Ketamine-Assisted Psychotherapy and Physician Burnout

As the demands of emergency medicine take a heavy toll on clinicians, many struggle with depression and anxiety, often finding little relief in traditional treatments. For medical professionals seeking solutions, could ketamine therapy provide a breakthrough in combating burnout and restoring mental well-being?

After struggling with severe depression and suicidal ideation and failing to find relief with conventional medications, emergency medicine physician Mel Herbert turned to ketamine-assisted psychotherapy, which he describes as life-changing. Ketamine lifted his depression and reshaped his brain’s neural pathways, allowing him to experience joy and gratitude in ways he hadn’t for decades. However, Mel warns against the dangers of unregulated ketamine use, stressing the importance of controlled administration with a professional therapist, proper dosing, and integration therapy. 

In this episode of Living Medicine, Dr. Sandy Newes interviews Mel Herbert, the Founder and CEO of EM: RAP (Emergency Medicine: Reviews and Perspectives), about his experience with ketamine therapy for professional burnout. Together, they discuss training considerations for professionals entering the ketamine-assisted psychotherapy field, how providers customize treatment to patient needs, and the ideal candidates for ketamine-assisted psychotherapy.

This episode is brought to you by the Living Medicine Institute.

LMI is a training, resource, and membership program educating providers about the legal and safe use of psychedelic-assisted psychotherapy.

To learn more or participate, visit https://livingmedicineinstitute.com.

Intro 0:03

Welcome to the Living Medicine podcast, where we talk about ethical medical use of psychedelic psychotherapy, teaching skills, examining the issues and interviewing interesting people. Now let’s start today’s show. 

Dr. Signi Goldman 0:19

Hi and Welcome to Living Medicine. This is Signi today. We have a really special episode where Sandy got a chance to interview Mel Herbert. Mel Herbert is the leading speaker and educator in the field of Emergency Medicine, and has also taken on a sort of prominent role in educating other medical specialties as well. And he started out educating people on medicine itself, but really lately, has moved into focusing on this growing problem of physician burnout, and so he is a prominent voice in speaking to that, and was willing to get on to speak to Sandy about his own personal mental health struggles and his benefit from ketamine assisted psychotherapy. So we’re really honored to be speaking to him today and for his willingness to share his story with Sandy. So without further ado, here’s Mel Herbert. 

Mel Herbert 1:09

My name is Mel Herbert. I am a physician, emergency physician who trained in Australia first and then in the United States. And I’m the CEO of MRAP, which is an education program that goes out to about 65,000 people across the world, mostly Dox, but also Dox and nurses.

Dr. Sandy Newes 1:24

And I am Sandy Newes I am a psychologist in Asheville, North Carolina. And I am the co founder of The Living Medicine Institute, which is a training resource and content based program for clinical and medical professionals who are interested in learning about ketamine assisted psychotherapy and psychedelic medicine in general. And we also have a sister program called Concierge Medicine and Psychiatry that is a program that does ketamine assisted psychotherapy and ketamine treatment for people with underlying mental health issues. So I’m honored to be here with you. Mel, yeah, this is really exciting. 

Mel Herbert 1:59

Yeah, we’ve been sort of chatting back and forth and like, we should do a podcast, and I need a podcast, and you need a podcast, so we’re gonna take this podcast and chop it up in a different ways. So if you think you’ve heard it before, you might have right.

Dr. Sandy Newes 2:13

Great. Well, I have been following you on social media for a while. I’ve been really interested in what you all did with MRAP, but what I think really brought us together, ultimately, was good timing, on my part, where you had just experienced some benefits of ketamine treatment yourself, and I was hoping that you might share about that, like what led you to that, and kind of, where were You before you started, and what? How about why ketamine?

Mel Herbert 2:42

Why ketamine? Yeah, so what led me to ketamine was the usual, failed other therapies, and then got to ketamine. So I had an episode of depression as a kid when I was about 13 or 14, and then I got busy with medicine, and I was too busy to get depressed, so I’ve been obsessive for the last 40 plus years. And then I had another episode, and it was quite severe. And I have a great primary care doc, and we tried SSL rise, and they didn’t work, as is the case. You know, 50% of the time, lots of side effects didn’t really work. And then we changed to a combined norepinephrine SSRI agent, and then I became actively suicidal. Oh, interesting. It’s a little bit humorous in that she told me, like, one of the side effects now is one in 20 people become actively suicidal. If that happens, call me. We’ll get you off it as soon as we can. And I started to become actively suicidal. But I’m like, it’ll be fine. It’ll go away.

Dr. Sandy Newes 3:43

I know what this is happen. Yeah,

Mel Herbert 3:47

I’m a doctor, a wife. What could go wrong here? And it was actually my wife when I was at the lowest Ave so what the hell is going on? And I asked her, do you mind if I kill myself as sort of a mirror matter of fact thing, just asking permission, please. You know, is it okay? And she’s like, What the fuck are you talking about? You’re so curious. Are you actually meaning? Yeah, and I meant it. I was just so depressed. But it was sort of it had gotten to this matter of fact thing, oh, the only way I’m gonna get rid of this is if I die. So thankfully, she is the woman that she’s like, Oh, I don’t think so. And dragged me down to see the dog, and we had a nice intervention there. And then she said, like, I got this group at UCLA doing ketamine. We’d actually spoken about ketamine before I started therapy. And so then I got into this program, and it was magic, actually. I mean, it really changed my brain. Is the only way I can explain it. And I know that there’s all of this stuff about neuroplasticity and changing pathways and doing ketamine and as if you’re doing therapy at the same time, you really can change the way your neurons fire. And for me, that was absolutely the case. That was. I don’t know, eight months ago, I did six sessions a week apart with therapy before, after still doing it once a week, I then

Dr. Sandy Newes 5:12

same therapist, same therapist, great who

Mel Herbert 5:14

is awesome, nice, so insightful, amazing woman, and with a physician as well. So in their program, you have a physician and a therapist in the room. The physician looks after the physician things, therapist looks after the therapist things. Really great team. And then I did two more a few months later, two more sessions a few months later, and that was about, you know, six months ago now, and I keep waking up every morning for the penny to drop, because I wake up every morning and I have not felt this good in decades, like I’m excited about being alive. I’m so grateful to be a human. I really when I start the day and do my work, and it really has changed my brain. But like I say, I keep thinking when it’s like, when is this going to wear off? And we’ve talked about like, if it wears off, we’ll do it again. But right now, I’m in that place where I’m just so thankful for this therapy. And a lot of people ask, Why are you so open about talking about your mental health? It’s like because in my profession, I’m a leader, and in emergency medicine, we are in a crisis. Our docs are depressed, they have PTSD. They are committing dying by suicide at a rate greater than it’s ever has been. Is a real crisis, and we I joke, yoga is great, but we got bigger effing issues than yoga right now. We know other therapies, so that’s why I want to talk about it, so that those people are there. Let’s take some of the stigma away from this, and let’s understand that we’ve got these therapies that we should have had for a long time, but we stopped studying them 30 years ago, and now we’re studying them again, and we’re using them again, and that’s they’re profound, as long as they are done, in my opinion, with the right therapy group, somebody like

Dr. Sandy Newes 7:01

you. Yeah, well, thank you. I mean, it’s interesting because I’ve mentioned it, but I’ve since gotten a little bit more of the story. Is my co founder, my business partner, Dr Signi Goldman, her husband, Dr may doc. Goldman was an ER doc, and he actually gravitated towards co opening Academy in clinic with her because of really moral injury that he experienced as an ER doc, as the medical system became, you know, bought out by the large corporates. And you know, the dilemmas, the sort of professional and personal ethics that he was felt like worth compromising, and just the increased stressors and and just all of it, and, you know, so he would concur just like and so you know, bringing this to light, as you know, taking away the stigma and that it can really help with that PTSD and recalibrate your brain and Your nervous system after decades of that kind of chronic stress is really important. Yeah,

Mel Herbert 8:06

it’s a particularly difficult time. Er Docs and nurses and paramedics, they suffer a constant amount of PTSD. I mean, it’s there literally are people dying on every shift, children who are injured. It’s, that’s the baseline, yeah, and that’s hard. That’s so difficult. And then, as you say, now, we layer on top of all of these financial things that are going on during COVID, having patients basically taking a swing at you because they didn’t believe the science to be called liars. I had death threats because we were doing shows about COVID and how to treat it, and I was getting calls. You’re a lie. You’re part of this. You’re part of the system. You deserve to die. It’s like, and this was happening to lots of us. So yeah, it’s like, stress upon stress upon stress, and it broke lots of us. It broke most of us. In fact, I tell this story, and it’s it used to be shocking, but it’s not anymore. We did in our residency about 10 years ago, we asked anonymously to the residents. About 60 residents, are you depressed? Do you have any suicidal ideation? And a third of our residents had suicidal ideation on a daily basis. Third that’s so intense, and I’m sure it’s worse now, during COVID, the residents were in serious trouble, and now the whole profession is feeling it. So this is to say that this mental health crisis feels like it’s affecting about 100% of the docs I talk to, and I talk to a lot of them, it feels like every one of them, and it’s just about the degree to which they’re suffering. And I can tell you, since I’ve started talking about ketamine in my book and on podcast, I’ve had just an overwhelming number of people saying, Tell me more. Where do I go? How does this work? Should I just go to any random person down the street? Should I do it on the couch by myself? And my answer to that is Find A Reputable group and go in. Interview them, go talk to them, and start now. Do not start doing ketamine poppers on the, you know, couch by yourself. This is not a good idea. Have a guide that you need a guide, right?

Dr. Sandy Newes 10:12

Yeah. Well, and it’s interesting, because, you know, people don’t realize, or maybe some Do you know the listeners, that ketamine is really completely unregulated. So any you know, anybody who is a prescriber can get a controlled substance license, and you know, as long as they have kind of, you know, their ducks in a row, they can open a clinic and cap ketamine assisted psychotherapy providers. There’s also no regulations for training. So it’s really up to the consumer to understand that there are significant differences in the setting, in the guidance that you receive, in the way that you know the professionals work with you. It’s not just about the medicine itself, and I think that’s really just of critical importance for people to understand. I’m curious if you can speak to that kind of like because there’s the pharmaceutical effect of ketamine, which can have a profound effect. And some people just do ketamine alone, and whoosh, you know, the fogs lift, and that’s it. But that therapeutic component, we believe, is really important for many people, if not all, but certainly many, especially if we’re looking at chronic stress. PTSD effects on the nervous system often go back to childhood stuff. Yeah, yeah.

Mel Herbert 11:24

For me, I couldn’t imagine not doing it with a guide, a therapist, because you, your brain does get into this plastic state, and I don’t know how you would reform those pathways the right way if you don’t have somebody to help you. So for me, it was a lot of childhood trauma, abusive father, alcoholic mother, you know, five kids, and one of them is in a federal penitentiary, and the other four are drug abusers and alcoholics, and we’re all a freaking mess. So it all goes back to that. So just doing ketamine might be a nice experience, but I needed to work through that stress, and then I needed to work through the all of the terrible things I’ve seen the last 40 years that still I have these flashbacks, just like in war on a key I still see the dying children over and over again and and really had somebody to help me help heal my ear and my psyche, and the ketamine was an adjunct to that that had to occur, but the ketamine really helped me get that insight and that plasticity. So I don’t, I really think it’s a bad idea to do this without having a therapist there to help you through it. There’s a lot to work through. It’s it’s not a magic pill. It’s not just like, did a magic you fixed now, awesome. Yeah, right. Doesn’t work like that. It it for the vast majority people. If we think back, you know, to the shaman, they would take you up into the hills 10,000 years ago, and they basically give you therapy and then give you psilocybin. It was very similar, but you have to, you have to have that guide. And for me, what I want going forward is to never go through that again. That was very dangerous, as my wife says, Nobody died, but boy, it could have gone badly. And I want to have a team to,

Dr. Sandy Newes 13:16

yeah, sorry I didn’t or but when you get to where, like, hey, what do you think if I were to just kill myself? Like, as if that seems like a viable option, which is what people don’t realize about suicidality. Like, it’s, it’s when you begin to entertain that, as if that is like a reasonable idea. Like, well, it becomes

Mel Herbert 13:32

a reasonable idea because you believe that you would be better off, but also, really importantly, everybody else would be better off if you were dead, that’s the lie that your brain starts telling you. And I’ve had friends and colleagues die by suicide, too many to count, sadly, and I just could never understand it until I got there myself. I’m like, Oh, this is what you were feeling. You were feeling that the world would just be better if you were gone, and you would feel better if you were gone. And that’s such a dangerous place to be, because it’s a lie. It’s not true, but you were absolutely convinced of it, yeah,

Dr. Sandy Newes 14:06

well, and I love that you’re saying that because I think, you know, there’s so much stigma for mental health. And you know, I think doctors in particular, like, you’re trained to be the ultimate authority. So just as you said, Oh, I got this like, oh, that’s what this is, like, we’ll just analyze these symptoms and, you know, not recognizing the chronicity of the stress that goes along with that, and then how that’s going to impact your nervous system. You know, it’s like being in a persistent war zone over and over and over again that you have to be prepared for, you know, an indeterminate amount of suffering and pain and and then whatever kind of administrative stressors come from the setting itself.

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