perspective
0:46:04 or like you’re floating above yourself
0:46:06 and watching yourself like you’re a narrator,
0:46:09 like narrating a movie or something like that.
0:46:10 – So this is really important, right?
0:46:14 Because if you think about how we process things,
0:46:19 emotionally, oftentimes we’re so much in the first person
0:46:21 or it’s like me, I’m going through this,
0:46:23 I don’t know when that happens as well, blah, blah.
0:46:26 And when you get that kind of like one step removed
0:46:27 where you can like,
0:46:29 almost like it’s a friend you’re looking at
0:46:32 and like kind of like treat them
0:46:34 with a little bit more of love
0:46:36 and a kind of compassion for what’s going on
0:46:37 in that individual,
0:46:40 you have to imagine this is why
0:46:43 you don’t just knock someone out and it works, right?
0:46:45 Because like you could give people more of this compound
0:46:48 to where they don’t remember any of it, right?
0:46:50 But you keep them at this dose
0:46:54 where they are very much still aware that they’re here.
0:46:56 They might not be aware that they’re in their body,
0:46:59 but you are not out, meaning like you come,
0:47:01 like you never walk out.
0:47:02 – You can still talk, you can still talk.
0:47:02 – You can still, I’ve had patients singing,
0:47:05 I’ve even had patients trying to dance, undulating, right?
0:47:06 Yes.
0:47:07 – Yeah, so you’re still here,
0:47:10 but so it doesn’t work if you take someone
0:47:12 all the way to being fully knocked out.
0:47:13 – It works less.
0:47:14 – Works less, okay.
0:47:16 – Yes, and so what you’re getting at
0:47:18 is the big black box around the trip.
0:47:19 – So that’s called the trip.
0:47:21 – Yeah, the trip and what it means.
0:47:24 And it raises all these issues of consciousness
0:47:26 and being and spirituality and belief
0:47:27 and what does it mean to be me?
0:47:29 It’s a super philosophical exercise actually.
0:47:33 And my main, one of the things that’s super important
0:47:36 to me about this medication is to respect that
0:47:38 and to give that the time and the space it needs
0:47:40 because people who have transformations
0:47:41 on this experience, yes,
0:47:43 they may be cured of their depression.
0:47:46 They may feel like their life is 100% better,
0:47:48 but they also sometimes and often
0:47:52 have profound spiritual and philosophical insights
0:47:55 with this and are changed by that.
0:47:56 And I think that’s really important.
0:47:57 – I think it’s important too.
0:47:59 I think it’s beautiful.
0:48:02 I also think it scares the shit out of a lot of people,
0:48:04 especially if you come from a really religious background.
0:48:07 So I have a family member who won’t go into a lot
0:48:08 of details of mine that, you know,
0:48:12 I was raised Christian and no longer actively
0:48:15 practicing that religion for all the Christians out there.
0:48:16 I think there’s some good principles there
0:48:18 that are to be taken forward,
0:48:23 but I will say that I know Christian friends of mine
0:48:25 are like, ooh.
0:48:27 – Yes, yes.
0:48:30 I go into this, what am I gonna think about God?
0:48:31 What am I gonna think about the universe?
0:48:32 What am I gonna think of it?
0:48:34 Do you get that pushback from patients?
0:48:35 – 100% yes.
0:48:37 And that’s the reason that I started this clinic
0:48:38 and that I practice the way I do
0:48:41 because I, it personally grates on me.
0:48:44 The whole, that the whole psychedelic experience
0:48:45 seems to have been,
0:48:50 there’s a sort of a way that we as a culture
0:48:52 have sort of prescribed to have the psychedelic experience.
0:48:56 And it tends to be either really like sort of like 1960s,
0:48:58 old white dude hippie vibe
0:49:01 or appropriating indigenous culture, right?
0:49:03 In a way that feels very wrong to me.
0:49:05 So 100% yes.
0:49:06 And that I’ve had,
0:49:09 I’ve actually treated evangelical devout Christians.
0:49:11 People have come to me because they don’t want,
0:49:12 as one patient said to me,
0:49:14 she goes, I’ve been interviewing a lot of providers
0:49:16 and frankly, like I don’t want someone wearing a bare-skinned
0:49:18 rug with antlers behind them chanting
0:49:20 because this is, I don’t want my experience pushed
0:49:22 in that direction, right?
0:49:23 I need to get better.
0:49:26 And I don’t need it to be a philosophical experience
0:49:27 that you think I should have
0:49:28 or spiritual experience that you think I should have.
0:49:30 And that, to me, that rings really true.
0:49:32 I also resist that.
0:49:34 And I’ve had friends of mine, patients,
0:49:35 lots of people tell me,
0:49:37 I wanted to do ayahuasca, for example, but I got there.
0:49:38 And then, you know,
0:49:40 there was just so much mumbo jumbo
0:49:42 or this person was really pushing me
0:49:43 to have the kind of experience
0:49:44 that they thought I should have.
0:49:46 And that didn’t sit well with me.
0:49:48 And then not sitting well with me made me anxious.
0:49:50 And then I had a bad experience, right?
0:49:52 So, so just to be clear,
0:49:54 the trip, what we know about the trip,
0:49:56 and I think what I tell my patients
0:49:58 is what we know about it scientifically.
0:50:00 And you draw your own conclusions
0:50:01 about the philosophical insights
0:50:02 that you get because of that.
0:50:04 And what’s happening is there’s a part of your brain
0:50:07 that tells you what you get to think
0:50:09 and it gate keeps what stimulus,
0:50:10 what information is coming in
0:50:12 and it gate keeps that into consciousness.
0:50:15 So right now, your carotid is beating really loud.
0:50:17 Your heartbeat is right next to your ear
0:50:18 and it’s super loud.
0:50:20 And quite frankly, like you should hear it
0:50:21 ’cause it’s right there, right?
0:50:21 – Oh, interesting.
0:50:22 – Yeah, you should.
0:50:24 I mean, that’s why we use the stethoscope.
0:50:25 If I get close enough to you,
0:50:27 I could hear it without a stethoscope,
0:50:27 your heartbeat, right?
0:50:28 In your knack, it’s so loud.
0:50:29 But you don’t hear it, right?
0:50:31 Because your consciousness is like,
0:50:32 we get that signal, we don’t need,
0:50:33 he doesn’t need that right now.
0:50:36 If you hear, if you feel everything all the time always,
0:50:38 you can’t drive down the street, right?
0:50:39 So there’s a part of your brain
0:50:42 that gets to decide what parts of your brain get to talk
0:50:43 and what parts and what information
0:50:44 gets to rise to consciousness.
0:50:47 – I mean, the vast majority of the functions we do
0:50:48 are not conscious, right?
0:50:50 Like I don’t control my heart rate.
0:50:51 – You’re not thinking about your breathing
0:50:52 and your salivation right now, right?
0:50:54 So when you’re nervous, you do hear it, right?
0:50:55 Or if you’re freaking out
0:50:57 or if you’re in love, you might feel your heart beating, right?
0:51:00 So, yes, and what psychedelics do
0:51:03 is that they shut this part of your brain off for a second.
0:51:04 Okay, ketamine does this.
0:51:07 And the rest of your brain gets to talk to itself.
0:51:08 And other psychedelics as well.
0:51:11 When we look at functional MRI of people
0:51:13 who are under the influence of a psychedelic,
0:51:15 we see all these parts of the brain
0:51:18 lighting up and talking to each other in a very chaotic way.
0:51:20 I saw one researcher explain it,
0:51:22 like when you’re conscious,
0:51:25 your thoughts are all crossing like a tic-tac-toe.
0:51:27 Under a psychedelic, it looks more like a dream catcher
0:51:30 or a cobweb in terms of the interactions
0:51:31 of the different parts of your brain.
0:51:33 The part of your brain that likes the Rolling Stones
0:51:35 is talking to the part of your brain that smells cookies.
0:51:40 Okay, and so that crazy melee of sort of,
0:51:42 it’s like a free-for-all of all the different parts
0:51:43 of your brain talking to each other
0:51:46 can produce these incredible insights for people.
0:51:48 I’ve had people wake up from an infusion and say,
0:51:50 that was like 20 years of therapy in an hour.
0:51:53 I saw the face of God and I understand everything right now.
0:51:55 And I’ve also, but it can also produce nonsense.
0:51:57 I’ve had people wake up from it and say,
0:51:59 well, I saw a bunch of pink elephants, what was that?
0:52:00 – Yes. – There’s nothing, right?
0:52:01 It’s just silliness.
0:52:04 So you, going the trip itself,
0:52:06 and we know for other psychedelics as well,
0:52:08 and I’m gonna lump ketamine in as a psychedelic,
0:52:10 even though you’re right, it’s not technically.
0:52:12 We know that the trip is important,
0:52:16 that if you try to take the psychedelic experience out of it,
0:52:17 it doesn’t work as well.
0:52:20 And there’s lots of pharmaceutical companies right now
0:52:21 looking to try to take the trip out of it
0:52:23 for exactly that reason you said,
0:52:25 because most people don’t want their minds
0:52:27 and their consciousness is messed with, right?
0:52:28 – Right. – For good reason.
0:52:31 So it doesn’t, and so I tell my patients,
0:52:34 the trip itself, it’s not, we’re not hypnotizing you,
0:52:35 we’re not messing with your consciousness.
0:52:37 We’re just turning off a little bit,
0:52:39 the boss that’s conducting everything,
0:52:41 and duct taping that person, seeing them in a corner.
0:52:42 – To sit aside for a minute.
0:52:44 – Yeah, and letting the rest of your brain talk to itself,
0:52:46 and you can see yourself differently.
0:52:48 There are things that you might observe about yourself
0:52:50 that will give you insight, but maybe not,
0:52:52 and that’s okay because of the neuroplasticity,
0:52:54 which gets you to the second part
0:52:56 of how we really think this works, right?
0:52:58 Which is that for anywhere from,
0:52:59 we’re not sure exactly how long,
0:53:02 but maybe 24 to 72 hours after each infusion,
0:53:04 your brain has this increased neuroplasticity.
0:53:05 And what does that mean for people
0:53:07 who are kind of new to this?
0:53:09 When we’re younger and we’re kids,
0:53:11 our brain is like, we’re born with a brain
0:53:14 that’s like molding clay, it’s impressionable, right?
0:53:16 You’re learning things every day.
0:53:19 So we know that as we get older,
0:53:21 this doesn’t go away, you can still learn,
0:53:22 you can still change until you’re done.
0:53:24 – Recreating new pathways and connections, right?
0:53:28 – But it’s not as easy, it closes, that window closes.
0:53:30 So right around the end of adolescence,
0:53:32 that starts to close, and you’re not as neuroplastic.
0:53:33 So you can learn Greek when you’re seven,
0:53:35 or you can learn Greek when you’re 70.
0:53:37 But I’ll tell you, we both know
0:53:38 which one is gonna learn it faster and better.
0:53:40 And that’s because you’re more neuroplastic
0:53:41 when you’re seven, right?
0:53:43 You’re still neuroplastic as you’re older, but less so.
0:53:46 So for about 24 to 72 hours after each infusion,
0:53:48 you open up this window of increased neuroplasticity.
0:53:51 And from animal studies, where we look at a depressed,
0:53:53 say, hamster or mouse, and a non-depressed,
0:53:57 say, hamster or mouse, we see that depressed hamsters or mice,
0:53:59 they have these parts of their brain,
0:54:00 their neurons are shorter.
0:54:02 They’re overpruned, we call it, right?
0:54:03 The brain cut it down too much.
0:54:04 And after ketamine therapy,
0:54:07 and after some of the other plant medicines,
0:54:09 those neurons grow back and they more closely match
0:54:11 the controls or the happy mice, right?
0:54:13 So there is something going on here,
0:54:15 this beyond just like a philosophical thing,
0:54:19 where we actually are growing and changing
0:54:21 and maybe possibly healing ourselves.
0:54:22 – Could it be something where it’s happening
0:54:23 at the same time?
0:54:26 Like, for example, like I often think about,
0:54:28 you know, when I came to you,
0:54:30 I came to you specifically for a lot of anxiety
0:54:31 that was happening.
0:54:33 I had a really hard startup, we talked about this,
0:54:36 and yeah, I was like, okay, I just, you know,
0:54:37 let me give this shot.
0:54:38 My buddy Tim Ferriss had tried it,
0:54:40 like I wanted to give it a shot.
0:54:45 And, you know, I was just so focused day to day
0:54:48 on this rumination of like these issues
0:54:50 and this is happening and I’m being attacked here
0:54:53 and I didn’t, you know, and I was kind of like,
0:54:55 it almost felt like ruts in my brain
0:54:57 that I just couldn’t escape out of.
0:54:58 – Right.
0:55:00 – And then, you know, when I was in that mode,
0:55:04 that hour and change out there, that part shut off.
0:55:06 I wasn’t really thinking about that.
0:55:10 I had other things that were just beautiful experiences
0:55:12 and things that were just kind of like,
0:55:17 and I described it as like a weight coming off of me.
0:55:20 And if I’m thinking that these neurons
0:55:22 are obviously firing lots going on at that time
0:55:24 and these new pathways are being formed,
0:55:27 is the thinking that like, if we’ve got these grooves,
0:55:28 let’s call it depression or something,
0:55:30 of these pathways that we always just keep going down,
0:55:32 always keep going down,
0:55:34 that we’re creating these new bonds and connections
0:55:38 and now that’s a bit of healing that’s happening.
0:55:39 Is that kind of what we’re thinking?
0:55:40 – Yeah, yeah, kind of.
0:55:43 I mean, look, I had one researcher explain it like this.
0:55:45 It’s like in the wintertime,
0:55:47 if you see a path where there’s a sled going by
0:55:48 and there’s deep ruts and grooves,
0:55:50 you know that the sled goes down that path
0:55:51 every day, twice a day.
0:55:54 And what ketamine would be like is like a new snowfall.
0:55:55 So you still see the path,
0:55:56 but there’s now, there’s more snow on it.
0:55:59 So it’s not, it doesn’t look as warm.
0:56:00 – And if you wanna turn a little bit, you can.
0:56:02 – Yeah, yeah, I mean, that’s what we think.
0:56:05 But honestly, there’s so much more about this, right?
0:56:10 And look, if you have severe depression,
0:56:13 you also might know that you can get out of it
0:56:18 by doing things that also will grow new pathways, right?
0:56:20 You might travel.
0:56:23 You might go and learn a new skill, right?
0:56:24 – All this stuff helps.
0:56:25 – Right, there’s other stuff
0:56:28 that causes neuroplasticity that can, it’s been exactly,
0:56:29 proven by experience, we know this.
0:56:31 But one of the things that’s so interesting
0:56:33 about psychedelics and about ketamine
0:56:35 that I keep, my mind keeps getting stuck on,
0:56:38 my heart keeps getting stuck on is the sense of awe.
0:56:39 And I kind of heard that a little bit
0:56:42 in what, to your point about what you were describing before.
0:56:43 – There’s been a couple of times
0:56:45 where I’ve come out with you and I’ve just been like, whoa.
0:56:47 – Right, the whoa, right.
0:56:49 – Wow, I saw the universe.
0:56:50 – Right, right.
0:56:52 And this is what is so fascinating to me
0:56:54 because we obviously have pathways for awe.
0:56:57 And they’re obviously, they’re important.
0:56:58 I don’t understand why.
0:57:01 I don’t know what the evolutionary benefit is
0:57:02 of being able to appreciate awe.
0:57:03 And this is where we also touch on religion
0:57:04 and things like that.
0:57:09 But the thing that really changed my mind about awe
0:57:12 and made me realize that it was so important,
0:57:14 an important part of human existence
0:57:15 for us to experience it.
0:57:17 We have to have this in our life.
0:57:21 I went hiking in med school in the back country in Utah,
0:57:23 like super far, like 10 miles away
0:57:26 from in this southeastern part of Utah.
0:57:27 It was–
0:57:28 – Like with bears and shit out there, or was it just?
0:57:30 – No bears, this is, this was Canyonlands.
0:57:33 So this is like hundreds and hundreds of miles
0:57:34 from any civilization, okay?
0:57:36 And we then got out there and then we hiked in.
0:57:38 Like, I wanna say it was like eight to 10 miles.
0:57:40 I might be like making it bigger than it was.
0:57:42 But we bring it in all the water so far from anything.
0:57:44 There’s no one around.
0:57:46 And my girlfriend and I set up camp.
0:57:50 And I was looking up, I was resting
0:57:51 and I’m looking up at this guy.
0:57:52 I’m tired after we set up camp.
0:57:54 And I hear the sound and I can’t quite,
0:57:56 my mind can’t quite put what the sound is.
0:57:59 It’s like a crunching sound.
0:58:00 And in the context of where it was,
0:58:01 I couldn’t figure out what it was.
0:58:03 And then I saw it.
0:58:04 It was a plane.
0:58:06 It was like, this is like 10 o’clock at night.
0:58:08 A transcontinental plane, one.
0:58:12 30,000, 35,000 feet in the air.
0:58:15 And I heard it the whole way it crossed over, right?
0:58:17 And I thought to myself, well, that’s crazy
0:58:19 because in civilization,
0:58:21 there’s planes going over me all the time.
0:58:22 And I never hear them, right?
0:58:24 And right after the plane cleared,
0:58:26 and it occurred to me that I’d been living my life
0:58:28 like my brain’s been filtering that out
0:58:30 and what that effect might be on me.
0:58:33 I saw it, the curtain of the Milky Way,
0:58:34 hanging in the sky.
0:58:36 Like I had never seen it really, I think that clear, right?
0:58:38 There’s no light pollution.
0:58:39 We’re 100 miles away from anyone.
0:58:43 And it felt like a cathedral, right?
0:58:45 I mean, anyone who’s seen this knows what I’m talking about.
0:58:48 The sense of awe, this thing took over me.
0:58:50 It was like a religious experience
0:58:53 that you are simultaneously so insignificant
0:58:56 against this carpet of stars, right?
0:58:58 You’re just floating on this little rock
0:59:01 and you’re nothing, and also you’re everything, right?
0:59:04 And that feeling, I’m getting goosebumps
0:59:06 thinking about it now, that feeling of awe
0:59:08 was so beautiful and it carried me quite frankly
0:59:11 through like residency, the horrible days of residency,
0:59:13 and many years after, I can still recall it
0:59:14 and it will be helpful.
0:59:16 It is medicinal.
0:59:17 We know this, people go out in nature,
0:59:19 they hike, they have to be, it’s super medicinal
0:59:21 and we have, so we have pathways for it.
0:59:24 And I hadn’t had it juiced before that, I think, right?
0:59:27 And when I had it juiced, it felt so good.
0:59:30 And what psychedelics do is that they can give you that.
0:59:32 – Yeah, so ask him meditation.
0:59:33 – Right, ask him meditation, correct.
0:59:35 – And when I have my Zen master on here talking about it,
0:59:37 he describes a lot of what you just said.
0:59:38 – Yeah.
0:59:40 – The sense of awe, the sense of everything
0:59:45 and just appreciation for right now, for what is right now.
0:59:48 – And that’s something, so for people
0:59:49 who are really religious, I’ll tell them like,
0:59:51 I’m not gonna prescribe that for you.
0:59:52 – And I love that about your clinic too.
0:59:57 When I walk in, nothing about this says shaman crazy,
0:59:58 like, you know–
0:59:59 – No offense to any shaman’s out there,
1:00:00 I respect your work, it’s just–
1:00:02 – Of course, they have their thing,
1:00:06 but you are very much in like the like, come as you are,
1:00:08 like this is a safe space, you know,
1:00:10 you get warm tea when you’re done,
1:00:12 I get my little crackers on the side
1:00:14 ’cause you’ve been fasting, like,
1:00:17 you treat this in a very professional manner
1:00:20 in a way that is not like a clinic at all.
1:00:23 It doesn’t feel, ’cause like, I’ve seen pictures
1:00:24 that I’ve been inside of one of these clinics
1:00:27 that was like one of those more shady ones,
1:00:31 and it’s like they don’t take set and setting that seriously.
1:00:33 And I think that’s another piece of it,
1:00:35 of putting people at ease is like making sure
1:00:37 that set and setting is appropriate.
1:00:39 – Because this is a medicine after all,
1:00:42 but it is also maybe a pathway to all, right?
1:00:45 And so I think we have to give it that respect,
1:00:46 and people also need to feel comfortable
1:00:48 in order to do this.
1:00:51 And I think if you’re comfortable,
1:00:54 then you’re much more likely to have a better experience.
1:00:56 And so that’s super important, obviously, to me.
1:00:57 I’m glad that you appreciate that.
1:00:58 – Yeah, it was great.
1:01:03 So I’d love to have, do you have a couple of examples
1:01:06 of just outcomes that you can talk about?
1:01:08 Obviously, I want to keep people’s names anonymous.
1:01:11 I’d love to know also about age.
1:01:15 Like, you’re seeing people in their 20s
1:01:16 all the way to their 70s,
1:01:20 or like what range is this appropriate for?
1:01:24 – So there is actually no upper range for this medicine.
1:01:26 – That’s the oldest person you’ve treated.
1:01:28 – I think they were 80-something.
1:01:28 – Wow.
1:01:29 – Yeah.
1:01:32 I had a 90-year-old come to me and 94-year-old,
1:01:34 and I actually declined to treat him
1:01:37 because he had some other issues that would make it dangerous
1:01:37 for him.
1:01:42 But as you get older, obviously you have to take more care
1:01:44 because of the cardiovascular effects
1:01:46 of the increased heart rate and blood pressure.
1:01:48 Youngest you can treat, I mean, as I said,
1:01:50 I train on this to use in children.
1:01:52 So I’ve used this medication in toddlers,
1:01:54 but the evidence is not as good
1:01:56 for mood disorders for children.
1:01:57 And I think that’s because,
1:02:00 personally, I don’t know if we know the reason for that,
1:02:02 but I think it’s ’cause they’re already so neuroplastic.
1:02:04 So for treating children with depression,
1:02:06 it’s not as robust the evidence.
1:02:07 But there is no–
1:02:08 – And there’s still changing a lot too,
1:02:09 you have to imagine, right?
1:02:11 So what would your comfort level be on that?
1:02:15 Like, you say 18 for your clinic or–
1:02:17 – My comfort level, again, using this medicine
1:02:21 is I would go all the way down to near an infant
1:02:21 if I had to to use it.
1:02:24 – I’d probably get that in the emergency room.
1:02:25 What if a parent came to you and said,
1:02:26 “Hey, I have a 16-year-old
1:02:28 “that talks about suicide a lot.”
1:02:31 – I actually don’t see anything wrong with trying it.
1:02:34 I just would tell them that it’s not likely
1:02:35 to be as effective.
1:02:37 The possibility is that it would not be
1:02:40 as effective for adults, just based on the literature.
1:02:42 But I don’t actually have a problem with trying it.
1:02:43 I don’t think, because, and this is,
1:02:44 you’re hitting on this point,
1:02:46 which is that it’s not going to change who you are.
1:02:47 I mean, that’s what people are scared of.
1:02:49 This is gonna make you a different person.
1:02:51 I’m not gonna make you a different person any more
1:02:55 than when you were 13 and you were neuroplastic
1:02:57 and something happened to you that was really important
1:02:59 that that made you a different person.
1:03:00 No, you’re the same person.
1:03:02 You just experienced something and it shaped you, right?
1:03:03 – Right, I mean, I think if anything,
1:03:05 and I’m speaking of, you know,
1:03:06 and of one here, just myself,
1:03:08 but if anything, it made me just a little younger.
1:03:12 Like, I feel a little bit more like my younger self,
1:03:13 or I’m just like, “Hey, I’m just like
1:03:14 “a little more happy care-free.”
1:03:15 And I’m like, “You know what?
1:03:16 “That person said something, should he?”
1:03:19 – Yeah, all right, let’s just let it go, you know what I’m saying?
1:03:21 – Yeah, yeah, I had a lot of patients say that to me,
1:03:22 a lot, that I feel younger,
1:03:24 and that even a few patients said to me,
1:03:25 “People have said I look younger.”
1:03:27 And I think it’s just ’cause they’re acting like that.
1:03:29 And a lot of people say to me,
1:03:30 “This is like when I was in college.”
1:03:33 I feel like my mind, because I feel, once again, really,
1:03:37 like depression will rob you a lot of your motivation,
1:03:40 your excitement for things, your attention span.
1:03:43 So, in that sense, when you’re cured of that,
1:03:46 when those symptoms go away,
1:03:47 you become excited again,
1:03:49 and about you start reading again,
1:03:51 or you’re back to, you’re interested,
1:03:53 and engaged in your relationship again, right?
1:03:57 – This must be so, just when you go home at night,
1:03:59 and you see some of these changes,
1:04:01 you just must be so thrilled.
1:04:02 – I am.
1:04:04 – It must really be fulfilling for you, personally.
1:04:06 – It really is, like you have no idea.
1:04:07 It really really is.
1:04:08 – What have you seen?
1:04:11 Give me a couple examples of some of the craziest things
1:04:12 that you’ve seen that you can keep anonymous.
1:04:14 – I mean, the best things that I’ve seen
1:04:18 is I’ve seen people come to me suicidal and leave, not.
1:04:20 I have one patient who,
1:04:25 her, without giving away who it was,
1:04:26 but someone very close to her
1:04:27 and her family committed suicide.
1:04:29 But before they did, and she wasn’t depressed before this,
1:04:33 before they did, they had two years of grinding,
1:04:36 like almost committing suicide every day for two years.
1:04:38 And so she ended up having to care for this family member
1:04:40 by like tying bells on the door and stuff
1:04:42 to make sure that she would hear if they left a room,
1:04:45 ’cause she had to watch this family member.
1:04:46 – Like ’cause they might go to the kitchen.
1:04:47 – They might kill each other, right.
1:04:50 So can you imagine that trauma of having to do that?
1:04:51 And then that person did,
1:04:53 and they did it in a really public way
1:04:55 and in a really awful way.
1:04:58 And this person, she collapsed.
1:05:01 Like she, everything, she lost her job,
1:05:02 she lost all of her friends.
1:05:04 She collapsed into herself.
1:05:05 She moved from the city.
1:05:09 She lived in, she came here to Los Angeles
1:05:11 and she holed up in her apartment with her two dogs
1:05:13 and never, she became agoraphobic.
1:05:15 She never left the house.
1:05:18 She said she would leave the house only to walk the dogs.
1:05:19 Everything was delivered.
1:05:20 It was awful.
1:05:24 She saw no one and she fought every day
1:05:27 the desire to go commit suicide and join this family member,
1:05:28 right. – Wow.
1:05:28 – She wasn’t depressed before this.
1:05:29 – How did she hear about you?
1:05:31 – A friend referred her.
1:05:33 Someone who had experienced the clinic.
1:05:39 She came to me and she was absolutely,
1:05:43 just I hadn’t, this is one of the worst cases I’ve seen.
1:05:47 She just absolutely had, she couldn’t do anything.
1:05:48 She couldn’t call a friend.
1:05:49 She couldn’t, she could only,
1:05:50 and she lived only for her dogs.
1:05:52 And she said to me, I’m only alive for my dogs
1:05:53 and they’re dying.
1:05:54 They’re old, they’re old.
1:05:56 They were like, I don’t know, 14, 15 or something.
1:05:57 Little tiny dogs.
1:05:58 And she was like, they’re gonna die.
1:06:00 And that was the only reason I’m here.
1:06:02 And so, can you help me?
1:06:05 And we did and something really interesting happened
1:06:07 which happens with grief sometime is that
1:06:10 during one of her sessions, she actually saw
1:06:13 the person who died, who killed himself.
1:06:14 And she had a conversation with them
1:06:15 and she felt their presence.
1:06:18 And she woke up very transformed by that.
1:06:22 And that the person in that had given her permission
1:06:23 to let go on.
1:06:25 Like you can let go, I want you to let go.
1:06:27 I’m okay, I’m safe where I am.
1:06:29 Like this is the way she explained it to me.
1:06:31 She felt that she was, that they were on a different plane,
1:06:33 that they somehow communicated to her from beyond the grave
1:06:35 wherever they are.
1:06:36 I’m okay now.
1:06:37 I’m actually at peace now.
1:06:39 You need to not do this.
1:06:41 – That could be your own subconscious talking to her.
1:06:42 Like, we’re not saying it’s a religion.
1:06:43 – No, I’m not saying what it was.
1:06:46 I have no idea what it was, what it was.
1:06:49 I’m actually much more skeptical on the scientific.
1:06:51 So I’m much more inclined to try to look through literature
1:06:54 for like neurological reasons why she had this, right?
1:06:56 But I’ll tell you that this is not the first time
1:06:58 I’ve heard that for people who come to me for grief either.
1:07:01 So, but she said, no, no, it wasn’t like
1:07:03 I had a dream where they came to me.
1:07:05 It was like I smelled him again.
1:07:07 And I, and she started weeping because she said,
1:07:10 I’m so sorry, I forgot what you smelled like.
1:07:12 Like in the thing, she was apologizing to him
1:07:13 because she smelled him again
1:07:15 and she had forgotten what he smelled like.
1:07:17 And I’m so sorry.
1:07:18 I let go of you.
1:07:20 I’ve been trying to hold your memory for a year
1:07:23 and I lost your smell and now it’s back.
1:07:24 And now I’m so sorry.
1:07:25 Please like forgive me.
1:07:28 And, you know, he said to her like,
1:07:30 you’re not meant to remember.
1:07:31 You’re not meant to hold on to this.
1:07:32 I’m okay.
1:07:33 Like you have to go.
1:07:34 You have to go.
1:07:35 You can’t stay here with me in this plane.
1:07:38 She said, I want to stay here forever with you.
1:07:39 You cannot.
1:07:42 And I promise you, like you will find me again.
1:07:42 You’ll be okay.
1:07:45 And like that, she woke up from that
1:07:46 just tear streaming down her face.
1:07:49 I remember digging my fingernails into my hand
1:07:51 to not cry and I lost it.
1:07:52 I was crying with her, right?
1:07:53 Obviously.
1:07:55 But she got better.
1:07:59 She started, she met with her agent again.
1:08:00 She started working again.
1:08:02 She started taking learning Chinese
1:08:03 so she could get some roles.
1:08:07 She started calling up friends and family
1:08:08 and socializing again.
1:08:12 And because she need all six or eight, 10.
1:08:13 She needed 10 actually.
1:08:14 She needed more.
1:08:15 Yep.
1:08:16 She needed more.
1:08:16 But she did it.
1:08:17 She got out.
1:08:18 She started working again.
1:08:19 She got out of her apartment.
1:08:21 She reached out to her family again.
1:08:23 People, her friends again, like she’s social.
1:08:24 She, she made it.
1:08:25 She crawled out of that hole.
1:08:26 And I remember when she came to me
1:08:27 at the first couple of times,
1:08:29 cause it doesn’t happen for everyone right away
1:08:30 after one treatment.
1:08:31 Most people actually take three or four
1:08:34 before you start to see any effect at all.
1:08:37 And I remember her so frustrated the first couple of times.
1:08:39 Even getting to the clinic was hard for her.
1:08:39 Getting dressed and getting out.
1:08:42 And I told her, you know that silly parable
1:08:44 about a donkey at the bottom of the well.
1:08:45 Have you heard that one?
1:08:46 No, no, no, no.
1:08:47 That a donkey falls in a well
1:08:48 and the farmer looks over and sees the donkey
1:08:49 at the bottom of the well.
1:08:50 And he’s like, I’m not gonna be able
1:08:51 to get that thing out of here.
1:08:52 So I’m just gonna bury it.
1:08:53 Alive.
1:08:54 I don’t know why.
1:08:56 So he starts shoveling the dirt into the well.
1:08:57 And the dirt falls on the donkey’s back
1:09:00 and then he shakes it and it stomps,
1:09:01 it goes on the ground and then he stomps on it.
1:09:03 And then the farmer keeps doing that
1:09:05 and he eventually makes his way out of the well.
1:09:06 I told her this story in the beginning like,
1:09:07 look, we’re gonna do this,
1:09:10 but it’s gonna take a long time to get out of this well.
1:09:12 And she, it really resonated with her.
1:09:14 And about around the third or the fourth,
1:09:16 she was like, oh my God, I think I can see.
1:09:17 Okay, she’s seen–
1:09:18 I can see the sunlight.
1:09:20 I think I can see my way out of here.
1:09:21 Right.
1:09:24 And so, I mean, I have lots of stories like that.
1:09:26 But that’s just like, and she did it.
1:09:27 But my point is like,
1:09:28 she actually made it all the way out of the well.
1:09:30 She got out.
1:09:33 You sit with every patient after you’re done.
1:09:36 Like you’ve come into my room and you come into others
1:09:39 and you just like do a debrief kind of like afterwards.
1:09:42 What are the most common themes that you see?
1:09:45 I’m just fascinated after treating so many patients.
1:09:47 What do people say that they experience?
1:09:51 So, a really common thing is self-esteem
1:09:52 and self-compassion.
1:09:54 It’s a huge, huge thing.
1:09:56 And interesting, it’s interesting ’cause I feel like
1:09:58 for men it’s harder for them to admit that,
1:10:01 but it’s self-esteem and love for themself.
1:10:02 I felt that with mine.
1:10:04 I came out there, remember one time I was like,
1:10:06 why am I taking everything so seriously?
1:10:08 I was just like beating myself up
1:10:11 and like really carrying this burden of just like,
1:10:14 I was just like taking everything so seriously.
1:10:18 And when I was out there, I don’t know what it was.
1:10:21 ‘Cause we should mention that you have a journal
1:10:22 sitting right next to people’s tables
1:10:25 that you give them so that they can write down
1:10:28 because you do kind of lose some of the that you’re thinking.
1:10:30 And so it’s very important to journal afterwards
1:10:32 and capture some of this. – If you can, if you can.
1:10:34 Yeah, some people will record on a phone.
1:10:36 – Yeah, and so it’s like,
1:10:38 but I remember just kind of like rebuilding myself
1:10:40 as kind of like a part of,
1:10:42 by the way, we should mention music for,
1:10:44 I would imagine a lot of people as a big part
1:10:47 is I put noise canceling headphones on.
1:10:49 I have a great playlist that I use.
1:10:51 Do a lot of people use music in this as well?
1:10:53 – Yeah, I mean, there are clinics
1:10:55 where they put stuff on a screen for you to watch.
1:10:57 There are places where you don’t use music,
1:10:59 but I think music helps a lot.
1:11:03 And so the best, I think the best way to do this
1:11:05 is to have noise canceling headphones,
1:11:07 have a playlist, no lyrics usually,
1:11:08 for most people they don’t like lyrics.
1:11:10 And music that evokes emotion.
1:11:12 Because the best way that this medicine works
1:11:16 is when it can allow emotion to well up
1:11:19 so that you can kind of look at that emotion
1:11:20 with dissociation.
1:11:21 And when you can kind of look,
1:11:23 it’s like a window into your own top.
1:11:26 Because I think what I’ve learned from doing this now
1:11:27 for hundreds and hundreds of patients
1:11:31 is that we seem to all have this like,
1:11:34 I wanna say code running in the background,
1:11:36 all these different codes like running.
1:11:38 And we’re not always aware of them.
1:11:40 And our emotions are kind of going up and down
1:11:42 in their own currents and eddies underneath, right?
1:11:45 And we’re, the gatekeepers not allowing us to be aware of them.
1:11:46 – I think of this all the time.
1:11:48 Like I consider us like little mini computers
1:11:50 where we have an operating system running underneath.
1:11:51 And there’s like all these little things
1:11:52 that are allowed to serve us and not.
1:11:54 And like little bugs in the code.
1:11:55 – June, do you wanna know what’s really interesting?
1:11:57 I read this in a book a while ago,
1:11:59 but apparently a human society is all over the world.
1:12:01 We always conceive of consciousness
1:12:03 based on the highest level of technology
1:12:04 we have at the time.
1:12:05 So like the Romans, they used to think,
1:12:07 ’cause you know, your brain has these big holes
1:12:09 and it calls ventricles and lots of fluid bathing it.
1:12:11 And the Romans had aqueducts.
1:12:13 That was their great technology.
1:12:15 And so they thought thinking was when you’re,
1:12:18 the fluid around your brain was like sloshing around.
1:12:19 And so like when you thought like this,
1:12:21 you know that the thinker like Rodinus,
1:12:22 the thinker, you put your head forward,
1:12:24 it’s because the fluid is like going forward
1:12:27 in your brain and that’s giving you like consciousness.
1:12:29 So it’s just funny to me like we as humans,
1:12:31 we always use the highest technology we have
1:12:33 to as an analogy for consciousness.
1:12:35 So for us to be talking about computers and AI,
1:12:37 that makes sense, right?
1:12:39 But whatever it is, it seems like the best way
1:12:42 this medicine works is when it allows you to see that code.
1:12:43 Right?
1:12:44 And you can do with it what you want.
1:12:47 And that’s why this is like there is no prescribed
1:12:48 philosophical or religious way to do this.
1:12:50 Because if you use this medicine, right,
1:12:51 you’re just going to be able to see yourself
1:12:53 and see the things that are kind of like
1:12:56 pulling your strings in a different way.
1:12:56 – Yes. – Right?
1:12:59 And so yeah, like I think the best thing,
1:13:01 music is good because it sort of evokes emotion
1:13:03 and that emotion will kind of carry you into the journey
1:13:05 or the trip, whatever you want to call it.
1:13:08 And allow you to sort of like play in those emotions
1:13:10 and see them and see how they’re affecting you.
1:13:11 – Yeah, 100%.
1:13:16 So a lot of people worry with things probably largely
1:13:20 due to, you know, painkillers in the society we live in
1:13:22 around addiction to substances, right?
1:13:26 There is, even though this puts you out into a state,
1:13:28 there is no high.
1:13:29 Like you don’t, like, you know what I mean?
1:13:32 Like you’re not feeling like, like, you know,
1:13:35 I had a chest surgery one time, they gave me Percocets.
1:13:36 That’s a high.
1:13:37 Like, you know, you take a few of those
1:13:39 and you’re like, oh, I feel warm and fuzzy all over.
1:13:40 I could do this forever.
1:13:42 You know, and you’re like, oh, wait a second,
1:13:43 this is why we have the opioid crisis, right?
1:13:44 – You know what though?
1:13:47 That’s your experience, right?
1:13:49 Other people will say the opposite.
1:13:50 They’ll say, I took Percocets, that wasn’t a high,
1:13:51 but this is a high.
1:13:52 – Oh, really?
1:13:54 – Yeah, and so what you’re touching on, okay,
1:13:56 so addiction is such an interesting and tricky topic
1:13:58 because ketamine is used to treat addiction.
1:13:59 – Right.
1:14:00 – I don’t know if you knew that.
1:14:01 – Oh, I didn’t know that.
1:14:02 – No, yes, there’s good evidence.
1:14:04 Actually, a lot of it coming out of the UK.
1:14:06 Ketamine is used a lot for alcoholism,
1:14:09 alcohol use disorder, but it’s also used to treat
1:14:11 other forms of addiction, like cocaine.
1:14:12 – Okay, I like my wine.
1:14:14 Maybe I should come in for a little bit.
1:14:16 – Yes, and in fact, a lot of people do describe
1:14:18 that it reduces cravings for alcohol.
1:14:19 – Yeah.
1:14:21 – But it also can get you high.
1:14:23 Actually, that’s your experience though,
1:14:26 but so what makes something addictive?
1:14:27 – It would make sense because we do see
1:14:28 street usage of it, right?
1:14:29 – We do, right.
1:14:30 – And people wouldn’t be doing it on the street level
1:14:32 if there wasn’t something associated with it.
1:14:34 – But what’s so fascinating about addiction
1:14:37 is what makes you high is very much dependent
1:14:39 on who you are and the society you’re in.
1:14:41 Because I, as an ER doctor, there were people
1:14:43 who used to come into the ER for IV Benadryl,
1:14:44 like to scam us for IV Benadryl
1:14:46 because they would get high off Benadryl.
1:14:48 Like, you’re so confused right now.
1:14:49 – Why don’t you just buy that at the store?
1:14:50 – Your face is like this right now,
1:14:52 but like, my point, to explain it,
1:14:54 ’cause it’s not the same as IV, that’s why.
1:14:56 But my point is that it’s not the substance
1:14:57 that makes the addiction, right?
1:14:58 – Yeah.
1:15:00 – It’s the substrate, it’s the person
1:15:02 and the stuff they’re going through
1:15:03 and the society that they’re in, right?
1:15:05 There’s a reason why, like crack cocaine
1:15:06 was a big thing in the ’80s.
1:15:08 It’s not, it’s still addictive,
1:15:10 but it’s not so much of a big thing as now.
1:15:12 The opiates were, we’ve had opiates
1:15:14 for 200 years, what, maybe actually more than that,
1:15:17 but like commercial opiates used for medicine.
1:15:19 But it became, but there are certain circumstances,
1:15:22 socioeconomic, societal, cultural circumstances
1:15:24 that make things maybe more addictive
1:15:26 to certain people or certain groups of people, right?
1:15:27 It’s very complex.
1:15:29 So it’s not the substance.
1:15:30 – Okay.
1:15:31 No, this is really helpful.
1:15:33 This is like clearly, I hadn’t thought about that.
1:15:35 Yeah, you’re framing it in a way
1:15:36 that makes a ton of sense.
1:15:39 It’s like, it explains why we do see street usage of it.
1:15:43 – We do. And to be fair too, Ivy is different from,
1:15:46 like if you’re snorting it at a concert or something,
1:15:49 that’s, I sound so old snorting at a concert.
1:15:52 If you’re in the club and you’re using ketamine,
1:15:53 it’s a different experience than Ivy.
1:15:54 Ivy is much more intense.
1:15:57 So I think what you’re explaining
1:15:59 and what we generally agree with is that
1:16:01 the Ivy experience is so intense
1:16:03 that it’s less likely to be addictive.
1:16:03 – I see.
1:16:04 – That experience.
1:16:05 – ‘Cause when I walk out there, I’m like,
1:16:07 there’s no way in hell I wanna go back and do that again.
1:16:08 I need a two days break.
1:16:11 Right, it’s intense, right?
1:16:12 It doesn’t, not for everyone.
1:16:16 Sometimes it’s just relaxing or confusing or just chill.
1:16:17 – Oh, I’m very chill when I get back home.
1:16:19 I just sit in a rocking chair for like two hours
1:16:20 and just enjoy the afternoon.
1:16:21 – Yeah, yeah.
1:16:22 – I mean, I love that you called the clinic
1:16:24 golden afternoon because like, I’m like,
1:16:25 this is exactly what it is.
1:16:26 – This is exactly what it is, right?
1:16:28 We called it that because that’s a poem
1:16:30 that said the front of Alice in Wonderland.
1:16:31 – Yes.
1:16:35 – It’s, the author of Alice in Wonderland decided
1:16:38 he would write the book when he was on a ferry ride back
1:16:40 in the afternoon with Alice Little,
1:16:41 the girl that it’s based on.
1:16:44 And he’s basically talking about a liminal space.
1:16:46 So a space between spaces, right?
1:16:48 And a time between, and just that afternoon,
1:16:49 that space gave him the inspiration
1:16:50 to write Alice in Wonderland.
1:16:54 But liminal spaces, like all, are important for humans,
1:16:55 right?
1:16:56 Spiritually important, they’re medicine.
1:16:57 And we need to be in that space.
1:16:59 And that’s another thing that psychedelics can help you be.
1:17:01 They can help you get to that liminal space.
1:17:02 – Yes.
1:17:04 – And that in and of itself can be transformative.
1:17:05 – 100%.
1:17:07 Couple more questions for you.
1:17:11 Boosters, so I have a friend of mine.
1:17:12 She’s a dear friend.
1:17:17 She did this three years ago for severe depression.
1:17:19 It not only did it fix her severe depression,
1:17:22 she felt a big pop happen in her sixth session.
1:17:23 She was pissed.
1:17:25 She says she was pissed that she bought the whole package.
1:17:27 She did this in a different state.
1:17:29 And she bought a package of six, you know?
1:17:30 And like every single time she’s like,
1:17:31 “I don’t like this, I don’t like this.”
1:17:34 And then number six, she like physically heard a pop.
1:17:36 Her depression went away.
1:17:41 And she said her body dysmorphia did as well.
1:17:43 She had some feelings around that.
1:17:46 She hasn’t needed a booster or anything since.
1:17:48 She’s been completely fine.
1:17:51 Some people, they can benefit from coming in
1:17:53 and getting another treatment.
1:17:54 How does that shake out?
1:17:55 Where do you see that?
1:17:56 Like what people–
1:17:57 – So the science on that, we don’t know.
1:17:59 We don’t have studies to show who needs boosters
1:18:01 and how often, which is unfortunate.
1:18:03 So some people can come in, they can be cured
1:18:04 and they never come back and see me, right?
1:18:05 And I don’t know.
1:18:06 And then other times they can be cured
1:18:08 and they think they never have to come back.
1:18:09 But then something awful happens
1:18:10 and maybe sends them back into as far.
1:18:12 So part of it is like life, right?
1:18:15 You lose your job, your family member dies,
1:18:17 that might send you back somewhere.
1:18:19 There isn’t a lot of great evidence
1:18:19 about who needs a booster
1:18:21 and how often it should be done.
1:18:23 – You never prescribe boosters, right?
1:18:24 – I don’t push it.
1:18:26 I definitely say like, we’re here if you need us
1:18:27 ’cause I don’t want people to feel like,
1:18:29 oh God, it didn’t work after six months
1:18:30 if they’re starting to feel depressed again.
1:18:32 I explain that you can come back in.
1:18:33 But I don’t prescribe it
1:18:35 because we have no way of knowing who needs it
1:18:35 and how often.
1:18:37 But what you tell people is, look,
1:18:40 I, the most often I’m comfortable doing it
1:18:42 is usually once or twice a month, okay?
1:18:43 And that’s usually for anxiety
1:18:47 ’cause anxiety is a trickier creature than depression.
1:18:49 But I have patients who will come in and see me
1:18:50 maybe after six months or a year.
1:18:53 I have patients who schedule it every eight weeks or so
1:18:56 because they know they want to get ahead of their symptoms.
1:18:58 So yeah, so booster, it’s a–
1:18:59 – What a wild thing.
1:18:59 – It’s a wild thing.
1:19:00 – Some people don’t even need it
1:19:02 and others need it like every few weeks.
1:19:03 – Right?
1:19:03 – Yeah, it’s a wild thing.
1:19:05 – But still, that’s better than suffering, right?
1:19:06 Like it’s amazing.
1:19:07 – It is, but it’s kind of like ibuprofen.
1:19:09 Like if you have arthritis, I don’t know how often
1:19:10 you’re gonna need to take it.
1:19:11 – Right.
1:19:12 – Maybe, you know.
1:19:16 – Have you seen any downsides, like in terms of literature
1:19:19 around, I’ve certainly seen that if people,
1:19:20 I remember reading some article around it,
1:19:25 the people that snored it, stomach lining issues,
1:19:28 bladder issues with people doing it recreationally.
1:19:30 – Yeah, so if you Google it,
1:19:32 there’s all these horror stories out there, right?
1:19:34 And so I don’t want anyone to be scared
1:19:36 because most of these effects that you’re talking about,
1:19:37 so you’re talking about this kind of aggressive
1:19:39 kind of cystitis that can happen,
1:19:43 cystitis meaning affecting your bladder that is awful.
1:19:45 And this is affecting people who are taking
1:19:47 like 1,000 milligrams a day, daily.
1:19:50 And just for context, like your dose would probably
1:19:51 be like 80 milligrams.
1:19:52 – Yeah, and by the way, we should say
1:19:54 it’s not the same dose for everyone.
1:19:55 – No, no, it’s weight-based, it’s a weight-based.
1:19:57 – Yeah, so every time I would come in,
1:19:59 you would always put me on a scale.
1:20:02 You’d get my, and you do a milligrams per kilogram
1:20:03 of body weight ratio.
1:20:04 – Right, right.
1:20:05 – And so it’s not like it’s just like
1:20:06 same shot for everybody.
1:20:07 – That’s right, yes.
1:20:09 And it’s also, we also have to titrate it to,
1:20:11 ’cause sometimes it takes more for someone
1:20:12 to get to a psychedelic place than others,
1:20:14 even within that range.
1:20:16 – We’ve had a friend that’s a relative of mine
1:20:20 that came to see you that needed a pretty big monster dose.
1:20:21 – I wouldn’t say that was a monster dose,
1:20:23 but yeah, a higher dose.
1:20:26 Before they felt any of the benefits.
1:20:27 – But that’s not uncommon.
1:20:29 That’s not uncommon ’cause the psychedelics place
1:20:30 that we’re trying to take you to,
1:20:32 it’s gonna be different for everyone, right?
1:20:35 – But you said that there was some red-haired people
1:20:37 for some reason with that genetic, does that mean?
1:20:37 – There’s a thought.
1:20:40 Well, so redheads in general need higher levels
1:20:42 of anesthesia and lidocaine, right?
1:20:44 It’s like a variant on the gene that they carry out.
1:20:45 – Is that like a known thing?
1:20:47 – It’s a known thing in anesthesia.
1:20:48 It’s a known thing in anesthesia.
1:20:50 But I don’t know actually if,
1:20:53 I haven’t seen any studies on this for ketamine.
1:20:54 I don’t think there are any.
1:20:56 But anecdotally, in the community,
1:20:57 there’s this sort of idea that if you’re redhead,
1:20:58 you might need more.
1:21:00 We also, there’s this anecdotal thing
1:21:01 that maybe if you’re on the spectrum,
1:21:02 you might need more.
1:21:06 I think that it’s very hard to know
1:21:09 because most doctors aren’t trying to figure out
1:21:10 if a person had a psychedelic experience
1:21:11 and how psychedelic after.
1:21:13 They’re just giving the med.
1:21:14 They’re just clearing the patient.
1:21:15 And then frankly,
1:21:16 they usually don’t even talk to the patient again
1:21:18 after they let the nurse just administer the next sense,
1:21:19 right?
1:21:20 – As to why you’re sitting in and asking questions,
1:21:22 like how was it?
1:21:23 – So I usually come in after just to,
1:21:26 and I’m not trying to like do therapy or anything.
1:21:28 I just need to find out like how psychedelic was this.
1:21:29 What did you see?
1:21:30 So I can get the dose to the right place.
1:21:31 And that’s different for everyone.
1:21:33 – Yeah. ‘Cause you kind of dialed me in.
1:21:34 I was like, it’s like a third or fourth time
1:21:36 I went in there, we nailed it, right?
1:21:38 And I was just like, wow, okay.
1:21:40 I got the full thing, you know?
1:21:41 – ‘Cause we know that’s important, right?
1:21:42 – Yeah. That’s so cool.
1:21:46 How you can, you do that for each individual patient.
1:21:49 Okay. So last thing, pricing for this,
1:21:53 some people are priced out sadly because it’s not cheap.
1:21:55 I mean, you have like real clinicians
1:21:58 that are you have people that are putting in IVs
1:21:58 that are working for you.
1:22:02 But you’re not the obviously the only one there.
1:22:05 So you have to hire medical professionals.
1:22:05 – Right.
1:22:07 – Insurance doesn’t cover this.
1:22:08 – Right.
1:22:10 – Is there any reimbursement in the horizon
1:22:11 for this type of stuff?
1:22:14 – So I think I don’t really know how they’re getting away
1:22:16 with not covering it when it’s so effective honestly.
1:22:19 Like as a human being, I just don’t sort of understand it.
1:22:20 But I do know it’s not,
1:22:21 so we should mention it’s not FDA approved
1:22:23 for this indication and what that means, right?
1:22:25 So we’re using it off label in the clinic.
1:22:26 – Right, right.
1:22:28 – And you know, lots of medications are used off label.
1:22:30 Like if I use birth control pills to treat your acne,
1:22:31 that’s off label.
1:22:33 And what it means is like if you have a medicine,
1:22:35 you create it, you invented it.
1:22:38 You will want to push it through all these experiments
1:22:41 to show the FDA it works for this thing.
1:22:43 I said this medicine would make your rash go away.
1:22:46 So I have to show you that it did just make your rash go away.
1:22:47 If we simultaneously discovered
1:22:49 that it also makes your legs stronger,
1:22:52 that’s we have to do a whole nother thing for that
1:22:53 to show to the FDA.
1:22:58 So Ketamine’s been generic since for a long time, right?
1:23:02 So nobody, there’s no money to be made in generic Ketamine.
1:23:03 It’s going to cost billions of dollars to push it
1:23:05 through the FDA to get approval for it.
1:23:07 So there’s no real incentive.
1:23:08 I don’t know why, I don’t know why,
1:23:11 because I think the studies conducting like these kinds
1:23:13 of high quality studies are very expensive, right?
1:23:15 So Johnson and Johnson decided they were going
1:23:18 to tweak the molecule and make something a little bit different
1:23:20 so they could patent it and then push that
1:23:21 through the FDA approval process.
1:23:22 – Which they got through.
1:23:23 – Which they got through and so what they did is
1:23:26 they took Ketamine which has two enantiomers now.
1:23:28 Enantiomers are just the same molecule
1:23:29 but mirror images of it.
1:23:33 And in biological processes when you have a receptor
1:23:35 and a chemical that’s reacting with a receptor,
1:23:36 it’s like shaking hands.
1:23:38 So if you can imagine a right-handed shake
1:23:40 and a left-handed shake are not exactly the same thing.
1:23:42 So that’s the R and the S.
1:23:44 So what Johnson and Johnson did is they took the R out,
1:23:46 version out, so now we’re just giving you the S
1:23:48 and we’re putting it in a nasal spray.
1:23:49 We’re going to push that through the FDA approval process.
1:23:52 They did, they spent the millions, they did.
1:23:55 And then after that, they marketed that as FDA approved
1:23:56 for depression.
1:23:57 That is covered by insurance.
1:24:00 If you have failed multiple SSRIs,
1:24:01 depending on your insurance,
1:24:03 it depends how many SSRIs you have to fail, okay?
1:24:05 And that doesn’t work as well
1:24:06 because they took the enantiomeral
1:24:08 because biological processes very often
1:24:10 involve chemicals that are both enantiomers.
1:24:12 – So plus it’s intranasal.
1:24:12 – Plus it’s intranasal.
1:24:13 – Correct.
1:24:14 – You’re not getting high enough dose.
1:24:15 – But even when you do head-to-head studies
1:24:19 with the two enantiomer version intranasally,
1:24:20 the two enantiomer version works better.
1:24:21 – Yeah, I bet.
1:24:24 And also you have to go into a,
1:24:27 they don’t prescribe it to you to take home.
1:24:28 – Right, for the ascetamine.
1:24:29 – You have to go into a doctor’s office
1:24:31 and you’re going to get the nasal spray.
1:24:34 – So my point about all that, bringing all that up,
1:24:35 is we are using this,
1:24:37 I think that’s why it’s not covered
1:24:39 because it’s not FDA approved, it’s off-label,
1:24:42 so they can kind of say that, which is super unfortunate.
1:24:45 – I wish we could somehow raise the funds required
1:24:49 to get that, those trials done.
1:24:50 So this is why insurance could cover this.
1:24:53 ‘Cause I mean, it’s expensive.
1:24:55 So what are you currently charging per dose?
1:24:58 – So we do, if it’s individual, we do 750 per infusion.
1:25:02 And if you buy a package of six, it’s 600 per infusion.
1:25:03 And it is super expensive.
1:25:06 And that causes me a lot of anguish
1:25:09 because I never want to turn anyone away.
1:25:11 But the problem is that we have,
1:25:14 you have a really high level of critical care doctors
1:25:17 and nurses that are present to watch over you
1:25:18 while we’re administering this.
1:25:20 – Oh, we should have mentioned that you have cameras
1:25:22 in the room, which I think is a great idea
1:25:25 because it’s more like, for me, it was like,
1:25:28 “My music stopped working, I can’t control my phone.”
1:25:31 And so you watch and if someone raises their hand,
1:25:33 someone’s in there within 20 seconds.
1:25:37 – Yeah, yeah, we don’t record, we just use it to observe.
1:25:40 – Which is huge, it’s important, right?
1:25:41 ‘Cause you’re right out there by yourself
1:25:43 and you also don’t want somebody sitting over there
1:25:45 watching you when you’re in your journey.
1:25:45 – Exactly, exactly.
1:25:48 – So it’s like one step removed and it’s safety.
1:25:51 It’s like, you feel like you got a supportive back there,
1:25:53 but also not someone that’s just hovering over you.
1:25:54 – Right, exactly.
1:25:56 – Which is quite nice, right?
1:25:57 So I appreciate that level.
1:26:02 But yeah, I mean, I was talking to a ketamine doctor
1:26:04 up in the Redding, California area,
1:26:05 which is where I was born.
1:26:09 And he was really upset because he’s like,
1:26:12 listen, he also has a practice outside of that
1:26:14 ’cause oftentimes doctors have to have both
1:26:15 to kind of support it.
1:26:19 And he’s like, I treat a lot of veterans.
1:26:22 And he goes, they just don’t have the cash.
1:26:26 And he’s like, I will give them super insane discounts.
1:26:29 And he’s like, I’m losing money on some of these people.
1:26:31 He’s like, but I can’t turn them away.
1:26:32 – Yeah, I’ve done that too.
1:26:36 And I wish, I mean, there are some organizations
1:26:40 that are sort of charities that collect money for veterans
1:26:43 to be used for them to receive psychedelic medicine.
1:26:44 – Do you know the names of those?
1:26:46 We’ll put those in the show notes of this episode.
1:26:49 – I don’t, but I want more of them.
1:26:50 I want more people to,
1:26:52 I’ve had a few people contact me trying to set this up.
1:26:55 So if anybody out there has a lot of cash
1:26:58 that they are feeling like helping set up a charity
1:27:00 and help your, it’s usually, it has to be local
1:27:02 because you’re trying to get people to.
1:27:04 – Yeah, even if it’s just like an offset, right?
1:27:06 ‘Cause like the difference between somebody coming up
1:27:09 and saying like, if we could put together some fun,
1:27:12 you say, hey, listen, Kevin, I’ve vetted this person.
1:27:15 I’m not going to obviously give you any of their information,
1:27:16 but here’s the kind of profile.
1:27:19 I think they’re really, they want to kill themselves.
1:27:21 They’re a serious, very serious case.
1:27:25 And they can afford 250, but they can’t afford 600.
1:27:27 And like that’s where you pull people’s money together
1:27:28 and we get people help.
1:27:30 Like, oh gosh, I wish that could be some kind of like tech,
1:27:31 tech surround, ’cause you could do that
1:27:33 through a non-profit arm.
1:27:34 That might be interesting as well.
1:27:35 – I think you can.
1:27:37 And I’ve heard of these things happening.
1:27:38 I don’t know anyone personally.
1:27:39 – This brings me in real time here.
1:27:41 – Right, right, we’ll figure this out.
1:27:44 – And also treating them can also, I think, be tax deductible,
1:27:46 but that’s what my home was telling me.
1:27:48 This person was trying to set up a charity.
1:27:49 She came to me to talk about this,
1:27:53 but it is, yes, I wish it were more accessible.
1:27:55 And so a lot of times people, ’cause they can’t afford it,
1:27:57 they’ll turn to the intranasal
1:27:58 or they’ll use the laws and just,
1:27:59 which were less effective
1:28:01 and yet have a higher abuse potential.
1:28:02 So that’s unfortunate too.
1:28:04 – Yeah, it is.
1:28:06 All right, so one of the things I was wondering
1:28:08 if you were open to is like you said,
1:28:10 you do these boosters.
1:28:14 I would love to, the anxiety treatment I’ve had
1:28:15 for me has been amazing.
1:28:18 I feel I’ve, we first started like,
1:28:19 what, like six months ago or something?
1:28:22 And I’ve felt the lasting effects of it has been great.
1:28:29 I feel just, I take on a lot of work with ease now,
1:28:31 where it’s like I just don’t have
1:28:35 the same kind of like weight to everything.
1:28:37 That’s the only way I can describe it.
1:28:40 The best analysis I’ve ever come up with has been like,
1:28:41 I’m still doing crunches in the gym
1:28:43 and I hate doing crunches,
1:28:45 but I don’t have the 25 pound backpack on.
1:28:47 That’s like the best thing I can come up with.
1:28:51 And it’s like, life’s not a wonderland,
1:28:53 but it’s way better.
1:28:54 – It’s a circus.
1:28:55 It’s a circus.
1:28:56 – Yeah, exactly.
1:28:56 – Right?
1:28:57 – Yeah, back to her.
1:29:00 Like I say, it’s a circus and that’s okay.
1:29:03 But I would like to demystify this a little bit further.
1:29:07 If you would allow a camera into your actual facility,
1:29:09 I think it could be fun to transition
1:29:11 and actually show people.
1:29:14 And I would love to just do the inner muscular,
1:29:17 which is where you give two shots for the treatment.
1:29:20 You get the same full ride.
1:29:22 And for as long as I can,
1:29:24 I think I can, with a mic on,
1:29:27 describe to people exactly what it’s like to feel this.
1:29:28 – Oh, wow.
1:29:29 – At least in my–
1:29:31 – Yeah, that would be great, I think.
1:29:32 I think that would be really interesting.
1:29:34 If you’re comfortable doing that, I mean–
1:29:35 – Why not?
1:29:37 I’ve had, as you can imagine,
1:29:39 I’ve had so many people reach out to me after this
1:29:40 and be like, I don’t want to,
1:29:43 well actually, we’ll say this.
1:29:44 ‘Cause I know he’d be okay with it
1:29:46 and I’ll double check before we hear the subject.
1:29:48 There is someone that you and I both know
1:29:49 ’cause he was a patient of yours
1:29:53 that is a very famous entrepreneur.
1:29:57 You know, built companies much larger than I have ever done.
1:29:59 Definitely household name, if we said it,
1:30:00 we’re not going to.
1:30:03 Came out singing your praises and hit me up.
1:30:05 I hadn’t talked to him in years.
1:30:06 And he hit me up and he’s like,
1:30:09 “Kevin, your podcast, I got turned on to it.
1:30:13 “I did it, it changed me, this is amazing.”
1:30:16 And that’s awesome.
1:30:19 When I heard that, I was like, wow,
1:30:24 that person is such an amazing entrepreneur
1:30:26 that I know that them being in the right state of mind
1:30:28 is just gonna make the world a better place.
1:30:30 – Let me tell you, that person also turned around.
1:30:32 The first thing he did was reach out
1:30:35 and try to help multiple other people.
1:30:36 – Oh, really?
1:30:37 – It was the very first thing he did when he got better.
1:30:38 – That’s amazing.
1:30:41 – Yeah, so he has actually made the world a better place,
1:30:43 literally, and he actually has paid
1:30:45 for people who couldn’t afford it.
1:30:46 – Oh, that’s fantastic.
1:30:49 – Yep, and he has, I can personally tell you,
1:30:51 he has saved several people’s lives.
1:30:52 – That’s awesome.
1:30:53 – So, yes.
1:30:54 – Yeah, so he was out of town.
1:30:56 We’re supposed to catch up here soon,
1:30:58 and I’m sure he’ll share those stories,
1:31:01 but that is, oh, I just love hearing that kind of stuff.
1:31:04 And so, but I think back to my point
1:31:05 about the common question is like,
1:31:08 I’ve had people come to me privately,
1:31:09 and you know, you can talk about it
1:31:11 on a podcast with Tim, and that was awesome,
1:31:13 but to actually see what it’s like,
1:31:15 to get a glimpse behind the curtain,
1:31:17 like what does the place look like?
1:31:19 What does the environment look like?
1:31:21 What does it feel like?
1:31:22 – And you wouldn’t be nervous to do that
1:31:23 in that vulnerable state.
1:31:24 That’s interesting.
1:31:25 (laughing)
1:31:26 – Like, why not?
1:31:28 You know, it’s like, I think it’s important
1:31:33 that we make this seem a lot less scary,
1:31:34 because there’s so many people
1:31:37 that read the very unfortunate Matthew Perry story
1:31:39 and say, oh, doll, never touch that.
1:31:40 – Right, right.
1:31:41 – You know, and it’s like,
1:31:44 you kind of have to understand that,
1:31:46 like to your point about this whole episode,
1:31:48 it’s like the dose is the poison,
1:31:49 and there’s very beneficial things
1:31:52 that can happen at the right dose,
1:31:54 and you take that very seriously.
1:31:56 – Yeah, part of this is also the stigma
1:31:59 that comes with it being quote unquote, a drug, you know,
1:32:00 and with the whole war on drugs,
1:32:02 and Nixon Reagan propaganda
1:32:04 about the hallucinogens in general,
1:32:06 which is so unfortunate,
1:32:08 that we as a humanity have a medicine
1:32:09 that can help so many people,
1:32:12 and that they’re afraid to use it
1:32:13 because of, partially because of that,
1:32:15 that’s really, yeah, so yes,
1:32:17 I would be on board with that, let’s do it.
1:32:18 – Well, thank you for doing this interview,
1:32:20 and then I guess we’ll just cut over to me,
1:32:22 sit in the chair and get ready.
1:32:23 – Awesome, let’s do it. – Let’s do it.
1:32:24 – Awesome.
1:32:34 – Here I am, I’m at the clinic at Golden Afternoon.
1:32:36 This is in Santa Monica, California,
1:32:38 which is on the west side of LA.
1:32:41 As you can see, it’s a beautiful space,
1:32:44 bright colors, a lot of fantastic books on the shelf,
1:32:46 some of which I’ve read actually,
1:32:47 how to change your mind with Michael Pollan.
1:32:49 If you get a chance, go back and listen to my interview
1:32:51 with Michael Pollan, that was a really good one as well.
1:32:55 You know, tea here, very, very calm, safe.
1:32:58 Set and setting is so very important
1:33:00 when you go onto one of these journeys.
1:33:02 Also, I think it’s important to say
1:33:05 and really get into actually why I’m doing this today.
1:33:06 Why am I here?
1:33:08 I want to give you a tour of the facility,
1:33:11 I want to show you what a high quality facility looks like,
1:33:13 but I also want to take some time
1:33:17 and walk you through a few really important points to hit
1:33:19 before we actually go in and do the treatment.
1:33:22 So first and foremost, you know, why am I doing this?
1:33:25 It is not to convince you to do this.
1:33:26 You know, I’m not a doctor,
1:33:28 Dr. Jen is not your doctor.
1:33:31 This is not an endorsement of treatment.
1:33:33 There are risks that we discussed in the episode.
1:33:33 There are also risks
1:33:36 that we did not discuss in the episode.
1:33:40 My hope is that given how many people watch this show,
1:33:43 which has been fantastic, we had great viewership,
1:33:45 I know based on those numbers,
1:33:48 you know, some subset of people out there
1:33:50 are sitting with crippling anxiety
1:33:53 or they may have treatment resistant depression.
1:33:54 I’m sure there are even some
1:33:56 that are fighting off suicidal thoughts.
1:34:01 A friend of mine came to me after I had my sessions done.
1:34:03 This is a colleague of mine.
1:34:05 And they said that they were having
1:34:08 some really dark suicidal type thoughts.
1:34:12 They said that they weren’t thinking about taking their lives,
1:34:15 but they were encouraged to go do this treatment.
1:34:18 And so they came in here to golden afternoon
1:34:19 and did a series of treatments
1:34:23 and now thankfully are in remission.
1:34:26 When I saw that, I, along with a few other friends now
1:34:28 that have been through this,
1:34:30 I was convinced that this could have
1:34:31 some benefit for other people.
1:34:34 So I wanted to bring you here today
1:34:36 to really to just kind of demystify
1:34:38 the whole process for you.
1:34:40 To let you know how approachable it can be
1:34:42 and how non-scary it can be,
1:34:45 what a good high quality clinic actually looks like.
1:34:48 For me, even if one person that’s watching this show
1:34:50 gets some relief from it, it will have been worth it.
1:34:52 Also, I wanted to let you know
1:34:56 I have zero financial ties to golden afternoon clinic.
1:34:58 I’m not an investor.
1:35:00 I’m gonna pay for today’s session.
1:35:01 This is very important to me.
1:35:02 I always want to have full disclosure
1:35:04 on all that stuff whenever I do it.
1:35:06 And then lastly, what are we gonna do?
1:35:10 So we are going to do two intermuscular shots
1:35:12 in my arm of ketamine therapy.
1:35:14 I’m gonna try the best that I can
1:35:19 until I leave my body to describe to you
1:35:20 what I’m feeling.
1:35:21 What does this feel like?
1:35:23 What is this sensation as you kind of lead up
1:35:25 to that moment where eventually
1:35:27 I’ll pull down my eye mask,
1:35:30 I’ll have my noise-canceling headphones on,
1:35:32 and I’ll go on a little journey for 45 minutes to an hour
1:35:33 and then come out of it.
1:35:35 And then we’re gonna talk to me afterwards.
1:35:40 So, you know, we’ll go in now and talk with Dr. Jen,
1:35:43 do our step on the scale, get weighed.
1:35:44 That’s very important.
1:35:45 We need to know how much I weigh
1:35:46 so they can dose it appropriately.
1:35:47 Everyone’s different.
1:35:49 I wanted to bring you through every step of the process
1:35:52 and make this feel a little bit approachable.
1:35:55 If it is something that you, when you talk to your doctor,
1:35:56 they say it is for you.
1:35:58 And I know there’s a lot of people out there
1:35:58 that are suffering.
1:36:01 So, my hope is that we get a few people
1:36:02 some high-quality treatment.
1:36:05 And with that, let’s step in and see what this looks like.
1:36:08 All right, let’s do it.
1:36:11 We exposed the world how much I weigh.
1:36:14 86.4 kilograms.
1:36:17 – Are you ready to go ahead and have a seat?
1:36:18 – And this is the antinazia?
1:36:19 – Correct.
1:36:20 – Okay, so we each take that an hour.
1:36:21 – I’ll take it now.
1:36:22 Well, yes, please.
1:36:23 – Okay, cool.
1:36:27 – Yeah, so, Zofran, right?
1:36:31 Yes, this is Zofran’s standard classic antinazia med.
1:36:32 I’m gonna do this under the tongue.
1:36:34 It’s a four milligrams.
1:36:37 Not everybody gets nausea on this stuff,
1:36:39 but you know, it’s just like a preventative thing.
1:36:42 And it’s, I’ve done it before it works.
1:36:46 So we’re gonna start off by filling out a little form here.
1:36:49 This is a questionnaire around depression and anxiety.
1:36:53 One is called the PHQ-9 and the GAD-7.
1:36:55 So they ask you questions like,
1:36:57 do you have little interest or pleasure in doing things?
1:37:00 Are you feeling down, depressed or hopeless?
1:37:04 There’s, it looks like there’s close to 20 questions here.
1:37:06 And then you circle, not at all,
1:37:09 several days, more than half the days or nearly every day.
1:37:11 And then they tally up the score
1:37:13 so that the doctor has a sum score
1:37:15 of where you’re at currently today.
1:37:17 And then they can kind of track that over time
1:37:18 and how your symptoms are improving.
1:37:27 Thank you.
1:37:35 – How did you feel after your last injection?
1:37:36 – I felt fine.
1:37:39 Yeah, it was actually no problem at all.
1:37:41 I had a little bit of a soreness the next day,
1:37:43 but you know, to be expected.
1:37:44 – From the arms, from the–
1:37:46 – Yeah, just from the injection, but that’s–
1:37:47 – You kind of light-headedness, no dizziness.
1:37:49 – No, none of that.
1:37:51 – Thank you, I’m slow, deep breath.
1:37:57 Alrighty, have you picked out a playlist?
1:37:59 – I got the playlist ready to go.
1:38:01 Yeah, and I’m just gonna stay,
1:38:04 let me make sure I can actually sync this up first.
1:38:07 Pro tip for those watching,
1:38:09 make sure you have downloaded your playlist
1:38:11 so that there’s no interruptions.
1:38:13 Get my mask ready to go.
1:38:14 Okay.
1:38:18 All right, oh, let me put this back a little bit.
1:38:19 – Oh, thank you.
1:38:20 – Okay, thank you.
1:38:22 – You’re welcome, let me put this off, please.
1:38:23 – Yep.
1:38:24 – Go into outer space.
1:38:26 – Yeah, there we go.
1:38:28 Yeah, you just go, I like going back as far as possible,
1:38:29 so that sounds good.
1:38:32 All right.
1:38:36 Perfect, thank you so much.
1:38:43 All right, so obviously situated cozy,
1:38:46 got my heart rate monitor on,
1:38:48 we’re gonna be testing,
1:38:50 I think it’s like every 15 or so minutes,
1:38:52 they check your blood pressure.
1:38:53 There’s a camera in the corner there,
1:38:54 which is pretty awesome.
1:38:58 It doesn’t do audio, but they are always watching you.
1:39:00 So if you need anything,
1:39:01 you can always just kind of raise your hand,
1:39:03 and they’re like in here within a few seconds,
1:39:04 which is great.
1:39:06 There’s been a couple of times I’ve had like audio issues
1:39:07 where my audio’s cut out,
1:39:08 and they come in and help you out there.
1:39:12 So I guess it’s time to do it, time to do the shots.
1:39:13 – Time to do the shots.
1:39:17 – Hey, Kevin, how are you doing?
1:39:18 – All right, we’re doing it.
1:39:20 – Yeah, how have you been feeling?
1:39:21 – Pretty good, yeah.
1:39:23 I mean, obviously being on camera,
1:39:26 doing this creates a little bit of like,
1:39:28 what is the world gonna think of this whole thing?
1:39:29 – I bet.
1:39:31 – But, you know, excited for a booster.
1:39:33 I think, you know, taking something like this,
1:39:36 and then going in to some good cardio tomorrow,
1:39:38 getting some meditation in,
1:39:40 like just doing healthy brain activities
1:39:43 to reinforce some of that neuroplasticity that’s happening.
1:39:45 Obviously, probably a pretty good thing.
1:39:47 Any other things you’d recommend to people,
1:39:49 like one post procedure?
1:39:50 – Well, the post is important,
1:39:52 but also getting in the right frame of mind
1:39:53 before you come in.
1:39:55 So, I mean, you probably talked about this already,
1:39:56 but you do have to fast,
1:39:58 and you do want to be in the right head space.
1:40:02 So if you’ve been consuming any media that’s upsetting,
1:40:03 or if you’ve been having an argument
1:40:05 with your mother-in-law or something right beforehand,
1:40:08 you want to kind of let that all seep out of you,
1:40:11 and be in a relaxed state, and an open and curious state.
1:40:13 – Yeah, I mean, it’s a great reminder, though,
1:40:15 because I think one of the most important things
1:40:18 is this idea of, you know, when you’re out there,
1:40:21 and you’re somewhat conscious still,
1:40:24 it can be a little bit like, where am I right now, right?
1:40:27 And if you question that, and you don’t let it go,
1:40:30 and drop it, it can be a little anxiety producing, right?
1:40:33 And so, I just have this mantra that I’ve used successfully
1:40:36 so many times, of just like, just this,
1:40:38 and just letting it go.
1:40:40 And so, if something seems weird,
1:40:42 if I’m not sure where I’m at, I’m like,
1:40:44 I can hear my music, that’s my connection back
1:40:46 to where I am, and just let it go.
1:40:49 And then, immediately, that kind of shifts my perspective,
1:40:50 and I’m like, I’m good to go.
1:40:52 Was that a pretty common, like,
1:40:53 is that a good strategy for us at one place?
1:40:56 – No, it’s a big issue, and a lot of people
1:40:57 have a hard time letting go.
1:40:59 And if you have anything uncomfortable that comes up,
1:41:03 anything at all, fear, anxiety, a bad memory, sadness,
1:41:05 if it’s bothering you, and you feel yourself
1:41:08 kind of resisting, just get curious about it.
1:41:10 Try to look at it, welcome it, let it come in,
1:41:12 and sit at the table, and listen to what it has to say.
1:41:14 And often, if you’re curious enough,
1:41:16 the uncomfortable feeling will dissipate.
1:41:18 But just to remember, as you know,
1:41:19 there’s no wrong feeling in here, right?
1:41:21 It’s just a way to look at yourself.
1:41:23 – Yeah, and every session’s gonna be different, right?
1:41:24 – Absolutely.
1:41:25 – So like, there’s some rocky ones,
1:41:26 and that’s part of the process,
1:41:28 and there’s some amazing ones,
1:41:31 and it feels like that’s how they typically go, you know?
1:41:33 – Right, right, it’s your subconscious, so.
1:41:36 – Yeah, exactly. – It’s not a predictable journey,
1:41:39 but it is a worthwhile one to take, so that’s great.
1:41:40 Is there anything that we can do
1:41:42 to make you more comfortable while you’re–
1:41:44 – No, I think I’m all good to go, like we said,
1:41:46 you know, I’m fasted, you know, there’s no liquid here,
1:41:48 so I’m not gonna be drinking anything
1:41:52 until after post-procedure, and we’ll just,
1:41:54 I’m gonna try and stay kind of semi-conscious
1:41:56 as long as I can after the first shot,
1:41:58 and try and talk people through the experience
1:42:00 on what this is all about.
1:42:03 – Yeah, feel free to just say whatever you need to say,
1:42:05 let out whatever emotion you need to let out.
1:42:06 – Sounds good, thank you. – Okay, great.
1:42:07 All right, you ready to go?
1:42:09 – Let’s do it. – Let’s do it.
1:42:11 – So let’s set the mask.
1:42:13 – I’m gonna try and stay conscious
1:42:16 as long as I can until it goes.
1:42:18 – We need a room.
1:42:19 – Shots are always fun.
1:42:26 – All right, thank you.
1:42:31 All right, shot one is in, here we go.
1:42:36 So the shot on a one to 10 in terms of pain,
1:42:38 I don’t know, I’m not that bad with shots,
1:42:41 so this for me was like pretty benign,
1:42:43 but they just squeeze the muscle a little bit,
1:42:44 push it right in.
1:42:48 It’s an inner muscular, so it’s not subcutaneous,
1:42:49 so they have to go in a little bit deeper
1:42:51 into the actual muscle.
1:42:54 Right now, obviously just one minute in,
1:42:55 so not feeling anything yet,
1:42:57 but I’m just gonna sit back and relax,
1:43:00 and thankfully got Hayden right here with me,
1:43:03 hanging out until I go to Lolloland,
1:43:06 and yeah, we’ll see what happens,
1:43:09 so I’ll let you know as the textures start changing
1:43:10 or whatever else comes up.
1:43:13 – Did you come in setting certain intention?
1:43:15 – Good question, so my intention going into this
1:43:19 is just to really hopefully one,
1:43:21 relax and reset myself,
1:43:23 and give myself a little bit more grace,
1:43:26 and allow myself to have even less anxiety,
1:43:29 and set myself up for the coming months,
1:43:32 but also is a gift to everyone else
1:43:33 that is hopefully suffering,
1:43:36 and can see that this is something that’s approachable,
1:43:38 it’s something that they don’t have to be scared of,
1:43:40 so my intention is to help others,
1:43:45 and also give myself a little bit of relief as well,
1:43:49 in terms of just the burdens that we all carry.
1:43:50 So let me give you an update,
1:43:52 it’s about what would you say, in two minutes in?
1:43:55 The first sensation now I’m starting to feel
1:43:58 is my eyes are getting a little bit slower
1:44:01 in that tracking around the room,
1:44:03 like looking from one side to the other
1:44:07 is taking a little bit longer than it would normally take.
1:44:10 I don’t feel, I feel a little bit of warmth,
1:44:14 feel a little bit of just kind of like body buzz,
1:44:17 so there’s like a kind of a natural body buzz.
1:44:20 Yeah, we’ll just let this kind of unfold slowly
1:44:21 over the next few minutes,
1:44:24 and I’ll do my best to describe how I’m feeling,
1:44:26 and Hayden, feel free to ask questions.
1:44:28 How does the seat feel?
1:44:30 Do you feel like you’re slowly falling into it
1:44:32 and settling into it?
1:44:36 Yeah, so right now I feel like the seat,
1:44:39 it almost feels like it’s starting to wrap around me
1:44:44 a little bit, imagine like a glove or some type of like,
1:44:47 free falling into a bean bag almost,
1:44:52 like it’s like sucking the body in a little bit,
1:44:55 so you get a sensation of this wrapping
1:44:58 that’s starting to happen around my body right now.
1:45:01 So when you’re listening to me and you’re seeing this,
1:45:05 like know that like I’m truly like feeling this right now,
1:45:08 like it’s actually, it’s kicking in right now,
1:45:12 like it’s hitting and happening,
1:45:15 and it’s gonna get harder very quickly
1:45:19 to describe what is happening,
1:45:23 because as this compound takes hold,
1:45:28 I’m not gonna be able to describe things as well.
1:45:32 So it’s starting to, as you can probably tell,
1:45:34 it’s starting to kick in.
1:45:36 So now that we’re, let’s call it three,
1:45:41 four minutes into this, it’s lighter.
1:45:44 Like you said, Hayden, you know,
1:45:45 things pull back a little bit.
1:45:50 So visually it’s just, things are just kind of being pulled
1:45:55 back of the, it’s hard to just, hard to describe.
1:46:00 This is, we’re gonna have to edit some of this,
1:46:04 but it’s starting to kind of pull back
1:46:09 and reality starts to kind of describe this.
1:46:15 Okay, obviously we’re not gonna edit this,
1:46:17 but Hayden, I’m glad you’re here, brother.
1:46:19 Thanks for being here.
1:46:24 Yeah, thanks for helping me demystify this for people,
1:46:30 ’cause it’s important that people have a sense of,
1:46:38 it’s so hard to get words out.
1:46:43 So this is the point where you start to lose touch
1:46:49 with the entire process.
1:46:51 And the entire room.
1:46:52 So here we go.
1:46:58 Dude, you’re, I’m so excited.
1:47:02 I’m just gonna shut up now.
1:47:03 All right, so.
1:47:14 I’m gonna go ahead and hit play here on the playlist.
1:47:15 Here we go.
1:47:20 (dramatic music)
1:47:34 Whoa.
1:47:43 That was a, that was quite a journey.
1:47:46 (gentle music)
1:47:56 Awesome, thank you.
1:48:07 Wow, hey, Hayden.
1:48:11 I can’t even see anything, I don’t know.
1:48:13 That was wild.
1:48:17 Hey, dude, Hayden.
1:48:20 How are you feeling post?
1:48:22 Feeling post?
1:48:25 Things get better by the minute.
1:48:30 You can tell that I’m not fully back to where I wanna be.
1:48:36 It’s very cloudy slash.
1:48:40 Let me restart that again, hold on a sec.
1:48:44 Hayden, I will murder you if you put these files out
1:48:46 on the internet.
1:48:49 You have to keep these locked in the balls.
1:48:52 You know, when you’re like coming online
1:48:55 and you’ve been out there and then you’re like coming back
1:48:59 and you’re like, how do I, how do I present myself, you know?
1:49:01 When you come out of this, what you can,
1:49:04 this is horrible.
1:49:06 It’s like the worst video footage ever.
1:49:09 It’s funny ’cause there’s like that fumbling time
1:49:10 and it’s like here’s the horrible
1:49:15 and I’m like right here between the, okay, let me try again.
1:49:18 Clearly.
1:49:23 Obviously I’m out of it still,
1:49:26 but you just have to give yourself a little bit of grace
1:49:29 and relax because you’ve been through a journey,
1:49:31 you’ve been out there.
1:49:36 It’s funny ’cause about every 60 seconds or so
1:49:39 I get 0.5% smarter.
1:49:44 And so it’s like, yeah, I’m like, oh, that’s not
1:49:47 as good as, yeah, I’m getting better and better
1:49:50 as this goes on.
1:49:53 It’s a pretty emotional journey that you go on
1:49:54 when you’re out there.
1:49:58 And it just pulls you apart in a way
1:50:01 that allows you to look at yourself
1:50:05 from a slightly different angle.
1:50:07 It’s like Kevin sitting over here
1:50:10 and I can look at Kevin and I can say,
1:50:15 oh, I can observe some of the things
1:50:18 that are happening to this person.
1:50:25 And I can see where the anxiety or the fear
1:50:30 or the depression or whatever it is that comes up,
1:50:34 you can see it and then if you can see it,
1:50:36 you can feel it and if you can feel it,
1:50:37 you can relate to it.
1:50:40 And then once you kind of relate to it,
1:50:43 it just, you realize how silly it all is because
1:50:48 doesn’t really matter and nothing really matters.
1:50:52 Like it just doesn’t really, it just,
1:50:54 it lets you disconnect from this idea
1:50:57 that you have to be anything but yourself.
1:51:02 Like I just feel that some of what you realize
1:51:03 the way you’re out there is that,
1:51:08 oftentimes you’re your own worst enemy in a way
1:51:12 and you don’t have to really be so hard on yourself.
1:51:15 I think it allows you to say to yourself like,
1:51:18 okay, I can see myself externally.
1:51:22 This is me being my own worst enemy, you know,
1:51:24 in a way, which is like,
1:51:28 I think obviously what a lot of people struggle with
1:51:33 is being there a hard critic of themselves.
1:51:36 So, hi, how are you?
1:51:38 – How are you feeling?
1:51:42 – Ah, that was quite the adventure.
1:51:43 – How so?
1:51:45 – It was fantastic.
1:51:47 I mean, I went pretty far out there
1:51:51 and I think that these sessions that you and I have
1:51:54 are afterwards are always the hardest, right?
1:51:56 ‘Cause like, you just can’t put into words
1:52:00 what you’re feeling, is that common?
1:52:03 – Yeah, and it’s okay if you don’t too, right?
1:52:07 I always like to just focus on what did you feel, right?
1:52:08 What did you see?
1:52:13 – Yeah, so for me, I saw, Hayden was in here with me
1:52:15 and we were talking and then the room
1:52:17 started to get a little fuzzy
1:52:22 and then I could tell that there was some separation
1:52:25 starting to happen and I was like, okay, we gotta go in.
1:52:27 So I put the headphones on, put the mask on
1:52:32 and then from there, like a big pullback,
1:52:37 pop pullback from reality and rooms and expansive space.
1:52:45 And this is that moment where it’s really hard
1:52:48 to put it into words, but it’s this idea
1:52:51 that we tend to be our worst enemy,
1:52:54 our own worst enemy, you know what I mean?
1:52:56 Like oftentimes the internal judge,
1:53:00 the internal cynical, exactly is the person
1:53:05 that is like beating you up and when you can see that
1:53:08 and you can kind of like see that it’s just so silly
1:53:11 because you can just kind of like,
1:53:13 when you can pull yourself back from it a bit,
1:53:17 it helps you shed it, you know, it just helps you drop it.
1:53:19 – Watching that happen to someone else.
1:53:20 – Yes, exactly.
1:53:22 – And so then you can have compassion
1:53:23 for the whole process.
1:53:24 – Yes.
1:53:25 – For both yourself suffering
1:53:26 and then yourself as a critic, right?
1:53:29 – Thank you for talking, ’cause I can’t talk right now.
1:53:31 – It’s okay, you can pressure yourself.
1:53:33 – No, but that’s exactly right.
1:53:37 I mean, it puts you in this state,
1:53:39 this dreamlike state when you’re out there,
1:53:41 you just can have a little,
1:53:45 if you can find a little compassion for yourself
1:53:50 and just say, it’s okay, like we don’t have to,
1:53:54 this is my journey, but for me,
1:53:58 it’s like we don’t have to take ourselves so seriously,
1:54:00 you know, like we don’t have to,
1:54:03 we can relax into this a little bit,
1:54:05 everything’s gonna be okay, you know?
1:54:10 And it’s like that release, I think, is probably what…
1:54:13 – It’s one thing to see that or to read it,
1:54:16 to know that you should aim for that
1:54:17 in your meditation practice.
1:54:18 – Right.
1:54:19 – It’s another thing to actually feel the relief.
1:54:20 – Right.
1:54:21 – And that’s what’s really interesting
1:54:23 about this medication, you can actually feel
1:54:24 what it would be like if you let go
1:54:27 of trying to hold on to life so strongly.
1:54:28 – Right.
1:54:30 – If you felt that lack of seriousness for a moment.
1:54:32 – That’s right, yeah.
1:54:34 So it’s like, that’s the tension, right?
1:54:39 Because I think, especially with extremely driven people
1:54:42 that wanna achieve great things and they wanna build
1:54:44 and they wanna, you also need to be able to let go.
1:54:48 ‘Cause not everything is gonna be a work.
1:54:50 – And sometimes it doesn’t matter
1:54:51 if you hold on tight, right?
1:54:52 – You don’t control what you think you control.
1:54:54 – Exactly, exactly.
1:54:55 – So you might as well let go, ’cause…
1:54:56 – Yeah.
1:54:57 – Right, yeah, that’s a great feeling.
1:55:00 Did you have any emotions in the journey
1:55:01 that you can recall?
1:55:06 – I had an emotion of just feeling just at peace,
1:55:09 I guess is the best way to put it.
1:55:13 Just because I’m just like, yeah, this is gonna be okay.
1:55:15 Everything’s gonna be okay.
1:55:19 Because there’s no other thing,
1:55:21 it can’t not be that way.
1:55:22 – It’s worked in, it’s baked in.
1:55:23 – It’s baked in.
1:55:24 – Everything’s gonna be okay.
1:55:25 – Yeah, exactly.
1:55:26 – Yeah.
1:55:31 – Yeah, because it’s almost like once you let go
1:55:37 and release, there’s no, if you can surrender to that,
1:55:42 then it’s like, so it goes.
1:55:43 So it goes, you know?
1:55:44 – Yeah.
1:55:46 – It’s actually a great artist,
1:55:49 the artist I love called Sony.
1:55:51 It’s a song, so it goes.
1:55:52 And that’s like one of the lyrics.
1:55:57 And it’s like, release like just waves, waves just so it goes.
1:56:01 – Right.
1:56:03 – It’s nice, beautiful.
1:56:06 – It’s also nice to know that this is your capable feeling
1:56:07 that way, that that is a kind of a code
1:56:09 or a program running underneath.
1:56:09 – Yeah.
1:56:11 – That you can access, that they didn’t come from outside.
1:56:12 – Right.
1:56:13 – You went inside and looked inside.
1:56:14 – Right.
1:56:15 – Or something like that.
1:56:19 And I was curious like, is that the realization
1:56:22 that you see other patients have,
1:56:25 is like, is when do they feel this like,
1:56:29 sense of like, oh, it’s gonna be okay?
1:56:31 – Yeah, I think one of the most interesting things
1:56:34 is when people say, I had your experience of what you felt
1:56:36 and I realized it was familiar.
1:56:37 I’ve been here before.
1:56:38 – I’ve been here before, yeah.
1:56:42 – The topography of this piece is something I know.
1:56:44 And I can access this and I had just sort of forgotten
1:56:46 or it got cloudy with all the other things
1:56:47 I put on top of it, right?
1:56:48 – Yeah.
1:56:51 – And also, you know, just being for a moment
1:56:55 outside of your own emotions is also just a relief
1:56:57 to be able to see that your emotions
1:56:59 aren’t necessarily reality, right?
1:57:00 – Yeah.
1:57:01 – It’s just a kind of an information
1:57:02 that your brain is getting.
1:57:04 It’s not the world.
1:57:07 – That’s right, exactly right, yeah.
1:57:10 Yeah, you should just host my podcast now for now on
1:57:11 ’cause I can’t talk, so.
1:57:13 – You can usually host it, I can’t even use that.
1:57:14 – Yeah.
1:57:15 (laughing)
1:57:16 – The best podcast I own, right?
1:57:19 – Yeah, but I just think, you know, obviously,
1:57:22 we’ll start to wrap things up,
1:57:25 but I just wanna say, you know, thank you
1:57:28 for inviting me in here today
1:57:30 and for giving me this little booster
1:57:35 and I intend to take it forward and go
1:57:40 and, you know, get some good positive neuroplastics.
1:57:43 I’m not even gonna say that,
1:57:47 but I’m gonna try and go and take it forward
1:57:49 with, you know, healthy habits of meditation
1:57:53 and walking and exercising and post-recovery,
1:57:56 I think is a big piece of this is–
1:57:58 – It is, and in fact, there are some very interesting studies
1:58:00 that have been done that show that if you do try
1:58:04 to shape this in the neuroplasticity in a positive way,
1:58:05 a light neuroplasticity, if you will,
1:58:08 that that does result in a longer lasting remission
1:58:11 of symptoms, so absolutely do that.
1:58:12 Treat yourself the same way
1:58:16 you would a very neuroplastic human being like a child.
1:58:16 – Right. – Right?
1:58:18 So baby yourself, do all the good things,
1:58:21 the affirmations, the antidepressant behaviors,
1:58:22 go forth and do good.
1:58:23 – Amazing. – Hi.
1:58:25 – Thank you so much. – You’re welcome.
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