📍 Today on 50 shades of pain, we’re talking about psychedelic therapy.
📍 Welcome to the 50 shades of pain show. I’m Dr. Danesh Mazloomdoost the medical director of Wellward regenerative medicine, and I’m here with my cohost, Dr. James Escaloni. Today we’re talking about ketamine as psychedelic therapy.
So tell me a little bit more about this psychedelic therapy. It’s illegal, right?
No, it’s not. So history of depression, there’s only been a small category of medications that have been used in depression. But there are problems with it because it takes about four to six weeks for anyone to respond in 30% of people on antidepressants actually still feel depressed.
There’s a lot of rotation through the different medications for people to find the medications that work for them. And so there’s long been this conversation around rapid acting antidepressants or rads. Rads are. Yeah, they’re rad.
That sounds pretty kill.
Very eighties, rad. At them.
There’s a variety of different medications that are considered rads, but they’re all in that psychedelic category. Like psilocybin or magic mushrooms, LSD, PCP, MDMA MDMA and the one that I have the most familiarity with because of my history and anesthesia is ketamine. So we’ve been using a lot of ketamine in the practice for treatment resistant depression.
As well as other conditions like neuropathic pain and opioid dependency or substance dependency. These are all problems that focus in one part of the brain. And so there’s a great deal of utility in using this medication and the different ways that we do.
Okay. So how exactly does this work to help somebody with depression. I don’t understand this very well. So you got to speak to me like a dumb kid or something.
So it’s not that complicated. Have you ever had a dream where you were like, oh man, that’s completely makes sense with what I’m going through in life. Like you were having some hardships and you have this dream and you’re like, aha, you have this aha moment.
Yeah. You wake up and you’re like, that was it.
So those are what are called catharsis or cathartic moment coming from a dream. It’s kind of your subconscious working things out. For some people that sounds kind of voodoo, but there’s a really good explanation for it. If you can divide the nervous system into three parts, you’ve got the thinking brain, you’ve got the middle brain, which is more of right.
Like your regulatory brain controlling heart rate and blood pressure, as well as controlling your emotions or interpreting emotions. That’s the middle brain. Then you’ve got the peripheral nervous system, which is essentially the nervous system that helps you move your limbs and feel different sensations like touch and pain.
So these three have to coordinate and it’s the middle brain that does a lot of that coordination. Well, interestingly enough, the fact that people who are anxious are going to have a higher heart rate. If you’re depressed, you’re going to move more slowly while all of that is taking place in that middle brain.
when it’s not functioning properly, you’ll see it manifest in the physiology or the way the body functions. So when people are depressed, there are changes in that middle brain. And interestingly enough, a lot of these psychedelics or these rad medications all have activity in that middle part of the brain.
In fact, traditional antidepressants, most of their activity is in that middle part of the brain, but it just one very niche category of treatment where all of these rads come in, is they also influenced that middle part of the brain in different ways. In anesthesia. For instance, we use it in order to create a separation between the thinking part of your brain, your conscious brain, and that middle brain, where a lot of pain processing, a lot of emotional processing, all of that takes place.
So we use it to anesthetize somebody when they’re going in for surgery. But in my training in anesthesia, I found that patients who have either been on high doses of opioids before, patients who have been depressed. These patients have very variable responses during surgery.
And when I use ketamine as an add on to the overall anesthetic, they smooth out quite a lot.
And smooth out? What do you mean?
So remember how he said the middle brain controls your physiology. Your heart, you’re breathing rate. All of that needs to be controlled in anesthesia. And when patients had either emotional disturbance or a substance use disorder, their blood pressure, heart rate, their reactions in surgery, their pain after surgery, all of that was much more unpredictable when quite highs and lows afterwards, until I started using ketamine as part of my anesthetic plan.
In the clinic, we started using it for our pain patients. But interestingly enough, we saw these amazing dreams coming out that were just a perfect representation of what patients were going through. Like for instance, we had a patient who came in on massive doses of opioids and he was just out of his mind with it.
His relationship was suffering. He was no longer walking because when you take that level of medication, you actually become more sensitive to pain and the medication becomes more problematic. So his relationship with his family and his children was suffering. Like he was just not a human being at that stage.
And so we use ketamine to stage him down off of his medications. And the first time we did an infusion with him. He was a huge world war II butted buff. His family was a long line of soldiers. And he was big into world war two and he started calling out,
“Hey doc, Hey doc, come over here.”
And so I was like,” what’s going on? What’s wrong, what’s wrong?”
And he said,” doc, I need you to release the bomb.”
So I was like, wait, what? The bombs, I’m sorry, it’s been on.
He said, “I need you to release the bombs.” And I was like, “what are you talking about?”
Well, it turns out he was having this dream. Where he was a fighter pilot or a bomber in world war two, and we were going into battle together. And all of the soldiers, all the minions on the ground were a tiny little representations of the doctor he was seeing before me, who have ramped them up on these high doses of medications. It was the first time he became mindful or aware of how angry he was with this doctor who he felt like did not serve him right. Did not do him justice.
And just by expressing that anger, I mean, in the context of all the other things that we did, it was a huge leap forward for him. We cut his medication after that first dose for that first infusion, from the equivalent of 900 milligrams of morphine, down to 30 milligrams of morphine in a single infusion, which something that would otherwise take months.
That it’s because of the chemical effect of the ketamine, but there’s also this psychological effect of ketamine that’s been even more fascinating because since then we’ve had more patients who have come in for ketamine therapy for psychological therapy then for pain or for opioid dependency.
Okay. So what is the psychological therapy side? Like what does that look like?
So the analogy I use with a lot of patients is, it’s like, you know, when you’re dealing with some kind of an emotional distress, you know, major hits in life, emotional trauma loss of loved one. These are all situations in which your brain goes into a distress mode. It goes into fight or flight mode.
And so it can shut down. That reprocesses in the middle part of the brain start to disconnect from the processes and you’re thinking brain. So things don’t necessarily make sense. You feel sad. And so you start thinking and you start attributing your sadness to different things in your life and it just becomes this vicious cycle.
The analogy I use is, it’s like you’re in a room that’s on fire and all of us will have a tendency to want to put the fire out. But if the room is on fire and there’s smoke, filling the room, you end up walking around and bumping into furniture trying to find the resources to just put the fire out, let alone find the fire itself.
Our tendency is to keep looking, but the solution in those situations is really to vent the smoke. But a lot of times our subconscious is what’s preventing that venting because we’re afraid of what we’re going to see when the smoke clears out. We’re afraid of the damage that we’re going to find in the house that we’ve built over a lifetime.
To see a wall of devastated. It’s just too much to bear. So subconsciously you kind of shut the windows and hunkered down in this smoke because you don’t want to see what or where the damage is. Well, ketamine and the psychedelic medications are very helpful in creating a firewall between your thinking and your emotions.
So that for a period of time, you’re able to actually process and vent the smoke without having the devastation of how much damage there is in the house.
So it’s like our internal consciousnesses are just constantly at war with each other. And a lot of these states, and this allows us to take a step back and just see it clearly and just say, oh, it’s this?
Yeah. It’s like that middle brain and the thinking brain are not communicating anymore. And they’re actually arguing with each other. And the identity like me as a person. It’s like the child of two parents who are going through divorce. They’re not able to get along enough to take care of the child that is struggling.
This is some pretty deep stuff, guys. Like, I’m really curious about this serious. Yeah.
It’s a profound treatment. Now. There’s a lot of places that are providing ketamine. But I hate it when medicine becomes a business, because then they just water it down or they try to shortcut it instead of doing it the right way.
And a lot of places will just simply sedate patients during that ketamine infusion that gives them the chemical reset. Because when that firewall exists between your thinking brain and your middle brain there’s a reset process that goes through. Everything just kind of reboots and you do get an uplift for a few days.
In fact, studies show about 72 hours of a mood uplift. But to get a more sustained outcome you really don’t want to sedate the patients because then you take away the opportunity to vent the smoke, clear the air and look at the room that’s been inflamed and start to piece together what walls need to be knocked down, what needs to be rebuilt.
And that’s really where the heart of it comes. That’s a process that we’ve developed over an integrated approach using myself as an anesthesiologist who understands the physiology, those separations between the conscious brain and the middle brain. A psychiatrist who understands the chemistry of mood disorders of depression, of anxiety, of trauma, and then a mental health care therapist who understands how psychology and behavior, and the narratives that are going on in our head.
All of those things are interwoven and tied together. So the process is really building this methodology from the ground floor up using these three different disciplines collaborating altogether.
It’s almost like give a man a fish versus teaching the fish.
Exactly. That’s a really good analogy. Yeah.
Every once in a while I come up with this..
Without the ketamine. Yeah.
This is really cool stuff.
Yeah. It’s definitely something I’m very excited about. I’ve had it for myself then I’m happy to talk about that in a future episode, because it really had a profound impact on me.
A lot of the things that people fear, like is it going to induce addiction and is it going to create a whole nother dependency? It really doesn’t do that. Like, I don’t have any kind of craving or desire to repeat it, but I know that the session that I had, it helped me gain clarity on a number of issues that I was really struggling with.
I don’t know, guys, I’m actually really interested in hearing about his experience with this. Cause I’ve never had this, but this is some cool stuff. We’ll do that for a very soon episode.
Thank you for joining us on 50 shades of pain show where today we talked about ketamine. Please join us on future shows.
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