Ketamine-Assisted Psychotherapy and Physician Burnout

Mel Herbert 14:46

Yeah, and you and physicians, you know, die by suicide, you know, at an extraordinarily high rate, because they like, as you said, we’re told that we’re supposed to have our shit together. We’re not the person. Situation, we don’t get sick. We’re supposed to be in charge here, and it’s really hard for physicians to go and ask for help like it becomes this, I must be the only doctor that feels like this, because look at all these doctors. They’re in charge, and they’re always in charge of the team. So to again, to say to these people, no, you’re a human. You didn’t get not to be human just because you went to med school and worked really hard for a long time. You’re human. And we’re all suffering from this,

Dr. Sandy Newes 15:30

right? And I think something that people don’t realize about that kind of a trauma response is that it’s really physiological. I mean, it is attached into the survival part of your brain and your nervous system. So it’s not it, you know, it bypasses any real psychological issue. It shows up as psychological but it’s not a personality flaw. It’s a biological response to chronic life threatening stress that, in the case of physicians, especially ER docs, is is very real life threatening stress, and so your brain is just doing its good job to keep you in the state of hyper vigilance. But then we put that state onto things that are in front of us, and we begin to interact with our life as though everything is a life threatening event. So So treatment isn’t about processing the content. That’s a little bit about it, but it’s really, like you said, it’s about adjusting your brain and your nervous system to be able to feel safe and allow a sense of well being to settle in as your norm.

Mel Herbert 16:28

Yeah, it’s, it’s so true, like, after shifts, it’s so difficult to come down because of that adrenaline, yeah? And some people don’t, and there’s a lot of alcohol use, you know, it’s that sort of the preferred drug by most ER docs. They’re like, I’ll just go home and I’ll have a glass or seven of wine to calm down. And it’s a terrible drug. It’s, I mean, it’s in small doses, it’s great. It’s a great sociologic drug, but to treat the symptoms, it’s terrible. It has a poor side effect profile. It has a short term effect, which then exacerbates the underlying condition. So as a drug, it’s like, this is not the right drug to be doing, but it is. But if you’ve just gone off one hard shift and you’ve got another hard shift, and then you’re doing night shift, then day shift, then night shift, then day shift, it’s been shift work alone is sort of the cardiovascular equivalent of two packs of cigarettes a day. So you’ve got all of these physiological stresses. It’s no wonder this profession

Dr. Sandy Newes 17:25

is in trouble. Yeah. I mean, I have physician friends who have families, you know, they have homes, they have families, they have lives. They work, you know, somewhat regular hours, and then, bam, they’re on call for four days, you know, and they just like, work around the clock, and they’re just expected to do, like, life saving, life threatening things, and then, as if, and then come back and just be like, pick it up and be like, Hello, children, hello, you know, family and no sleep. And as if, that’s just normal. I certainly don’t have the solution to that, but I’ve often marveled at just that phenomenon, what that must do to people’s, you know, functioning in so many levels? Yeah, there’s

Mel Herbert 18:04

a there is some solutions to that. A lot of groups don’t do it, part of the solution. And I knew this when I was a resident in training at UCLA. I remember turning to the residency director in my last year, like, I’m not gonna be able to do this past 50 that was when I was in my late 20s. Like, one of I did this, and he was a sort of finance guy. I’m like, tell me how you save for retirement. Because there’s no way I’m going to be able to do this when I’m in my 60s and 70s. No way, physiologically, not going to happen. And I retired at 50 for all of those reasons, like, it’s hard to do night shifts when you’re 30. Try it when you’re 50. Try it. When you’re 60, your body’s like, I don’t think so. Yeah,

Dr. Sandy Newes 18:44

yeah, you don’t. You can’t think, I mean that you know that need to make those fast decisions on your feet, like life threatening decisions, and the constant ness of that. So I just have a lot of compassion for that, and I I hope that you know this and other things at least kind of help physicians see the need to, I call it tending your nervous system right to, like, get the care and the support that you need to tend it. And I think ketamine and ketamine assisted psychotherapy can be amazing for that, because it can happen fast and it can happen in really profound ways, and it can really shift your perception. So I was wondering if you if we could go back to your experience for a minute and talk about, what is it actually like to be in the medicine, and then, you know, it sounds like you had a therapist with you, and to also be in the care of somebody else while in that because a lot of people think ketamine is just like inward focus, And you just sit there, and really it’s, in my experience, it’s much more relational than that. But I’m just curious what your experience was like, What did you see? What was it like? And then what was the experience? If there was a relational piece to that?

Mel Herbert 19:54

Well, I should say, for the record, I’ve given ketamine to thousands of patients, so in the. We use ketamine at high doses, the dissociate dose, 1.5 milligrams or higher, basically to disconnect your brain from the rest of your body while we put you back together. And we would always tell patients, like, as you’re coming out, you can be very bizarre experience. I’d had an experience when I was practicing, but we’d like, we’re going to try and keep it as calm as possible. But you might be seeing pink elephants and stuff, and stuff. And I don’t know what goes in that cat hole space, but apparently it’s pretty weird. And we would have people come out of that dissociative state screaming, terrified, in part because of where we were doing it, which was in a busy, horrible, bright lights, loud, flashing, yeah. And they would come out and be disoriented, and then to come into an emergency, but where there’s vomit and all this stuff going on, some people came at him, like, that was awesome. I’d like do that. But for me, we would do therapy beforehand and talk about what maybe things that I needed to explore that day. Yeah. And then lie on a really comfy couch and put on some eye shades and a really comfy blanket and some really nice low music on the side, yeah, and then I would be sent off into the K hole. And I was instructed that if I needed to say anything, or or needed to be held, or whatever it was, that the therapist was going to be there the whole time. And for me, I didn’t need that. I was just experiencing the ketamine effect. And then when I came out, that was a very powerful time, as that started to wear off, and I was coming back to the real world. I call it the donut world, because my wife would always bring me donuts after we did ketamine, I’m going back to the donut world. That’s when we really did a lot of great therapy, where I was still disinhibited and able to really talk. It was that time so the ketamine hadn’t worn off, but I was very disinhibited, but now back in the real world, able to talk, and we really did some deep work during those short periods of time, and then spend the next week thinking about those, journaling about it, and then come back the next week, I will say that the first time I did ketamine, I got quite scared, because It’s really hard to describe what it’s like, but it’s, it’s like a Nolan movie. I’m out in space, floating around, separate from this universe, but part of the whole universe. And it’s a very strange sensation. But the first time, I started to get panics, like, will I be able to get back to the real world? I don’t know how to get back to the real world. Like it was something I would have to do. I’d have to find the door out in space to find my way. So I was a little bit panicked. We talked about it beforehand, and my therapist said this is really common. Don’t worry, the drug will wear off, and you’ll just magically come back. And that happened. And then so after that, that fear had gone. So I was just able to come out without fear and just like be in that, that sort of semi dissociated state, and be able to do therapy at that point as well. Yeah, good,

Dr. Sandy Newes 23:09

good. And for us, we often work with that as just being part of the parallel process, right? Like, kind of noticing what happens when you face fear and what happens. And we use what is called tethering, where we kind of, sometimes we make our presence more known, you know, than others. And you know, help, actually help people come back from that. 

Mel Herbert 23:29

So how do you decide the dosing? So we started pretty low again, we use a lot of ketamine now in the ER low dose sub dissociative for pain, it’s a really great tool for treating pain with or without other pain medications. And we usually use like point two milligrams per kilogram. What? What do you usually start your patients on? What kind of dosing

Dr. Sandy Newes 23:50

we start at? Point five milligrams per kilogram, just as like your starting point to consider. So you know you can do that as cut and dried, when in doubt. That’s a good starting point. And we do mostly IB, so we would do em if there was a reason, if somebody felt strongly. But we like IV, because it’s a nice stable state. It comes on, it stays pretty consistent, and then it wears off, and kind of that wearing off pieces, the tail that you’re talking about, but, but that at that dose level. So and then we might adjust down if somebody’s really anxious or psychologically or physiologically has a higher degree of fragility or is also just expresses a lot of nervousness. We’ll call that first session to be just about understanding the medicine. And then, as a therapist, I’m kind of holding on to what we call parallel process. Like, how might that be, like other things in their life? Like, it’s like legit. It’s very legitimate to be concerned about turning yourself over to this experience and in the care of others. And that makes perfect sense. So normalizing that, but also really tracking the way in which those patterns might emerge in somebody’s life in other ways. And that’s what preparation is about. But that. Would be another reason that we would take into account for dosing. Now, if somebody has a lot of psychedelic experience, or, you know, there’s a number of other reasons, but we might gently bump it up, but we’re rarely gonna go more than just a little bit above that in the beginning, because we personally find in our clinic that getting to that sweet spot right below psychedelic psycholytic, which is where you can still track what’s going on, but you’re still very much in an altered state, is useful for the work that we do, which is often sounds like more talking during than you did, not that that’s good or bad. There’s just different camps in that. And so that’s where we start. And sometimes we bump up. Kind of we go up, generally go up five milligram increments. Sometimes we’ll go up 10 if the person, if there’s a reason why we think a higher dose might be effective, and there are psychological reasons for that. And sometimes we’ll, you know, bump back down if the person got overwhelmed, if they got panicky, because we don’t, you don’t want somebody like that fear state is something to look at and something to be with. And, you know, there’s probably a degree of tolerance that can be taught around that. But that’s not where we want people to land. You know, we don’t want people to, like, tighten up and hold on and have that just be the whole thing like, that’s that’s not particularly therapeutically useful.

Mel Herbert 26:22

And I my ketamine was, I am great for me. There’s also oral ketamine the doses, because of its first past metabolism, which a big word for it getting broken down before it gets to get to your brain, the doses are much higher and it’s much more erratic. So I don’t know really, if anybody is using much oral ketamine for this type of work. So for me, it was, I am and it worked. It worked great. I want to go back to something you said, which is really important as a control freak physician, it was really important for me to trust the therapist and to trust the process, even though I know ketamine is incredibly safe, we have so much experience with ketamine in much bigger doses than we’re talking about here, much bigger doses. It’s very safe drug. There are lots of case reports of accidental overdoses by nurses and doctors in hospitals 10 times 100 times a dozen patients basically just slept for 12 hours and woke up. Very safe drug. Having said that, with any drug you can hurt yourself, Matthew Perry is the great example. They were giving him truly massive doses of ketamine, just insanely large doses of ketamine, and then he would get in a pool of water that is just asking to drown. And that’s what don’t

Dr. Sandy Newes 27:36

take really high doses of ketamine and go into water that’s a really blind herself while the

Mel Herbert 27:41

person who injected it leaves the house, right? I mean, everything about it was crazy, like,

Dr. Sandy Newes 27:44

hard, no, like, that is like a pathway to death. So, you know, it’s just super unfortunate occurrence. But, yeah, that’s what happens.

Mel Herbert 27:54

And compared to, like, propofol, which is how Michael Jackson died, propolis, a much more dangerous drug, it is very easy to stop people breathing if you give too much. And ketamine is a bizarre agent which you don’t stop breathing, which is kind of crazy. Every other drug we use in medicine to sedate you enough to put back your broken arm also has the side effect of potentially making you stop breathing. But not ketamine, it’s an amazing drug unless, of course, you’re underwater

Dr. Sandy Newes 28:19

again, with the caveat, like,

Mel Herbert 28:22

five gallons of alcohol at the same time. That’s also bad for you.

Dr. Sandy Newes 28:26

Yeah, I don’t mean to make light of it. It’s just that’s been such a big thing in our you know, what happened to Matthew Perry? Well, Matthew Perry took way too much ketamine over extended periods of time and then drowned, you know? And so, I mean, that’s we hear. We have a year of dogs come through our training program, and one of them just had this famous line like, yeah, we give ketamine, like water, you know, we do have absolutely zero concerns about, you know, physical effects, but that, that process of getting into that dose range where you’re not sleeping, and that you are cognizant of what’s coming up, you know, Is is quite intense and, and there’s so much richness to be learned from that.

Mel Herbert 29:05

So, yeah, so I if I wanted to start a ketamine clinic tomorrow, and I don’t, but if I did,

Dr. Sandy Newes 29:15

I mean, you have all the qualifications that one needs.

Mel Herbert 29:21

I’m perfectly comfortable using ketamine in large doses to do procedures, but I don’t really know how to use it for, you know, therapeutics. So where would I go to learn that? And how would I learn that? And how do you find a psychologist to link up with? If you want to be the MD and you want the psychologist and you want to be a team, where do you go to find these people? Right?

Dr. Sandy Newes 29:41

So that’s a great question, so I would highly recommend that anybody who works with it gets training. This is one of the weird parts about the field. Like you wouldn’t go into a different type of area in medicine without getting training, but you can with ketamine, like psychedelic medicine. As an emerging specialty, just as emergency medicine was an emerging specialty. I don’t know 25 years ago. Is that accurate? Yeah, probably like

Mel Herbert 30:07

40 years ago, yeah. So at one

Dr. Sandy Newes 30:09

point, right at one point, emergency medicine was not a particular specialty, and psychedelic medicine is now just considered kind of this, like in the medical field, this like thing that you can just go do. And you know, there are many physicians out there, or medical professionals who are prescribers that are making very sweeping claims about that they work with all kinds of mental health issues. And the reality is, is that ketamine alone can be helpful, but it can also be harmful. And so, you know, the biggest, the biggest, like adverse effect that is reported attached to ketamine is people going into er, for you know, perceived psychosis and psychological effects of high doses of ketamine administered in ketamine clinics or in recreational context. So always keeping that caveat in mind, is physiologically safe, but it is not always psychologically safe. So there’s the medical training, and then there’s the at least having an awareness of the psychological training. And then I also think that people should get some experience with the medicine themselves. So there are many training programs around and there are many good ones, but you want to specifically focus on from the medical side. You need training on the dosing protocols, on understanding of the different routes of administration. So in our training program, there’s inter nasal, there’s sublingual, which is lozenge or Troche, there’s IV and there’s I am so understanding the pros and the cons of the different routes of administration and the dosing protocols that go along with that. What are some of the things that you might be watching with with patients. What are the different factors that go in with that? So if you’re going to be doing you know, what does go into preparation? What does go into integration? What about set and setting variables? What about the music? Because the music is huge piece of the experience. So all of those things combine to create the whole experience. And you could do ketamine without without a like a clinical professional, but it’s great if you have one, like in our clinic, we actually do do both, and the medical providers kind of make that determination, or they offer it to the clients. As we do more and more cap ketamine assisted psychotherapy, we have more and more people asking for it and wanting it. And I think that there’s a piece about the medical team, over time, coming to really understand the benefit of that. Because ketamine just started without therapists at all. You know, we just it came out of the ER, we found people had profound benefits with treatment resistant depression. Then we layered in a series where we do them more, you know, spread apart to try to extend the benefit. And the latest layering on is the therapist, so it can be done with it. But, but so there’s the medical pieces. You know, we assume medical professionals already have a sense about the physiology. And, you know, can learn about the medicine that. How do you dose it? What about set and setting? What about music? What about patient care? What are the what are the things that you need to know? What are the contraindications? How do we refer somebody to that? And then, how do you develop a relationship with the clinical professional? You know, how does that work together? And then you can, so you can go to a training program like ours, the living Medicine Institute. You can consult with a with a professional who’s doing that. We have that available. And then there are other programs too that are specific ketamine, you know, ketamine for physicians. And I would always just say there is this really important understanding for people to know that ketamine therapy can so ketamine assisted psychotherapy is one version, and then ketamine treatment, or ketamine therapy, is another version, and the words are interchangeable. So just because somebody says they’re doing ketamine therapy doesn’t mean they’re working with a therapist. So it’s just, we just don’t have a lot of standardization of terms. But that patient care. How can we be caring? What is the different lens for diagnosis, you know, how might we engage with them differently than just a, you know, a patient in a medical clinic? And then, how does that impact it? So, so in our training program, people do you know, we actually really recommend that people have their own experience with the medicine so they can really understand and be sensitive to that that is not a widely accepted tenant. Like some people don’t agree with that. I would just kind of raise a question mark, like, why would you want to do this if you’re not interested in doing it yourself. Like, it seems logical to me, but, you know, just in summary, there is no requirement, but I believe that there will be. So if you want to start a clinic, like, get in on that, you know, get get in on the ground floor, get your training. Like, do good work. Like, you know, follow that tenant do no harm, because if you’re doing a higher dose and you’re just sending people away without any sort of integration, you have no idea about the adverse effects. You’re going to hear about the positive effects, but you’re not going to hear about the negative effects, because people are walking away feeling ashamed, like they did something wrong. They’re the weirdo. They had a weird experience. So. Get your training, get your get get some mentoring, get some supervision, and not just on the medical side, but also exploring the mental health side, the set and setting variables and all the things that go into good treatment. Because the medical person is an integral part of the team, obviously, if they’re the only member of the team, but even if they’re working with a clinical professional, like, how the medical person comes in and engages with the client is absolutely critical to the process.

Mel Herbert 35:29

Yeah, so I have lots of training in ketamine for procedures. Here’s an here’s a question. I would have no idea which patients would be a good candidate. So who is a good candidate for this type of therapy. And, you know, in similar fish, in a similar way, who is not a good candidate for assistive

Dr. Sandy Newes 35:47

therapy. Let’s start with the rule outs. Because, you know, I mean, in the private sector, right? There is just like, straight up, let’s just own it. There is a piece about who shows up at your door, right? So it’s like, you know who it is effective for is a lot of people like struggling with a range of mental health issues, and always keeping in mind with the caveat with that that a lot of treatment resistant depression is related to PTSD complex trauma, just like repeated chronic stressors that are often associated with relational issues that can go back to childhood, and that is probably why a lot of those do not respond to SSRIs. Now, that is my bias as a trauma therapist and but just get you know with that caveat, because that kind of opens the door to understanding the complexity of people’s presenting issues. Just because somebody presents with depression doesn’t mean we just remit the depression, because you can also have the depression remit and suddenly a bunch of other stuff emerges, because the depression kind of squashes people, like, it’s almost like a protective so, you know, understanding that piece is really, really important. Like, what at least, having an understanding enough of mental health, if you want to work in mental health, you should have some understanding of underlying mental health issues, so that and so, you know, recognizing that it’s appropriate for a lot of people with a range of presenting issues, probably treatment resistant depression is the one that’s the most kind of it’s the most well studied, and it seems to remit the fastest, but it’s also has a lot of recognition that, you know, a month later, two months later, a lot of anxiety can also emerge for people with trauma, the more complex mental health issues that you start to get at, like, you know, chronic and persistent anxiety, worry and rumination, OCD, things like that, at that point, you want to really be considering partnering with the therapist. So I say, the more presenting issues and the more complex they appear. On the mental health side, the more you want to partner with a mental health person, and then in terms of Contra indications, like significant kidney disease or significant kidney issues. And that’s because one piece of data around ketamine is that there can be bladder issues with repeated persistent use, and we don’t really know exactly what that’s about, but you want to monitor that really closely, and we don’t want to do harm in that area. But there’s something going on with bladders with chronic and persistent use, of which ketamine treatment in a clinic is not that but we still don’t know exactly. So if you want to be really careful, untreated high blood pressure, because people can get anxious during session and their blood pressure can spike. And then we want to look at daily use of benzos. And a couple of the mood stabilizers are not rule outs, but they might diminish the effectiveness. Beyond that, you want to look for, you know, self harming, kind of impulsive, sort of behavioral issues that can be destructive, recognizing that ketamine can also be really helpful with that, but there’s always that caveat that for some people, things get worse before they get better. So you really want to assess, does somebody have a social support system? Are they cutting? Are they hurting? Are they excessively drinking? And those are not rule outs, but they’re because ketamine can be super helpful with diminishing compulsive behaviors and impulsive behaviors. However, you also don’t want somebody to hurt themselves in the process of getting better. So, you know, and then, like, really persistent personality disorders. And again, do as a medical professional have the capacity to assess for that. If somebody appears to be extraordinarily narcissistic, like they continually elevate themselves over and over again, to the point where it feels weird even to you, you know, just know there, there is a relational component to this, and that is likely to show up. So those are beyond that. It again. The big caveat is, you know, the more physiologically or psychologically complex somebody appears, then either consult or get additional members on the team or just very much Handle with care. And I also really believe in patient education, like ketamine can be addictive. Like. Don’t go seek this out recreationally. Do not go seeking the high, right? Because you can have a ketamine experience that has a big therapeutic impact in a recreational setting, but that’s kind of begins to be like chasing the crack cocaine high, right? Like you’re not gonna get that by consistently using it recreationally. That’s just not going to happen, and that is not the same as working with trained professionals in a medical clinic with a specific treatment goal. It’s just not the same. Yeah,

Mel Herbert 40:30

so that was one of the questions that I had for you. What do you think about the recreational use of ketamine? I’m so glad you said that ketamine is addictive, because people are saying that it’s not, and I’m like, no anything, anything that changes your brain can become addictive, whether it’s exercise, ketamine, heroin, whatever. So all of these things have potential for addiction. So I see a lot of tech bros right now that are doing ketamine at parties by themselves, and a couple of them, the most prominent of them appear to be coming increasingly unstable, and I’m terrified that that is the ketamine is part of what we’re seeing with some of these people who will remain nameless, but are very, very rich. Oh,

Dr. Sandy Newes 41:11

undeniably so like, and, you know, there’s a part of me that’s almost like, this is just personal, but I’m almost mad. I’m just like, Come on, don’t get my profession shut down, you know, like, don’t give us a bad name here. Like, don’t, don’t do that. And I and that, that sounds like, not compassionate, but it’s just like, because people don’t know that, it’s addictive. And you know, then we get these Matthew Perry’s, and we get things like that, and then, you know, and then that brings regulatory eyes down who might not know about it. And so that, you know, it’s a nuanced kind of thing, but we see that a lot, and I really, what I believe happens is that people are like, Oh, this is used in, you know, therapeutic settings. And so, you know, we set ourselves up to and we have this profound experience. And so then why not do more of it? You know, we’ve been using it in the ER, it’s safe. And so people begin to use it more and more often at higher and higher doses, and they end tolerance develops. I’ve seen that. And then it becomes this chasing the high that is really just like chasing any other high. Because I do believe that if you’re doing it consecutively, that pretty soon that benefit is going to wear off, and so just the same as any other drug, you use more of it, you use it more frequently, and you’re chasing that original, what really probably was a therapeutic experience. And another pathway to addiction that we see more and more is this chasing of spirit. Is kind of what I call it, like people have a trans personal experience, and then they start to do more and more and more in an effort to try to kind of go through the portal, almost to access that, like as if you are moving towards special powers. Well, that also looks a lot like mania and psychosis.

Mel Herbert 42:55

Yeah, my therapist said the same thing, having a few patients where they wanted to go live in that world forever. Yes, they were constantly doing the drug to try and live in this place. And they saw themselves as sort of the shaman within that space. But that means, as you said, more and more doses, more and more frequently, just like Matthew Perry was doing towards the end of his life, just truly extraordinarily high doses of the drug. Yeah, and I

Dr. Sandy Newes 43:21

would say, you know, if there is anybody out there listening who’s like, Hmm, well, I use it recreationally, and I like it and, you know, okay, then limit it to once a month, like, you know, like, we have patients in the clinic who come in once a month and do ketamine. And so limit it, you know, don’t yet, but don’t let the reason that people come in and do six sessions over three weeks. We call that an infusion series, or for you, with six sessions over six weeks. Bo, justification for doing it more frequently than that, like, or continuing to do that for many months, that’s we don’t know what that’s going to do to you. Like, we just don’t know. And what I see in people, and I don’t see a lot, but I’m tracking this pretty carefully, people like you said, the tech bros, it makes them kind of messy and strange, like it no longer has that, like, chill dissociative effect. They’re like, kind of get kind of twitchy, and you start to see the unraveling. And I don’t think it’s good,

Mel Herbert 44:15

right? So another question about, another question about prophylaxis. So I’ve sort of become to believe, and I’ll go back to the ER doc experience, but this is true of any profession where there’s an enormous amount of psychological damage going about. I’ve been telling residents, increasingly, I think you should get a therapist the day you start your residency, that you should prophylactically be doing therapy, however often, once a month, more frequent, if you’ve got other issues to deal with, but you should have somebody to talk to. And then I was wondering, should we be doing ketamine prophylactically? Is there any studies out there to suggest that maybe for these high risk professions, that in a therapeutic environment, that maybe you. Psychedelic therapy could be used prophylactically. Well,

Dr. Sandy Newes 45:02

I don’t know of any studies like that. I mean, we have one particular caveat, which is that, you know, if you’re going to stay within the scope of practice, and we’re going to stay within FDA approval, people have to have a diagnosis to be able to have it be utilized, because it’s not technically okayed for therapeutic use, it is okay for off label use for mental health issues. So that kind of puts us in a particular lane. Now, people stretch out of that lane a lot, but like wellness retreats and leadership retreats and things like that, unless people are if you’re going to follow those you know specific to stick with that, people have to say that they have a mental health diagnosis. Now, any hot, any high functioning professional who’s experiencing burnout and chronic stress would certainly qualify for either depression, you know, depressive disorder not otherwise specified, or anxiety disorder not otherwise specified. And so, but people have to be willing to do that again. You can stretch that if you want. That if you want. That depends on your own personal level of risk tolerance. But there is a study recently that came out, and I think it was in JAMA that talked about ketamine reducing burnout in medical professionals. So there is actually data to support that. And then there is a group Bill Wolfson is one of the pioneers in the field, and his group has come up with an acute stress protocol, which is actually low dose ketamine in a group context. And I think individual and or group and that’s low, like 25 milligrams to help when, when people are in more of an acute stress situation, to help with nervous system. I think it’s what happens with the neuro plasticity, and the fact that your brain changes, and your nervous system kind of reprograms itself, ideally in a relational context therapy or other relational context, so that you can move into neutrality or contentment, as being your default state, instead of chronic stress, it kind of like stops the stress response and helps you get back to a more baseline. So I don’t know that it is being done, but I would 100% get behind it. I would get behind a research effort. I think that it could make fabulous sense. There is a there is a company called enthya that I actually did a podcast with their founder, where they’re actually working with private companies to allow ketamine as an employee, as like an EAP employee assistant benefit for a really for exactly that reason, like give your give your employees this benefit. It’s underneath mental health, but it can certainly be used in that prophylactic kind of way, like it would be amazing if medical professionals, and really any professionals, recognized before they got to that point that being in a state of chronic stress is actually not healthy.

Mel Herbert 47:53

Yeah, that’s the place where I’m really thinking about it, being in a relationship with a therapist, so that you can recognize when you’ve passed some particular threshold, and then maybe do ketamine therapy. What’s fascinating to me is my professors. So I’m 60. All my professors are in their early 80s now, and almost to a man and woman. They were the kids of the 60s, and they did psychedelics during the 60s, and I haven’t found one of them, which is kind of, I haven’t found one that says that was bad. They all credit some of their or much of their success to the fact that that was a thing that they did in the 60s. Now we probably don’t hear from the ones who became addicted and fell out of society and and these are high functioning, but it seems like we then went through this 40 year period where you can’t talk about it, you can’t research it, you can’t think about it, and it kind of went away, and now we’re back to where we were in the late 60s, where we’re studying it. We’re trying to think about how that we could best use this. But we, I feel like we’ve gone through this period of time where the people with experience of this are now in their 80s,

Dr. Sandy Newes 48:54

totally and it’s super interesting, because a lot of the kind of leaders in the psychedelic field have essentially jumped ship from, like, mindfulness or trauma or other areas, and as it’s become more okay to speak openly, like we still only have pockets of legality, I always give you to my everybody, like, ketamine has never been illegal. Like, it’s 100% legal. It’s never been illegal. Like, you can’t just veer off and use it however you want, but it’s not but the others are and have been, except in small pockets. And, you know, many of them saying like, Oh yeah, psychedelics informed my, you know, mindfulness practice ketamine, you know, psychedelics informed my compassion practice, like one of my, you know, there are a number of people whose work I follow that have kind of jumped ship, and in exactly that way, not only was it not bad, it was profoundly helpful in shifting their consciousness and, you know, expanding their intellectual interests and curiosities and maybe even capacity in ways that really furthered their careers. So I’d like to remove the stigma from mental health and psychedelics and then certainly any stigma about blending them. I. Because we all could, you know, I’m not saying, therefore everybody should go trip. I’m saying in intentional ways, you know, used for intentional reasons, that these medicines can be super helpful for people.

Mel Herbert 50:11

So you’re not saying, remove the fluoride and put the ketamine in the water. I

Dr. Sandy Newes 50:15

am not. And I’m also not saying, like, broad legalization. I’m saying that, you know, let’s pay attention to the intentional use of psychedelics for, you know, addressing entrenched mental health issues, really, such as your own, like that you spoke of.

Mel Herbert 50:32

So what about so LSD is illegal. Psilocybin is illegal outside of trials, where are we with new molecular and old molecular entities in addition to ketamine? Because a lot of experts I speak to say, you know, of all of the drugs, ketamine isn’t really the best. We’ve got much better drugs we could be using. So where are we with those other medications?

Dr. Sandy Newes 50:55

Well, let me first just say I’m not convinced night that other drugs are better. So just that caveat, like, ketamine fits into a clinical practice really well. You know, if you put consecutive sessions like you had along with the trained therapist, I’m not certain that the data would show that psilocybin or LSD or MDMA is better. I’m not it remains an open question mark. So you know, ketamine has a lot of properties actually, that are much like MDMA when done in a relational context, so separate conversation. But I want to just make that caveat, because I actually got into this thinking that the people that I work with and train with were in line to do MDMA psychotherapy. And I was like, sweet, I’ll just do this ketamine like, while I wait for that and and then I came to really appreciate it. So, so where we stand with all of those things MDMA this summer in August, was not, was not, was turned down for approval by the FDA for therapeutic use after 20 some years of research that the FDA was involved in this is, you know, I’m just going to come out and say it like the FDA got involved in the research, they coached the research, they supported the research, they participated in research design. And there were multiple trials, stage three, clinical trials, exceptionally well designed from a psychotherapy outcome research perspective. And at the end, after all of that, then they didn’t approve it. So it’s mysterious. They have not made public the reasons why, um, it looks like there’s going to need to be another round of clinical trials where they follow some specific guidelines, but given what you said about SSRI, is getting only, like, 50% efficacy and having all these side effects, that just seems weird, because the adverse effects reports were actually very low, and the reports of lasting and profound effects on PTSD symptoms were unheard of. So that’s still in the works, and I think the state of Utah has okayed it, oddly, like you think of Utah as a conservative state, but you also okayed it used for therapeutic use. I don’t know how that’s going. Australia has has approved it. The Netherlands has approved it. So we’re going to kind of see how that goes. Will it, you know, will it follow the the cannabis route, where states are going to begin to approve it? We’ll wait and see. Psilocybin has some really super promising research in a lot of domains, and there are pockets where it’s been decriminalized or made legal. Oregon, the state of Oregon, you can go to designated centers with designated providers, and they license providers, they license suppliers, and they license centers, so you can actually go there and get utilized psilocybin for therapeutic use. Colorado has also done the same. They started with decriminalization, so you weren’t going to get arrested or prosecuted. And they’re moving, they either have moved towards or are moving towards full opening for therapeutics and their their laws are looser than Oregon’s in terms of having to be certified providers and things like that. So it’ll be interesting to watch. There are counties in various states like there’s a county in Michigan where it’s decriminalized. There was a reason on the ballot for silly for, I think, psilocybin in in Massachusetts that didn’t pass. So there’s a lot going on. LSD has gotten off of like no one ever can utilize it ever, ever, ever, in the history of the world to being given what is, I forget, what the status is like. Very promising treatment status for generalized anxiety disorder so it can be researched under extraordinarily controlled conditions. There’s a race in Big Pharma to make analogs of these things that can come out and kind of bypass these things. So we’re probably going to see some of those analogs. It’s a super interesting policy landscape to

Mel Herbert 54:55

follow. So yeah, there’s a lot of work being done on trying to find. Part of the molecule has the therapeutic effect, and is it different from the the psychological effect the trip? And I’ve heard some of your colleagues argue about, I think that that experience is is at least important as any other part of the molecule. So to divide them out, well, you know, it’ll take us years to find out, maybe it’s just this tiny piece of the psilocybin, and then there is no trip that goes with it, and you’ll still feel better, and maybe the two will always go together. I don’t know, but I know that there’s a lot of interest in the pharmaceutical industry into

Dr. Sandy Newes 55:32

this right now, for sure, well, and what we talk about in our clinic, kind of, as part of our, you know, initial client intake process, or, you know, when a new client calls, is it’s really a three part this comes from Dr may DAW Goldman, who runs the clinic, is it’s a three part stool. There’s the pharmacological effect, there’s the experiential effect, which is what you go through in your own internal landscape and what you come out with. And then if you and those two things, in and of themselves, are quite profound. And then if you add in a therapist or a clinical, you know, therapeutic component, then you’ve also got the psychotherapy effect. So I think at good clinics, we’re trying to weave together all of those different pieces to really maximize our outcomes, to create the optimal conditions for clients to have profound and lasting effects. So, you know, can you take any one of those pieces out and kind of, I don’t know, like, certainly, we know there are pharmacological effects, but what we don’t know then is what happens when you only isolate that and you don’t have the experiential part or the therapeutic part. So,

Mel Herbert 56:37

yeah, I can say, for me, the experience part really set. I think myself up psychologically like something strange and weird and and hopeful is occurring here, and that was an important part of the the therapy for me, so I can’t imagine it being as effective, but we’ll see.

Dr. Sandy Newes 56:55

Yeah, I just have another question I’d love to ask you just if we could, just, what do you see? You know, having been a person who has experienced this, being a medical professional, you know, working in a in a profession that has access to this and could do this like, you know, what is the potential and how do we make this as effective as possible, like, I know, based on my experience and my review of the research and training and doing it clinically, that this can be extraordinarily potent and effective. I know that it doesn’t work for everybody, and I also know that people can have adverse outcomes, and yet people can have really life changing experiences that set them on a different path. So, you know, what are your thoughts from your you know, side of the fence here. How do we do this as effectively as possible, and what is the potential?

Mel Herbert 57:48

Well, I think first of all, we have to de stigmatize mental health. We’ve been trying to do that for a few decades. We’ve still got some work to do there. We now need to de stigmatize novel therapies, because the sort of the non normal therapy, non novel therapies, sometimes work, sometimes don’t, and it’s their their effectiveness is not so great. So I have great hope for these therapies, and the initial studies are really positive, but I think the way we move this forward in the medical field is by more research, more research, more research, more research. Let’s work out the exact protocols. I mean, when we first started to do this, it was basically people in the ER pushing ketamine, somebody had a dislocated shoulder, who was depressed, the shoulder grip, put back in. That was easy. And then they’re like, I’ve never felt this good in my years. And it carries out. I’m not suicidal, right? But then it would wear off if you just did it once. And so we still, I think, have to work out the protocols, the dosing, the all of this stuff, and that takes years, but in the meantime, it’s offering an enormous amount of relief to a lot of people, and we should not be afraid of it. This is an extraordinarily safe drug given under the right circumstances. And so I just think we should do be doing what we’re doing right now, Sandy, getting the message out, and going on podcasts and writing books and doing all these things and de stigmatizing this while at the same time doing that research, which is expensive and takes a long time to help us guide where we should go in the future. But we should be doing this now, if you have failed therapies, other therapies for your depression, anxiety, PTSD, you absolutely should go and consider this therapy. Yeah? Me life saving. Yeah, I love that.

Dr. Sandy Newes 59:31

Well, I’m really appreciative of your time. Thank you so much. This has been phenomenal, and I’m very grateful. And thank you so much for sharing your your personal story, as well as your professional expertise. So I think people really need to hear that. And thank you so much. 

Mel Herbert 59:47

Thank you Sandy.

Outro 59:50

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