So I'm Celeste and I'm here with Whitney and she's gonna introduce our friends today. We're gonna talk about mental health and ketamine and the way we interact with it in our setting and kind of my perspective of it of what I hear from patients and then we're gonna talk to people that do this every day. Some professionals that can give us like insight and help us understand how to consume it because I think from my perspective people are throwing it around like it's curative so that's the kind of thing. So why don't you get us started with yeah. Well it is an honor to introduce Austin Frankham, nurse practitioner and Candice Crousone, licensed clinical social worker and owners of ketamine therapy at Therapeutic Alternatives.

It's a top premier ketamine clinic in Utah, specifically West Jordan but I know you guys make house calls as well. Oh wow, that's neat. Welcome. Thank you. Oh yeah, here we go.

So a lot of people talk about ketamine in our space when there's dysmorphia or depression and they're coming in here for like hormone treatments right? Coming in here right? They're doing hormone treatments and I'm like wow this is a problem for an SSRI you know. You need a little more support than progesterone or you know like some pre-pregnant alone like a little neurotransmitter support. Yeah, it sounds like you're like you have a good approach I think with progesterone I think you're referring specifically to like premenstrual mood dysphoria but there's sometimes more to our psyche than just that so where you know there's no cure-alls I guess.

And anything, dang it, not even tri-zepatide. Son of a... Like a lot of things you just use all the tools in your medicine bag and try to find something that you can you know collaborate and do the best for your patient I guess. Yeah, okay. Well I'm excited.

I'm going to let you answer ask some questions. I think people want to understand how ketamine therapy or ketamine treatment for mental health issues work. You know there's some gap in knowledge of how it works you know and I guess you could say that it's even true technically of like SSRIs or whatever but I think the kind of the front running theory is that it causes some it's a more of a neurogenesis theory meaning it creates new pathologies, yeah, then the connections and maybe reinforces some positive ones you know is that experiential and you know like a lot of psychedelic drugs you produce a novel experience, almost profound experience and that can kind of rewire your perspective or your lens. Sometimes I'll explain it to patients like it's you know in the 70s the magic viewfinder you're just changing the lens in your... Oh the little circle guy.

Yeah, those are actually pretty cool. That's the front running theory. We also like the idea of you know there's more of a little bit more of a woo woo type of theory where you know in our culture you know Western culture I guess we don't have mystical experiences, rites of passage and medicines like ketamine and other similar medicines may produce that kind of profound mystical experience. Is it really mystical? I don't know.

Well that's like kind of your own personal perspective. Perception, absolutely. Right, because whatever you encounter people extract meaning, right? Some people would call it luck or a blessing or you know things like that so it's kind of what you extrapolate or what your little boop boop what was that thing? The circle thing?

The magic viewfinder. Like how many times do you click that a day and how many times do you recognize who's fingers on it? Things like that maybe? Whatever else can be kind of stepping on your perception. It can be good for clarity sometimes you know just for a different lens on how you're viewing.

I never thought of it that way. From a therapeutic sense and that's kind of the way I approach it is I like to describe ketamine as it provides a container, a safe container for you to go in and feel what you need to feel and pulls you back a little bit from the intense feelings of like trauma, depression, anxiety and it kind of pulls you one step away so you can sit with it and look at it and feel what you need to feel in a really safe way. And so I kind of come to it from that side of kind of like how do you get people to… The control of it. Yeah, it's just pulling back one step from your… Extracting yourself from your experience or your controls that you're putting on in a daily basis. I think people like what I've seen is really good for people with depression, anxiety, trauma, OCD, the thoughts that just take you down, the stories that take you down.

It's you know one thing I hear really early on are people just that they're like the thought that the stories they just don't take they just don't have as much control. They still come in, I still have them, I experience it but I'm like able to look at it and say hey this is a thought. So when you talk about that some of the things that you're saying were people that are candidates but where are they at on their journey that makes them a good candidate? Because I've met a lot of people in a few different professions that I've done and sometimes I personally feel like they're not necessarily stable enough to go through ketamine but I'm not quite sure of your criteria on how you… Really good point. You do want people, we don't always know, we don't spend too much time with them.

We always do a consultation, a pretty detailed consultation. Like a screening? A screening, an initial screening and then we, Austin and I will meet with them the first time they come in and do another screening to make sure like they have a good support system, good resources. Not everybody does have the resources, the inner resources to deal with whatever comes up because ketamine does shake things up a little bit. So what does that mean?

That's kind of your… Good coping mechanisms or tools to deal with whatever volume come up. The problem is you can't always know that and sometimes people… Yeah I feel like when we talk about ketamine or because I understand ketamine from a sedative standpoint, right? Which is you live in 4 milligram-ish land or less, right? Actually, per kilogram probably half a milligram to a milligram. Oh so quite a bit less.

And then the sedation is 4 milligrams and up, right? Probably, yeah. Much higher than we ever use, yeah. Right, so for me I understand it from a sleepy night to a night. I'm like, farewell, it's dinner time, goodbye!

That's fun too. I call it the goodbye. So when you're like… We want people… You live in the wedgie land, right? We want them still here with a foot in this world. Pliable foot.

We don't want them… I mean they won't come back with anything if we give them those… Sedation, right? Yeah, we don't. And we actually don't want a sedative or anesthetized amount of experience. We think that's important to… Along those lines of when it is appropriate, there are… I mean it can be nuanced. This is so interesting because every time I'm like, oh I've got a grasp, you grab it and you're like, no, just kidding.

Some people… Like it feels because of… It alters your level of consciousness, right? At the basis of it. Yeah, for sure. Yeah, it definitely is… We kind of consider it a psychedelic intervention actually. So then when we talk about just kind of generalized drug use, we can't always predict like, it takes you eight glasses of wine and it takes me a thimble.

Right. So it's kind of like that when we start to talk about it with patients. It's not going to be something that's so specific and controlled. The weight-based is kind of what we have to go on to start with a patient. Obviously, where you're giving four milligrams per kilogram, I mean we're talking about significantly higher dose that's still very safe.

What Candice said is true as far as having support, but you could make a counter argument saying unlike SSRI, sometimes a drug like ketamine can work fairly quickly. Oh, I see. There's some data that suggests it takes away suicidal ideation almost immediately where as you know with prescribing SSRIs, it can take four to six weeks. And it can become worse in a certain amount of time. And I'm not against those drugs.

I use those for patients. In tandem. Yeah, absolutely. Because ketamine isn't all the time. So let's go back to this.

You said at what point in my pathway would I be a good candidate? So you were saying if they're more stable, but you also said suicidal ideation. Because that's pretty immediate. That's somebody that needs help right now if they have a plan, right? Right.

I mean, if it were, that's where I guess our clinical decision-making comes in. Okay. You know, being able to, is this an intervention we can make on an outpatient basis? What kind of set having social support there, saying say someone does come in with suicidal ideation, we can do this treatment, we can safety plan with the family or friends or whoever their social support is, husband, wife. But we both worked in crisis a little and I think we have a good feel of it.

Ability to assess. We can go to the hospital. Yeah. Basically, people that we wouldn't work with, it's such a safe medicine that we would pretty much take anybody who comes in unless they are manic or psychotic. That's kind of our criteria.

Those are cut offs. Okay. Yeah, that's an easier way. And is there any like respiratory, like if I had any conditions, would I not be a candidate? Like disease processes.

Yes, like what you mentioned, like with comorbidities where they're fairly fragile medically, I will usually refer them to the University of Utah. Very rarely do we see these kinds of patients but occasionally you need to go where there's a higher level of care, there's an anesthesiologist available, you know, support staff if there's a more intense medical event. But that's surprisingly rare. I mean, I think I can maybe two people that I've ever. Pretty good.

When we started doing this, I think Candice Lesoak, I think Candice had a better idea of how ketamine could work but I really had it in my mind that you had to be, you know, you had to have nothing else to work for. I see, last resort. And that's how it was sold for years, how they did it for years. But not so much anymore. Like they would say, oh, try if you're treatment resistant, depression and you tried multiple interventions and they failed, you can do ketamine.

But we don't really think you could start with it, honestly. Yeah, I really had it in my mind. It was a coin flip between ketamine or ECT. But I kind of come back and I was like, wow. Candice's vision was different.

But as we worked with, I've come to, you know, the really high functioning people, you know, really benefit from it. You know, people that maybe are moderate mild depression and whatever, anxiety seem to pull going through life challenges, sometimes grief and loss. I mean, there's a broad scope of people that really find benefit from it that maybe wouldn't. So we have almost everybody's a candidate and you guys have specialized screening tools that help protect people if they're not. And then depending upon where they're at in the process is primarily your judgment to see what skills they have when they leave.

Yes, we'll find out pretty quickly if this isn't for them. Not everybody likes the feeling. It's a very strange feeling. It's weird. It isn't for everybody.

Can I ask you, have you done ketamine? I have. And have you it yourself? Absolutely. It is why I wanted to do this and work with it is I'd had, I'd seen such good outcomes with my patients.

I worked at LDS Hospital in the psych unit and we had a lot of patients who were doing ACT and I had one doctor tell me that they had better outcomes with patients that they would anesthetize. Anesthetize. That's a hard one. They would add ketamine to it and then they would come out with better outcomes. And I was like, why don't we try ketamine first then?

Because it's less invasive. And then if they need the ACT, we could do the ACT. But let's try and a couple of doctors did it. And it was crazy. We would see, I mean, I saw some really amazing things.

In particular, there were two patients who had OCD that was so bad they were hospitalized. And what I saw with these, and I'm thinking of two in particular, they were in the hospital in and out weeks at a time. And we tried ketamine on them first before they, and they had done ACT without a lot of success. And then they did ketamine, just ketamine, because it's less invasive. And I just saw changes in them so quick.

You were like, ooh. I got so excited about it. I left the hospital and opened up my own practice, but I was so excited about what I'd seen in the hospital. They were trying to find ways. I started sending my patients as a therapist to another ketamine clinic.

And it was crazy. They'd come back and their affect would be different. And they'd smile and laugh in therapy. Something changed in them. And so then I was interested in what I was sending them into.

So I contacted the ketamine clinic and asked if I could come and see what it was like for myself to kind of know what the experience was. And it was my own work there that led me to decide that I wanted to work with it. You were like, this is my future. Yeah. It was like I did it five times.

I'm like, I'm in. And that's where we connected. I had worked at uni and he had also worked at uni. And we decided we'd give it a try for our patients because we'd seen it had so many treatment failures. I think she told me, I don't want to put words in your mouth, but when she approached me about it, she was like, you know, she felt like it was just they kind of left her there.

The experience. Yeah. And I think her vision was to kind of have a therapist there in a more supportive environment. A little bit more guided. I just kind of viewed my role as being the, you know, the providing that and her providing the emotional support, which I think is a good thing.

So if I come into your practice and I'm a candidate, then what's, what does it look like to get a treatment? Like what, like what is the experience? We usually like, we'll review your medical history or psychiatric history. We'll do a psych about, I'll do a history and physical. It's very mental health, you know, not too in depth.

Yeah. But, but, and then we'll just talk to you about more of this is kind of what Candice talks to you about really. We'll prepare you for the session. We'll tell you what to expect. You'll be in a room with either a couch or chair, just really comfortable, more therapy, like kind of therapy.

Like a snugly softer room. Couch. So like, am I getting an injection or an IV? You could do either. And then there's some people that do oral, right?

We don't do that at the office, but you can do that. Injection or an IV. We try to collaborate with that's part of the patient to see what's best. Route of administration feels good and dosing and like I said, I tried. And how long would I be?

About less than two hours. I mean, you'll be in a kind of a dissociative state for less than an hour and probably a little intoxicated. So I should make a lot of decisions right. Right then, right then. You have the space for two hours in our clinic.

The deepest part of it is about 45 minutes to an hour. And then you have time to kind of come back and gather yourself before you have to. So what if I have a teenager in my life that has mental health issues? Like our teenager. I know teenagers do their own drugs, right?

Heard about it. I don't have a lot of experience with drugs, but all my experience has come through my children being like, what the vape? Oh my gosh, I really like I was raised in this state and I have little to know. The only part of my like psych or my patho and or not my patho, my farm. I felt the drugs part.

Like what's a ball? And I'm like, I don't know what you want, but my kids, they have tried some things and how does this affect a brain that has neuroplasticity because it's not yet formed? Question. What does that look like for these kids? Well, I think that when we've done it for teenagers, we won't go too young.

And that's where we go to like the inner resourcing. Too young is how young? Below 15. I mean, there's a little bit of a question of like judgment and everything, but there's something about working with teenagers that's so cool because their brains are so plastic and they don't have 30 or 40 years of trauma and ways of programmed in their head already. So it's like a horrible closet.

It's just everything. It's not like it's like it's less to work through. You have the kitchen drawer that you're like, what the hell? It's really fun to work with. But what we do with, we take that on a case by case.

We'll go down as 15, 16, not much younger than that, but we will always meet with them in person and make sure in these type of settings. They have to be because they're minor. So we won't, we always want to talk to the teenager. Go through a trip and not supposed to call it that, right? Well, we, I mean, there's a trip.

It's not a big ball. You just watch them. They're laying there. They're just laying there and they're just traveling through space. But we, we always want to make sure that they want to do it and it's not the parent pushing them to do it because they're, they don't know what to do.

We want to make sure they want to do it. And then we also are checking into making sure that they maturity to handle. This is a little bit more of where we check into like, do they have the maturity to handle whatever, like it's cause it's this crazy experience. We found just experientially and we've, this is true with, you know, particularly with kid, with, with minors, we want them to be on board with it. Yeah, that makes sense.

Independent of and people are more receptive to things that they're willing to participate in too, right? We feel like it will improve our chances of success with this. And so sometimes that can warrant a hard conversation with the parents saying, I don't. They're not ready. It's not your choice.

We also like any treatment team member involved with the kid on board. Yeah, for sure. Having a therapist. Or their other mental health providers. So we like a little more of a team approach with, with minors, just to make sure everybody's on board with the program, including the patient, most importantly, the patient.

So all you three have tried this. I've never had this. Tell me about, I'm like, I'm rough on Benadryl. I don't know. I'm like, uh, and my butt cheeks are so clenched to get all my goals.

I don't know if I should be on clenching though. Like I've been shoving that shit in there so long. It's all buttoned up. I don't know. I think ketamine is probably the best medicine for butt clenchers.

I've been using ketamine, um, ketamine therapy regularly. There is a big difference between recreational ketamine and ketamine. You can get in a clinic and I think it's like a lot of the concern about, oh, ketamine therapy is about the recreational use, the, the Matthew Perry and stuff. And like, and I'm seeing it everywhere. I lived in LA, like all my neighbors were like, Hey, you want some K or like, I see it everywhere.

Well, I didn't even know that that's what Perry's, I didn't know that. So, um, I think there is such a difference because in the clinic it is like, to me, it's like, okay, I'm going to go do my homework on my mental health. I don't bring my phones on silent. I don't have anywhere to be except this place where I'm monitored. And it's for me.

And you know, like, unless I'm a millionaire or billionaire, like Elon Musk, I'm not going to be able to afford ketamine treatments three times a day or whatever. So I think there is a huge difference between the stigma on using a recreational drug versus using a medication that is in a controlled setting with support and kind of outcomes. Yeah, I agree. I mean, supervision is important with that too, right? If, yeah, quite frankly, with Matthew Perry, had he been in a clinic, um, he'd be alive.

That makes my feelings hurt. Well, he was doing a mix. He was in clinic, get receiving therapy. And then he had, yes, he was, he was using it therapeutically, but he was using it additionally at home. Ask you a weird question.

What about the patients that have addiction that would be concerned to come? And then I have one other question. That's even another layer. Cause I see a ton of people do ayahuasca stuff. How, what land does this live in and microdosing and Well, let's let me, I'll stop laying my questions and really go with the first one.

Well, so addiction with, with ketamine, it's a bit, I mean, it's a, it's nuanced because it is an abusable substance, right? With ketamine, and this is probably true of most psychedelics, there's not a direct, let's take an opiate, for example, you, you take an opiate, you have a predictable response. Let's tell people what a normal opiate is. Like heroin or There you go. And what's a prescribed opiate?

Oxycodone. Oxycodone, there you go. So, yeah, so you get a predictable response. You also get physical addiction here. You, you're neuroadapt and you become dependent on that type of, with psychedelics and ketamine is included, the response isn't predictable, nor is it pleasurable.

People may have some reliance on it because it alleviates some of their Symptomatic relief. And yes, you can abuse almost any drug or a lot of other things for that matter. So there is a, there is some danger there with, with abuse, but Generally when people are doing it in the supervised setting, you know, the, that, and they're, they're in therapy, they're, they're connected with their provider, their therapist. You know, if they're, we have patients in recovery that go to their, go to their 12 step meetings or, and so if they have that support, their, use of ketamine can actually reduce relapse rate significantly for alcohol, um, stimulants, about cut that in half. Statistically, um, opiates, it only, it's very marginal.

So what if I'm like, Ooh, should I do ketamine or should I go do ayahuasca in Mexico? Like if that's like, because the, I see that all the time in my practice, people are like, you know, what's cheaper going to Mexico? And I'm like, you know, what's safer? Not coming to me. They're just different.

Yeah. What I, they're just very different. They're both beautiful. Not comparable. They're not mutually exclusive.

I think what people are doing in Mexico is a drug called Ibogaine. Oh, you're right. Well, and ayahuasca. Which I would say is potentially cardio toxic. And they talk about, uh, it helping with addiction and PTSD from, um, there was that, they had one on Netflix, right?

That was about it for alcoholism and PTSD for addiction. Outside the U S it's supposed to be pretty phenomenal. I guess the former governor of Texas is really promoting. Well, last week, um, our president did a good thing and he took it off. He's, uh, he signed a bill to let us let them do more studies on it legally.

So there's some good things coming down the line, but they're not the, the thing that's nice about ketamine is it's available now. It's available here. You don't have to go out of the country. It's, it's legal. Oh, that's a good one.

It doesn't interact with other, it doesn't interact with other medications. If you, because of the half-life, it's a short medication, right? No serotonin syndrome, ayahuasca, SSRIs. You can't do reddit over here. Huh?

No, not reddit. Lift it. Lift it. Not reddit. I've done ayahuasca quite a few times.

I think it's like such a beautiful medicine, but it is like every time I'm about to go to those ceremonies, I am anxious. I'm like, Oh God, again, it's never like, it's a deep, really deep experience, very like physical too. And with ketamine, like it's quick. I can go back to work the next day and like, you can take a ketamine with SSRIs where ayahuasca you either it doesn't work or it's the same receptors. Serotonin syndrome could happen.

Oh, little zaps, little brain zaps. I was the itself as an MAOI. And so you get all the risks are, um, I think all these drugs are, they are medicines have some value, but, um, I think ketamine has a little bit of a foot in the Western world where, you know, licensed ethical standards are taking care of you, which is a good thing. Yeah. If some people feel more comfortable with most people aren't going to find their way into a psilocybin ceremony or an ayahuasca ceremony.

Just in this, in general, it, it's hard. It's kind of a bridge too far to hang out with Whitney. Yeah. Yeah. It's fun.

It's fun. But, uh, it is a bridge too far for a lot of people who have never, who have never stepped their foot into this world at all. So this is a very, this is like, Oh, we've got a therapist here and we have a nurse practitioner or a doctor and it feels a little bit, a little bit safer. It's more available. Accessible.

Yeah. What about, what about the costs? It's the secret, right? That's the thing. How much does my insurance cover this?

We, we are a cash only, but there are places that have been able to find a sneaky way around it. When we talk about off-label, what we're saying is it's not been studied because a lot of people don't understand what off-label because we use stuff all the time. Let's talk about Viagra. Once upon a time, it was just a little blue pill trying to save someone's blood pressure. Now it's the wiener wonder.

Yeah. And it was used off-label for how long? Like how long? So when we want to talk about off-label, we have to remember that it doesn't make a medication bad. It's just not ready yet.

Off-label for depression. Yeah. It's not, it hasn't been studied for this particular thing, but we've studied the hell out of it for sedation at higher doses. And it has actually been approved for depression in, in the way that they give it. Spravato is approved for depression and it's the way that they, that you receive the medicine, right?

It's kind of like the dose shot. Yeah. It's the manner of how they dose you. We have studied it in the proprietary delivery method that makes you pay us more. Honestly, it's cute.

It's purple. I mean, I think Spravato is a derivative of the reciement ketamine that we use. So they're able to brand it as a new drug. Therefore they can, they can charge a lot. Ketamine is the medicine itself is actually pretty inexpensive.

What you're paying for in the clinic is the time, the space, the overhead education is not really the medicine. So the way they're making money. Botox doesn't matter. You rub it on your own face. I don't care.

It's my hands. It's my education. And Georgetown. That's a way that they have found a way to make money off of ketamine because nobody is going to make money off of ketamine because of the, just based on the medicine, because it's not that expensive. It is what it's where you go and what they're doing with it and how they, how they do it.

I would guess the clinics that take insurance, they'll bill for like a office visit, like a 99214 and then procedural, like starting an IV. And then they make up that difference with the labor costs, either by cutting the amount of people that are oversight, you know, overseeing it or billing additional costs. So in your land, what does it cost? If I'm coming to go, they're all like, here's all the secrets. Okay.

So it's, it's 300 for intramuscular. Okay. And it is 400 for IV. It's a little more. That doesn't sound bad.

It's a little more for the IV just for the placement of it. So your IV pricing is 400 and your IM pricing is 300. And then we do offer a package where if you buy a series of six, which is the protocol that has been studied, we give you the price of, we give you six visits for the price of five. And that brings the price down to 249 or 349, I believe. So let me say that one more time.

So when you, now you're jumping back to studies. When we talk about it this way, we're talking about studied for what you're doing, but not studied for the FDA's guidelines. Because the FDA isn't setting the standard of care. They're protecting the consumer. So we always have to remember this.

The FDA is not setting the standard of care we want. They're putting the bar on the place we can trip. Right. That's exactly. So we just want to remember that we don't, there's a lot of times where we discount and say that it's not a good organization.

I don't live in that land. I just remember what it's for. Not for what I need. Right. It's like, here's a seatbelt and, and yeah, we're actually getting out of the car and you're like, I need to take off the seatbelt.

Yes. You know, it is time. I'm walking. So that doesn't actually, to me, I live in Med Spa land. So that's like one round of Botox for a couple treatments.

Yeah. I mean, if you do a series of six, it's 14.95 in our clinic. And it varies from clinic. That's about what it is. It ends up being about 249 per session.

That's a little less than, uh, cheeks in some people's clinics. So I'm just comparing it to my math. Or if you think about your life and your stability and that feeling of the lack of anxiety, I think that sounds pretty reasonable. I was pre-blood clenching and that's a good price. Yeah.

And it is a six six treatments is kind of arbitrary. We just base that's your studies, but you can evaluate. And I think most providers do. We've had patients do less and get benefit. The reason we want to stop at six is to take a drug holiday, see how long your, your symptoms are, are in remission.

For the node. And then the other thing is you're saying we need time to clinically evaluate your benefits. So yeah, if I can just maybe see if I understand it. Yeah. You don't really build much of a, you don't build a tolerance to this.

It's not about tolerance. It's about regulation of the binding receptors. And if they're allosteric, the type of binding it is. This must be a nerds nerds. No, that's just me.

Like nerd it down for me. So if you're talking about like insulin, right? So you develop insulin resistance and that's not because you've taken medications. That's a response to high blood glucose constantly. And how often or close together can you do these treatments?

The study we go off of does it twice a week. We, for practicality reasons, it's a, we do it about once a week because most people don't. Have time to take. Two hours off. They had to have a right there.

So we're kind of deviating a little bit from that and we try to accommodate what the patient wants to do. You know, we usually, I would say, you know, I always just say, I'd say more than 50% of people will, will notice a return of symptoms. The, it just depends on how long that is. It might be six months, might be a year, maybe three months. There's no.

Way to measure. And there's so much, there's so much variability of what we're exposed to. Bordasol, our coping mechanisms, situational. Kind of what you're saying with receptor regulation, it varies from person to person, right? It does, but you can start to notice there's, there's it's variable, but there's that bell curve where you see it occur.

And if you're seeing a study where you're indicating there's six, there's usually enough the data to say, aha. He's like, no psychedelics mushroom rules. I think the problem with that is just the, there isn't great longitudinal studies. I mean, which we've noticed just anecdotally, the variability of positive benefits seems to be pretty broad with between individual patients. So where is ketamine synthetic?

It is synthetic. Does it mimic any molecule in nature? No, no. I want to say it's from the aliens. It's from the aliens.

Yeah, there's something to it, but it could be because I work in tech. It was developed in the sixties during Vietnam to, because it's so safe, doesn't do anything your heart or your breathing. That seems like an oxymoron that it was developed during Vietnam because it was safe. They could give it to each other. They could give it to each other.

Would you like that? I've never heard that about Vietnam or the sixties or the sixties. It was created as an anesthetic that they could give to each other and it was so safe. And then they started discovering that people were actually, they had improved moods. It helped with their trauma and things like that.

And so then it developed from there. It's been around a long time. It really didn't start. I don't know. It's been around a long time.

Which are, which I guess were to your point, the on-label use as an anesthetic, which is how you use it usually. So yeah, it was a valuable battlefield anesthetic because it's not respiratory suppressing, hemodynamics aren't really affected. Your blood pressure actually goes up a little on heart rate go up a little. I think that's more from a catecholamine release from the experience can be very intense. But so yeah, it's safe in that respect.

It's more chemically similar to like phenocycline like a PCP. Well, that's a different one. They've met, they maybe have rhinestone pants, but they're not the same. Different heights. Yeah.

Different. I think from my side, from the therapeutic side of why I would say six is a good number, not getting into any of the nerd stuff would be if six is a great number for me to see like, is this helping with their depression? Is this helping with their anxiety? Is this helping with their suicidal ideation? Are we able to get into things, you know, into the trauma and what I think it helps people feel safe?

So that this is just from the therapist side of like creating safety in your body and in your nervous system so that we can start to talk about the hard things that they couldn't get to before. And so if someone's done six and nothing's happened, I'm not going to tell them to throw good money after bad. This is pretty cost prohibitive. And that's where there's a little bit of safety with this. If you're not getting it off the street, it's like most people can't afford to get addicted to ketamine the way we do it.

There is a little bit of safety if you have to come to the clinic and you do it. I think in regards to so for me, if they if it's six, they haven't most people that they try six, they're going to experience something. We're going to experience some. They're going to be some change. You're going to see a change.

I would never say 100%. Some people do six and they go, but I it rarely happens where someone's really like doing it. They're not going to see something. So for me, just my measurement for whether it's working is did they see, you know, we'll check in with that. Here's the category.

Yes. And how have you improved that your experience? And then and then what we do is have them take a look a little holiday. I asked them to check in with what are you people? People know their signs and their symptoms.

What what are the things all those thoughts that keep me up at night? The stories that take over the the not not sleeping, the whatever it is. And then I tell them to check in for like what when you notice your signs and symptoms coming back, come to a booster. Don't get don't come down here to rock bottom. You start to see some of your stuff and then you go in and for a booster and that'll generally keep them going for a few more months.

Everybody's so different. Some people will do like come in maybe four or five times a year after that initial six. But sometimes people we're not trying to keep you forever coming in for pedamine. You want to we want to like have them go further and further. You know, but somebody might do an initial six and then I'm going to come every other week and I'm going to come every fourth week and then so taper.

You know, like, yeah. And sometimes people are like, oh, the October is hard for me. I'm going to come in in October. Well, I do it twice at least twice a month for because I have PMDD, which means like the during 10 days before my period, it's just I'm different. I'm depressed.

I'm dreadful black and white thinking. That's when I know it's kicking in and polarizing. Like there's no reason to be this way except for what whatever like I guess my brain is reacting to the dip in hormones. So I will schedule I'll try to schedule it 10 days before and then three days before. And I mean, technically you could say, but why aren't you healed from PMDD after that?

And chat should be T even said, not during your luteal phase, but like the 10th and third day before my period. And I know I have an appointment. I just need like one fucking break. Please. It just helps me feel relief and relief fast.

And then it also kind of like makes me realize like this is so temporary. Yeah, it's okay. Yeah. And so that's that's how I take care of my mental health. I feel like PMDD is quite a large thing.

Like you summarize that very well. But the gravity of the feelings for PMDD, like not to be over descriptive or offensive, but this is the feeling that makes women kill their husbands and their children. So this feeling is profound. It is not subtle. It's not slight.

This is something that is immense. Now, I'm not going to kill anyone, but I will admit that I like to watch a Doomsday movie. So apocalyptic events. Like I just watch it. I don't feel it.

Yeah. So the way you paraphrase that was superb, but I feel like it really minimized how intense that emotion can be. It's pretty profound to have like and you and then you said like just like the thought of being able to say, okay, I have this that feeling of security that you have something that you can utilize to. Well, it immediately takes me out of the like the whatever is going on in my mind, like all my sense. It's like my ADHD medicine doesn't work.

My antidepressants like it's just bad and it immediately like I'm talking about three minutes gives me relief and I'm able to go home and just be like, it's like all these things that are spinning through my head is it's not a big deal. It's temporary. Like you got to get through like you're going to get through it. It's perspective. Yeah.

It's just like. It doesn't really calms your nervous system. No, so that you can because you can know all these things, but to actually feel it is so different on clincher. Yeah. Like, hey, but I mean also like I do way other things during a variety of different things.

Like I won't make too many plans. The progesterone I go up a hundred milligrams, which really helps. Um, and then just so much grace and compassion and dog cuddles. And then I have to remind myself like it's temporary. Yeah.

So you're like this too shall pass. But this sounds like, you know, if anyone has the magic pill out there, send it over. She's like, I'm ready. That's the thing to remember about ketamine is it is a tool. It's a power tool, but it's a tool.

And this along with the other things like that you just mentioned, you know, therapy, movement, exercise, eating healthy. I mean, all those things are. Ketamine alone probably isn't going to just fix everything. I mean, it won't, it won't. And, and so just remembering it's just, it's just a tool, but it's a really good tool.

Can I take this if I'm pregnant or breastfeeding? Not pregnant. It's against it if you're pregnant. I mean, I don't know. I think they've changed the pregnancy categories, but I think it's pregnancy category C or was.

I don't know. You probably, I don't know. We haven't worked in. But yeah, so we advise against it. No, that means no.

But breastfeeding. It's a little sad. Yes. Pump and dump. Pump and dump.

Because it's a three hour half life. Exactly. Yeah. So it's good for people with. PMDD.

Yeah. Postpartum. Because we can help they can get, they can get help really fast rather than waiting six weeks for that antidepressant to kick in. They just pump and dump and. And those, those meds too are also category C, but I would still just, unfortunately I wouldn't want to.

Well, this isn't medical advice. This is just discussing who can use ketamine and you still would have to talk to your doctor. Yes. You would still have to consult a professional. You don't want to freestyle it.

Make sure you ask Jack GPT about. No, no, no, no. Use Jack GPT as something to do while you're in the bathroom. Don't pretend like he has hands. Use Claude.

Claude's. I would, I would just say yes. Damn Bob. Whitney, quit it. Fuck.

Yeah. Just generally if pregnancy would encourage them to pursue conventional treatment till they're. Till they've delivered. Well, that's good. That's good to know.

I feel like you guys are kind of special and great. I've seen a lot of people transform with ketamine. Like actually like. It's cool. Yeah.

It's kind of, it's very special. To be able to facilitate that in somebody's life is a pretty big deal. I love it. I mean, it's something I'm quite passionate about. I believe in it.

I see it work. I experienced it myself and I get excited too. And I've seen a lot of friends be helped, but it's been really remarkable to see where you've started and where you've come from. Like where you're where you've come from and where you've arrived. Thank you.

I've got a team of good people. Yeah, but it's, it's really, it's pretty special. I'm very proud of you. Good job. Well, I don't have any more questions.

Do you do? I don't think so. I'm so glad you guys came. Now I know a little bit. Yeah, we can refer people because we have a lot of people that come in here for.

A wrinkle that's not, it's not a wrinkle. It's something in your soul or your heart. You know, and they're like, what if we fix this? And I'm like, oh, my beautiful woman, let's get you some estrogen and progesterone and let's have a ketamine adventure and then make sure that this is still something you want to do. Because we really want people to be here for an ethical reason, not to fix something that's.

That's not the. Well, and perhaps you maybe need support with something and there's other aspects of your life that need support. Botox is beautiful, but it doesn't wrinkle out your heart. It doesn't doesn't doesn't do those. A heart wrinkle.

Those are hard to get out. I don't fuck with those too hard. But yeah, it was so nice to meet you. Nice to meet you, too. Thank you so much.

I appreciate you.