Ketamine for Breakthroughs in Brain Health & Emotions

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey everyone. Today I speak with Dr. Ken Adolph about ketamine, which is a legal psychedelic and poses a potential breakthrough for brain health and emotions. We discuss what ketamine is and how it works. We also discuss what some of the research shows in models of depression, PTSD, addiction, prior trauma, what’s happening in the brain when one uses ketamine, impacts on the default mode network, and disassociation, which can be helpful when people get locked into a certain way of thinking. We use an example that’s probably fairly easy with which to identify, especially if you’re living in a Western society, which I’m assuming most people listening to this are. That is being worried about work and life stress, and having a tendency to ruminate and thought loop over and over again on these things, and how that can pull you away from the things that are presumably more important in life. Things like family, friends, time in nature, and how correspondingly, when people go through therapeutic sessions with ketamine, they tend to find themselves all of a sudden spending more time in nature, with friends, and with family, even though their work or life situations haven’t changed.

DrMR:

I think a really important thing to keep in mind is that even though it may seem like, and I include myself in this, you’ve got to work “X” number of hours per day, or do “Y” amount of stuff, there are opportunities to shift your perspective. And those expectations that you have of yourself are not actually set in stone, they are amenable. And again, one of the ways that they seem to shift after therapeutic ketamine is people having simply a more balanced life.

DrMR:

We also discussed the potential benefit that ketamine therapy has for those who have food reactivity and environmental reactivity. So this is a very interesting and enlightening conversation, and what’s so exciting about ketamine is that it’s legal. Now, you can’t go down to the grocery store and purchase ketamine, but it is a medication that can be used as part of a clinic, and it doesn’t require this underground use like many of the other psychedelics do. So with that, we’ll now go to the conversation with Ken, and I should just remind you that if you’re in need of a resource for gut health, please don’t forget about Healthy Gut, Healthy You, which lays out a self-help plan for how to use diet and natural medicines for improving your gut health, which of course can have carryover to emotional and brain health, as I experienced with pretty debilitating food reactive brain fog, which cleared up nicely after improving the health of my gut. All right, and now we will go to the interview.

DrMR:

Hey everyone. Welcome back to another episode of Dr. Ruscio radio. Today, I have a special guest, Dr. Ken Adolf, and we will be talking about psychedelics, more specifically, ketamine. What’s nice about ketamine is that it’s something that’s legal, and it can be used in the clinic. So it doesn’t require this underground realm like if you want to use something like LSD or psilocybin. So definitely something I’m curious to pick your brain on a little bit more here, Ken. Welcome to the show and thanks for being here.

DrKenAdolph:

Thank you for having me on.

DrMR:

Let’s tell people briefly about your background, because this is not a conventional spot to end up in. So I’m curious as to what the lead up to this was like.

DrKA:

Well, I grew up in New Orleans, and early on knew that I had generalized anxiety and that my upbringing just really heightened that. I grew up as most people do with a perfectionist environment from both parents. I have two sisters, and we were all pretty much raised in a very similar fashion. You have that real deep sense of almost feeling as though your love is conditional and based on your success, whether it be on the sports field or in academics. And so I’ve always put a lot of pressure on myself, and that’s also from outside sources as well. That’s really at the core for me if I were to describe the root causes of being led into this direction of trying to help others with anxiety, depression, and trauma.

DrKA:

And that is usually where it’s from; your childhood and your upbringing. Of course there are genetics and other other factors as well. Later in life, of course growing up in new Orleans, I used alcohol and many other different things to try to quiet my anxiety. I’m in my fifties now, but probably in my forties I would say that my coping mechanisms fell apart. And as a cardiac anesthesiologist, I’ve been in practice now for about 25 years here in Austin. I started a group and continue to lead that group. It’s not a calm environment. It’s idling high, and it’s interesting that the dichotomy of my personality is that it’s something that I’m attracted to because it keeps me in that space, but yet on inside at times when I’m just in my resting state, I can feel my anxiety. And I’m sure that there’s people out there who probably identify with that.

DrMR:

Sure. I mean, anxiety is something that I personally haven’t dealt with much, but there’s been, I’ll say long story short, a few experiments that have gone wrong and I felt the pretty painful whip of anxiety. It’s a tough one. I think what’s so challenging about anxiety is that it can lead you to think that things are wrong with you that have a very small probability are actually the case, but in that anxious state they feel so real. And it’s really quite gripping. So anyone who we could prevent from having anxiety would be a big win.

The Benefits of Ketamine

DrKA:

What I want to say is, at the time of really being brought to my knees in my forties, when my coping skills and my coping mechanisms failed me, I realized that anxiety wasn’t defining me. I didn’t want to be defined by the feeling or the emotion, which sent me to begin to understand exactly what is the core and what is the basis of anxiety? I mean, it’s actually a feeling or an emotion, but underneath that, the reason why we have anxiety is because we’re fearful of what may come in the future. And I can tell you that I’ve worried 10,000 or maybe 100,000 times more about things that may happen. And then when they do happen, I have no anxiety at all because I’m so prepared and ready for that event, whatever it may be, a death or an accident or something. As an anesthesiologist, I picked the right profession, but the idea that anxiety defines someone and that they’re trapped in it is the bigger thing. I wanted to dive deeper and find out what was the root cause. How could I help myself be relieved of the emotion, and be able to sit in it and identify it and look at it in a different way.

DrMR:

Let’s help people understand this therapeutic of ketamine that can be used for anxiety, in case people haven’t heard of it. What is it and how does it work?

DrKA:

I’ll start with the history of ketamine because I really think it’s very interesting, and it ties into how it came to us. It was first developed in the 60s, and it was developed for Vietnam. When we were going to war, we needed a drug that was very safe on the battlefield. When soldiers need to have an anesthetic in the field, we don’t want to drop their blood pressure or their heart rate. We don’t want to decrease their respiratory drive, but we do want to take care of their pain, and ketamine does all of those things. It increases heart rate, increases blood pressure; it does not affect respiratory drive. So it’s a very, very safe drug that we can use in the field and we can use it in the ER and we can use it in the operating room.

DrKA:

And so it’s a very tried and true drug that was developed for a different purpose and which is now used off label. Many, many studies have been done on this old drug, which is actually rare because most studies are done on new drugs, with research and development done by pharmaceutical companies. But many of the research studies that have been done have shown improvement with all of the things that we began to talk about. And instead of just opening it up as a mental health issue, I like to classify it as any mental health issue that involves a rumination loop. That can be eating disorders, OCD, addiction, which again is coupled into depression and anxiety and trauma.

DrKA:

And so when we really get down to the root of why ketamine works, because we can talk about the actual hitting of the receptor and what it does, it severs that rumination loop. That rumination loop is very important to those people who suffer from depression, anxiety, trauma, or any of the things that I’ve just discussed, because it gives you the space to be able to let your brain rest from continuously thinking over and over again. If it’s depression it’s about what’s gone on in your past. With anxiety, it’s what may happen in the future. With trauma, it’s reliving the trauma over and over again. With OCD, it’s body dysmorphia, and with addiction, it’s memories related to trauma, coupled with using that substance that you’re utilizing to soothe yourself from the emotions.

Ketamine Research

DrMR:

Where is the body of research with ketamine? I’m more familiar with psilocybin and LSD, although I’ve seen some studies with ketamine. What is the research arm of this looking like? I know that there are some centers that are really pioneering this, but help get us up to speed there.

DrKA:

Well, actually there are more studies that have been done on ketamine at this point. I know that it’ll be surpassed very soon because we have larger and larger studies being done with psilocybin, it being a naturally-occurring substance. MDMA was studied back in the 80s, it also being an old drug. With all of these drugs, it’s the renaissance of psychedelic medicine. Ketamine falls right in the middle, as far as how well-researched it is. Everyone likes to say the research is done, but the studies are not big enough. If someone were to put money into it, and that’s really what we’re looking at, the problem is Big Pharma. Big Pharma controls research and development of any drug that’s going to come to market.

DrKA:

And so right now a lot of the research is through MAPS, but we have many companies right now that are actually publicly traded on the Canadian stock exchange that are creating patents on psilocybin and psilocybin derivatives. And they’re waiting in the wings ready to be able to pour. MAPS has a hundred million. At the very top of the feeding frenzy of the psilocybin derivatives, you’re talking about 600 million to a billion. So a lot of opportunities to bring it to clinics like mine and others all over the country. Obviously the studies that are being done with ketamine are oftentimes repeated in the same sense that they’ve been done for the last decade. So lots of studies on veterans with PTSD, lots of studies with depression, not as much on anxiety. An overall synopsis is that 80% of the cohort that is studied does respond to the general accepted practice of a six infusion series over a month.

DrMR:

That was my next question, which is how often. So it’s six sessions over a one month period? Is that what you’re saying?

DrKA:

Right, and so it’s a stacking effect, so to speak. One of the benefits is that it’s rapidly acting, and you see a response some more than others. We can talk about the spectrum of why that is, but most people feel an immediate release of that heaviness of depression, that they’re lighter and that they can see colors more readily. And again, most patients that we see that are seeing a response are doing subtle things like not sleeping as much, getting outside, enjoying the outdoors, or deciding to go and engage with friends or engage more with family and loved ones. The changes that patients feel are subtle in the beginning, and then they slowly ramp up over the month where they’re beginning to feel their sixth infusion.

DrKA:

And again, every drug has it’s bell-shaped curve. We certainly do see the patients that come in that are younger and haven’t been on an antidepressant or an SSRI for a very long time are rapid responders and do very, very well, versus someone who’s maybe in their fifties like myself, who’s been on an SSRI or a few SSRIs where their emotional range is tamped down and their brain architecture has been altered. It takes them a longer period of time and more infusion. So the six infusions may extend to eight to 10 over two months. All patients are different, and the response is different, but overall it is an 80% response rate.

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Effects on the Brain

DrMR:

I want to ask you more about something you said a second ago, which I find interesting. People are perhaps loosening up the grip on their life a little bit and spending more time in nature, more time with friends and family. But before we expand on that, what’s happening in the brain? I know there are a few theories and mechanisms that are being mapped out from the default mode network to this theory of more electricity going through the brain so alternate pathways are forged, and now people aren’t forced to just fire these faulty pathways all the time. But I’m I’m unclear on if that’s more consolidated to something like psilocybin, MDMA, and LSD, or if that also happens with ketamine. So tell us more about what’s what’s going on underneath the hood.

DrKA:

Ketamine is an NMDA receptor antagonist. It’s just a fancy word that says what it does is creates a flood of glutamate, which is a different neurotransmitter. You don’t really hear much about glutamate when we start talking about neurotransmitters in the brain and how they affect patients who suffer from mental health issues. And the psilocybin, the DMTs, and the mescalines, LSD, those are all serotonergic receptor agonists, where they’re actually attaching to the receptors, similar to the serotonin in our brains. It’s a similar receptor, but they’re acting at a different receptor. So with ketamine and glutamate, like you were talking about with the default mode network, that is what is involved in the rumination.

DrKA:

So at rest we tend to ruminate, whether you want to call it daydreaming, and we derive memories, we start thinking about a past memory. With people that are suffering from depression or from trauma, those can be very difficult to deal with, and they can’t stop that loop. So again, you are correct. Ketamine does sever that loop. And it basically gives our brain neuroplasticity, very much like psilocybin does, by releasing something called brain derived neurotrophic factor. What that essentially does is it wakes up the neurons that have atrophied. There are mostly animal studies that have been done to actually show that patients who have suffered from depression, anxiety, and trauma for decades, will show atrophy in the areas of the hippocampus and some of the limbic system where we process emotions and memory. We see that when they look at animals that have been given ketamine, those areas of the brain have increased growth. It’s not new neural growth, it’s just an expansion of the neurons that are in place, meaning a stronger connection, more synaptic firing of those neurons that are involved in the hippocampus.

The Effects of Isolation

DrMR:

Do you feel that part of these rumination disorders could be caused by the lives that we live in the West, which tend to be more isolated, especially now? One of the silver linings of the COVID-19 lockdowns is that people don’t have to be commuting, but I also think one of the unfortunate and perhaps unseen side effects of that may be people are now going to be more isolated, even after things open back up. If people still are working from home, if you live alone, then one of your main sources of contact and comradery may have been at an office setting. So I wonder if part of this could be fueled by that? Part of the reason why I ask is one of my colleagues just got back from spending some time living with the Hadza hunter-gatherers. One of the remarks that he made that I found interesting as someone who thinks of myself as a deep thinker, was they spend very little time pondering existential matters. They’re just there in the moment, cooking over a fire or joking with the other tribespeople. What degree do you feel that the way that we live now maybe leading to that rumination?

DrKA:

Well, I completely agree with you about COVID. It’s altered our lives completely. How we get back to a new normal, we’ll have to wait to see what that is. But currently what we’re doing is we’re comparing our lives electronically, obviously through social media and through other mediums that create expectations. And instead of being able to, like you pointed out, live in the moment, which again, that’s exactly what we need to do. I mean, meditation is natural way of being able to do that where we’re actually taking time to continuously take ourselves out of that default mode network and make it so that we’re in the moment. That is so hard in today’s electronic world, because we’re constantly comparing our lives to something that is manufactured. I mean, I can give so many examples because if we were to dig just a little bit underneath the surface of a lot of someone’s Facebook page with happy faces, we see that it can easily be created. It’s a façade that we all have to live with, and it’s very easy for our brains to get tricked. And we’ve done this in such a very, very short amount of time. I mean, we’re talking about a blip of nanosecond in human existence.

DrMR:

Not to derail your train of thought, but I’ve got to share this because you just sort of reminded me of something. I’m sorry if I told this already, but I was at dinner the other night and I saw this other couple and the entire night they were so disengaged with one another. It almost looked like they had just gotten into a big fight or something, because they were had no eye contact, were not looking at each other, were barely making any conversation. Towards the end of the night, they got close together, smiled really big and took like six photos of themselves each and then they go right back to being miserable. And I’m thinking, my goodness, if you were to paint an example of what’s wrong with looking at people’s social media, that would be it.

DrKA:

That paints it exactly as to what I mean. I’ve experienced the same thing. My partner, Alison and I, we’ll look around and we’ll see couples. They both have their phones out while they’re at dinner, obviously on social media or texting or posting or doing something that obviously isn’t engaging each other. And I mean, it’s a sad existence, but that’s what we have done. We’ve created another way to numb our emotions, to distract ourselves from what we’re actually feeling. When we put the electronics away, that’s just the proverbial tip of the iceberg. We have so many things that we’re currently trying to deal with emotionally, that ketamine, psychedelics, they’re all tools. They’re not going to be cures.

DrKA:

They’re a way to actually present yourself with almost a rite of passage. Even if you’re an adult, you actually have a different lens on your life to actually see, this is what life is. These are the things that are important. My family, my connections to these people that I love, the support that I have, the gratitude that I have for the earth and for the existence, how lucky that I am to be living, to breathe, to be able to have a practice of gratitude every single day, that being a human is hard. We’ve come to try to have an expectation that we should be happy just to be comparing ourselves in the first world issues. And I think that we’re going to lose ourselves deeply if we don’t wake up. And I think that the psychedelic renaissance is providing that. We’re waking up. We’re waking up and saying, “You know what? No, I’m not gonna exchange agency to Western medicine just take that pill to numb my feelings and my emotions so that I don’t feel depression or I don’t feel anxiety.”

DrKA:

We’ve taught ourselves that that’s the road to go down. What we’re saying is that ketamine and psychedelics, because I have experience in all, that these medicines, I’ll call them medicines because they are, they bring up emotions and feelings for me so that I can face them so that I can process them. Because I’ve been trash compacting it all my life to try to shove it down so that I can get through med school, then I’ll address it when I’ve finished that or when I get through residency or when I’m successful in practice and it’s been a delay of decades, and now I’m just peeling away the layers. They’re onion layers, and there’s more and it’s never ending. We should look at life as a celebration of a journey that we need to educate ourselves about our own emotions, that we have to empower ourselves, that we can heal ourselves through the medicines that put us into the state of the subconscious, so that we can feel the things that we’ve resisted.

DrMR:

It seems in a way that what these compounds in large part end up doing is allowing you to slow down, be present and not get sucked into television, social media, whatever kind of somewhat perverse behavior that may be. I’m sorry if that sounds like a strong label, but for anyone who spends too much time on their device or in front of the television, I’m sure you don’t feel good after that. It’s almost like coming back from eating fast food. Why did I do that? Maybe that’s where a lot of the benefit comes from. I feel like what you’re somewhat alluding to here is it gets you to, as you said earlier, spend more time in nature or with friends. We know these things are therapeutic. Forest bathing, for example, has been shown to acutely improve mood and energy.

DrMR:

And that people who spend more time with others have a higher self-perceived quality of life than people who don’t. But for some reason we tend to shy away from those, which I get from my own perspective. Not because I’m the guy posing 13 times for one photo that I’ll post on Facebook, but for me, the thing that skews me might be work and just feeling that iron hand needing to get more done clench tighter and tighter. And it’s a balance, because I think to perform well you have to be able to be a little bit disciplined and work and push through, but it’s probably easy in our society not to have that counter veiled, because it’s not like social opportunities are aplenty, like if everyone’s living this European lifestyle where you just walk out your front door and you’re smacked with all these opportunities to sit at a cafe and socialize. Just like the European guys who always used to hang out at this cafe near where I used to live in California. So I think there’s a lot of benefit obviously to that, but it seems like we drift into these imbalances and this is a way of restarting or almost jolting back to life the appropriate framework or perspective in the brain. And then that leads you to initiate behaviors that are more conducive to further health and happiness.

DrKA:

I completely agree. And I think one of the points that I want to make is with ketamine, with which I have the most experience, I watch people transform before my eyes over a period of one month to two months. And then, even a year later they’re still deriving benefits, because again, it is a tool. And we try to encourage people that during the time that they’re receiving their infusion series, you want to take advantage of this time of neuro-plasticity. So I give the analogy of if you’re a cross country skier and you’re in that set of tracks and you’re constantly in that set of tracks, it’s the path of least resistance. You’re automatically going to go that way. The only way to change and the only way to rewire our brains is to begin to make changes to our lifestyle so that we can stop the negative feedback, that rumination loop.

DrKA:

All of the simple things, meditation and a practice of gratitude is the beginning, but journaling about your feelings and emotions, getting away from electronics and TV, spending more time with your family and engaging people in relationships where you may not have done that. Those may have been the things that you’ve struggled with, because the only way that you’re going to be able to take advantage of the time that you are working. It’s like going on a diet or changing your training regimen. It’s the same thing for your mental health. To be able to take advantage of that time, to really put the effort into getting a coach, which is what we recommend, we guide people into that process so that they can take advantage of it. The studies have been done that show the effects of ketamine will be extended by 50 to 60% if you have integration. Integration looks different for everybody, it can be a practice of yoga, it can be a practice of meditation. It can be mountain biking or road cycling where you get into a meditative flow state. It’s being able to practice breaking the rumination.

The Role of Therapists

DrMR:

Let’s go there for a moment, because that was one of the questions I wanted to ask you. I know some clinics have psychotherapists there during the session. I’m not sure if that’s fully needed. I’m curious, what are you finding or recommending in terms of at one extreme, perhaps you don’t need to have a therapist right there for some people. I’m picturing myself in that situation; that feels like it may be a bit more than I’d want, but maybe some people would need that. But also at the other end of the spectrum, no guidance on unpacking some of the realizations may be just like throwing someone out there. So what are you recommending in terms of this integration?

DrKA:

In the beginning of opening the clinic, we had a definitive mindset that we were going to start forming relationships with other therapists and other psychiatrists, to try to form a network where we can refer and cross-pollinate, so to speak. And I will tell you, it’s not that it didn’t work. Ketamine is a drug where people experience a psychotropic world that not many people understand. And I think that what we’ve done in the last six to eight months is to begin to collaborate with a company called being true to you. They’re out of Colorado. Colorado has about 40 to 50 ketamine clinics. We’re just scratching the surface, and in order to be able to guide people through this process, just like when we talk about psychedelics, where we have people who are very knowledgeable about the drug that they’re administering and the medicine that they’re administering, to be able to know what the effects are, to be able to help that patient when they get into the tough spots, because that happens with the ketamine infusion as well. As you begin to peel away those layers, those emotions are going to rise, and they’re going to feel like, “I might be getting worse with this ketamine.”

DrKA:

We oftentimes have to support those people, those patients, to say, “You know what? This is progress. This means that you’re feeling. You’re crying again.” This is when you really want to sit with your emotions and begin integration with your life coach, or whether it’s a therapist who understands ketamine. We just don’t have enough providers who understand ketamine. And that’s our Achilles heel, so to speak, in this arena. When we have MDMA and psilocybin available to us, we’re going to have clinics opening, but we’re not going to have the providers that understand the drug.

DrKA:

I’ll tell you a short story. My society, the American Society of Ketamine Physicians, it’s now Ketamine Providers, the second annual meeting was in Denver, pre-COVID years. In 2019, Alison went to that meeting with myself and another employee of ours. We were at a table, and Alison and I were talking about when we went through our series. We did it together, not simultaneously, but time-wise the same week, first and second infusions at about the same time. And we would come home and talk and integrate and integrate with other providers, our life coaches. It was an amazing experience because we now know what it’s like to dissociate. We can get into that in a minute of what dissociation is, because I really feel like that’s the therapeutic space for ketamine. But when we were at that meeting and we were at a table of 12 providers who all own ketamine clinics, not one provider had taken ketamine before.

DrMR:

That’s a problem with trends in medicine, I guess. Not to say that you have to have used every therapeutic. A good straw man example of that would be an oncologist. But in this case, I agree with you that I think there’s a lot to be experienced because it’s such an experience-centric sort of therapeutic.

DrKA:

I’m an anesthesiologist, I don’t need to go and take the drugs that I provide my patients obviously, but you made a good point. This is a spiritual experiential, and for me, life-altering, process that I think you need to have done it in order to be able to guide someone through it.

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DrMR:

One of the things that I’ve been thinking more about is shamanism. You’re the doctor that probably knows the most about this. I think this happens a lot with more of the ancient realms of medicine is that they can easily be misinterpreted or typified as woo-woo. There crackpots in every field. Even at the highest levels of academia, you have some people who are just seemingly off their rockers. The academic system probably partially filters those people out, but nonetheless, despite there being some stereotypes of these things being very woo-woo, there’s likely also a rich history that has been passed down from generations of shamans and a lot of experience with these sorts of compounds. How to use them, how to interact with people who are using them and going through the process. Is any kind of shamanism something that you’ve integrated at all?

DrKA:

When you say shamanistic, what we feel about the mental health space right now in this country for Western-trained physicians is that we try to avoid transference. So when we have a patient that we’re connecting with and we’re talking with them, showing them empathy in the sense that you even go to hug them is taboo. I feel like that is not a practice that I believe in. I think that when people need to be supported that needs to happen. You can feel empathy when you walk in our clinic, because we’ve tried to dial back the clinical façade, so to speak, of what we need to make people and patients feel safe.

DrKA:

Of course, when they undergo the infusion, they’re fully monitored, their oxygenation, their blood pressure, their heart rate. Of course there’s somebody in the room at all times with them. They feel safe, but that’s the same process that a shaman is utilizing, obviously without monitoring, but that’s where we need to be. So it’s a blending that we feel like is happening and it’s going to happen when the FDA hopefully approves the usage of these medicines. To be able to help people we have to go about a blending of Eastern and Western approaches.

DrMR:

Well said. Also it may be that conventional medicine crash cart, so to speak, is more necessary because of the devolution of our health, where people now are just so much less robust. Having that’s probably an even better idea now than it was for the shaman a few hundred years ago or more.

DrKA:

I would say the vast majority of our patients have never had a psychedelic experience, and ketamine is very different from any other psychedelic. I kind of group psilocybin, LSD, mescalin. Those are very familiar to me. When I take them, I understand them. When I’m in for an infusion and I do still receive boosters from time to time, meaning around six to eight weeks apart, it’s just completely different. And I’ll be honest, every single infusion is different. It depends on what I’m going through at the time, what I’m working through. And regarding the difference between those two, I believe that ketamine puts you in a subconscious state, meaning that your dissociation occurs when you no longer feel your body, you no longer have somatic input. You can imagine if we take away all of that input, then your brain is alive and able to really process in the subconscious state. It kind of gives you a feeling that you’re numb and that you’re floating.

DrMR:

Dreamy? Is that a way you described that? Like a dreamy state?

DrKA:

Like a dreamy state, exactly. And I would say that most of the time, you fall into somewhat of a dream that’s a cascading of things, of memories that lead into something else. Many times it can be a distortion, but it’s all part of your brain processing it. Whereas my experiences with psilocybin is it’s in the conscious state. You’re actually thinking about an emotion or an event and you’re consciously looking at it. And you’re like, “I can’t believe I’ve never thought of it that way, but it’s true.” You have that “aha moment” before where you see something in a different way, because again, it’s just part of the way that our brain works in the conscious state.

Potential Negative Side-Effects of Ketamine

DrMR:

I’m curious to hear more about how the traditional psychedelics, psilocybin, LSD, MDMA, how they feel in reference to ketamine. One of the things that I guess is a double-edged sword of the traditional psychedelics is you can have a bad trip, as it’s said. Now, I think the more you unpack that it could be just a bad trip period, or there could be a challenging experience from which there’s a lot of enrichment that occurs. It could be really cathartic, like “I saw myself as a architectural XYZ and I got this powerful connection to whatever,” and all these kinds of ethereal realizations. Or it can be, “Holy crap, I got stuck in this dark thought loop, and it was really challenging.” Do you have that same sort of potentially dichotomous experience, or is ketamine a bit more level in how it presents and how you feel it?

DrKA:

I’m an anesthesiologist, and it’s all about dosing. When I partake in any psychedelic, it’s dose, and it’s an absolute. You have to know what you’re taking. With ketamine, it’s an exact dose. We give it through IV so we can turn it off. If someone’s having quote unquote, “a bad trip,” instead of that, I would say that they’re having a difficult infusion where emotions are coming up. What a bad trip is, is too much, too soon, not enough preparation. When someone takes something, a hit of LSD that they thought was a hundred mics and it’s 300 mics, it’s going to send you into the deep end.

DrKA:

I don’t know if you’ve heard of any of the studies done on bad trips, but they were done a long time ago, in the 60s, where most people saw that experience as we’re talking a year out. Whereas, a month out, they described it as the worst experience of their life, they would never do the drug again and would never want to experience or wish that on anyone. In three months and six months and then a year, they look at it as the most monumental experience in their life thus far. Because even though they got thrown into the deep end, they were forced to face their emotions, their emotions that have been, again, like we’ve talked about, they’ve been suppressed. And most of the time it’s with the people like myself who are control freaks.

DrKA:

I don’t like dissociation, I’ll be honest. It’s not a real fun feeling for me to surrender. And that’s what I do before my ketamine infusions, of course everyone’s not always in the right frame of mind, but I suggest to all my patients meditate to surrender because I want to surrender to the dissociation. I want to let go of the control that I think that I have on my life. Key point, think that I have in my life. I’m not sure if you follow stoic philosophy…

Meditation and Dissociation

DrMR:

Oh yeah. We’ve had a stoic philosopher on the podcast maybe a year ago now. But yeah, we’ve talked about it. I agree that your point about those who are in the most controlling position, so to speak, or they live the most controlled lives, may have the hardest time with this, myself included. I do also think a buildup is important because it seems that you need chances to confront a situation that you have no control over and be okay with letting go. Myself, I do so much to never feel poorly, because there was a time when I had an intestinal parasite and I had food reactive brain fog and insomnia, fatigue, depression, and it sucked. And I would have done anything not to feel that way.

DrMR:

So now I do everything within reason not to feel that way. So when I feel some anxiety, as I have once or twice from psilocybin, it spins me out at first, because all the alarm bells go off. Like this is the thing that you’ve been fighting against, not to feel for so long. But I think deeper below that as an opportunity to just feel that feeling. This is where some of Sam Harris’s meditation and practices have been really helpful. He has this one meditation where he recommends you go through vividly reliving the last time someone really insulted you or offended you. And then reliving that experience, being able to feel that emotional signature, put it in a box, put it on the shelf, and look at it from outside of the experience and realize that’s just an emotional signature. It doesn’t actually mean that you’re in danger or you have to react in any given way. I guess that’s actually an exercise in disassociation. So that’s where I see the benefit coming from, but it does take some practice, because sometimes it’s easier said than done. So it seems having those successive exposures is where you can really master that. So yeah, I can totally see the viability of that approach.

DrKA:

That’s why it’s six infusions, because the first infusion is I what I call shaking hands with ketamine. A very low dose where you’ll feel somewhat euphoric, with a lot of feelings of love and emotion and appreciation coming up. I’m not saying that you’re inevitably going to end up in a dark place, it’s just that as you increase the dose and start to approach dissociation, we don’t want to throw anybody into dissociation because again, like we said, nobody likes to be in the deep end without knowing how to swim. So the best way, the art of providing ketamine in the right way is knowing if somebody has a recent history of trauma, especially sexual trauma. It may be one that’s unknown. They may feel like, “I know something’s there, and I know that may be the root cause of what’s going on.”

DrKA:

And so we’re very careful and slowly walk up. And that’s the other thing, interviewing patients immediately after to see how they did, if they’re comfortable with increasing the infusions. We’re not trying to push the dosage to get them to a point where it’s scary. We’re just trying to get them to a point where they’re starting to feel like they’re dissociating. And like I said, that’s an art, and that’s just through a proper interviewing process and seeing how patients feel. If they feel scared at all, and this can sometimes happen in the infusion, we just turn the infusion off. We have our infusionists put their hand on their shoulder and just speak with them, let them recover, tell them that they’re there, everything’s okay, do some breath work, and ask if they’d like to continue at a lower dose. And again, it’s peeling the onion layers off very, very slowly. And if you ever get to a place where it’s feeling kind of raw, we even say, “Let’s stop the series, go and process. Get to a point where you’re feeling comfortable to come back, and we’ll restart your series.” Integration’s important; I can’t emphasize that enough. Ketamine’s a tool. The integration is where the healing is going to happen. It’s not just the drug hitting the receptor.

DrMR:

Yeah, and I like the way that you’re posing that because even though psychadelics in a single administration have been shown to have remarkable impacts on things like PTSD, this is best done as part of a conscious process. Almost like if you want to run a better mile, and someone said, “Well, there’s miracle injection XYZ, and that showed these athletes took 30 seconds off their mile time,” well, okay, that’s something I guess. But really the healthiest long-term perspective would be good sleep, good training, good nutrition, and to build yourself up to be a healthier athlete. And I really appreciate that perspective.

DrKA:

Well said. With the spectrum of patients that we see, we are able to bring those things to light. Like diet and sleep and being able to utilize a healthier lifestyle. Oftentimes what’s so difficult is what is the dynamic at home? We can’t change that, but patients often realize that they’re in a toxic environment. The only way they’re going to heal is to a change that. Sometimes that can be a difficult decision, especially if it’s marriage, if it’s a child living in a situation where they’re needing to get away and starting to grow as an adult, that oftentimes comes to light. I can bring up so many different stories.

DrKA:

One I think that you would identify with is, I’ve seen many high-functioning CEOs or executives that come to us and they’re on the Adderall during the day, Ambien at night, and functioning in that way for decades. They’re feeling successful, but feeling completely disengaged with everyone around them. It’s interesting to see their transformation because it was very like much like myself. I felt like my edge was idling as high as I possibly could get. Highly caffeinated, up and buzzing around, doing as much as I possibly could and very little sleep and function. It was all not going to work for very long, and it didn’t. But to be able to realize that I don’t need that edge to function and be successful; you can let that part of yourself go and still have the same amount of “success.” We can reevaluate what’s important in our lives and we can live better, more fulfilled lives.

Ketamine Effects on Chronic Inflammation

DrMR:

I think this example is a great one, and probably one that involves a big realization for people who are living their lives that pinned. I’m wondering what your observations are on another patient type. Clearly these types of medicines have been studied for anxiety, depression, prior trauma, whether it be PTSD, but there’s another type of patient that may have food reactivity, environmental reactivity, or some sort of chronic inflammatory disorder. It may not so much be manifesting as anxiety, or at least not overtly. There are theories that maybe there’s this subconscious anxiety, so to speak, that’s causing the immune system to be overreactive, as in limbic imbalances and limbic retraining, but are you seeing any of this? I’m sure our audience is really curious as to what you’ve seen and what kind of responses people are noting in this general sort of cohort.

DrKA:

Well, one of the things that I find fascinating is that as human beings, when we are suffering mentally, we’re going to manifest so much physically. We have the sayings, “I can’t stomach this,” or, “It’s making me sick to my stomach.” Obviously, gastritis and peptic ulcer disease with stress is going to be something that’s manifesting as a physical symptom. Well, the span of that, I’ve seen dysautonomia where patients have high heart rates, they’re bradycardic, have hypotension, syncope, are passing out, and they have no idea why it’s going on. They’ve seen a dozen doctors and they can’t figure it out, and then they come to us anxious about it. And then suddenly through a series two months later, they’re like, “I don’t have that anymore.”

DrKA:

And it’s not like this is a magic pill. This is an emotional issue that’s manifesting in a physical sense. We see it with fibromyalgia, somebody that’s been diagnosed with fibromyalgia and has been on opioids for a large portion of their lives. Fibromyalgia migraines also manifest in this way. Any kind of gut issues that you’re speaking of as well. Of course I want to start with gut health first. I want to start with nutrition first. But of course, mental health plays a huge factor in being able to create the right environment for all of those things to actually gel and provide a good, healthy gut flora for instance. I could go on and on, but many, many patients who have chronic shoulder pain, chronic neck pain from stress and anxiety, I won’t say it’s 100% gone, but it’s like, wow, it’s 80% better. I’m a believer that there are physical manifestations of many things. Not so much on the environment, like say mold toxicity or some of those issues. I do believe that that’s a hard one to tease out, meaning is there some anxiety related to it? Like is my environment or my house is poisoning me? That’s a hard one, but I would certainly not say that it’s not multifactorial. I mean, it is.

DrMR:

It makes sense. One of the things we’ve discussed on the podcast is if you have the same two people with a symptom of bloating, one person could just spin out into this rumination loop where they’re thinking about all the stuff wrong with them that could be causing that bloating, and someone else might go, “That’s a little bit annoying, but whatever.”

DrKA:

Or maybe, “I ate some of that, and I won’t do that again.

DrMR:

Right, exactly. So it sounds like one of the things that ketamine could obviously help with is interrupting that rumination.

DrKA:

For sure, for sure.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

DrKA:

I’m a believer in ketamine because it’s what we have right now. I’m definitely saying that it’s one of the tools in the toolbox. The things that I appreciate about ketamine are its quick onset, short duration, and very fast acting from the standpoint of results and response to a patient. Whereas when we’re getting into the metabolites of psilocybin and MDMA, you’re talking about hours.

Length of Treatment Sessions

DrMR:

And that’s one of the other questions I wanted to ask. How long does the session tend to be?

DrKA:

We’re completely electronic, so if somebody comes in and they’re ready, we try to make it so that a patient walks in and the only thing they need to do is meditate and get an IV, and the infusion will start in five minutes. We try to make it as streamlined as possible, where all the consultations and the paperwork and the things that are going to affect your set and setting are done before you ever come into the clinic. I think that’s something that we did a long time ago, that we understand that we don’t want to trigger anybody into any kind of thought process. We want them to be in a meditative state so that they can create a peaceful mind, so that they can go into dissociation quickly. The infusion lasts an hour, and then recovery is about 30 minutes.

DrKA:

And so we schedule blocks of two hours for every patient where there’ll be in the infusion room. Typically ketamine is a diuretic or has diuretic effects, so a patient will want to use the restroom immediately after. We don’t give them a lot of fluid during the infusion. It’s in a syringe of maybe 50 to 60 CC. So it’s a very, very small amount of fluid. After they use the restroom, we try not to have them go and get on their phone immediately. We recommend meditation, or we have a headset and, they can listen to some sound bowls or chanting. We have the gamut to choose from, and of course we have TVs. Ketamine is very visual, so some beautiful nature scenery with some song sound bowls and chanting is my favorite.

Episode Wrap-Up

DrMR:

Gotcha. Well, this has been a great conversation. It’s really nice to know that especially at the clinic there’s someplace we can point people to, because you’re in Austin, obviously we’re in Austin, but ketamine is not just in Austin. There are clinics all over the country. I guess one of the things people would want to do, and I’m curious what your thoughts are, is if they’re going to do this locally, do their research. Is there anything that you would say is a green flag or a red flag when they are doing their research?

DrKA:

Well, I guess I’m going to show a lot of bias obviously, but I feel like IV ketamine is the way to go. I feel as though if someone isn’t in the room monitoring you, that’s a red flag. I feel like patients should be with someone, not because of something like they could stop breathing. You need someone there because you can feel the presence of that person, and that gives you the security and the ability to surrender to the dissociation. If it’s an IM injection or an intramuscular injection, and someone dissociates much more readily than the normal person, it may be a very high dose for them. They need someone sitting with them to say, “I’m feeling, off-kilter, and, I’m nervous,” and they need somebody to talk them through that.

DrKA:

There are clinics that do provide great services that do that technique. I’m partial to IV because you can turn it off and it’s gone in minutes. When I say it takes 30 minutes to recover, I mean that you’re able to walk out with very little help. Coming out of a dissociative state can really be done in a few minutes. You just need to have someone bring you out of it by being present. The route of administration would be the number one thing. But also it’s how do you feel when you come into the clinic? When you walk into our clinic, it feels like a med spa. That’s what we wanted because after having an infusion, we thought, “What were the things that made me nervous?” Well, I don’t want anybody with a white coat on first of all.

DrMR:

Or a table full of sharp instruments.

DrKA:

Yeah, a table full of sharp instruments. You know, the IV stuff is behind the recliner, and as soon as you’re laying in the infusion chair, we’re trying to minimize that. You want to feel cared for. You want to feel an empathic feel. And that’s the only way that I can describe what we try to coach. And it’s very hard to teach. I think that’s an inherent attribute of someone’s personality is can you be empathic in all senses, even when someone is having a bad day? Those are the things that differentiate our clinic and what we coach and what we teach and how we train, because they’re all necessary, not just with ketamine but in any form of medicine. Practice of medicine is not a service or customer oriented type of environment. That’s where I believe that we need to, as physicians, listen, be present, hold space.

DrMR:

Yeah. That’s well said. A lot of that is a direct application of the set and the setting piece, which are so important for psychedelics. And also probably a bit of incorporation of the knowledge that we know that natural settings are more therapeutic, evidenced by some of the studies that take two groups of people, one group goes for a leisurely walk in the city, and one group goes for a leisurely walk in nature. Only the group in nature reports improved subjective well-being. A lot of these things are just intelligent. Why would you have a stressful environment with a reality TV show blasting in the waiting room? It doesn’t seem like it’s very fitting. Well Ken, this has been a great conversation. Will you tell people again about your clinic, your website, and where else they can connect?

DrKA:

Sure. Illumma.com is our website. We’re also @Illumma for Instagram, and we have links to Facebook and lots of articles and research and testimonial videos from our patients. They are anyone from veterans suffering from PTSD to females with eating disorders that have felt change in their lives and are willing and have been very brave to be able to share their experience.

DrMR:

We have had one of the staff from our office go over and do a session with you. I won’t name any names, but she had really nice things to say about her experience. At some point I’ll probably be over there too, because it’s something I would benefit from. I’ve shared on the podcast, how psilocybin really helped move me further in a direction that I was already going. Now that I’m reflecting back on it, it was pretty cathartic in getting me to loosen that perspective of always got to be working more and working harder, and re-finding some balance. So definitely something I personally recommend for people to at least consider. Ken, I love what you’re doing and I learned a bit today and hopefully our audience did too. Hopefully if you’ve been thinking about psychedelics and are looking for something that doesn’t require you to go to the underground, so to speak, we’ve helped kind of sway you. I really appreciate it, Ken.

DrKA:

Absolutely. Thank you again.

Outro:

Thank you for listening to Dr. Ruscio radio today. Check us out on iTunes and leave a review. Visit Dr. Ruscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates.

 

What is ketamine and how does it work

• Developed in 60s as battlefield anesthetic 
• “Rumination disorders”: 
  • Eating disorders, OCD, PTSD, addiction, depression, anxiety, trauma

Research

• Many studies, similar to psilocybin, MDMA, LSD
• PTSD, depression. Less research on anxiety. 
  • 80% response rate
• MAPS research 

 

What is happening

• Ketamine = NMDA antagonist.  Vs. serotonin agonists (traditional psychedelics). 
• Default mode network
  • Alters rumination loops
  • Alters neuroplasticity by releasing BDNF
• Is isolation driving this? 
  • HG don’t ponder existential questions
• How are you integrating?
  • Psychotherapist
  • Being True to You – collaboration

 

How many, how long

• 6 sessions in one month
• 2 hour block per session

• Organic Pharmer
• Elemental Heal
• Dr. Ruscio Resources