Dr. Anthony Kaveh Talks Psychedelics as Treatment for Mental Health
This month we take a closer look at significant advances made in the treatment of mental health disorders. Considering these exciting developments, Stephen Cheung, founder of Blackburn, takes a moment to chat with esteemed medical doctor and YouTube personality, Dr. Anthony Kaveh about psychedelics as a form of treatment. Dr. Kaveh is a Stanford/Harvard trained anesthesiologist and integrative medicine specialist who has garnered millions of views exploring the power of healing during an altered state of consciousness.
This interview is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
The emergence of psychedelics as a treatment for mental health, particularly ketamine, marks a significant shift in the landscape of mental health. Often stigmatized due to their association with recreational use and counterculture movements, psychedelics have recently gained attention for their potential therapeutic benefits. Ketamine, initially developed as an anesthetic, has shown promising results in treating resistant forms of depression and other mental health disorders.
Let’s dive right into it! Ketamine. Because so many people know it as the party drug “Special K”, it’s easy to assume the only reason it might help with depression or PTSD is because you get a high. Is there anything more to that?
Absolutely. Ketamine actually works by changing the way messages are sent in the brain. Any time there is a trigger — whether it’s PTSD, anxiety, or depression, we have an opportunity to respond to it differently. That’s learning. What we call “neuroplasticity” is simply a fancy word for being able to respond differently. So, maybe instead of grabbing a shot of whiskey or grabbing the cigarette or taking the hit of cocaine or falling into a depressive ruminative thought loop as your response [to a trigger], ketamine or any psychedelic with that neuroplastic quality allows for throwing a monkey wrench in that otherwise well-oiled machine.
It almost sounds like it has the potential to break an addiction cycle. But there must be some risk there, I imagine.
Absolutely, it’s tricky. It’s tricky because in the case of ketamine, ketamine can be a drug of abuse as well. How do you use a drug of potential abuse to fix addictions and to heal the root cause of addictions? And I’ll say personally, I’ve been successful in doing this with patients –completely life-changing. The more times you take that shot of whiskey, the stronger that connection becomes. Ketamine allows you to break that. Nothing else that I’m aware of in modern medicine allows for that level of retraining the brain to break these ways of thinking.
And what happens when you’re able to break this loop?
Ketamine can allow you to access the expansive consciousness made available needed to address the root cause. For addiction, it’s often symptoms of something deeper. In the case of addiction, the addict is often seeking something. And it’s usually not what they’re addicted to.
To get to the core of the issue rather than be a band-aid for it sounds incredible. Where do the traditional forms of therapy, like talk therapy fit in with the ketamine treatment program, or does it sit separately?
First, you have to prime the mind and prepare [the patient] for what to expect. Then, we have the experience itself, which has medical and psychological aspects. And then stage three, the integration portion, is critical because having the therapy [aspect] can arrest all those negative self-thoughts for days or weeks. But if you don’t apply something new to take its place, if you don’t rewrite that narrative in the same circumstances that will come up again, the same weeds will grow out of that garden unless you’ve actively planted something new and de-weed it.
When do people usually come to seek this form of treatment versus other treatments that are currently out there?
Somebody may have the precursor to a major depressive episode, but they may only start feeling stuck. They might be feeling numb. It’s very important to ask the patient what the trajectory looks like because I don’t believe it’s appropriate to let somebody fall into their first major depressive episode, have their first panic attack and go to the emergency room, get a giant bill, and have their heart checked out. This is still off-label use of ketamine, but when used in this holistic view, and the responsible and ethical use, the wrapper around ketamine, we can prevent someone from having their first major depressive episode, from ever needing to go on an SSRI or a benzodiazepine, like Ativan, Xanax, etc. Ideally, we can do this in a finite number of interventions to give them that self-empowerment and confidence.
An age-old analogy describes two types of trees — the mighty oak tree whose branch snaps in the storm and the willow reed that can wave back and forth. That suppleness, that resilience…when human beings begin to lose that resilience and become more rigid, it is the stepping stone to being stuck. Being stuck often underlies depression, anxiety, PTSD, or chronic pain and it’s a worthwhile discussion about whether there might be a role for trying ketamine.
What about ketamine for someone who is normally fine but is going through a tough period? Would that be an appropriate use case?
We know that a tough time for someone might be them contemplating hurting themselves or others. A tough time for someone else might be them on the verge of starting a new medication with new side effects. Every case of major depressive disorder has the potential for a permanent IQ hit on someone. That to me is something worth strongly considering. If we can abort early on from a situation that you’re describing –maybe grieving someone dying, and they haven’t come back after three or four or six or eight months, there might well be a role for ketamine. There are many other approaches as well, and we need to make sure that patients are aware of all possible treatments.
How have your patients described what it feels like?
It is different for every individual. There are some shared themes of levity, of clouds, sometimes of water. The more willingness to surrender to the experience, typically the greater the benefit and the more comforting the experience. The more agitation, apprehension, anxiety, or rigidity prior to beginning an experience, the more constricted they are where the experience takes them. There’s a level of trust that has to be there that you’re going to be safe. It’s not uncommon that I do one-on-one sessions for an hour with an individual holding their hand, not because they’re weak, but because there is so much past trauma that is now being brought up, that they need reassurance, reorientation and care. And I think that’s probably the biggest difference when you think about it used recreationally versus in a medical setting.
You lower the risk of a bad “trip”?
Right. There are a lot of people who do too much of one thing or do too little or in the wrong environment like at a club and the experience is different. Imagine you’re at a club, dropping acid, and thinking, ‘What if the cops find us?’ What kind of mindset is that? What kind of setting is that? What kind of paranoia might be amplified through the altered state of consciousness versus being in a safe environment with a trusted doctor.
How much do we know about the long-term effects of this type of treatment?
It’s an ongoing question. It has been studied in this use for over 20 years now. This is why the responsible use of ketamine is so important. How do we minimize the number of interventions needed and are we using every infusion to its greatest potential so that someone doesn’t relapse in three months just to require another infusion. So, the wrapper around this is pivotal to making sure that we are not overusing a medication because there are known risks, however rare, to prolonged ketamine use. Some of those risks include addiction, problems with the bladder, and we don’t have good treatments for those.
What about long-term prognosis?
Fortunately, if we are adaptable, over 90 to 95 percent of individuals find significant relief within a number of minutes to hours to days. How long that goes on depends on many factors, because unfortunately, stressors that have led individuals to their condition in the first place do often return. We do our very best in coordinating with therapists who do the integration because it’s a pivotal part of this to give them those tools for sustained relief.
With that level of efficacy, you must see transformative benefits in a lot of patients, right?
It is surprising the number of unexpected breakthroughs. Somebody may come in with depression or anxiety. And after two or three weeks, they might suddenly be either losing weight or gaining weight in the right direction. When we have people who are anorexic, for example, suddenly they want to eat again. One person even told me that their kidney function improved, which I didn’t believe. I asked for the lab tests. Sure enough, they had improved. And thought it was a lab error because ketamine does not fix your kidney.
And the patient said, ‘No, no, doctor, you don’t understand ‘I like the taste of water again.’ And I said, ‘You’re telling me you’ve been dehydrating yourself, either purposely or unintentionally?’ She’s like, ‘Yes, I didn’t even have the will to drink water.’ These are things that I would not have predicted would transform someone. If we can uncover an innate healing capacity, possibilities are far greater than we could ever anticipate at the onset.
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