Ketamine Treatments: Purely Biological? or Something More Holistic?

*We do not give medical advice* Explore the two major models of ketamine treatment for mental illness: 1) The strictly medical model, which treats ketamine as a chemical that can fix a patient's biological illness; and 2) the more holistic model, which emphasizes psychological growth and sees value in the altered mind-states that ketamine can cause. We discuss how best to think about a patient's role throughout their treatment. Is it most helpful to see a patient as a passive recipient of care? Or is it more accurate to see them as active participants? What would it mean to see a patient as their own primary healer? Co-hosts Lynn and Molly also discuss the role of shame, isolation, friendship, and community in the healing process.

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Transcript

[00:00:00] Theme Song: She's sometimes sad, she's sometimes happy. She's doing things to make her life less crappy. Trying a treatment that's new on the scene. Let's sit back and talk about Ketamine.

[00:00:15] Molly: God damn, I love that theme song. Thanks so much for joining us for episode two of Ketamine Insights. In this episode, we're going to compare the two major approaches to ketamine treatment.

[00:00:31] We're also going to get into the role of community in mental illness and the healing process. We have a couple requests for you. Please head over to patreon. com, search for Ketamine Insights, and help us cover the cost of this good, good shit. We've got, , just one sponsorship level right now, which is five bucks a month.

[00:00:51] Um, also send us your questions and stories and feedback and we love a good joke, uh, to ketamineinsights at gmail. com. Finally, if you're enjoying what you hear, please rate and share this show. Thank you so much. Uh, welcome to what I believe will be episode number two of Ketamine Insights. This is Molly.

[00:01:15] Lynn: And this is Lynn, your co hosts. 

Molly: Um, today, our topic is the two major. approaches to ketamine therapy, um, or ketamine treatment, I guess I should say for, um, treatment resistant depression. Um, this is kind of like an ongoing debate or fight even, um, about the best way to do ketamine for depression. Um, there's basically two big models that like what I'm going to call the therapeutic approach and the medical approach.

[00:01:53] Um, I feel like honestly, the therapeutic approach is better myself. Like, I'll just let you know, that's where my kind of, um, biases. That's what I've tried. Um, and at the same time, I feel like the medical approach is the one that's being. used by most ketamine patients at this point. Um, I think the therapeutic approach is losing out this argument right now.

[00:02:21] Lynn: But you're going to talk to us about both of them. 

Molly: Yeah, exactly. So I'm just gonna outline both. Um, starting with the medical approach, which is like, basically it sees the ketamine patient as, and all patients, like, you know, the Western medical approach in general sees patients as like passive receivers of medicine.

[00:02:43] In this case, the idea is that the chemical of ketamine itself boosts the mood. Um, in this model, like treatment is much more transactional. You go in, you pay for it, you get the ketamine, it's given to you, you leave. That's that. Um, there's basically like very little context given or like wraparound care.

[00:03:05] So a lot of people with this, like when they're prescribed infusions, they might go in to the infusion clinic and not know. What it's going to be like at all, you find a lot of questions on like online forums and stuff like, I've got a mean infusion tomorrow. What happens? It's kind of scary. Yeah, so they really are not prepared.

[00:03:22] Yeah, yeah, I think so. A lot of them feel that way. Um, and there's like no expectation of like personal preparation before treatments. Um, and Basically, in this model, like, it's the medicine that does the work. It's not the patient. And in this case, it's not even the doctor, right? It's just the medicine. Um, so that's like a real brief outline of like the therapeutic approach.

[00:03:47] Interesting. Maybe the medical approach. I'm sorry. That's it. Yeah, exactly. Okay. So there's no therapist

[00:03:52] Lynn: involved. Like no, um. Psych, there's no psychologist or, um, psychiatrist or anything who's involved in sort of longer term therapy or helping you kind of think about like, okay, what, you know, what happened to, you know, what, what were your thoughts?

[00:04:10] What was this? Um, what insights did you have? Anything like that? It's just sort of like, yeah, okay, you did this, this happened, go home and then come back next time. Hope it works.

[00:04:20] Molly: And a lot of people will even like report. Yeah. Yeah. Because they haven't been told really about how infusions work. A lot of them will, they're told they can't drive, but they'll like take an Uber back to work.

[00:04:31] Go back to work on the rest of the day at work. That's

[00:04:34] Lynn: crazy. What?

[00:04:35] Molly: Yeah, so like, you're loopy for a good two or three hours. Yeah. But like, you can walk around. Yeah. If your work's not too demanding, you can do it. Um, I don't recommend it, but a lot of people haven't heard that there's a different way to do it, or they don't know, um, that maybe they should take it easy on themselves.

[00:04:54] Yeah.

[00:04:55] Lynn: As long as it doesn't involve heavy machinery. Exactly. Right.

[00:04:59] Molly: They can, they can technically do it. Um, whereas the therapeutic approach is like. much more time intensive. In a lot of cases, it's a lot more expensive. Um, and it involves a lot more work on the part of the patient. Um, so the therapeutical, the therapeutic approach will include not just the like ketamine infusion or the lozenge or the nasal spray or whatever, a different way that you're taking the ketamine as a drug.

[00:05:29] It'll also include like talk therapy, journaling, um, intention setting, which is like basically deciding on a kind of theme of the infusion before you do the infusion itself. And then that, so intention setting before the

[00:05:51] Lynn: infusion, like, I want to go to Marshmallow Unicorn Land or like,

[00:05:59] Molly: that would be awesome.

[00:06:00] Dear Ketamine, take me to Marshmallow Land because I hear it's awesome. Are there unicorns?

[00:06:13] infusions in. Um, and I think we should do a whole episode on setting intentions. Um, basically, there are some questions you might ask yourself before an infusion. So like one of them might be like, what is hurting my heart right now, for example, or what do I find really inspirational in my life? And then you will try to like, boil that down to like, maybe three or four words at the most.

[00:06:52] So some people will like want to focus on like, feeling more safe, for example, or, um, you know, I don't know, understanding, um, Um, the, the, the source of whatever difficult emotion that they're struggling with, whether it's anger or sadness or some, some way that they're feeling overwhelmed, um, they might choose to like delve into that topic, um, during the infusion.

[00:07:24] It's important to note that it doesn't necessarily guide the infusion at all, or it might guide it in a way that's not immediately evident, especially during the infusion. But it's a way of kind of trying to point in the direction that you think will be helpful for you. Um, and then a big part of infusions is like, acquiescing and allowing the experience.

[00:07:49] Um, but, but the intention setting kind of helps you prepare psychologically. Okay. So it's an important part, I would say, Sometimes I feel better just after setting an intention. Like, I don't even, I don't, like, the infusion is one thing, but even before I do the infusion, I feel better after having done the work to set the intention, because it involves, like, figuring out what it is that you're struggling with at the moment.

[00:08:17] Yeah.

[00:08:18] Lynn: which can be a really helpful process. You've just kind of, it's like just accepting for yourself, like, okay, this is, this is what it is. This is what the issue is. This is what I want to work on. Bothering. Yeah,

[00:08:28] Molly: it might not be the only thing, but it's one of the things that's bothering me at the moment.

[00:08:32] And then after an infusion in the therapeutic approach, you'll do integration, which is really, really important. Um, and it's just about like, usually it's about explaining Um, what happened if you remember the infusion experience and helping to like parse some meaning from it, or like going through the process of trying to parse the meaning from the experience.

[00:09:00] Lynn: So explaining to who and when exactly do a therapist usually, so is it like right after the infusion? So the infusion lasts an hour and then immediately you kind of get up and your therapist is sitting right there. Yeah. Yeah. Can you talk to him or her?

[00:09:15] Molly: Yeah. So there are different ways, but yeah, like in the model that I, that like what I do with my therapist is he actually sits there through the whole infusion silently, which is weird.

[00:09:27] I mean, it's, it's great, but it's not, most therapists don't have the time to do that. And it's, it depends on how your insurance reimburses things, but, um, but yeah, some of therapists will actually sit there during the infusion and then. immediately after the infusion, you'll start telling them as soon as you feel comfortable with, um, talking.

[00:09:50] Cause ketamine does tend to like shut down the verbal part of your brain. Um, so when you start talking, you sound a little loopy at first, you're a little high still, and that's like actually can be a source of great insight. Um,

[00:10:05] Lynn: like those things

[00:10:06] Molly: that you say when you're high.

[00:10:07] Lynn: Yeah. And

[00:10:08] Molly: another thing you can do actually is record those sessions and listen to them later because they can be hard to remember.

[00:10:13] Um, for the patient, um, or the therapist can take notes and let you know, whatever. Anyway, the integration process is about like understanding what happened, pulling out threads that might be useful to talk about in therapy later, that kind of thing. Okay. So you want to,

[00:10:29] Lynn: um, talk immediately with the therapist and about what you experienced and what you're feeling and then be able to continue, like revisit that experience.

[00:10:44] Okay. Thanks. What you experienced, what you felt, the insights you gained with your therapist and maybe on your own and journaling and that kind of thing. That's the idea behind integration.

[00:10:53] Molly: Yeah, that's the integration process. Yeah, it doesn't have to necessarily be immediately. I would say there's value to doing it immediately, but it's still integration if you're doing it later that day or even the next day.

[00:11:05] Um, but you may have

[00:11:07] Lynn: forgotten some things if you do it later. Yeah. Yeah. Okay. Yeah. Yeah. Interesting. Um, so if it's in a medical setting, you would just, you stop the infusion and you just get up and go home and maybe you choose to talk about it or write about it or something, but you don't, and you don't necessarily talk to a therapist about it.

[00:11:29] Molly: Exactly. Yeah. There's no sort of system by which you do integration work. There's no like interpretation. Yeah. And actually there are medicines now being developed. It's like there are delivery mechanisms. where you don't trip at all. You don't have a altered experience. Um, there's two different ones that are trying to be developed right now.

[00:11:51] There's a ketamine, there's a chemical similar to ketamine that supposedly has the mood lifting effects without the psychedelic I forget the name of it. Yeah. Interesting. And then there's a, Another way where they're doing very, very low dose, like almost constant. So it's a patch. It's a transdermal patch of ketamine, basically, that you wear and you never feel anything, but the ketamine is slowly entering your body at a low enough dose where it doesn't have any psychedelic effects at all.

[00:12:26] You didn't talk about this at all in

[00:12:28] Lynn: episode one.

[00:12:29] Molly: Oh, you're right. I forgot about it. Well, they're not. Yeah. You can't. They're under

[00:12:32] Lynn: development. They're not done yet. Okay. Okay. Okay. And this is, this, these would be all about mood lifting or mood stabilization without the, um, dissociation or what you called, um, you talked about as like giving you insights or like psychological health.

[00:12:50] I think, which, which for you is kind of like the sort of groundbreaking piece of what made ketamine different, was that you get these insights, um, helping you to forgive yourself, right? Something that a typical antidepressant can't do. So this is, those new ways of delivering ketamine sound like ways of, you know, I'm using it more as a typical mood stabilizer, right?

[00:13:14] But maybe it will be effective for some people, but isn't what you're using ketamine for.

[00:13:20] Molly: Right. So I would say there's, there's really two points. Like there's two purposes to ketamine for depression. And one of them is the chemical kind of mood lifting ability that the drug seems to have for most people.

[00:13:41] kind of psychological growth that can happen. And so in these two models, like the medical one really depends only on that chemical interaction between your body and the chemical of ketamine, whereas the therapeutic approach takes advantage of both.

[00:13:59] Lynn: Okay.

[00:14:01] Molly: The chemical benefit and the kind of like, insight that's caused by the experience of using ketamine, like the psychedelic aspects to the chemical.

[00:14:11] Lynn: Yeah.

[00:14:12] Molly: To the, yeah. Interesting. And the way that you can use that in therapy. And we'll actually talk, I think, in a different episode, too, about different ways to, like, use a lozenge because you can do it at home. You can do it if you're not too, too, um, influenced by the lozenge. You can do it, You can actually do a chem, you can do a therapy session while the lozenge is in your mouth or just after you've taken it, and it kind of, it creates a different dynamic.

[00:14:39] Oh, with your therapist in their office. Exactly. Or in a virtual therapy session maybe. Exactly.

[00:14:45] Lynn: That's cool.

[00:14:46] Molly: Yeah, yeah, it changes the conversation in my experience like pretty profoundly. Yeah. Yeah. Interesting. So, um, yeah, so like in the, I would say like another thing about the therapeutic approach is like the depressed person is not just an active participant in healing, but they're actually the primary healer.

[00:15:05] Oh, so, okay. Like one of the things that kind of surprised me talking to my therapist about this when I was first starting out was he was able to say things like, you know, don't worry, you're not going to do this wrong. Because your mind and your body want to heal, like if you if it's similar to the way like if you get a cut.

[00:15:29] You want to wash it, you want to put a band aid on it, but you don't actually know how the healing happens, because you don't decide to do the healing. Your body does that. Yeah, your body will heal. And with, with mental, exactly, you're, you can create a, a kind of context in which it's more or less likely to happen quicker, healthier, not get infected, that kind of thing.

[00:15:51] But like, if you asked us, you know, most people walking down the street, how to heal a cut, they would, you know, we don't know how our bodies do that. And he said, it's similar with, with psychedelics and therapy. Like it's a little different from talk therapy because you're not often trying to figure out what happened or what went wrong or how to fix it.

[00:16:10] You're just letting the healing happen. So it's like a strange combination of active work on the patient's part and also like allowing your Mind and heart and psyche and soul and body or however you want to think of it to heal themselves

[00:16:29] Lynn: Interesting

[00:16:30] Molly: approach leans on that a lot more heavily.

[00:16:33] Lynn: Yeah Interesting.

[00:16:35] So in the therapeutic approach you need to be more active than in the medical approach in the medical approach. You're more passive In the therapeutic approach, you are much more active. It seems like you need to be more active because you're not just getting, you're not just taking a medicine, but at the same time, you're not, you're not going to do anything wrong.

[00:16:55] You're not going to mess it up. Um,

[00:16:57] Molly: yeah, like if you, like, if you go into an infusion, you know, worried that you're not going to like do it right somehow. Like that's not like, you're not going to, you're not going to like, Think the wrong thing and mess it up, you know, like, yeah, it's more about like getting out of the way.

[00:17:13] Yeah. Get out of the way of your own mind. Once the infusion. Yeah. Yeah. Of course. Of course. Yeah. Um, so yeah, ideally, like if you're going to do this therapeutic approach, you're working with not just working with a therapist, but working with a therapist who is trained in psychedelic assisted psychotherapy and it can be hard to find that.

[00:17:35] But I'll put a, um, link in the show notes to the CREA Institute, which is K R I Y A, the CREA Institute. And they have like a list of providers in different states and different nations around the world. Um, and they, those are the people who are trained in psychedelic assisted psychotherapy. It's like very, um, There's more and more every day, but there, you know, there's not as many as we would, as we wish.

[00:18:01] Um, and part of the work that's needed from just like to go back, the work that's needed from the patient and the therapeutic approach is more about like delving and journaling and talking and exploring yourself before

[00:18:13] Lynn: and

[00:18:15] Molly: after the infusion. Um, and, um, there are a lot of ways you can kind of do the therapeutic approach if you prefer.

[00:18:27] Okay. even if you don't have access to a psychedelic assisted, a therapist trained in psychedelic assisted psychotherapy. So that might include like, um, developing a mindfulness practice, for example, and like, learning mindfulness on your own, um, that you can kind of, that, you know, it's just a way to help being like introspective in that way.

[00:18:51] I think journaling is another like really important tool for ketamine work. Um, that doesn't include a therapist, obviously. Um,

[00:19:04] Lynn: Okay, so tools that you could use, and those are probably good things to learn. I mean, whether or not you have a therapist and you're, whether or not you're, um, using ketamine, um, to help you with your depression, right?

[00:19:20] Um, I know those are things that you've used and that have been helpful. So those are great tips. If you have treatment resistance to depression, you probably should be journaling.

[00:19:29] Molly: Yeah. If you can like, yeah, be doing mindfulness for sure. I especially think like mindfulness is like, it's a necessary but not sufficient thing to do for your mental health if you're facing any kind of mental illness.

[00:19:42] Yeah. Um, Um, it's real hard to get better without any mindfulness, my experience, and I've known a lot of people with a lot of different mental illness. And yeah, you can also like set intentions by yourself, you know, before a lozenge or before an invasion, you don't necessarily need a therapist's help to do that.

[00:20:05] And the other thing, the last thing that I'd say that like helps with having a therapeutic approach, even if you don't have a specially trained therapist is just to like have a sense of community around your treatment in general. So whether it's like your personal support network that you're more open with.

[00:20:24] Or, um, finding other ketamine patients, um, even things that don't have anything to do with ketamine, like any source of community is really helpful when doing this type of approach and like being open in particular about the fact that you're in treatment for depression, um, really helps to like fight the shame.

[00:20:46] Yeah. So the sense of community is also like important in that like The, the Western model of medicine in general tends to be real hierarchical, as you know, like, as, as most people who've had interactions with medicine, unfortunately, like, And the hierarchy, like the hierarchical, um, structure really. Um, I think that's a big part of why medicine is harder.

[00:21:21] Like as a patient, it's harder to be a person of color. It's harder to be a woman. It's harder to be a kid. It's harder to be L-B-L-G-B-T-Q, like it's hard to be, um, anyone who experiences oppression in a hierarchical system. Mm-Hmm. . Um, and so like. The patient as passive becomes like very problematic, especially with mental illness, um, because no matter what in mental illness, like, we have to do a lot of work as patients.

[00:21:56] Um, we're the ones like, we have to stop our negative self talk. We have to address our past traumas, whatever it is that is like underlying, if there is anything, um, it has to be us that does that work. And so like to go in and expect, um, a medicine to help, Or to fix, just fix that. Like I'm not saying medicines aren't helpful, I've tried a million of them and some of them have been helpful and some of them haven't been, but, um, they're not, they're, they're just not, they're often necessary, but just like mindfulness, it's necessary, but not sufficient.

[00:22:28] And that community aspect is like very helpful when it comes to, um, like not feeling like a passive, um, person. Part of your,

[00:22:39] Lynn: yeah, treatment. It's not just a doctor and a medicine doing something to you. You're not just receiving. Yeah.

[00:22:47] Molly: Especially I think with like, they find that mental illness, I think, um, especially depression is like, um, and trauma too, like really do have community.

[00:23:01] Aspects to them. So like I was listening to something about trauma recently. It's kind of an aside, but they were saying that like there wasn't nearly as much PTSD, for example, in New York city after September 11th, as there would have been had it not been the whole city that was traumatized at once.

[00:23:19] That's interesting. And obviously some people were closer, much closer, you know, but. The isolation part of trauma, like, wasn't there. And it wasn't stigmatized the same way a lot of traumas are.

[00:23:35] Lynn: So Because people weren't alone in it.

[00:23:38] Molly: It was a shared experience. Exactly.

[00:23:40] Lynn: Wow. Yeah. That's so interesting. If you

[00:23:43] Molly: take away the isolation and the shame from trauma, it's often not even a trauma at all.

[00:23:48] I've never heard that, but that is so interesting. It makes a lot of sense. Right, and like you can see where it's easier. Of course, it's easier to get depressed when you're alone. Absolutely,

[00:24:00] Lynn: and no one really gets it. No one's experienced it or no one experienced it the same way as you and

[00:24:06] Molly: yeah. So people think like community is like a nice to have.

[00:24:11] I think it's much more central to healing.

[00:24:14] Lynn: Wow, that is so interesting. Never heard that about trauma. That's

[00:24:19] Molly: part of like the philosophy, like the difference in the two philosophies of like met the medical model is just like a much more like you're an individual physical biological being and we can fix you with biology as opposed to this much more like kind of social holistic approach that the therapeutic model entails.

[00:24:39] Lynn: Yeah.

[00:24:41] Molly: So those are the those are the big that's the big argument that's happening with ketamine right now. It's really like kind of a fundamental argument about like how do we treat mental illness? Is it? Is it a medical problem or is it something much more complex? Welcome to this outro. First, thank you for listening.

[00:25:00] We love that you're here. Second, we mentioned that we'd linked the CREA Institute's list of providers in the show notes, and we did. Um, but it is important to note that these providers are not vetted by anybody. They've opted into that list. So they're saying that they are Uh, trained in psychedelic assisted psychotherapy, but there's no guarantee that they are trained or that they're good at what they do, even if they are trained.

[00:25:27] Um, so we mentioned this in episode one, you should always feel free to interview mental health providers um, before beginning your work with them. Ask them what they'd name a dog, ask them why they like their job, who their role models are, what they ate for lunch. Um, as my Irish aunts always say, be free.

[00:25:46] Third, Here's the credits. Why not do them in the middle of the outro? Uh, our co hosts are Lynn Schneider and me, Molly Dunn. Editing and all that stuff is done by me. Our theme song is done by Solid State Symphony. Now that we're done with that, please head over to patreon. com and help us out at 5 a month, Patriot.

[00:26:05] Patrons get to join a community of listeners and help shape the future of our show. Finally, please do rate us if you like what you hear, that helps other people find our show. And if you know anyone with two ears and a heart, share this show with them. They'll surely thank you.