Ketamine: The New Cure for Depression?

[00:00:00] Fiorella: Is that it detaches you from that experience to a point where you can talk about it without being triggered. We

[00:00:06] Uribe: all have a way of thinking that’s a program of the way we think it’s how we survive. So if we’re breaking down that programming and trying to create a new one, a crisis could put you

[00:00:14] Michelle: back.

[00:00:14] Michelle: It’s estimated that 21 percent of U. S. Adults will experience major depressive disorder. 1 3rd of patients with major depressive disorder are estimated to have treatment resistant depression where the condition does not respond adequately to typical treatments. Ketamine is increasingly being used to treat T.

[00:00:33] Michelle: R. D. We’re commonly known as treatment resistant depression, but why is it being used in this episode? We’re diving into the world of Ketamine. I haven’t

[00:00:42] Uribe: had not one client that has had a negative out every single The person that I have treated with the mental health

[00:00:48] Michelle: part is doing amazing. What even is ketamine?

[00:00:51] Michelle: We’ll chat about ketamine assisted psychotherapy, the whole infusion therapy deal, and how often folks get these ketamine infusions. Now, here’s an interesting bit. Using ketamine to treat depression. Why does it work so well? Why is everybody talking about it? Ketamine and where it fits with the other psychedelics.

[00:01:08] Michelle: Rhinosmasher, Wonk, or Ketamine. And is this stuff really safe for everyone? And the big question, is ketamine right for you? We’ll touch on its connection to substance abuse and figure out who’s eligible for this kind

[00:01:23] Fiorella: of therapy. It’s not something that is promoted to use in mental health until

[00:01:27] Michelle: recently.

[00:01:27] Michelle: I’m super excited about today’s chat because we got two amazing guests in the house. First off, we got Dr. Uribe, a rock star in the mental health scene for over 12 years. And then we got Ms. Bianchi, who’s been in the mental health field for over 5 years. She’s right there next to Dr. Uribe, exploring the world of ketamine assisted psychotherapy.

[00:01:52] Michelle: You both decided to pick this facilitation in ketamine. What brought

[00:01:57] Uribe: you into this? Psychedelics have been around for years. You know, prior to the 80s, they had studies on psychedelics. And they did, they showed promising results in mental

[00:02:07] Fiorella: health. In the 60s, there was huge studies on it. But the mentally ill is not inhabited by the devil.

[00:02:13] Fiorella: But then the war on drugs happened. Where now they were completely monitoring and reducing and making it illegal to take these drugs. So we didn’t have Access to this kind of information. Jumping into like, why we became so interested in it.

[00:02:28] Uribe: My husband. My husband suffers from bipolar. Mild form. So when I say mild form medication is not always necessary, just depending on how he was managing his care, it got to the point post COVID that it was really bad.

[00:02:41] Uribe: Anxiety, depression was, went to the roof and he wasn’t special to it either. So looking for various treatments. He kept hearing, and he’s a big podcast person. He’s always listening to YouTube and all that, and he kept hearing people talking about psychedelics, but then they would mention some of the ketamine stuff you could do, ketamine therapies, which are really weird, like a lot of people are doing ’em for depression.

[00:03:01] Uribe: So I started Googling to find out what’s around here, what’s, what’s, you know, what’s psychedelics are being used right now, honestly, out of desperation. And we landed on the clinic in South Miami. I, you know, they told us about ketamine, how it works. And it did amazing for him. What didn’t happen was the mental health part.

[00:03:19] Uribe: It was still I guess early on in what ketamine is and how to use it that they weren’t doing the mental health part in that clinic. They

[00:03:25] Fiorella: were reintroducing it to like society because it became Ketamine is FDA approved, but not for mental health. Like it’s not something that is Promoted to use in mental health until recently.

[00:03:38] Fiorella: It’s always been used for chronic pain Or as an anesthetic because that’s what it is, right? The whole concept of using therapy with these psychedelics with these dissociatives to really penetrate like trauma and to really get into it and Talk about these things freely without being triggered without going into an episode has been substantial.

[00:04:00] Fiorella: It’s incredible.

[00:04:00] Michelle: Now, now they’re realizing this Now it’s being more acceptable

[00:04:04] Fiorella: And then they’re doing it with LSD, MDMA.

[00:04:08] Uribe: So when I saw the lack of integration with mental health, especially for my husband on a personal level, I saw this is a huge limitation. So I was able to walk him through what he was experiencing, but perishably because I don’t want to be my husband’s therapist, which we can’t be.

[00:04:24] Uribe: We’re not biased. We’re biased because of our emotional attachments to our, you know, our, our people. So I recognized that limitation. I said, okay, this is something here. And I, because I saw his transformation, I said, there’s no antidepressant that can do this. So that’s where I dived in. I started doing more research.

[00:04:40] Uribe: I started, you know, getting more studies. I ended up meeting. And a theologist who wanted to do ketamine as well. So as I met with him, started talking, he wanted to do the ketamine. I said, let’s do it. I can do the mental health part, you do the infusion. And that’s where we started and here we’re, I haven’t had not one client that has had a negative outcome.

[00:04:59] Uribe: Okay? Every single person that I have treated with the mental health part is doing

[00:05:03] Michelle: amazing. What is Ketamine Assisted psychotherapy. In a cap session, you take a carefully prescribed amount of ketamine and it induces a dreamy of trans like state. For example, you can be in a quiet room, maybe with soft music playing or an eye mask to create a relaxed atmosphere.

[00:05:23] Michelle: Then for about 45 minutes, you chat with the therapist about your thoughts and feelings while under the influence of ketamine. After the session, you and the therapist talk about what came up, and people are reporting breakthroughs faster than with traditional talking therapy. But overall, Ketamine assisted psychotherapy is showing promise as a unique approach for those who haven’t had success with other forms

[00:05:45] Fiorella: of therapy.

[00:05:45] Fiorella: It’s that it detaches you from that experience to a point where you can talk about it without being triggered, without falling into an episode. Allows for serotonin to actually bypass, which is something that happens in depression. It kind of stopped functioning like they should. This medicine allows for those synapses to connect again, to start passing serotonin, to give that euphoric feeling, to give that feeling of, I can do this, I can talk about this, I can retake my life, and not be taken over what depression or PTSD does or anxiety that doesn’t allow you to do on your day to day.

[00:06:22] Fiorella: Yeah, so back to the question. The way it works is that there are six sessions for six weeks. This is how we work. I know that most clinics have their own, you know, sometimes they do two to three a week. But the way that we function is In a six week time, you go once a week. You have your session, you go through your trip, which is an intravenous way.

[00:06:43] Fiorella: Those are

[00:06:44] Michelle: the infusion treatments? Yes, the infusion

[00:06:47] Fiorella: treatments, yeah. So you go through your treatment, you go through your trip. Once you are done, it takes about 45 minutes. We allow you to go home, rest, process what happened. And the following day you meet with our doctor. Um, Dr. Uribe. And she will process with you.

[00:07:04] Uribe: What makes it so different is there’s they don’t only see visuals, but what they do is feel mostly. It’s big on feeling and emotion. Most people go in thinking they’re gonna see something. Most people don’t. Most people may see darkness, or just may see colors. But the feelings associated with the experience is what I’m tapping into.

[00:07:27] Michelle: As a therapist, when you see a client progress, that’s when you’re like, Oh, okay, this

[00:07:30] Fiorella: is what I do. Well, when you see that weight being lifted off their shoulders, it’s almost like this immediate response. Yeah. And it’s, it reminds you why you do what you do. It’s definitely all for that.

[00:07:42] Michelle: How safe is ketamine?

[00:07:43] Michelle: Because, you know, some people might have concern out of all the stigma, illegality of it,

[00:07:49] Uribe: right? I mean, you don’t Being that ketamine has been used for the, you know, as an anesthetic, it’s very safe. I believe it’s a, it’s a schedule three, if I’m not mistaken, right now. Um, and for it to be approved for mental health, it needs to be out of the schedule, I believe, completely.

[00:08:02] Uribe: Yeah. Um, and that’s where, that’s where they’re going to work towards. So right now, ketamine is approved off label use. Florida. I don’t know about any other state. From what I understand, there is no other state. But I’m not sure, I haven’t done further research on that. So, the clinics are safe. There are professionals, medical professionals, you have the doctor who’s an anesthesiologist by trade, or you’ll have a nurse or a nurse practitioner even, actually putting the infusion on you, managing your blood pressure at the same time and your pulse.

[00:08:33] Uribe: Because it could affect your blood pressure, some people do experience an increase in it. I’ve noticed that if they have a blood pressure history, that’s gonna be the impact. But as far as after the fact, you may have a little disorientation, a little bit of dizziness. It’s a little, maybe a little bit of fatigue, but this is seconds to minutes and you’re done.

[00:08:52] Uribe: Okay. Some people do get tired after, some people get energy after. My husband was the one that after two, three hours, he would go to the gym. When I did it, I did not go to the gym. I wanted, I needed to rest. So it just goes to show you the type of person. You know, it’s going to be different for everybody.

[00:09:09] Uribe: It’s

[00:09:09] Michelle: highlighted that only a small percentage of participants reported side effects that impaired functioning, and most side effects remitted within two hours after the infusion. Studies show that 71 percent of participants had a positive response to ketamine treatment for depression, with a much better chance of positive response associated with receiving more treatment.

[00:09:29] Michelle: Everyone can have a different set of habits. What would be like the worst case scenario and

[00:09:33] Uribe: like the best case scenario? I think the worst case scenario is that the episode or the trip itself gives you a visceral reaction and it scares you. Right. Like, but I haven’t even seen that. In your experience. In my experience.

[00:09:45] Uribe: And the beauty about intravenous, they turn off the pump, you’re back. Yeah. It’s that fast. You get flushed out. It’s that fast. Oh, okay. Yeah. Yeah, so it’s not like taking a pill and you’re at the mercy of that pill. Yeah, yeah, yeah. Wait for it. Right. And you have to wait for it to pass, not with the IV. You can just turn it off and you’re back that fast.

[00:10:04] Uribe: Interesting. Yeah. That’s what makes it a lot safer in that way, that if

[00:10:08] Fiorella: you’re not feeling right. It’s a medical procedure at the end of the day. You have your medical professionals there. You are receiving this medication, yes, but you’re being monitored. We haven’t found necessarily long term risks that are going to affect you.

[00:10:23] Fiorella: And this is over the years of research when it comes to the drug itself. Not so much, like, just the use of therapy or There hasn’t been any real long term risk. I think that’s why they use it in the ER so frequently. It’s one of the first things that they do, especially when it comes to pain management.

[00:10:41] Fiorella: So, the risks aren’t necessarily too much now. Will you maybe experience a side effect? It depends on the person.

[00:10:49] Michelle: Can ketamine lead to substance abuse? Effects of disassociation and hallucinations make it popular among teens and young adults at dance clubs. The risk of misuse includes its use as a date rape drug due to its memory impairing properties.

[00:11:05] Michelle: It’s classified as a Schedule III non narcotic drug under the Controlled Substance Act. Ketamine indicates the potential for codependence, the need for higher doses to achieve the same effect, and the risk of addiction. It is crucial to distinguish between the valid medical use and non medical use of ketamine.

[00:11:23] Michelle: While generally safe when administered by a trained professional in a clinical setting, individuals with heart conditions should avoid taking ketamine. Some people debate, you know, they get into the

[00:11:33] Uribe: whole drug war

[00:11:35] Michelle: and addiction. Is there any risk of addiction of hooking yourself for six weeks?

[00:11:42] Fiorella: I’m glad you brought that up because like any drug that anyone takes, that has

[00:11:47] Uribe: risk of addiction, right?

[00:11:48] Uribe: Everything, anything that we take, antidepressant. Anything has a risk of abusing it, right? So we’re assessing history. We’re assessing, you know, coping for me is a big thing I don’t need to understand. How do you cope now? Because if you have maladaptive coping, you know, you’re harming yourself. You’re using Substances to cope to you know, um to distract or just kind of wash yourself out of it That’s not gonna be good for me to give you ketamine and they expect you to go home and do the same thing.

[00:12:18] Uribe: So I may even do some sessions before they do ketamine to kind of let them understand this and I need you to be in a certain place, readiness for it before we do this. Most of them have had therapy before. Most people have had some form of treatment before and are at their, their wits end and desperate for change.

[00:12:35] Uribe: Like this is the last resource. But

[00:12:38] Fiorella: also highlighting the fact that this isn’t something, at least in our practice, you’re not going home with it. You’re coming to a clinic, you’re sitting down, you have people watching, you have people monitoring you. Falling into a bad trip, they’ll pull you out of it.

[00:12:56] Fiorella: Yeah. And

[00:12:57] Uribe: how they know that is they’re just, they’re observing you. They’re checking in every few minutes to see how

[00:13:01] Fiorella: you’re doing. So the risk of falling into an addiction when it comes to ketamine is low. At least when it comes to our practice. I think it’s low. Okay.

[00:13:09] Michelle: I mean Like you mentioned, it’s every drug, right?

[00:13:13] Michelle: Even the not scheduled ones. Even the legal ones, like oxys, tannins.

[00:13:19] Uribe: Tannin! Simple tannin. Yeah. People are addicted to tannin.

[00:13:22] Fiorella: Caffeine. Caffeine! People are addicted to caffeine. People are addicted to alcohol. You know, we, it’s all about behavior. Yeah. And it’s all about how you cope. Which is why it’s such a big thing.

[00:13:35] Fiorella: Assessing the person’s history is also a very big thing. If you have addictive behaviors, if you have family history of addiction, that may be something we may reconsider and try different pathways. But at the end of the day, like any medication, if you abuse of it, you will fall into

[00:13:53] Michelle: addiction of it. Is ketamine right for everyone?

[00:13:56] Michelle: Ketamine is not considered suitable for everyone. Ketamine and esketamine are not used in children’s or teens, and ketamine and esketamine are classified as Schedule III drugs due to their potential for addiction and misuse. They should only be used under the supervision of a doctor. and a control setting.

[00:14:14] Michelle: Furthermore, potential side effects of ketamine previously discussed are important to consider. While these side effects are generally short term and occur during and shortly after treatment, they should be considered. The cost of ketamine treatments may not be covered by insurance, posing a potential barrier to access for some individuals.

[00:14:33] Michelle: The decision of whether ketamine is right for an individual depends on various factors, including their age, medical history, Previous treatment response, potential for misuse, ability to manage potential side effects, and financial consideration. It is crucial for individuals to consult with their healthcare providers to determine if ketamine is a suitable option for their specific circumstances.

[00:14:57] Michelle: Who is a good candidate and who is a bad candidate? Have you ever had anybody that you’ve had to

[00:15:01] Uribe: say, no, we can’t give you this, so far? When we say bad, I would say the conditions that have more of psychosis. Root to it’s schizophrenia. Bipolar, depending on how bad the manic, uh, phases, episode is, is not recommended.

[00:15:18] Uribe: And only because they’re already in, not so much the bipolar, but they’re already in a delusional state for the most part. We’re, we don’t want to put someone in another delusional state. We don’t want to bring you to another realm.

[00:15:29] Michelle: We

[00:15:29] Uribe: don’t want to trigger Go back to space, you know, for a little bit. We don’t want that.

[00:15:33] Uribe: We don’t want, we don’t want Yeah, we don’t want a negative

[00:15:35] Michelle: situation. Disorders.

[00:15:38] Fiorella: Right. So schizophrenia, bipolar disorder, one with mania. Yeah. Um, any kind of psychotic disorder with, uh, anyone that falls into psychosis, they wouldn’t be proper candidates and it would be mostly because we’d be putting them at risk.

[00:15:55] Fiorella: And that’s not

[00:15:56] Uribe: the point. Maybe in the future, once the dosages are, because the dosages right now are based on body weight, but we need more studies, long term studies, even though we do have them prior to the 80s. We need more for modern times.