November 13, 2023 • 41 mins
This week Kat is talking to the founders of Willows Health and Recovery, Selena Phillips & Rhonda Bartine. During this episode they discuss how Ketamine is now being used to help those who struggle with Treatment Resistant Depression.
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Episode Transcript
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Speaker 1 (00:00):
Coming up on you need therapy.
Speaker 2 (00:02):
I've got a gentleman that when he came to me,
he tried several medicines, and his PHQ nine, which is
the Patient Health Questionnaire depression screening that we use, he
was scoring twenty seven out of twenty seven. So he
was one of the most severely depressed people that I've
ever seen. So I said, okay, let's try this. That
(00:26):
was probably two years ago. Today he boosters once a
month and his PHQ nine is four out of twenty seven,
which indicates no depression or mild depression.
Speaker 3 (00:38):
I started to realize that not being an expert isn't
a liability, it's a real gift.
Speaker 4 (00:44):
If we don't know something about ourselves at this point
in our life, it's probably because it's uncomfortable to know.
If you can die before you die, then you can
really live. There's a wisdom at death's door.
Speaker 5 (00:57):
I thought it was insane. Yeah, I know what to
do because there's no Internet.
Speaker 3 (01:02):
I don't know, man, I'm like, I feel like everything
is hard.
Speaker 1 (01:08):
Hey, y'all, my name is Kat.
Speaker 3 (01:10):
I'm a human first and a licensed therapist second, and
right now I'm inviting you into conversations that I hope
encourage you to become more curious and less judgmental about yourself, others,
and the world around you.
Speaker 1 (01:24):
Welcome to You Need Therapy.
Speaker 3 (01:27):
Hi guys, and welcome to a new episode of You
Need Therapy podcast. My name is kat I am the host,
and quick reminder before we get into everything today that
this podcast does not serve as a replacement or a
substitute for any actual mental health services, and it also
does not serve as any form of actual medical advice.
(01:50):
And that is especially important for me to say today
because today I have two people that I actually met
when I started working in a treatment center as an
intern and now actually refer a lot of my clients to.
Their names are Selena and Ronda. And Selena is a
Board certified family nurse practitioner that specializes in mental health,
(02:13):
and Ronda is a Board certified psychiatric mental health nurse practitioner,
and both of them have been really helpful to me
personally and with clients. And I asked them to come
talk today on the podcast because there is this thing
that is becoming more and more prominent. You might not
(02:36):
have heard of it. You might have heard of it,
you might have kind of caught a glimpse of somebody
talking about it, and that is using ketamine as treatment
for treatment resistant depression. So this is one of those things.
When I first heard it, I was like, whoa, whoa, whoa,
Like stop signing, there's no way that we're doing this.
This seems wrong. However, the more I learned and the
(02:58):
more I actually listened to some of the research, some
of what Rond and Selena were saying, and some of
just like the conversations around this, the more open I
became to this idea. So I asked them to come
talk about it, because it's one of those things where
it can be you know, put up the red flag
like I did at first, or it can be actually
really helpful to certain people. And I think it is
(03:21):
personally my job to stay up to date and educate
it and continue to listen to what new stuff is
coming out that we might want to let our clients
know about or just be aware of.
Speaker 1 (03:32):
And so I wanted to have that.
Speaker 3 (03:33):
Conversation today to maybe just give some information to you
guys who might not have ever heard about this being
used for depression and treatment, and some people that might
be interested in it, and some people who might be like, yeah,
that's not for me. We're just going to give you
some education, some information, so then you can actually decide
(03:54):
is this something that you would be open to, whether
or not it's you're somebody who has experienced treatment, resists
and depression, or maybe you're somebody who works with people
who have. So that's what we did today. We just
had a conversation. I asked some pretty basic questions. We
didn't get into too deep of the nitty gritty that
kind of like loses us when we're like, what actually
are we talking about. We just talked about the basics
(04:16):
of what this is, why people are using it, and
where it came from, why we even started using it.
So thank you very much to Ronda and Sulina for
having this conversation and for being people who have been
open to new advances in mental health treatment.
Speaker 1 (04:32):
Now.
Speaker 3 (04:32):
Ronda and Sulina both are the owners of the Willows
Health and Recovery which is located in Nashville, Tennessee. It's
actually very close to my office, so if you are
wanting to know more about them or want to learn
more about this, you can find them there Willow's Health
and Recovery dot Com. I will put that also in
the show notes. So I think it's about that time.
(04:53):
Let's get into my conversation with Selena and Ronda. Okay, guys,
I am here with two past colleagues, Ronda and Selena,
who I met probably in twenty thirteen, and we are
going to be talking about something that is somewhat sensitive,
might be a little well, it might be new for
(05:14):
a lot of you, and something that I've wanted to
talk about for a while, just myself professionally to learn
more about it, but also on the podcast to just
bring up some awareness and have a conversation about something
that might be controversial for some. And before we do that,
I want you guys to hear a little bit about
where Ronda and Selena come from, what has brought them
(05:37):
to what they are doing now, and why you should
even care about anything they say. So who wants to start?
Speaker 1 (05:45):
Ronda?
Speaker 4 (05:46):
I graduated from Vanderbilt in twenty thirteen, and I had
spent a year working at a residential treatment center here
in Tennessee as an intern, and then I was offered
a position. So basically, my first love from a clinical standpoint,
has always been working with those suffering from addiction. So
(06:08):
now been in the field for ten years and still
board certified as a psychiatric mental health nurse practitioner. And
I met Selena at that same residential treatment center where
we met you.
Speaker 3 (06:20):
And I should say this now if you guys didn't
catch it in the intro, that RNDA and Selena actually
worked together. Now, so you guys met there and became
friends enough to the point where you want to keep
working together outside, and now they have their own would
you close a practice? Yes? Okay, practice very close to
where my office is in Nashville. So Selena, tell us where.
Speaker 5 (06:44):
You came from.
Speaker 2 (06:45):
I came from South Mississippi. So I actually started working
in mental health at age eighteen as a tech at
a psychiatric hospital and worked my way. I went to
nursing school, became a nurse, and then in twenty fourteen,
became a nurse practitioner. So I've been working in and
out of mental health and addiction since I was eighteen
(07:07):
years old.
Speaker 3 (07:08):
What made you want to work at eighteen in the
psychiatric hospital.
Speaker 2 (07:13):
The truth is that my aunt worked in human resources
at a hospital, and my mother told my aunt to
find me a job.
Speaker 3 (07:22):
So was that a fun experience? So it was, and
it also really a weird word to say, but exciting,
sometimes hard, challenging.
Speaker 5 (07:33):
Yes, it was.
Speaker 2 (07:34):
And actually I helped open an adolescent child unit, so
right after I started working there, I worked there about
a year and then helped open that unit, and then
later became the nurse manager of that unit after I
became a nurse.
Speaker 1 (07:47):
And it was one of.
Speaker 2 (07:49):
Those things that I guess was led me to where
I am today. It made me look at myself and
look at my issues and my past trauma that had
i'd always just been squashed, you know, So it really
gave me a glimpse that people can heal.
Speaker 3 (08:07):
It makes you look at I don't know how to
say this in the right way, but I think working
in a space like a psychiatric hospital or a residential
treatment center, we're seeing things that are in the world
out there looked at as bad or like evil or
(08:27):
I mean any of those just like icky stigma thoughts.
Then you get to work and one of those places
and you then you're like, wait, these are people and
we actually can help them. And it almost might be
a weird word to use, but it almost is addicting
to get into this field because then you see how
much it's very hard and can be very taxing, but
(08:49):
then you see like, oh my gosh, there's so much
good that you want to be able to spread from
absolutely changing your own mindset.
Speaker 1 (08:59):
So when you started, you had an internship.
Speaker 5 (09:02):
This is also very similar human resources.
Speaker 4 (09:06):
No, No, but I worked at Vanderbilt for twenty years
before I went to graduate school, and it was through
trials and tribulations in life that led me to say,
I want to help other people get out of the
way of themselves. And I enrolled in Vanderbilt, got accepted.
(09:28):
Probably Yeah, I'm like, yeah, it's just because I was
an employee, right, But they sent me to the ranch.
Oh as for my internship, and I didn't know about
the ranch. I didn't know anything about psychiatry or addiction
treatment or anything. Before I was I worked in critical care.
Speaker 1 (09:50):
Okay, yeah, so big shift. Isn't that funny? How like
life just like does that for you?
Speaker 5 (09:57):
Absolutely, it is a little.
Speaker 3 (09:58):
Lesson on how we don don't need to be in
control so often.
Speaker 5 (10:01):
No, And I tell my kids that all the time.
Speaker 2 (10:04):
Yeah, at eighteen, I never would have solved that I
would be here.
Speaker 5 (10:09):
Yeah, that was certainly not my plan.
Speaker 3 (10:11):
Yeah, you know what. Actually, my plan when I went
to college was to be a nurse. And then I
got to college, I took one anatomy class and I said,
this is not for me, and I got.
Speaker 1 (10:20):
Out of there.
Speaker 3 (10:22):
Okay, so today what we are going to talk about,
and again, I want you guys to listen to this
episode as a step. This is like one step to
a whole world of information. So I want you to
take whatever you're hearing not as like gold and truth
(10:44):
and God's word. I want you to take this as
something that might help you become more curious and open
to a new type of treatment that I find very interesting,
and I honestly don't know that much about it.
Speaker 1 (10:57):
So that's one of the reasons, like I said, I
want to have this conversation.
Speaker 3 (11:00):
So we're talking about ketamine, which I will tell you
I have a little bit of information of how this
is not what I used to think it was. But
when I think of ketamine, I just think of like
really intense street drug.
Speaker 1 (11:14):
What is it special? Okay, Okay, it sounds scary to me.
Speaker 3 (11:17):
So I want you guys to in the simplest way
you can explain, Okay, what is ketamine? How is it
more than just this drug that we might have heard
about in their class and fifth grade In the simplest
(11:38):
way you can explain, Okay, what is ketamine? How is
it more than just this drug that we might have
heard about in class and fifth grade.
Speaker 4 (11:46):
Well, kenymine was first synthesized in the nineteen sixties and
it was used for humans and animals as an anesthetic,
and it's made it popular choice for surgical procedures because
it's so dissociated in nature that people can it's not
really a pain medicine, but they can tolerate, let's say,
(12:07):
alone bar puncture, or they can tolerate if they dislocated
their shoulder that being put back into place. And the doses,
of course for an anesthetic are way higher than they
are to treat depression. And it wasn't until really the
early two thousands when there were several psychiatrists, one being
(12:30):
doctor Ceven Levine from New Jersey Princeton, New Jersey, who
had evaluated a client and really went into great depth
in detail to find out and no medicine had ever
worked except for this one time when they were on
a certain cough medicine, so that got his brain really
(12:51):
looking like, oh my gosh, is this about a certain
receptor in the brain that that cough medicine was targeting,
and that he was really revolutionary and one of the
psychiatrists that started doing a lot of research and actually
established ketymine options there with.
Speaker 1 (13:12):
The cough medicine that was there.
Speaker 3 (13:14):
Wasn't ketymine and a cough medicine, they were just looking
at a receptor that both of those maybe active drugs attacked.
Speaker 1 (13:22):
Okay, that's fascinating.
Speaker 3 (13:24):
And what I want people to know when listening to this,
we're talking about ketamine as a treatment for depression, right.
Speaker 5 (13:35):
Right, treatment resistant depression.
Speaker 3 (13:36):
Okay, so what is treatment resistant depression?
Speaker 1 (13:40):
How is that?
Speaker 3 (13:40):
What does that mean compared to like, is that like
the diagnosis you give them, compared to major depressive disorder?
Is that just a type? What does that mean?
Speaker 2 (13:48):
So typically people have a major depressive disorder diagnosis, but
when they come see us, they will do full psychiatric
evaluation and look at their medical history as well. But
as far as treatment resistant goes, really you only need
two of the traditional medication failures of the oral antidepressants,
(14:10):
and those are your typically your SSRIs SNRIs, like your
pro likes a pro well beuchure and effects ers, those
kind of things. So really you just need to fail
two of those type of medications to be considered treatment resistant.
Speaker 1 (14:26):
That feels a little common.
Speaker 3 (14:29):
Absolutely, absolutely do you find it frustrating for clients, Like,
what's your experience with a client who's coming to see
you for medication and medication management?
Speaker 1 (14:40):
And I know.
Speaker 3 (14:41):
From my little experience with some of that with my
clients that sometimes it takes a while to figure out
what's going to work. So how do you differentiate between
it's going to take a while for us to figure
out what's going to work in the dosage and when
like this just isn't working.
Speaker 4 (14:58):
Many times, So a lot of the clients that come
to see us, they've got a list of mile long,
or they haven't had genetic testing, or you know, because oh,
my primary care physician has been managing it, and then
before that I saw I saw this person, I can't
remember their name, you know.
Speaker 5 (15:15):
So usually by the.
Speaker 4 (15:18):
Time they get to see us, you see like failures
with SSRIs or SNRIs and they haven't completed genetic testing,
which can help us learn how they metabolize medicines and
better medicines.
Speaker 5 (15:29):
For their body.
Speaker 3 (15:30):
Could you say more about that? Yeah, So what is
genetic testing in the form you're talking about.
Speaker 4 (15:37):
It's the mouse swap and we can do it here
in the office. We can send it to their home
and they can complete it and then ship it back
and we learn several things. We learn most importantly for me, Selena,
and I don't know how you consider this, but for me,
it is how you metabolize medicines based on your genetics,
because you could be a rapid metabolizer of multiple say ssries,
(16:02):
So it's going to take a higher dose to reach
therapeutic effect. And so that's I think so helpful to
know that, and that's going to always be my first option. Like,
let's look at this, but if somebody is acutely depressed
and or suicidal, I might forego that and recommend kedemye.
Speaker 3 (16:25):
Okay, so let's switch to what got you guys into
being interested in using this.
Speaker 2 (16:34):
I think for me it was seeing so many people
just come to me and be kind of at the
end of their rope, meaning that they have tried so
many medications in the past and nothing work, or it
works for a little while and then it stops, and
then you know, before they know it, they're on three
and four medications and still just not feeling well. We
(16:58):
had seen it used at the residential treatment center that
we were at before and saw really good results. And
then I also have collaborated with another physician in town
that provides ketamine and have heard, you know, his stories
of success of how well people do with it, and
(17:21):
Spravado had came out, which we can talk about that,
and really we just wanted to find a way to
think outside of the box.
Speaker 3 (17:30):
To better options here. Yes, do you remember your initial
thoughts when you first were introduced to it.
Speaker 4 (17:39):
I couldn't believe our medical director was going to do it.
I'm like, oh my god.
Speaker 1 (17:43):
I remember.
Speaker 3 (17:44):
I think we were probably all there at the same time.
I remember when we were at the treatment center we
had this meeting. I'm pretty sure I was the intern
at the time. I went with my supervisor and she
was already like kind of I can't believe this is what.
Speaker 1 (17:58):
Are we going to this meeting for?
Speaker 3 (18:00):
And then I just remember I think I took on
her anger, yeah, because I didn't know what to think,
because I'm like teacher, you whatever, But there was a
sense of wait, what we're using this drug that people
abuse in the world out there, we're going to get
then give it to them for medicine, and I didn't
have an understanding of medicine and the fact that like
(18:23):
that sometimes it's actually very common. But I remember just
being shocked and also feeling very resistant and also wanting
to not like it felt like a secret, almost like
I don't want people to know I would be doing
this or encouraging this.
Speaker 2 (18:40):
And I get that, and I think I felt a
lot of the same way when when we started using
it at the treatment center. However, since then we have
learned that after our own education, is that the dosing
that we use in our office for treatment resistant depression
is there's nothing like that I'm seeing that people are
(19:02):
taking on the street. Obviously it is under a controlled
setting here in our office, so there's really not an
abuse potential from that. By the time they leave our office,
the medicine has cleared their system.
Speaker 3 (19:15):
When I think it's important to have our beliefs in
our understandings and we're all gonna have a little bias
in everything that we.
Speaker 1 (19:25):
Do, but also remain open.
Speaker 3 (19:28):
Because if I was as closed off as I was
when I was twenty three, and I was like, I'm
so smart.
Speaker 1 (19:34):
It sounds like a lot of your clients would miss.
Speaker 3 (19:37):
Out on an opportunity to actually find something that works
for them. Can you explain what this does? How does
this work? What's the process of people? You mentioned people
are in your office when they're doing this. It's it's
not something you get prescribed and you go take it
at home.
Speaker 1 (19:58):
We do not do that. Yeah, a thing that happens.
Speaker 2 (20:01):
It can be prescribed orally as a sublingual tablet or
a tablet that you swallow, but we don't offer that
in our office.
Speaker 4 (20:10):
And it's not very effective. Oh because of the worl
route by. Availability of the drug is just not there. Okay,
So there's some clinics that are all on Facebook that
are I think I'm not going to mention it, but
that are offering this in home treatment with ketamine, and
(20:31):
I just would urge people to get Yeah.
Speaker 2 (20:35):
And I actually had a client that tried it and
then she came back and she was like, that didn't
that didn't help.
Speaker 3 (20:40):
And that can be a little bit disheartening and discouraging
too for somebody who's like this is my last effort.
Speaker 1 (20:46):
Maybe sometimes what they feel. So can you talk about really.
Speaker 3 (20:50):
What that is doing, Like what is that compared to
like an ssri ketamine.
Speaker 4 (20:55):
You know, there's been a lot of research on well
how does this work and what they've really focused on
the NMDA receptor in the brain, and this the theory
because we don't know truly what causes depression. We don't know.
One theory is that due to inflammation, if there are
(21:18):
areas of the brain that are just kind of they're
not working anymore. So this ketamine comes in and really
targets that receptor and kind of opens those pathways back
up and really kind of creates more neural connections. And
neuroplasticity is a big word we're using these days, and
(21:41):
it can have a really rapid onset, whereas oral antidepressence
can take five six weeks to even show a slight
bit of efficacy. Some people may feel a little bit
better after the first treatment, usually by treatment for it's
pretty significant difference in and they're scoring of their depression.
Speaker 3 (22:02):
Levels even after this drug is no longer in their system. Yeah,
so I'm going to repeat this back just to summarize,
make sure I'm hearing the correct thing. So this is
a drug that when it's active, it changes you say, neuroplasticity.
It actually changes and allows the brain to kind of
(22:24):
like rewire itself and open up long term and maintain
that versus another medication that might just be taken long
term is doing that kind of like every single time
you take it.
Speaker 1 (22:39):
Does that make sense?
Speaker 3 (22:40):
Yes, And I just think that's over and over to
get that same result versus this actually changes the chemistry
of your brain kind of.
Speaker 2 (22:48):
I will say that the oral anidepressants are acting on
the neurotransmitters serotonin orpanifferent diepamine. This is acting on the
glutamate system of our brain. So actually then we get
we get communication between the two systems in our brain.
Speaker 4 (23:03):
Okay, And on top of that, they've only really done
research on the NMDA receptor, but ketamine hits so many
more neurotransmitters. It hits opioid, the mute opioid receptor, the
serotonin nor ep from dopamine transporter, dopamine IWI transporter. You
think about a broad spectrum antibiotic that really goes in
(23:24):
and just we're gonna kill this infection. You know, this
to me is a broad spectrum antidepressant.
Speaker 3 (23:31):
Versus targeting one thing, correct, right, but we only have
research on the one thing right now.
Speaker 4 (23:35):
Well there's limited rears.
Speaker 3 (23:37):
Yeah, okay, So Selena, you mentioned Spervado can you talk.
Speaker 1 (23:43):
About what that is?
Speaker 5 (23:45):
Sure?
Speaker 2 (23:45):
Spervado is the FDA approved version of ketamine that chants
and pharmaceuticals came up with. They changed like one isomer
of ketamine to make esketamine under a trade name Spravado
and got it FDA approved for treatment resistant depression as
well as acute suicidal idiations. So with that, you have
(24:09):
to be a RAMS provider, which is a risk evaluation
and mitigation strategy.
Speaker 1 (24:16):
Is that something you have to get.
Speaker 2 (24:18):
You have to be approved okay for that, And we
did get approval for that, and we are a RAM
certified Spravado treatment center here.
Speaker 5 (24:27):
And we offer it.
Speaker 2 (24:29):
It's Spravado is a nasal spray and it's administered twice
weekly for four weeks and then once weekly for four
weeks and then booster as needed.
Speaker 3 (24:38):
And they'll come into your office get that and then
stay here.
Speaker 5 (24:42):
Yes, they're here for two hours.
Speaker 1 (24:43):
Okay, and they're being monitored.
Speaker 2 (24:45):
Yes, and are not allowed to drive home, so they'll
have to have a driver or a ride share.
Speaker 3 (24:50):
Okay, what is the conversation like when you have a
client who comes in and maybe has tried a lot
of stuff already, so it's like you don't even have
to go through that and you see their intake form
and you see all their medication history. What's the conversation
like for you inviting them into trying this?
Speaker 1 (25:10):
Well?
Speaker 4 (25:10):
I think depending upon their you know, you're also going
to evaluate your medical history. Ketymine and Spravado can transiently
increase blood pressure, and so for spravado and ketymine. But
as you know, a certified rooms treatment center, if a
client has any aneurysmal disease so that's disease of the
(25:31):
vessels or hypertension that's not well controlled, that would be
a contraindication for treatment. So we take the whole client
and where they are, and you know, ask them what
their goals are because we're here to support them and
reaching what they want.
Speaker 3 (25:49):
Do you get pushback from clients? Are you seeing pushback
of like, oh no, I don't want to do that,
or do you find that that it kind of offers
them some hope when they feel defeated.
Speaker 2 (26:00):
I think it absolutely offers hope. I mean, I think
some people have a little reservation because they feel maybe
like it's a last ditch effort.
Speaker 5 (26:11):
You know, it doesn't work, then what a way, right?
Speaker 2 (26:14):
But I try to reframe that with them and say,
but this is something that we can have hope for.
I have seen it work in my office in my practice,
So just trying to reframe it to that.
Speaker 4 (26:27):
Is seventy percent remission rates. That's what the data is
showing with spravado and with ketamine.
Speaker 3 (26:36):
I mean, do we have research on what that is
compared to like prozac.
Speaker 4 (26:40):
Well, if prozac is better than placebo at treating depression,
it is FDA approved and that's what it's not. Yes,
that's what it's evaluated. When you do blind you know,
double blind placebo control trials, they're evaluating it with placebo.
Well that's interesting and place ebo strong. But it's important
(27:05):
to know that.
Speaker 3 (27:06):
After you take servado, do you then continue most of
the time to have some kind of management plan. So
it's not like take servado and then like never again.
Speaker 4 (27:15):
Do you have to do anything If a patient meets
remission and they've done a month of you know, so
it's twice weekly for four weeks and then once weekly
for four weeks and they're at remission. I'm not gonna
want to test it much, yeah, because I want them
to have respite, yeah, right, and kind of getting their
(27:37):
sea legs in this new world, because you know, bad
depression is debilitated.
Speaker 5 (27:43):
Yeah.
Speaker 3 (27:44):
And then well you just you'll just monitor them as
that continues to make sure that's still nothing new has
come up.
Speaker 4 (27:50):
Right, and then then consider tit trading down to every
other week. Okay, are you still in remission? You know?
And then I've had clients go every other one and
they've done very well.
Speaker 3 (28:02):
What would you want the mental health community think about,
like therapists, practitioners like yourselves, people getting into the field,
even like texts and that, Look, what would you.
Speaker 5 (28:13):
Want people to know about this treatment?
Speaker 2 (28:16):
It's not as scary as we think, and to see
the improvements. I mean, I tell the story to all
of my clients, you know. I remember I've got a
gentleman that when he came to me, he tried several medicines,
and his PHQ nine, which is the Patient Health Questionnaire
depression screening that we use, he was scoring twenty seven
(28:39):
out of twenty seven, so he was one of the
most severely depressed people that I've ever seen. So I said, okay,
let's try this. You know, there is obviously no guarantee
that this is going to work. Let's try it and see.
We've tried many other things. So we did, and that
was probably two years ago. Today he boosters once a
(29:03):
month and his PHQ nine is four out of twenty seven.
Speaker 4 (29:07):
Which indicates no depression or mild depression.
Speaker 1 (29:10):
Right, that's incredible.
Speaker 3 (29:12):
And when you say he boosters every other month, that
is kind of what Ronda was saying earlier, where you
don't have to then go on another depression medication. You
can just get this medication in lower doses or less frequent.
Speaker 2 (29:27):
Maintain absolutely, and everyone's a booster schedule looks a little
differently typically for our clients for mine that are on
intramuscular and we didn't talk about that. I think we
need to talk about that a little bit. But the
intramuscular injection, our boosters are anywhere from every two weeks
to every six months. So I mean I have people
(29:48):
that come in about every six months and get their booster.
Now that person is taking an oral and adepressant with it,
it is recommended that they take an oral and adepressant
as well.
Speaker 3 (30:00):
So I want to bring this up for a second
because last week I did an episode where somebody wrote
me in an email about some depression and anxiety they
are feeling, and their long story short, their family sent
them to this faith healer wasn't the best experience for them. Yeah,
And they were asking me, like, how do you differentiate
between like something being a battle of good and evil
(30:23):
instead of your body and something being about spirituality and
faith and all of that, and something being like a
chemical imbalance in your body. And the way I approached
the question was inviting in the idea of can't both
of those be things at the same time, Like can't
there be an aspect where faith can help and religion
(30:46):
can help the healing process and can be part of
like let's say it is part of why your brain
isn't working the way. Maybe I don't know what religion
they exactly were, but like let's say Satan came in
and like cut a wire somewhere, you know, Let's say
that is true.
Speaker 1 (31:02):
Can it also be true that there are things.
Speaker 3 (31:05):
In this world that God has allowed people to create
that can help fix that wire right, absolutely, Okay, So
I am a therapist obviously. People that are listening to this,
most of them know that. I have a lot of
clients that come in and I'm their first step towards
healing their depression.
Speaker 1 (31:24):
And I think that's great.
Speaker 3 (31:26):
I think sometimes it's okay to go see somebody for
medication first.
Speaker 1 (31:31):
A lot of times they'll refer to a therapist.
Speaker 3 (31:33):
But one of the conversations I have so often with
clients is, well, like, I want to be able to
do this on my own.
Speaker 1 (31:40):
Isn't there like a.
Speaker 3 (31:41):
Treatment or a certain type of therapy that you can do?
Like what is there out there that I can do
to fix this without that? Because I don't want to
be dependent on this and I don't want to And
that's a tough conversation to have, because, yeah, there are
clients that have healed and work through depression through talk
therapy and experiential things therapy, and there are some that
(32:02):
that's not gonna it's not ever gonna work because of
the chemistry and their brain, and there are things that
can help that. And the long point I'm getting at
here is, especially because we're talking about what we want
the metal, like the mental health world. To know is
that just because we're pulling in this other resource doesn't
(32:24):
make this resource no longer valuable exactly, exactly. That includes
your faith, that includes going on walks, that includes irapy, therapy, everything. Yes,
we have so many things that we're allowed to use together.
And saying hey, I want to try this treatment that
sounds like it could help me doesn't mean that you
have failed it this other thing, and it doesn't mean
(32:45):
it's not valuable.
Speaker 2 (32:47):
Absolutely, It's just another piece of the puzzle.
Speaker 4 (32:49):
Yeah, it's the spoken the wheel of healing, right.
Speaker 3 (32:53):
Yeah, And I I know, and I say this maybe
because like it's something that I had to learn, is
that therapy is always going to be the answer.
Speaker 1 (33:02):
Sometimes it's the answer. A lot of times it's part
of the answer.
Speaker 3 (33:06):
And it's important to be open minded and be curious
and have conversations about these kinds of treatments because if
we just shut all these down because we shouldn't be
using I mean, I remember when there's a lot of
debate around harm reduction in the treatment world.
Speaker 1 (33:22):
I mean, that's always going to be a debate.
Speaker 3 (33:25):
We can shut those conversations down. However, I wonder what
would happen if we opened ourselves up to them, right,
It doesn't mean we're going to be, you know, telling
all of our clients so you can just like smoke
whenever you want to. Like, that doesn't mean what we're saying.
There's so much power in learning something that could be
helpful from being open to the conversation and what I
(33:48):
would want if there's not so much just potential clients
out there and humans and individuals, but mental health professionals
who are like, what kind.
Speaker 1 (33:56):
Of mean you don't have to use it.
Speaker 3 (33:59):
You don't have to to encourage people using it, You
don't have to do any of that. My encouragement is
to just be curious about it and maybe learn about it,
because even through learning about it, you might learn something
about the brain that you didn't now, or something about
these other medications that you've been fine with your whole
life that might shock you.
Speaker 4 (34:18):
Well, Selena and I truly feel, and this is our bias,
that medicine only makes space for the work that's good.
And you know, so we highly encourage therapy, and especially
weekly therapy while they're getting this treatment because of the
neuroplasticity and these neuronal connections they are going to develop
(34:40):
so much more insight.
Speaker 2 (34:42):
Oh yeah, I've had therapists, you know, contact me and
you know, we're collaborating about a client that's going through treatment,
and they're like, oh my goodness, it's like the wall
came down. They were able to drop in and access
places of their trauma or what.
Speaker 3 (35:00):
They're not in that protective mode anymore. And if we
can't get through that protective wall and it's there because
it believes it needs to be there, or it was
put there because it needed to be there at some point,
well then there's not much we can do. So I
love that. Will you say it again that medicine.
Speaker 5 (35:21):
Only makes space for you to jus the work?
Speaker 1 (35:24):
Did you come up with that on your own?
Speaker 4 (35:26):
I think I am regurgitating information from a former psychiatrist
that I.
Speaker 5 (35:33):
Used to work with.
Speaker 1 (35:34):
Any of those things that stick with you.
Speaker 4 (35:36):
Who is he comes out quite frequently and too, I
have that most respect for.
Speaker 3 (35:42):
There are two quotes that one of my bosses that
that treatment center said to me that I find myself.
Speaker 1 (35:47):
Saying over and over and over again.
Speaker 3 (35:49):
One of them is, this is when I was very
worried about what my clients thought about me. Was what
other people think of you as none of your business
that was so powerful as a therapist. And then the
other is, which you'll get this why she had to
say this so often, but other people's chaos is not
your emergency? Yes, yes, because everything at that place. I
was like, oh, there's another fire I have to put out,
(36:12):
And she's like, why you don't let them sit in
that they'll figure it out. So that's funny that it's
the things that stick. Okay, is there anything that we
haven't said that you would want to offer to somebody
who might be experiencing treatment resistant depression? Who's like, wait,
I've never heard of about this? Is this is new?
Speaker 1 (36:31):
And I am getting a little curious just that.
Speaker 2 (36:34):
I mean, by no means is it an end all
be all? You're all you know, it is again another
tool in the toolbox, but we have experienced the goodness
from it.
Speaker 4 (36:48):
Our clients should have. I mean, to see the face
of someone with a pH Q nine of twenty six
out of twenty seven, or twenty seven out of twenty seven,
you know, it's a different person it is to see,
to see their face shift in two weeks to the
he's a musician that would not pick up the guitar
and is now playing. You know, It's it's unreal to
(37:11):
see and also to see the progress they make with
their therapists and the insight that they develop and the
life they get back. I have the sweetest client that
another psychiatric provider referred for treatment and every time he
comes to these I've got to give you a hug.
You have changed my life so much. I want people
to have hope.
Speaker 1 (37:31):
And that's another thing.
Speaker 2 (37:32):
Like other providers can refer to us just for an
catamaine evaluation and stay with.
Speaker 5 (37:40):
Their current writer and we collaborate with them.
Speaker 1 (37:43):
Okay, you don't have to leave your your home banks,
absolutely no.
Speaker 3 (37:46):
No. I really scary when you find somebody that you
trust and value.
Speaker 4 (37:50):
Right, So, any psychiatric provider can refer to us and
will ask for a release of information, will ask for
a release of information from their medical provider, so we
can all be on the same page general release for
their therapist because we want to collaborate with them too,
and we could see if it would be a good
fit for them. There is a time commitment that I
(38:11):
think they need to understand. It's twice a week for
three weeks with kenemine and they can't drive. So that's
for people that most of us that have to work
and most of us that.
Speaker 5 (38:23):
Have life that's hard.
Speaker 1 (38:25):
Yeah.
Speaker 4 (38:25):
And with spravado it's twice a week for four weeks
and then once a week thereafter.
Speaker 1 (38:30):
Okay.
Speaker 3 (38:31):
So before we close this because I just want to
clarify this because I don't know if I even heard
this correct. Spervado is FDA approved for the treatment of depression?
Is there another form of this that is used that's
not FDA approved or is there another FDA approved form
of this?
Speaker 4 (38:49):
Ketamine was approved FDA approved a long time ago, and
so it's used off label for the treatment of treatment
resistant depression, okay, And it will never for ketemine itself
will never be submitted for reapproval for treatment resistant depression, okay,
because it was.
Speaker 2 (39:08):
Originally proved for or as an anesthetic.
Speaker 1 (39:12):
Okay.
Speaker 3 (39:13):
I'm learning about the medication world, okay, because sravado was
a little bit different. They you said, they changed one thing, yep,
and then now it's the asketamine asketamine Okay, So that's
why that is like a new approved thing. Yes, So
ketamine got FDA approved for the use of.
Speaker 5 (39:30):
Being an anesthetic as an anesthetic.
Speaker 3 (39:32):
And because it's FDA approved, we can prescribe it for
other things.
Speaker 4 (39:37):
Many drugs are prescribed off flabel.
Speaker 1 (39:39):
Okay, I didn't know that.
Speaker 5 (39:40):
Yeah, but it's.
Speaker 4 (39:41):
Really important to know. I mean that spravado would never
be here without ketymine being here first.
Speaker 1 (39:48):
Okay. Well that's helpful.
Speaker 3 (39:50):
Yeah, we saw that, and then that was created outside
of Okay, all right, well it sounds like there are
some options out there for you guys. And you do
SPAVI and the other form can other forms, yes, okay,
and that.
Speaker 1 (40:04):
Is an Is that an injection? It is? Okay, do
you have a preference or does it depend on the client.
Speaker 5 (40:10):
So it depends on the client.
Speaker 2 (40:11):
I mean the buy availability of the medication is higher
getting an injection, but I think we see just as
good of results okay in the nasal spray.
Speaker 5 (40:21):
It just takes a little longer to get there.
Speaker 3 (40:22):
Oh okay, cool, all right, Well, thank you for having
this conversation with me.
Speaker 5 (40:27):
Thank you, Thank you, Bully.
Speaker 1 (40:29):
It offered some new information.
Speaker 3 (40:31):
I have an assumption that a lot of people are
gonna be like what and some people are gonna be like, oh, yeah,
I've heard about this, and I turned that conversation away
and some people are gonna probably be thinking, I've been
wanting to learn about this, So we're gonna have a
lot of different opinions. If you have any questions, If
you're listening to this and you have any questions, feedback, anything,
you can email Katherine at nied Therapy podcast dot com.
(40:54):
Do you have questions for Selena and Ronda, you can
actually send those there And if it's a question that
we can answer on one of the Wednesday Couch Talks episodes,
we might be able to do that as well. If
you just want to contact them, Where can they find you? Guys?
Speaker 2 (41:10):
So our phone number is six one five eight six
one one one one four and our website is Willow's
healthandrecovery dot com.
Speaker 3 (41:17):
If you want to find me, you can do that
on Instagram at you Need Therapy Podcasts and at Kat
dot Defada. And until Wednesday, I hope you guys are
having the day you need to have and I'll talk
to you later.
Coming up on you need therapy.
Speaker 2 (00:02):
I've got a gentleman that when he came to me,
he tried several medicines, and his PHQ nine, which is
the Patient Health Questionnaire depression screening that we use, he
was scoring twenty seven out of twenty seven. So he
was one of the most severely depressed people that I've
ever seen. So I said, okay, let's try this. That
(00:26):
was probably two years ago. Today he boosters once a
month and his PHQ nine is four out of twenty seven,
which indicates no depression or mild depression.
Speaker 3 (00:38):
I started to realize that not being an expert isn't
a liability, it's a real gift.
Speaker 4 (00:44):
If we don't know something about ourselves at this point
in our life, it's probably because it's uncomfortable to know.
If you can die before you die, then you can
really live. There's a wisdom at death's door.
Speaker 5 (00:57):
I thought it was insane. Yeah, I know what to
do because there's no Internet.
Speaker 3 (01:02):
I don't know, man, I'm like, I feel like everything
is hard.
Speaker 1 (01:08):
Hey, y'all, my name is Kat.
Speaker 3 (01:10):
I'm a human first and a licensed therapist second, and
right now I'm inviting you into conversations that I hope
encourage you to become more curious and less judgmental about yourself, others,
and the world around you.
Speaker 1 (01:24):
Welcome to You Need Therapy.
Speaker 3 (01:27):
Hi guys, and welcome to a new episode of You
Need Therapy podcast. My name is kat I am the host,
and quick reminder before we get into everything today that
this podcast does not serve as a replacement or a
substitute for any actual mental health services, and it also
does not serve as any form of actual medical advice.
(01:50):
And that is especially important for me to say today
because today I have two people that I actually met
when I started working in a treatment center as an
intern and now actually refer a lot of my clients to.
Their names are Selena and Ronda. And Selena is a
Board certified family nurse practitioner that specializes in mental health,
(02:13):
and Ronda is a Board certified psychiatric mental health nurse practitioner,
and both of them have been really helpful to me
personally and with clients. And I asked them to come
talk today on the podcast because there is this thing
that is becoming more and more prominent. You might not
(02:36):
have heard of it. You might have heard of it,
you might have kind of caught a glimpse of somebody
talking about it, and that is using ketamine as treatment
for treatment resistant depression. So this is one of those things.
When I first heard it, I was like, whoa, whoa, whoa,
Like stop signing, there's no way that we're doing this.
This seems wrong. However, the more I learned and the
(02:58):
more I actually listened to some of the research, some
of what Rond and Selena were saying, and some of
just like the conversations around this, the more open I
became to this idea. So I asked them to come
talk about it, because it's one of those things where
it can be you know, put up the red flag
like I did at first, or it can be actually
really helpful to certain people. And I think it is
(03:21):
personally my job to stay up to date and educate
it and continue to listen to what new stuff is
coming out that we might want to let our clients
know about or just be aware of.
Speaker 1 (03:32):
And so I wanted to have that.
Speaker 3 (03:33):
Conversation today to maybe just give some information to you
guys who might not have ever heard about this being
used for depression and treatment, and some people that might
be interested in it, and some people who might be like, yeah,
that's not for me. We're just going to give you
some education, some information, so then you can actually decide
(03:54):
is this something that you would be open to, whether
or not it's you're somebody who has experienced treatment, resists
and depression, or maybe you're somebody who works with people
who have. So that's what we did today. We just
had a conversation. I asked some pretty basic questions. We
didn't get into too deep of the nitty gritty that
kind of like loses us when we're like, what actually
are we talking about. We just talked about the basics
(04:16):
of what this is, why people are using it, and
where it came from, why we even started using it.
So thank you very much to Ronda and Sulina for
having this conversation and for being people who have been
open to new advances in mental health treatment.
Speaker 1 (04:32):
Now.
Speaker 3 (04:32):
Ronda and Sulina both are the owners of the Willows
Health and Recovery which is located in Nashville, Tennessee. It's
actually very close to my office, so if you are
wanting to know more about them or want to learn
more about this, you can find them there Willow's Health
and Recovery dot Com. I will put that also in
the show notes. So I think it's about that time.
(04:53):
Let's get into my conversation with Selena and Ronda. Okay, guys,
I am here with two past colleagues, Ronda and Selena,
who I met probably in twenty thirteen, and we are
going to be talking about something that is somewhat sensitive,
might be a little well, it might be new for
(05:14):
a lot of you, and something that I've wanted to
talk about for a while, just myself professionally to learn
more about it, but also on the podcast to just
bring up some awareness and have a conversation about something
that might be controversial for some. And before we do that,
I want you guys to hear a little bit about
where Ronda and Selena come from, what has brought them
(05:37):
to what they are doing now, and why you should
even care about anything they say. So who wants to start?
Speaker 1 (05:45):
Ronda?
Speaker 4 (05:46):
I graduated from Vanderbilt in twenty thirteen, and I had
spent a year working at a residential treatment center here
in Tennessee as an intern, and then I was offered
a position. So basically, my first love from a clinical standpoint,
has always been working with those suffering from addiction. So
(06:08):
now been in the field for ten years and still
board certified as a psychiatric mental health nurse practitioner. And
I met Selena at that same residential treatment center where
we met you.
Speaker 3 (06:20):
And I should say this now if you guys didn't
catch it in the intro, that RNDA and Selena actually
worked together. Now, so you guys met there and became
friends enough to the point where you want to keep
working together outside, and now they have their own would
you close a practice? Yes? Okay, practice very close to
where my office is in Nashville. So Selena, tell us where.
Speaker 5 (06:44):
You came from.
Speaker 2 (06:45):
I came from South Mississippi. So I actually started working
in mental health at age eighteen as a tech at
a psychiatric hospital and worked my way. I went to
nursing school, became a nurse, and then in twenty fourteen,
became a nurse practitioner. So I've been working in and
out of mental health and addiction since I was eighteen
(07:07):
years old.
Speaker 3 (07:08):
What made you want to work at eighteen in the
psychiatric hospital.
Speaker 2 (07:13):
The truth is that my aunt worked in human resources
at a hospital, and my mother told my aunt to
find me a job.
Speaker 3 (07:22):
So was that a fun experience? So it was, and
it also really a weird word to say, but exciting,
sometimes hard, challenging.
Speaker 5 (07:33):
Yes, it was.
Speaker 2 (07:34):
And actually I helped open an adolescent child unit, so
right after I started working there, I worked there about
a year and then helped open that unit, and then
later became the nurse manager of that unit after I
became a nurse.
Speaker 1 (07:47):
And it was one of.
Speaker 2 (07:49):
Those things that I guess was led me to where
I am today. It made me look at myself and
look at my issues and my past trauma that had
i'd always just been squashed, you know, So it really
gave me a glimpse that people can heal.
Speaker 3 (08:07):
It makes you look at I don't know how to
say this in the right way, but I think working
in a space like a psychiatric hospital or a residential
treatment center, we're seeing things that are in the world
out there looked at as bad or like evil or
(08:27):
I mean any of those just like icky stigma thoughts.
Then you get to work and one of those places
and you then you're like, wait, these are people and
we actually can help them. And it almost might be
a weird word to use, but it almost is addicting
to get into this field because then you see how
much it's very hard and can be very taxing, but
(08:49):
then you see like, oh my gosh, there's so much
good that you want to be able to spread from
absolutely changing your own mindset.
Speaker 1 (08:59):
So when you started, you had an internship.
Speaker 5 (09:02):
This is also very similar human resources.
Speaker 4 (09:06):
No, No, but I worked at Vanderbilt for twenty years
before I went to graduate school, and it was through
trials and tribulations in life that led me to say,
I want to help other people get out of the
way of themselves. And I enrolled in Vanderbilt, got accepted.
(09:28):
Probably Yeah, I'm like, yeah, it's just because I was
an employee, right, But they sent me to the ranch.
Oh as for my internship, and I didn't know about
the ranch. I didn't know anything about psychiatry or addiction
treatment or anything. Before I was I worked in critical care.
Speaker 1 (09:50):
Okay, yeah, so big shift. Isn't that funny? How like
life just like does that for you?
Speaker 5 (09:57):
Absolutely, it is a little.
Speaker 3 (09:58):
Lesson on how we don don't need to be in
control so often.
Speaker 5 (10:01):
No, And I tell my kids that all the time.
Speaker 2 (10:04):
Yeah, at eighteen, I never would have solved that I
would be here.
Speaker 5 (10:09):
Yeah, that was certainly not my plan.
Speaker 3 (10:11):
Yeah, you know what. Actually, my plan when I went
to college was to be a nurse. And then I
got to college, I took one anatomy class and I said,
this is not for me, and I got.
Speaker 1 (10:20):
Out of there.
Speaker 3 (10:22):
Okay, so today what we are going to talk about,
and again, I want you guys to listen to this
episode as a step. This is like one step to
a whole world of information. So I want you to
take whatever you're hearing not as like gold and truth
(10:44):
and God's word. I want you to take this as
something that might help you become more curious and open
to a new type of treatment that I find very interesting,
and I honestly don't know that much about it.
Speaker 1 (10:57):
So that's one of the reasons, like I said, I
want to have this conversation.
Speaker 3 (11:00):
So we're talking about ketamine, which I will tell you
I have a little bit of information of how this
is not what I used to think it was. But
when I think of ketamine, I just think of like
really intense street drug.
Speaker 1 (11:14):
What is it special? Okay, Okay, it sounds scary to me.
Speaker 3 (11:17):
So I want you guys to in the simplest way
you can explain, Okay, what is ketamine? How is it
more than just this drug that we might have heard
about in their class and fifth grade In the simplest
(11:38):
way you can explain, Okay, what is ketamine? How is
it more than just this drug that we might have
heard about in class and fifth grade.
Speaker 4 (11:46):
Well, kenymine was first synthesized in the nineteen sixties and
it was used for humans and animals as an anesthetic,
and it's made it popular choice for surgical procedures because
it's so dissociated in nature that people can it's not
really a pain medicine, but they can tolerate, let's say,
(12:07):
alone bar puncture, or they can tolerate if they dislocated
their shoulder that being put back into place. And the doses,
of course for an anesthetic are way higher than they
are to treat depression. And it wasn't until really the
early two thousands when there were several psychiatrists, one being
(12:30):
doctor Ceven Levine from New Jersey Princeton, New Jersey, who
had evaluated a client and really went into great depth
in detail to find out and no medicine had ever
worked except for this one time when they were on
a certain cough medicine, so that got his brain really
(12:51):
looking like, oh my gosh, is this about a certain
receptor in the brain that that cough medicine was targeting,
and that he was really revolutionary and one of the
psychiatrists that started doing a lot of research and actually
established ketymine options there with.
Speaker 1 (13:12):
The cough medicine that was there.
Speaker 3 (13:14):
Wasn't ketymine and a cough medicine, they were just looking
at a receptor that both of those maybe active drugs attacked.
Speaker 1 (13:22):
Okay, that's fascinating.
Speaker 3 (13:24):
And what I want people to know when listening to this,
we're talking about ketamine as a treatment for depression, right.
Speaker 5 (13:35):
Right, treatment resistant depression.
Speaker 3 (13:36):
Okay, so what is treatment resistant depression?
Speaker 1 (13:40):
How is that?
Speaker 3 (13:40):
What does that mean compared to like, is that like
the diagnosis you give them, compared to major depressive disorder?
Is that just a type? What does that mean?
Speaker 2 (13:48):
So typically people have a major depressive disorder diagnosis, but
when they come see us, they will do full psychiatric
evaluation and look at their medical history as well. But
as far as treatment resistant goes, really you only need
two of the traditional medication failures of the oral antidepressants,
(14:10):
and those are your typically your SSRIs SNRIs, like your
pro likes a pro well beuchure and effects ers, those
kind of things. So really you just need to fail
two of those type of medications to be considered treatment resistant.
Speaker 1 (14:26):
That feels a little common.
Speaker 3 (14:29):
Absolutely, absolutely do you find it frustrating for clients, Like,
what's your experience with a client who's coming to see
you for medication and medication management?
Speaker 1 (14:40):
And I know.
Speaker 3 (14:41):
From my little experience with some of that with my
clients that sometimes it takes a while to figure out
what's going to work. So how do you differentiate between
it's going to take a while for us to figure
out what's going to work in the dosage and when
like this just isn't working.
Speaker 4 (14:58):
Many times, So a lot of the clients that come
to see us, they've got a list of mile long,
or they haven't had genetic testing, or you know, because oh,
my primary care physician has been managing it, and then
before that I saw I saw this person, I can't
remember their name, you know.
Speaker 5 (15:15):
So usually by the.
Speaker 4 (15:18):
Time they get to see us, you see like failures
with SSRIs or SNRIs and they haven't completed genetic testing,
which can help us learn how they metabolize medicines and
better medicines.
Speaker 5 (15:29):
For their body.
Speaker 3 (15:30):
Could you say more about that? Yeah, So what is
genetic testing in the form you're talking about.
Speaker 4 (15:37):
It's the mouse swap and we can do it here
in the office. We can send it to their home
and they can complete it and then ship it back
and we learn several things. We learn most importantly for me, Selena,
and I don't know how you consider this, but for me,
it is how you metabolize medicines based on your genetics,
because you could be a rapid metabolizer of multiple say ssries,
(16:02):
So it's going to take a higher dose to reach
therapeutic effect. And so that's I think so helpful to
know that, and that's going to always be my first option. Like,
let's look at this, but if somebody is acutely depressed
and or suicidal, I might forego that and recommend kedemye.
Speaker 3 (16:25):
Okay, so let's switch to what got you guys into
being interested in using this.
Speaker 2 (16:34):
I think for me it was seeing so many people
just come to me and be kind of at the
end of their rope, meaning that they have tried so
many medications in the past and nothing work, or it
works for a little while and then it stops, and
then you know, before they know it, they're on three
and four medications and still just not feeling well. We
(16:58):
had seen it used at the residential treatment center that
we were at before and saw really good results. And
then I also have collaborated with another physician in town
that provides ketamine and have heard, you know, his stories
of success of how well people do with it, and
(17:21):
Spravado had came out, which we can talk about that,
and really we just wanted to find a way to
think outside of the box.
Speaker 3 (17:30):
To better options here. Yes, do you remember your initial
thoughts when you first were introduced to it.
Speaker 4 (17:39):
I couldn't believe our medical director was going to do it.
I'm like, oh my god.
Speaker 1 (17:43):
I remember.
Speaker 3 (17:44):
I think we were probably all there at the same time.
I remember when we were at the treatment center we
had this meeting. I'm pretty sure I was the intern
at the time. I went with my supervisor and she
was already like kind of I can't believe this is what.
Speaker 1 (17:58):
Are we going to this meeting for?
Speaker 3 (18:00):
And then I just remember I think I took on
her anger, yeah, because I didn't know what to think,
because I'm like teacher, you whatever, But there was a
sense of wait, what we're using this drug that people
abuse in the world out there, we're going to get
then give it to them for medicine, and I didn't
have an understanding of medicine and the fact that like
(18:23):
that sometimes it's actually very common. But I remember just
being shocked and also feeling very resistant and also wanting
to not like it felt like a secret, almost like
I don't want people to know I would be doing
this or encouraging this.
Speaker 2 (18:40):
And I get that, and I think I felt a
lot of the same way when when we started using
it at the treatment center. However, since then we have
learned that after our own education, is that the dosing
that we use in our office for treatment resistant depression
is there's nothing like that I'm seeing that people are
(19:02):
taking on the street. Obviously it is under a controlled
setting here in our office, so there's really not an
abuse potential from that. By the time they leave our office,
the medicine has cleared their system.
Speaker 3 (19:15):
When I think it's important to have our beliefs in
our understandings and we're all gonna have a little bias
in everything that we.
Speaker 1 (19:25):
Do, but also remain open.
Speaker 3 (19:28):
Because if I was as closed off as I was
when I was twenty three, and I was like, I'm
so smart.
Speaker 1 (19:34):
It sounds like a lot of your clients would miss.
Speaker 3 (19:37):
Out on an opportunity to actually find something that works
for them. Can you explain what this does? How does
this work? What's the process of people? You mentioned people
are in your office when they're doing this. It's it's
not something you get prescribed and you go take it
at home.
Speaker 1 (19:58):
We do not do that. Yeah, a thing that happens.
Speaker 2 (20:01):
It can be prescribed orally as a sublingual tablet or
a tablet that you swallow, but we don't offer that
in our office.
Speaker 4 (20:10):
And it's not very effective. Oh because of the worl
route by. Availability of the drug is just not there. Okay,
So there's some clinics that are all on Facebook that
are I think I'm not going to mention it, but
that are offering this in home treatment with ketamine, and
(20:31):
I just would urge people to get Yeah.
Speaker 2 (20:35):
And I actually had a client that tried it and
then she came back and she was like, that didn't
that didn't help.
Speaker 3 (20:40):
And that can be a little bit disheartening and discouraging
too for somebody who's like this is my last effort.
Speaker 1 (20:46):
Maybe sometimes what they feel. So can you talk about really.
Speaker 3 (20:50):
What that is doing, Like what is that compared to
like an ssri ketamine.
Speaker 4 (20:55):
You know, there's been a lot of research on well
how does this work and what they've really focused on
the NMDA receptor in the brain, and this the theory
because we don't know truly what causes depression. We don't know.
One theory is that due to inflammation, if there are
(21:18):
areas of the brain that are just kind of they're
not working anymore. So this ketamine comes in and really
targets that receptor and kind of opens those pathways back
up and really kind of creates more neural connections. And
neuroplasticity is a big word we're using these days, and
(21:41):
it can have a really rapid onset, whereas oral antidepressence
can take five six weeks to even show a slight
bit of efficacy. Some people may feel a little bit
better after the first treatment, usually by treatment for it's
pretty significant difference in and they're scoring of their depression.
Speaker 3 (22:02):
Levels even after this drug is no longer in their system. Yeah,
so I'm going to repeat this back just to summarize,
make sure I'm hearing the correct thing. So this is
a drug that when it's active, it changes you say, neuroplasticity.
It actually changes and allows the brain to kind of
(22:24):
like rewire itself and open up long term and maintain
that versus another medication that might just be taken long
term is doing that kind of like every single time
you take it.
Speaker 1 (22:39):
Does that make sense?
Speaker 3 (22:40):
Yes, And I just think that's over and over to
get that same result versus this actually changes the chemistry
of your brain kind of.
Speaker 2 (22:48):
I will say that the oral anidepressants are acting on
the neurotransmitters serotonin orpanifferent diepamine. This is acting on the
glutamate system of our brain. So actually then we get
we get communication between the two systems in our brain.
Speaker 4 (23:03):
Okay, And on top of that, they've only really done
research on the NMDA receptor, but ketamine hits so many
more neurotransmitters. It hits opioid, the mute opioid receptor, the
serotonin nor ep from dopamine transporter, dopamine IWI transporter. You
think about a broad spectrum antibiotic that really goes in
(23:24):
and just we're gonna kill this infection. You know, this
to me is a broad spectrum antidepressant.
Speaker 3 (23:31):
Versus targeting one thing, correct, right, but we only have
research on the one thing right now.
Speaker 4 (23:35):
Well there's limited rears.
Speaker 3 (23:37):
Yeah, okay, So Selena, you mentioned Spervado can you talk.
Speaker 1 (23:43):
About what that is?
Speaker 5 (23:45):
Sure?
Speaker 2 (23:45):
Spervado is the FDA approved version of ketamine that chants
and pharmaceuticals came up with. They changed like one isomer
of ketamine to make esketamine under a trade name Spravado
and got it FDA approved for treatment resistant depression as
well as acute suicidal idiations. So with that, you have
(24:09):
to be a RAMS provider, which is a risk evaluation
and mitigation strategy.
Speaker 1 (24:16):
Is that something you have to get.
Speaker 2 (24:18):
You have to be approved okay for that, And we
did get approval for that, and we are a RAM
certified Spravado treatment center here.
Speaker 5 (24:27):
And we offer it.
Speaker 2 (24:29):
It's Spravado is a nasal spray and it's administered twice
weekly for four weeks and then once weekly for four
weeks and then booster as needed.
Speaker 3 (24:38):
And they'll come into your office get that and then
stay here.
Speaker 5 (24:42):
Yes, they're here for two hours.
Speaker 1 (24:43):
Okay, and they're being monitored.
Speaker 2 (24:45):
Yes, and are not allowed to drive home, so they'll
have to have a driver or a ride share.
Speaker 3 (24:50):
Okay, what is the conversation like when you have a
client who comes in and maybe has tried a lot
of stuff already, so it's like you don't even have
to go through that and you see their intake form
and you see all their medication history. What's the conversation
like for you inviting them into trying this?
Speaker 1 (25:10):
Well?
Speaker 4 (25:10):
I think depending upon their you know, you're also going
to evaluate your medical history. Ketymine and Spravado can transiently
increase blood pressure, and so for spravado and ketymine. But
as you know, a certified rooms treatment center, if a
client has any aneurysmal disease so that's disease of the
(25:31):
vessels or hypertension that's not well controlled, that would be
a contraindication for treatment. So we take the whole client
and where they are, and you know, ask them what
their goals are because we're here to support them and
reaching what they want.
Speaker 3 (25:49):
Do you get pushback from clients? Are you seeing pushback
of like, oh no, I don't want to do that,
or do you find that that it kind of offers
them some hope when they feel defeated.
Speaker 2 (26:00):
I think it absolutely offers hope. I mean, I think
some people have a little reservation because they feel maybe
like it's a last ditch effort.
Speaker 5 (26:11):
You know, it doesn't work, then what a way, right?
Speaker 2 (26:14):
But I try to reframe that with them and say,
but this is something that we can have hope for.
I have seen it work in my office in my practice,
So just trying to reframe it to that.
Speaker 4 (26:27):
Is seventy percent remission rates. That's what the data is
showing with spravado and with ketamine.
Speaker 3 (26:36):
I mean, do we have research on what that is
compared to like prozac.
Speaker 4 (26:40):
Well, if prozac is better than placebo at treating depression,
it is FDA approved and that's what it's not. Yes,
that's what it's evaluated. When you do blind you know,
double blind placebo control trials, they're evaluating it with placebo.
Well that's interesting and place ebo strong. But it's important
(27:05):
to know that.
Speaker 3 (27:06):
After you take servado, do you then continue most of
the time to have some kind of management plan. So
it's not like take servado and then like never again.
Speaker 4 (27:15):
Do you have to do anything If a patient meets
remission and they've done a month of you know, so
it's twice weekly for four weeks and then once weekly
for four weeks and they're at remission. I'm not gonna
want to test it much, yeah, because I want them
to have respite, yeah, right, and kind of getting their
(27:37):
sea legs in this new world, because you know, bad
depression is debilitated.
Speaker 5 (27:43):
Yeah.
Speaker 3 (27:44):
And then well you just you'll just monitor them as
that continues to make sure that's still nothing new has
come up.
Speaker 4 (27:50):
Right, and then then consider tit trading down to every
other week. Okay, are you still in remission? You know?
And then I've had clients go every other one and
they've done very well.
Speaker 3 (28:02):
What would you want the mental health community think about,
like therapists, practitioners like yourselves, people getting into the field,
even like texts and that, Look, what would you.
Speaker 5 (28:13):
Want people to know about this treatment?
Speaker 2 (28:16):
It's not as scary as we think, and to see
the improvements. I mean, I tell the story to all
of my clients, you know. I remember I've got a
gentleman that when he came to me, he tried several medicines,
and his PHQ nine, which is the Patient Health Questionnaire
depression screening that we use, he was scoring twenty seven
(28:39):
out of twenty seven, so he was one of the
most severely depressed people that I've ever seen. So I said, okay,
let's try this. You know, there is obviously no guarantee
that this is going to work. Let's try it and see.
We've tried many other things. So we did, and that
was probably two years ago. Today he boosters once a
(29:03):
month and his PHQ nine is four out of twenty seven.
Speaker 4 (29:07):
Which indicates no depression or mild depression.
Speaker 1 (29:10):
Right, that's incredible.
Speaker 3 (29:12):
And when you say he boosters every other month, that
is kind of what Ronda was saying earlier, where you
don't have to then go on another depression medication. You
can just get this medication in lower doses or less frequent.
Speaker 2 (29:27):
Maintain absolutely, and everyone's a booster schedule looks a little
differently typically for our clients for mine that are on
intramuscular and we didn't talk about that. I think we
need to talk about that a little bit. But the
intramuscular injection, our boosters are anywhere from every two weeks
to every six months. So I mean I have people
(29:48):
that come in about every six months and get their booster.
Now that person is taking an oral and adepressant with it,
it is recommended that they take an oral and adepressant
as well.
Speaker 3 (30:00):
So I want to bring this up for a second
because last week I did an episode where somebody wrote
me in an email about some depression and anxiety they
are feeling, and their long story short, their family sent
them to this faith healer wasn't the best experience for them. Yeah,
And they were asking me, like, how do you differentiate
between like something being a battle of good and evil
(30:23):
instead of your body and something being about spirituality and
faith and all of that, and something being like a
chemical imbalance in your body. And the way I approached
the question was inviting in the idea of can't both
of those be things at the same time, Like can't
there be an aspect where faith can help and religion
(30:46):
can help the healing process and can be part of
like let's say it is part of why your brain
isn't working the way. Maybe I don't know what religion
they exactly were, but like let's say Satan came in
and like cut a wire somewhere, you know, Let's say
that is true.
Speaker 1 (31:02):
Can it also be true that there are things.
Speaker 3 (31:05):
In this world that God has allowed people to create
that can help fix that wire right, absolutely, Okay, So
I am a therapist obviously. People that are listening to this,
most of them know that. I have a lot of
clients that come in and I'm their first step towards
healing their depression.
Speaker 1 (31:24):
And I think that's great.
Speaker 3 (31:26):
I think sometimes it's okay to go see somebody for
medication first.
Speaker 1 (31:31):
A lot of times they'll refer to a therapist.
Speaker 3 (31:33):
But one of the conversations I have so often with
clients is, well, like, I want to be able to
do this on my own.
Speaker 1 (31:40):
Isn't there like a.
Speaker 3 (31:41):
Treatment or a certain type of therapy that you can do?
Like what is there out there that I can do
to fix this without that? Because I don't want to
be dependent on this and I don't want to And
that's a tough conversation to have, because, yeah, there are
clients that have healed and work through depression through talk
therapy and experiential things therapy, and there are some that
(32:02):
that's not gonna it's not ever gonna work because of
the chemistry and their brain, and there are things that
can help that. And the long point I'm getting at
here is, especially because we're talking about what we want
the metal, like the mental health world. To know is
that just because we're pulling in this other resource doesn't
(32:24):
make this resource no longer valuable exactly, exactly. That includes
your faith, that includes going on walks, that includes irapy, therapy, everything. Yes,
we have so many things that we're allowed to use together.
And saying hey, I want to try this treatment that
sounds like it could help me doesn't mean that you
have failed it this other thing, and it doesn't mean
(32:45):
it's not valuable.
Speaker 2 (32:47):
Absolutely, It's just another piece of the puzzle.
Speaker 4 (32:49):
Yeah, it's the spoken the wheel of healing, right.
Speaker 3 (32:53):
Yeah, And I I know, and I say this maybe
because like it's something that I had to learn, is
that therapy is always going to be the answer.
Speaker 1 (33:02):
Sometimes it's the answer. A lot of times it's part
of the answer.
Speaker 3 (33:06):
And it's important to be open minded and be curious
and have conversations about these kinds of treatments because if
we just shut all these down because we shouldn't be
using I mean, I remember when there's a lot of
debate around harm reduction in the treatment world.
Speaker 1 (33:22):
I mean, that's always going to be a debate.
Speaker 3 (33:25):
We can shut those conversations down. However, I wonder what
would happen if we opened ourselves up to them, right,
It doesn't mean we're going to be, you know, telling
all of our clients so you can just like smoke
whenever you want to. Like, that doesn't mean what we're saying.
There's so much power in learning something that could be
helpful from being open to the conversation and what I
(33:48):
would want if there's not so much just potential clients
out there and humans and individuals, but mental health professionals
who are like, what kind.
Speaker 1 (33:56):
Of mean you don't have to use it.
Speaker 3 (33:59):
You don't have to to encourage people using it, You
don't have to do any of that. My encouragement is
to just be curious about it and maybe learn about it,
because even through learning about it, you might learn something
about the brain that you didn't now, or something about
these other medications that you've been fine with your whole
life that might shock you.
Speaker 4 (34:18):
Well, Selena and I truly feel, and this is our bias,
that medicine only makes space for the work that's good.
And you know, so we highly encourage therapy, and especially
weekly therapy while they're getting this treatment because of the
neuroplasticity and these neuronal connections they are going to develop
(34:40):
so much more insight.
Speaker 2 (34:42):
Oh yeah, I've had therapists, you know, contact me and
you know, we're collaborating about a client that's going through treatment,
and they're like, oh my goodness, it's like the wall
came down. They were able to drop in and access
places of their trauma or what.
Speaker 3 (35:00):
They're not in that protective mode anymore. And if we
can't get through that protective wall and it's there because
it believes it needs to be there, or it was
put there because it needed to be there at some point,
well then there's not much we can do. So I
love that. Will you say it again that medicine.
Speaker 5 (35:21):
Only makes space for you to jus the work?
Speaker 1 (35:24):
Did you come up with that on your own?
Speaker 4 (35:26):
I think I am regurgitating information from a former psychiatrist
that I.
Speaker 5 (35:33):
Used to work with.
Speaker 1 (35:34):
Any of those things that stick with you.
Speaker 4 (35:36):
Who is he comes out quite frequently and too, I
have that most respect for.
Speaker 3 (35:42):
There are two quotes that one of my bosses that
that treatment center said to me that I find myself.
Speaker 1 (35:47):
Saying over and over and over again.
Speaker 3 (35:49):
One of them is, this is when I was very
worried about what my clients thought about me. Was what
other people think of you as none of your business
that was so powerful as a therapist. And then the
other is, which you'll get this why she had to
say this so often, but other people's chaos is not
your emergency? Yes, yes, because everything at that place. I
was like, oh, there's another fire I have to put out,
(36:12):
And she's like, why you don't let them sit in
that they'll figure it out. So that's funny that it's
the things that stick. Okay, is there anything that we
haven't said that you would want to offer to somebody
who might be experiencing treatment resistant depression? Who's like, wait,
I've never heard of about this? Is this is new?
Speaker 1 (36:31):
And I am getting a little curious just that.
Speaker 2 (36:34):
I mean, by no means is it an end all
be all? You're all you know, it is again another
tool in the toolbox, but we have experienced the goodness
from it.
Speaker 4 (36:48):
Our clients should have. I mean, to see the face
of someone with a pH Q nine of twenty six
out of twenty seven, or twenty seven out of twenty seven,
you know, it's a different person it is to see,
to see their face shift in two weeks to the
he's a musician that would not pick up the guitar
and is now playing. You know, It's it's unreal to
(37:11):
see and also to see the progress they make with
their therapists and the insight that they develop and the
life they get back. I have the sweetest client that
another psychiatric provider referred for treatment and every time he
comes to these I've got to give you a hug.
You have changed my life so much. I want people
to have hope.
Speaker 1 (37:31):
And that's another thing.
Speaker 2 (37:32):
Like other providers can refer to us just for an
catamaine evaluation and stay with.
Speaker 5 (37:40):
Their current writer and we collaborate with them.
Speaker 1 (37:43):
Okay, you don't have to leave your your home banks,
absolutely no.
Speaker 3 (37:46):
No. I really scary when you find somebody that you
trust and value.
Speaker 4 (37:50):
Right, So, any psychiatric provider can refer to us and
will ask for a release of information, will ask for
a release of information from their medical provider, so we
can all be on the same page general release for
their therapist because we want to collaborate with them too,
and we could see if it would be a good
fit for them. There is a time commitment that I
(38:11):
think they need to understand. It's twice a week for
three weeks with kenemine and they can't drive. So that's
for people that most of us that have to work
and most of us that.
Speaker 5 (38:23):
Have life that's hard.
Speaker 1 (38:25):
Yeah.
Speaker 4 (38:25):
And with spravado it's twice a week for four weeks
and then once a week thereafter.
Speaker 1 (38:30):
Okay.
Speaker 3 (38:31):
So before we close this because I just want to
clarify this because I don't know if I even heard
this correct. Spervado is FDA approved for the treatment of depression?
Is there another form of this that is used that's
not FDA approved or is there another FDA approved form
of this?
Speaker 4 (38:49):
Ketamine was approved FDA approved a long time ago, and
so it's used off label for the treatment of treatment
resistant depression, okay, And it will never for ketemine itself
will never be submitted for reapproval for treatment resistant depression, okay,
because it was.
Speaker 2 (39:08):
Originally proved for or as an anesthetic.
Speaker 1 (39:12):
Okay.
Speaker 3 (39:13):
I'm learning about the medication world, okay, because sravado was
a little bit different. They you said, they changed one thing, yep,
and then now it's the asketamine asketamine Okay, So that's
why that is like a new approved thing. Yes, So
ketamine got FDA approved for the use of.
Speaker 5 (39:30):
Being an anesthetic as an anesthetic.
Speaker 3 (39:32):
And because it's FDA approved, we can prescribe it for
other things.
Speaker 4 (39:37):
Many drugs are prescribed off flabel.
Speaker 1 (39:39):
Okay, I didn't know that.
Speaker 5 (39:40):
Yeah, but it's.
Speaker 4 (39:41):
Really important to know. I mean that spravado would never
be here without ketymine being here first.
Speaker 1 (39:48):
Okay. Well that's helpful.
Speaker 3 (39:50):
Yeah, we saw that, and then that was created outside
of Okay, all right, well it sounds like there are
some options out there for you guys. And you do
SPAVI and the other form can other forms, yes, okay,
and that.
Speaker 1 (40:04):
Is an Is that an injection? It is? Okay, do
you have a preference or does it depend on the client.
Speaker 5 (40:10):
So it depends on the client.
Speaker 2 (40:11):
I mean the buy availability of the medication is higher
getting an injection, but I think we see just as
good of results okay in the nasal spray.
Speaker 5 (40:21):
It just takes a little longer to get there.
Speaker 3 (40:22):
Oh okay, cool, all right, Well, thank you for having
this conversation with me.
Speaker 5 (40:27):
Thank you, Thank you, Bully.
Speaker 1 (40:29):
It offered some new information.
Speaker 3 (40:31):
I have an assumption that a lot of people are
gonna be like what and some people are gonna be like, oh, yeah,
I've heard about this, and I turned that conversation away
and some people are gonna probably be thinking, I've been
wanting to learn about this, So we're gonna have a
lot of different opinions. If you have any questions, If
you're listening to this and you have any questions, feedback, anything,
you can email Katherine at nied Therapy podcast dot com.
(40:54):
Do you have questions for Selena and Ronda, you can
actually send those there And if it's a question that
we can answer on one of the Wednesday Couch Talks episodes,
we might be able to do that as well. If
you just want to contact them, Where can they find you? Guys?
Speaker 2 (41:10):
So our phone number is six one five eight six
one one one one four and our website is Willow's
healthandrecovery dot com.
Speaker 3 (41:17):
If you want to find me, you can do that
on Instagram at you Need Therapy Podcasts and at Kat
dot Defada. And until Wednesday, I hope you guys are
having the day you need to have and I'll talk
to you later.
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Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!