The Ketamine Question: Party Drug or Mental Health Breakthrough?

Dustin Grinnell (00:00:00 --> 00:01:21)
I'm Dustin Brunell, and this is Curiously.

In the world of tech titans, few are as familiar with the spotlight or the pressures that come with it as Elon Musk. Recently, though, Musk made headlines for something deeply personal: his openness about his struggle with depression. Instead of following traditional treatment paths, Musk turned to an unconventional option: ketamine. Once known primarily as an anesthetic or even a party drug, ketamine is now emerging as a powerful tool in mental health treatment. Today on the podcast, we'll explore the history and neurobiology of ketamine, current research on its effectiveness, and much more.

To help us unpack this topic, I invited Dr. Sherry Siddiquim back to the show. She's a clinical psychologist who runs a private practice in Brooklyn specializing in adult psychotherapy and psychological assessment. Along with her expertise in ketamine treatment, Dr. Siddiquim has a special interest in psychedelics for alleviating mental suffering. She recently completed the Psychedelics Assisted Therapies and Research program at the California Institute for Integral Studies, making her certified in psychedelic-assisted therapies and research. So join me as I sit down with Dr. Sidikum to explore the science, potential, and complexities of ketamine treatment for depression.

Dustin Grinnell (00:01:22 --> 00:01:25)
Well, Sherry Sidikum, welcome back to the podcast.

Sherry Siddiquim - 1 (00:01:25 --> 00:01:26)
It's good to be back.

Dustin Grinnell (00:01:27 --> 00:02:29)
So last time we talked about psychedelics and psychedelics-assisted therapy, and it was a very interesting discussion. And This time we're going to be talking about one substance, one drug, that's ketamine and its use for treatment-resistant depression. And you've given a presentation on this last spring to a group of psychologists, and you have experiences as an expert with this drug. And so, yeah, I was hoping to kind of explore how the drug is used and for what purposes and what the current data is saying about its effectiveness and share personal experiences, patient stories, if you can or want to. But to maybe kind of just start off, I kind of wanted to dig a little bit more into your background as a clinical psychologist. I was just kind of wondering, like, why psychology? What drew you to this field? What drew you to psychotherapy and working with people in a clinical setting?

Sherry Siddiquim - 1 (00:02:29 --> 00:02:44)
Yeah, I would say that my interest in psychology and clinical work started when I was pretty young, maybe an adolescent. You know, I had a cousin who was a therapist and a social worker, and I just like thought she was so interesting to talk to.

Sherry Siddiquim - 2 (00:02:44 --> 00:02:55)
And I remember being at her house and looking at the books that she had from Freud and finding those really interesting and finding my psychology classes in high school really interesting.

Sherry Siddiquim - 1 (00:02:56 --> 00:03:03)
And I think on some deep level, I'm just really, I find people really interesting and how they tick.

Sherry Siddiquim - 2 (00:03:03 --> 00:03:30)
And, and then another piece of it is, you know, as with many other therapists and healers, the desire to heal myself and, you know, heal certain difficult childhood experiences and wanting to really get deep in like how one does that and how it is that, you know, my own mind works and So yeah, I, I would say those were some of the biggest factors that led me to pursue this field.

Dustin Grinnell (00:03:31 --> 00:04:03)
Yeah, that's interesting about physician heal thyself kind of thing. What do you think it is about going through something personally that makes you want to help others in the same capacity? Like, I know a lot of healthcare providers who have a similar story. They had a traumatic experience and it and it is sort of the motivating factor for one to help other people. There seems to be a theme there. It's like I went through something and I used a certain strategy or approach to help myself. Now I want to help others.

Sherry Siddiquim - 1 (00:04:03 --> 00:04:42)
Yeah, I think certainly there's something about having experiences of, to put it really plainly, suffering that helps us build empathy for other people who are suffering or who we perceive to be suffering in similar ways to us. I do think that the desire to help and be of service is sort of innate. And so for me, insofar as having some of these issues and wanting to be helped with them as I was growing up, as I started to kind of do my own work, I think that just kind of naturally flowed in the desire to do that and to be that for other people.

Dustin Grinnell (00:04:42 --> 00:05:17)
Makes sense. So the topic of the discussion is the use of ketamine for depression treatment, resistant depression. I wanted to just talk about depression first a little bit. What, from your point of view, causes depression? And it's obviously complicated. It's obviously multifactorial. It's obviously genetic, social, biological. It's all things. But frame up this huge mental health issue and how you maybe explain it to patients or explain it to yourself.

Sherry Siddiquim - 1 (00:05:17 --> 00:05:28)
Yeah, I mean, what you said is exactly right in that it is multifactorial. And I think it's sort of oversimplifying to reduce it down to any of these factors.

Sherry Siddiquim - 2 (00:05:29 --> 00:05:38)
So for example, like genetics, we have good data to suggest that depression is something that is genetically passed down.

Sherry Siddiquim - 1 (00:05:39 --> 00:06:04)
That there are certain sort of biological factors that make someone more vulnerable to depression. And that is very much real and a part of this story. Other parts of the story are environmental. What was the quality of the parenting that the person received growing up? What did they learn about how safe the world is or isn't growing up?

Sherry Siddiquim - 2 (00:06:04 --> 00:06:07)
What did they learn about their sense of, like, efficacy in their life?

Sherry Siddiquim - 1 (00:06:08 --> 00:06:17)
You know, I'm a relational therapist, so, you know, what I'm focused on is how did people learn to relate to other people as they were growing up?

Sherry Siddiquim - 2 (00:06:17 --> 00:06:22)
And were these sort of secure relationships and secure attachments? How did they learn to relate to themselves?

Sherry Siddiquim - 1 (00:06:23 --> 00:06:43)
So those are, you know, relationships and the quality of relationships is certainly a big part of the picture with mood disorders. Things like, you know, having a sense of meaning or purpose, which I think in sort of ways direct and indirect are also tied to relationships. And, you know, a sense of purposelessness can lead to depression.

Sherry Siddiquim - 2 (00:06:44 --> 00:06:52)
And like behavioral factors, right? Like things like diet and sleep and exercise can also help or hurt someone's mood.

Sherry Siddiquim - 1 (00:06:52 --> 00:07:11)
And I think the other piece to keep in mind is that these factors are often interactional. So for example, if someone biologically has the propensity toward depression growing up, they may be, let's say, a little bit less socially engaged or more withdrawn.

Sherry Siddiquim - 2 (00:07:11 --> 00:07:41)
And then, you know, if the parents aren't very attentive if they're so kind of stressed out by their own lives that they're not noticing what's happening with the kid, they may miss that the kid is feeling totally socially disconnected. And then that kind of social disconnection and feelings of separateness and not belonging can be depressive in their own way. And it's something that's very commonly seen is like with depression, there are often disruptions with sleep.

Sherry Siddiquim - 1 (00:07:41 --> 00:07:47)
And that ends up becoming a vicious cycle because, you know, the person is depressed, so they're not sleeping well.

Sherry Siddiquim - 2 (00:07:47 --> 00:07:50)
And because they're not sleeping well, they're like further vulnerable to depression.

Sherry Siddiquim - 1 (00:07:50 --> 00:07:53)
So I do think it's all of these things.

Sherry Siddiquim - 2 (00:07:53 --> 00:07:57)
I think it's these things in different amounts for different people.

Sherry Siddiquim - 1 (00:07:57 --> 00:08:01)
And I think that the relationship between these factors is interactional.

Dustin Grinnell (00:08:02 --> 00:08:49)
Yeah. When you think about treatment for depression, also another vast topic. Before we get into ketamine, because ketamine is used for treatment-resistant depression, could you just give an example maybe, or briefly describe how the treatment process happens today, like modern treatment? Like maybe if you have an example of a patient who comes in to see a doctor with depressive symptoms, What is their journey briefly in a high level? What is that journey from diagnostic to trying medications, to trying therapy, to failing some of these things? What's the journey to ketamine and newer medications?

Sherry Siddiquim - 1 (00:08:50 --> 00:08:54)
I think that will largely depend on a few factors.

Sherry Siddiquim - 2 (00:08:54 --> 00:09:04)
For example, if the person goes to a physician who is really medication happy, they might just get prescribed an SSRI and go on their way.

Sherry Siddiquim - 1 (00:09:05 --> 00:09:36)
They might see full improvement, they may not. I would like to think that more often than not these days, once the person is seeing their primary care physician and reporting symptoms of depression or they're doing some questionnaire for the physician that shows depression, that these physicians are referring to therapists, are encouraging patients to seek therapy as a first line of treatment, and maybe also suggesting that they might want to take medication concurrently.

Sherry Siddiquim - 2 (00:09:37 --> 00:09:45)
If their depression is severe enough or if there's reason to believe that there is a strong biological basis for the depression.

Sherry Siddiquim - 1 (00:09:45 --> 00:09:49)
So then the person might come into therapy.

Sherry Siddiquim - 2 (00:09:49 --> 00:10:06)
And my personal approach to this is, again, barring some very severe depressive episode or even suicidality, in which case I might say, let's throw everything that we can at it sooner rather than later.

Sherry Siddiquim - 1 (00:10:06 --> 00:10:23)
What I might want to do is do a full intake process, get a sense of what's going on with the person, get a sense of what might be causing and maintaining the depression. And from there, kind of set goals, begin the work together, and pay attention to, you know, is the person getting better?

Sherry Siddiquim - 2 (00:10:23 --> 00:10:24)
Are they getting worse?

Sherry Siddiquim - 1 (00:10:25 --> 00:11:01)
Are they kind of stalling? And if, you know, after, I don't know, maybe a couple of months, it seems like the person's symptoms aren't remitting and they're kind of getting in the way of the person's functioning, then we might want to refer them to a psychiatrist psychiatrist to get a sense of whether, you know, medication might be helpful to them. So once they get to a psychiatrist or a psychiatric nurse practitioner, they would do their own evaluation with the patient. And typically the first line of treatment is in, in terms of psychopharmacology is—

Sherry Siddiquim - 2 (00:11:02 --> 00:11:06)
and for depression, right, for unipolar depression, which is to say not bipolar depression—

Sherry Siddiquim - 1 (00:11:07 --> 00:11:50)
would be an SSRI. Depending on how the person responds, they may stay on that SSRI, they may up their dosage. If it's not working for them, they might either try another SSRI or a different antidepressant, something like Wellbutrin. Then if at that point, after trying a couple of different kinds of medication and they're in therapy consistently, they're still not getting better, I think that that is a good time to start to consider whether ketamine therapy might be a helpful sort of next step. So that is the way it's typically done.

Sherry Siddiquim - 2 (00:11:51 --> 00:12:09)
Now, I think there is a legitimate question to be asked in terms of like, should SSRIs be the first-line treatment and are there situations in which ketamine might be appropriate as a first-line treatment instead of these more traditional antidepressants.

Sherry Siddiquim - 1 (00:12:09 --> 00:12:28)
I think it's not something that is done very often right now for several reasons, including costs. And, you know, we don't have long-term data yet about possible side effects with ketamine. So I think, you know, both for cost, safety, and probably political reasons as well, that's not done right now.

Sherry Siddiquim - 2 (00:12:28 --> 00:12:33)
But I think That's a model, right? That's another model. That's another way things might be done in the future.

Dustin Grinnell (00:12:34 --> 00:13:20)
Okay. Frame up how ketamine is being used today in kind of the modern landscape. What is that first interaction with the healthcare provider to think about ketamine and how is it prescribed? And I ask because it's relatively in the public eye, but not well kind of talked about. The time when I saw this kind of come into the public is when Elon Musk admitted in one of his interviews that he had tried it. He tried ketamine therapy and it had worked for him. And I think a lot of people started talking about it as a result of that, given his prominence. So yeah, just kind of wondering, like, set the stage for us on ketamine therapy in 2024.

Sherry Siddiquim - 1 (00:13:20 --> 00:14:16)
There are different models and different approaches to how ketamine is used for depression, as well as some other mental health conditions, which we can get more into later. So for now, I will just focus on the model that is being used the most often. I don't know about the kind of treatment that Elon Musk got, but I would imagine it's this one. So this is sort of what's called the medical model. There will definitely be variation from physician to physician, clinic to clinic, but this is the basic protocol is that the person will come into the clinic or come see the physician, and the physician will do an evaluation with them over the course of maybe a couple of sessions. This is both to get a psychological history and learn more about the depression, learn more about what the person has already tried.

Sherry Siddiquim - 2 (00:14:16 --> 00:14:22)
This is also to get a medical history to make sure that this is a safe treatment for the person.

Sherry Siddiquim - 1 (00:14:23 --> 00:14:33)
The other thing that's done in this evaluation period is there might be an assessment that measures the person's severity of depression and the kinds of symptoms that they're experiencing.

Sherry Siddiquim - 2 (00:14:34 --> 00:14:42)
And usually the physician will sort of track the person's symptoms as the treatment goes on to make sure that it's hopefully trending downward.

Sherry Siddiquim - 1 (00:14:43 --> 00:14:48)
Then the other piece is that the patient is prepared for the ketamine session.

Sherry Siddiquim - 2 (00:14:48 --> 00:14:56)
They're given a sense of what they might expect and they are encouraged to think about their intentions and what they're hoping to get from the experience.

Sherry Siddiquim - 1 (00:14:57 --> 00:15:31)
Oftentimes, hopefully all the time, they are encouraged to concurrently be working with a therapist while they are receiving the ketamine infusions. And as you know, again, we'll talk more about this later, but really, really important to emphasize at the top here that ketamine by itself is not going to have long-lasting effects in treating depression if the person is not ideally in therapy, but at the very least, like making lifestyle changes as well.

Sherry Siddiquim - 2 (00:15:31 --> 00:15:36)
So that's sort of the first step would be that evaluation period.

Sherry Siddiquim - 1 (00:15:37 --> 00:15:50)
After that, over the course of typically 2 to 2 to 3 weeks, the person will come in 2 to 3, I've even heard of 4 times a week to receive the ketamine infusions.

Sherry Siddiquim - 2 (00:15:50 --> 00:15:50)
Right.

Sherry Siddiquim - 1 (00:15:50 --> 00:16:40)
So that's going to be the ketamine being administered through IV. Typically, the person is sort of sitting on a comfortable chair. There might be like reclining clinics tend to be very like well decorated and homey and, and really set the stage for a comfortable experience that doesn't feel very obvious that you're in a medical setting. So they're hooked up to the IV for approximately 40-45 minutes. So during that time, they might have blindfolds on, they might be listening to music. And again, within this medical model, the kind of supervision that's going to be present is the medical professional, whether that's a doctor or nurse, kind of coming in and checking the person's vitals and making sure that they're doing Okay, but otherwise being pretty hands-off.

Sherry Siddiquim - 2 (00:16:41 --> 00:16:52)
And after those 40, 45 minutes, the person will maybe stay at the clinic for an additional half an hour, hour until they're feeling better and ready to leave.

Sherry Siddiquim - 1 (00:16:52 --> 00:17:17)
And so they will do that for about 2 to 3 weeks. And the reason for that is, you know, the research shows that basically doing these infusions close to each other and doing a number of them makes the biological effects of the ketamine more durable, stronger, So that's a model that we are seeing a lot when a person goes in for ketamine therapy.

Dustin Grinnell (00:17:17 --> 00:17:47)
And what are those biological effects? What is going on in the brain? And then how does that affect depression? With SSRIs, we, we know that that's a serotonin reuptake inhibitor. So it's kind of blocking the reuptake of serotonin, which means there's more in the brain and in the body. So that's the kind of neurobiological explanation. But for ketamine, I really don't know. How that's working. Yeah, how does it work and why does it affect depression in a positive way?

Sherry Siddiquim - 1 (00:17:48 --> 00:17:58)
Sure. So I'll start off by saying that we don't fully understand yet how ketamine works for depression, but we do have a sense of some of its mechanisms of action.

Sherry Siddiquim - 2 (00:17:59 --> 00:18:01)
So I'll just get a little bit into that.

Sherry Siddiquim - 1 (00:18:01 --> 00:18:11)
Basically, the main effect of ketamine is on the glutamate system of the brain, and glutamate is the most abundant neurotransmitter that we have.

Sherry Siddiquim - 2 (00:18:11 --> 00:18:21)
And what we know about it is is that it plays a big role in the brain's plasticity, or the brain's ability to change and adapt to new experiences.

Sherry Siddiquim - 1 (00:18:22 --> 00:18:38)
So specifically, once the ketamine enters the brain, it blocks a specific type of glutamate receptor called the NMDA receptor. And these receptors in the brain essentially act like gates that regulate glutamate's activity.

Sherry Siddiquim - 2 (00:18:38 --> 00:18:53)
So when we block them, there's an increase in glutamate levels across the brain, which in turn triggers, like, a whole cascade of different brain activities that ultimately help with strengthening the connections between neurons.

Sherry Siddiquim - 1 (00:18:54 --> 00:19:45)
And the reason this is important is because we've seen that in people with long-term depression, over time, these connections become weakened or sort of lost altogether. And so this process, which is called synaptogenesis, is helpful because to your question earlier, Depression isn't just about low serotonin levels, even though that kind of gets a lot of airtime. It's also about the structural changes that happen in the brains of people who are depressed for long stretches of time or who are under chronic stress. And all of this is to say that one of the things that's unique about ketamine as a medicine is that it actually repairs the damaged neural circuits. I'll say just a few more words about this idea of neuroplasticity that I mentioned earlier.

Sherry Siddiquim - 2 (00:19:46 --> 00:19:58)
Neuroplasticity is basically just the brain's ability to reorganize itself by forming new neural connections throughout a person's life, including in adulthood.

Sherry Siddiquim - 1 (00:19:59 --> 00:20:12)
This ability is what allows us to learn from our experiences, to adapt to changes, and importantly in terms of depression, to recover from stress or trauma.

Sherry Siddiquim - 2 (00:20:13 --> 00:20:29)
So on the other hand, when a person is depressed for long periods of time, the brain actually becomes less plastic over time and sort of gets stuck in ruts and can replay the same negative thought patterns or emotional responses over and over again.

Sherry Siddiquim - 1 (00:20:30 --> 00:20:45)
So coming back to ketamine, it seems that this medicine actually reverses this mental rigidity And it does this by triggering the release of a protein called BDNF, which we can think of as a sort of fertilizer in the brain.

Sherry Siddiquim - 2 (00:20:45 --> 00:20:55)
Basically, the BDNF helps neurons grow, and it also helps with both forming new connections between them as well as strengthening the existing ones.

Sherry Siddiquim - 1 (00:20:55 --> 00:21:09)
So again, in practical terms, increased neuroplasticity means that the brain becomes more flexible and more capable of breaking free from maladaptive patterns of thinking and feeling.

Sherry Siddiquim - 2 (00:21:09 --> 00:21:14)
So yeah, that's, that's just a little bit about what ketamine is doing in the brain.

Dustin Grinnell (00:21:17 --> 00:23:31)
That idea of rigidity is really clear and relatable, actually. I remember 7, 8 years ago, I sort of stumbled and had a depressive episode myself. I was just very stressed from like multiple angles, like financial and like my living situation wasn't perfect and my romantic life wasn't perfect. I was going through a breakup and, and I was trying to write creatively and get paid for it, and it was just, you know, kind of like a, a tough spot. And I went in to see my PCP and I scored low on the depressive, you know, questionnaire.

So we tried SSRIs and it, and it kind of worked for me. It, uh, it, it gave me that sort of stabilization, and I got into therapy and talked about things and worked things out. But I do remember when I I first met with my PCP, I was fixated on some, shall we say, psychosomatic symptoms in my body. I had low back pain, I had some like joint symptoms, I had like an elevated rheumatoid factor which suggested potential like rheumatoid arthritis or on the road to it. And I was very fixated on that, really preoccupied.

So the two words that always stood out in my mind were preoccupation. He said, you seem to be very preoccupied. With these symptoms. And the other was clarity. We kind of got into it for a little bit.

He gave me like an hour, which is insane in like a clinic. And I remember kind of like saying, how do you not see all these symptoms, man? Like joint symptoms, ice pick headaches, low back pain, cracking and popping of joints. Like, I'm struggling, man. And he said, I'm trying to get you to see clearly.

And by clearly he meant the stress of your life, the life stressors, the circumstances, all the things kind of going sideways is causing you to experience these symptoms. And we need to sort of get ahead of it and for you to see this clearly. And that always resonated with me, the ability to see clearly. My brain was very fixed and very rigid and very black and white. And it was depression, like, all the way.

Sherry Siddiquim - 1 (00:23:31 --> 00:23:47)
Yeah, I really appreciate that example because I think to me, the connection between clarity and sort of obsession or rumination is sort of like when we are depressed, our minds can really—

Sherry Siddiquim - 2 (00:23:47 --> 00:23:54)
like, our attention becomes really sort of narrowed in on what is wrong and what is not working.

Sherry Siddiquim - 1 (00:23:54 --> 00:23:59)
And that can become our entire life, right?

Sherry Siddiquim - 2 (00:23:59 --> 00:24:05)
Like, that becomes all that we notice, and we're looking for things that support the things that we believe about it and so forth.

Dustin Grinnell (00:24:05 --> 00:24:10)
And whenever you talk to people, you talk about just that, and people are like, what? Why are you hooked on this?

E (00:24:11 --> 00:24:12)
Totally, right?

Sherry Siddiquim - 1 (00:24:12 --> 00:24:19)
There's this sort of narrowing of attention, this fixation on this slice of life.

Sherry Siddiquim - 2 (00:24:19 --> 00:24:19)
Right.

Sherry Siddiquim - 1 (00:24:20 --> 00:24:43)
And to me, clarity— and I think this is actually something ketamine helps with— clarity is being able to kind of unstick yourself from that fixation and step back a little bit and see those problems in a larger context, right? Where it's not that these things aren't true necessarily, but they're not everything.

Sherry Siddiquim - 2 (00:24:44 --> 00:25:00)
And we can sort of right-size it and put it in its right place. And to me, that kind of perspective is a kind of clarity that a medicine like ketamine affords And that's like, you know, from lifestyle factors to antidepressants to psychotherapy.

Dustin Grinnell (00:25:01 --> 00:25:27)
Yeah, that seems like it's not like obviously broadening your perspective isn't like the curative aspect of this, but it's a big one, isn't it? Just ability to kind of open up your mind and put your struggles in the context of your social life, your political life, your life circumstances, and then to say, oh, okay, that's like the beginning of recovery. I feel like.

Sherry Siddiquim - 2 (00:25:28 --> 00:25:29)
Absolutely. Yes.

Dustin Grinnell (00:25:30 --> 00:25:48)
And so how does a substance like ketamine or any antidepressant for that matter— I understand how psychotherapy does it because the talking and the kind of weakening of the preoccupations happens through talking and things. But what about a substance? Does it change your consciousness in such a way so you can see things differently?

Sherry Siddiquim - 1 (00:25:49 --> 00:25:53)
Yeah. So one of the special features of ketamine, right?

Sherry Siddiquim - 2 (00:25:53 --> 00:25:58)
One of the subjective experiences that people can have is the experience of—

Sherry Siddiquim - 1 (00:25:58 --> 00:26:23)
we can call it dissociation, we can call it detachment. And that sometimes looks like the ability to again kind of step back and feel outside of our emotions, feel outside of our beliefs, and from a perspective of like almost being very neutral, be able to look at them.

Dustin Grinnell (00:26:24 --> 00:26:25)
They're not so charged.

Sherry Siddiquim - 2 (00:26:25 --> 00:26:27)
They're not so charged.

Sherry Siddiquim - 1 (00:26:27 --> 00:27:45)
Exactly. We're not inside of them in the same way, if that makes sense. And I can actually speak to this with one of my own experiences with ketamine several years ago, where I was also going through a period of loss and sadness about certain things. And my first experience with ketamine allowed me to kind of to just again stand back and see the sadness in myself. And the thought that came to me in that moment is like, my sadness isn't everything, and emotions aren't everything. And I know this is going to sound a little controversial coming from a therapist, and I mean it in a very specific way, but like, emotions aren't that important, right? Which is to say that feelings aren't facts. They might give us some information about, you know, what we're believing in the moment and our reaction to a certain thing, but they're not the truth. And so having this kind of detachment from our subjective experiences, I think, in some ways can be a really, really helpful antidote to this sometimes depressive experience of feeling very stuck in certain feelings and certain thoughts and certain beliefs.

Dustin Grinnell (00:27:45 --> 00:28:11)
When you had that insight on ketamine therapy that your sadness wasn't everything, that's an intellectual understanding. How did that then, you know, after you got back into your real life, help you heal? Like, that obviously stuck with you. It sticks with you to this day. So what was it about gaining that insight that helped you recover from the sadness, like, concretely, you know?

Sherry Siddiquim - 1 (00:28:11 --> 00:28:27)
Yeah, I appreciate that question. And first, I want to just turn to the first thing you said, which is sort of pointing to the difference between an intellectual understanding of something and a more sort of lived firsthand experience of it.

Sherry Siddiquim - 2 (00:28:27 --> 00:28:40)
So I'm a student of Buddhism, and like this idea of, you know, we aren't our feelings, we aren't our thoughts, is something I've been familiar with for a very long time. And like, intellectually, I understood.

Sherry Siddiquim - 1 (00:28:41 --> 00:29:26)
But I think that until that experience, it didn't fully click for me. It didn't fully become sort of an embodied experience. And I think that when we have embodied experiences like that, they feel much more true than if it's something that we're learning from another person. Now, is it the case that that insight has been with me every moment of every day since then, and I organize my life and thinking accordingly? No, but there is something about the kind of power of an experience like that, or, you know, what we call the noetic quality of an experience like that, that really sticks with you, right?

Sherry Siddiquim - 2 (00:29:26 --> 00:29:53)
And for me, that in moments of like great suffering, there's just like this tiny moment of like light that can come in that's like, oh right, you're like getting really focused on one thing and that's why you're really miserable, or you're like really taking your emotions very seriously, and that's why everything feels like sadness. It's just an experience that you're having in this moment. It's not who you are. It will pass, and so on.

Dustin Grinnell (00:29:53 --> 00:30:03)
Yeah, I remember Michael Crichton, the science fiction author of Jurassic Park and someone who I admire, he once just said, you know, emotions are like the weather to him.

Sherry Siddiquim - 1 (00:30:04 --> 00:30:04)
Yeah.

Dustin Grinnell (00:30:04 --> 00:30:19)
Wow, that's a really high-minded, really— that's really perspective. And they float in, they float out. They capture us, they go away, they— one day is different to the next, one day is bad, the next day it's okay.

Sherry Siddiquim - 1 (00:30:19 --> 00:30:20)
Yeah.

Dustin Grinnell (00:30:21 --> 00:30:47)
And it's the perspective, you know, often lived experiences of having gone through those types of things. Yeah. But so like ketamine therapy, even like psychedelic-assisted therapy, this is sort of like manufacturing that in a way. It's like an acute accelerated experience, giving yourself a dissociative experience almost. It's like it allows you to kind of pop out and look at yourself.

Sherry Siddiquim - 1 (00:30:48 --> 00:30:56)
Yeah, that's right. Sometimes, right? Like, you know, big caveat here is, you know, multiple experiences with ketamine.

Sherry Siddiquim - 2 (00:30:56 --> 00:30:58)
Every time it's something different.

Sherry Siddiquim - 1 (00:30:58 --> 00:31:23)
My patients who have had ketamine therapy report very different kinds of experiences. But this sort of popping out has been a sort of consistent thing for me, at least, that has been really helpful, really liberating. And this also looks like sort of dissociation from the body sometimes, which can be a really interesting experience, right?

Sherry Siddiquim - 2 (00:31:23 --> 00:31:38)
Like, there have been times where, like, with my eyes closed, I have felt like I'm sort of standing over myself, watching myself, or I'm sort of kind of seeing myself walk around the apartment or something like that.

Sherry Siddiquim - 1 (00:31:39 --> 00:31:50)
So that's sort of another— I'm not sure how therapeutically useful that piece of it is, and maybe it is, but it's just sort of an interesting quirk in terms of like another manifestation of the detachment.

Dustin Grinnell (00:31:51 --> 00:32:20)
Okay. If we could like maybe go back in time a little bit, just thinking about where ketamine came from. I guess I understand from your presentation you had given in March, you wrote that ketamine was developed in the '60s. It started as a derivative of PCP, and then it was used as an anesthetic in the Vietnam War. I was kind of wondering if you could put ketamine in its place in time. How did it come to where we are now?

F (00:32:22 --> 00:36:13)
In 1970, it was approved by the FDA for use in humans and animals because of its safety profile compared to older anesthetics. So for example, it doesn't impact the patient's ability to independently maintain their breathing and circulation like some of the older anesthetics did. So it became widely used in surgery and emergency medicine. And on the battlefield during the Vietnam War. So then as time went on, doctors were starting to see that as patients were coming out of their anesthesia, they were having these really strange out-of-body experiences.

And little by little, anecdotal evidence began to emerge that actually some people were seeing a relief from their depression symptoms right afterward.. And this was at the time this sort of interesting and unexpected side effect. So in the late '90s, researchers noticed that low doses of ketamine— so now we're talking about doses that were much lower than what they were using for anesthesia— had rapid antidepressant effects. And a landmark study in 2000 conducted by Dr. Crystal and Dennis Charney found that a single infusion of ketamine could significantly reduce depressive symptoms in patients with treatment-resistant depression.

And that, remarkably, this effect happened within hours of taking the ketamine. So as you might imagine, this was a game changer because at the time, the primary treatments for depression often took weeks to start working. And many patients didn't respond to these medications at all, or if they did, the effects were pretty minimal or had a lot of intolerable side effects. So in that context, ketamine offered hope for people who had exhausted other options. Fast forwarding now to the 2010s, and suddenly interest in ketamine for depression started to grow rapidly, and more and more studies came out that confirmed that it's effective not only for depression, but also also for other conditions like PTSD and chronic pain.

And then in 2019, there was a major milestone when the FDA approved esketamine, which is basically a closely related derivative of ketamine, as a nasal spray for treatment-resistant depression. And this was sort of a big deal because this approval signaled that ketamine was moving from the experimental fringes into mainstream psychiatry. So that brings us into the present where where, as you know, ketamine therapy in different forms is being offered at specialized clinics worldwide. And of course, research is still ongoing to better understand its long-term effects— things like optimal dosing schedule, how to combine it effectively with other treatments like psychotherapy and like traditional antidepressants. So while today it's still not considered a first-line treatment, ketamine now has a crucial role to play for people who maybe have not been very helped by the more traditional treatments for depression.

Dustin Grinnell (00:36:14 --> 00:36:22)
Okay, so you're saying a patient can come in to see someone, to see you, and they can get an infusion provided they have failed a couple treatments?

Sherry Siddiquim - 1 (00:36:22 --> 00:36:36)
Is, is that the case? Um, kind of. So first of all, I'm not a prescriber. Psychologists aren't prescribers. So I would— it's a little more complicated than this, but if they wanted to get infusions, I would refer them to a clinic.

Sherry Siddiquim - 2 (00:36:36 --> 00:36:40)
So if, if they wanted to kind of go through medical model, I would send them to a clinic.

Sherry Siddiquim - 1 (00:36:40 --> 00:36:52)
And I think even though what's being recommended is that people try a couple of antidepressants before going to ketamine, I think the reality is that the clinics are not actually requiring that.

Sherry Siddiquim - 2 (00:36:52 --> 00:37:01)
So anyone with depression can walk in and say, I want this. And I think a lot of physicians are kind of more liberal in the way that they use it.

Dustin Grinnell (00:37:02 --> 00:37:14)
Okay. So ketamine is not a psychedelic. Psychedelic, right? But I think you said in your presentation that it has properties of a psychedelic. I was wondering if you could kind of unpack that a little bit.

Sherry Siddiquim - 1 (00:37:14 --> 00:37:29)
So that one gets a little confusing, right? Like, I think conventionally people call ketamine a psychedelic. People call it the only legal psychedelic. And there are ways that it's different from so-called classical psychedelic.

Sherry Siddiquim - 2 (00:37:29 --> 00:37:31)
And then there are ways that it's similar.

Sherry Siddiquim - 1 (00:37:31 --> 00:38:08)
I'll unpack that. So in terms of its biology and its mechanism of action with classical psychedelics, like, you know, for example, psilocybin or LSD, they generally target the serotonin system. And again, with ketamine, its effects are more with the glutamate system. So biologically different. And subjectively, kind of going back to what, you know, I was talking about earlier, the subjective experience of ketamine tends to be a little bit more dissociative, a little bit sort of out of the body.

Sherry Siddiquim - 2 (00:38:09 --> 00:38:21)
And for example, with a classical psychedelic, the person might really like go into a certain emotion or have that certain emotion be very sort of amplified and big.

Sherry Siddiquim - 1 (00:38:21 --> 00:38:24)
And that can be enormously helpful, right?

Sherry Siddiquim - 2 (00:38:24 --> 00:38:27)
Because they are sort of releasing that emotion.

Sherry Siddiquim - 1 (00:38:27 --> 00:38:30)
They're fully experiencing it and metabolizing it.

F (00:38:30 --> 00:38:30)
Right.

Sherry Siddiquim - 1 (00:38:30 --> 00:38:32)
So, and again, none of these are absolutes.

Sherry Siddiquim - 2 (00:38:32 --> 00:38:35)
It depends on the person, the dose, all sorts of things.

Sherry Siddiquim - 1 (00:38:35 --> 00:38:43)
But with classical psychedelics, the experience can be more sort of emotionally intense and within the emotion.

Sherry Siddiquim - 2 (00:38:43 --> 00:38:55)
Whereas with ketamine, the experience can be like sort of stepping outside of the emotion and looking at the emotion from a more sort of like detached, neutral place.

Sherry Siddiquim - 1 (00:38:55 --> 00:39:08)
Having said that, there are ways in which it's very similar to the classical psychedelics as far as its therapeutic potential goes. We see some people have very insightful experiences.

Sherry Siddiquim - 2 (00:39:08 --> 00:39:23)
There are certainly changes in perception of time and space, changes in consciousness, and in higher doses, ketamine can certainly lead to mystical experiences in the way that the classical psychedelics do.

Dustin Grinnell (00:39:23 --> 00:39:27)
What is a mystical experience? How do you define that?

Sherry Siddiquim - 2 (00:39:27 --> 00:39:29)
Oh, that's a good one.

Sherry Siddiquim - 1 (00:39:29 --> 00:40:00)
I think, you know, one of the main features of a mystical experience is a sense of connection to the world, a sense of oneness with the world, in contrast to a sense of feeling like a separate self, in contrast to being very sort of identified with the ego and seeing the self as a very, like, separate, alone, isolated being in the world. So that, I would say, is at least one feature of it.

Sherry Siddiquim - 2 (00:40:00 --> 00:40:19)
You know, people certainly talk about having very strong experiences of love, seeing light, feeling the presence of God, if that's the way that they see things. So I would say those are some of the features of what we would call a mystical experience.

Dustin Grinnell (00:40:19 --> 00:40:45)
Yeah, I remember— is it, uh, Carl Jung talked about peak experiences, about the oceanic feeling? And people may have like one or two of them their entire life, and many people never have it. Have you had a mystical experience, whether taking a psychedelic or being out in nature or some other way? If you're comfortable sharing. I'm just curious.

Sherry Siddiquim - 1 (00:40:45 --> 00:41:00)
Or certainly, yeah, with psychedelics I have, and I would say almost somewhat reliably. I'm pretty sensitive to these substances, so I tend to have very big reactions to even smaller doses.

Sherry Siddiquim - 2 (00:41:00 --> 00:41:14)
Outside of my psychedelic use, I have had mystical experiences a handful of times in meditation, which felt almost accidental. Channel when it happened, and then a few times when I was younger, so like in my early teens.

Dustin Grinnell (00:41:14 --> 00:43:03)
And I was like, that's a peak experience for sure. You know, something was triggered in that moment. But I've had a few lower-level experiences like that in my life. I was in a yoga class once, and you're at the end, and it's vinyasa— shavasana, I mean. And as I was laying down, I almost felt the curvature of Earth.

I know that sounds ridiculous, but like, yes, we are on a globe and there is curvature. And with the right cameras over time-lapse, you can see it actually. And it's really neat. But I had my arms out and I felt very expanded. And that was probably a proto-mystical experience, I think.

I think. And at various times in my life, if I'm able to kind of get out on a walk and see the ocean, I, I can get close to one. And they're great, you know. There, there should be more of them. I would love to have them daily, you know.

I, I really think it would be great if we all had them more often because they do broaden your perspective. They do make you feel good. They do make you feel connected. And they make you feel small in a way, in a sense, insignificant. But there is the flip side of feeling I'm like, well, you are so small and insignificant, you might as well make the best of it.

Sherry Siddiquim - 1 (00:43:03 --> 00:43:09)
So two sides of the same coin. Yeah.

Dustin Grinnell (00:43:09 --> 00:43:16)
So I should ask, default mode network, ketamine relationship, what say you?

Sherry Siddiquim - 1 (00:43:16 --> 00:43:36)
So the default mode network is a network of different brain regions that are active when we're not engaged in some specific task. So we're not trying to pay attention to something outside of ourselves. And so in those moments, our minds might turn inward into thinking about ourselves.

Sherry Siddiquim - 2 (00:43:36 --> 00:43:41)
So we might think about our past or imagined futures, memories, and, and so forth.

Sherry Siddiquim - 1 (00:43:42 --> 00:44:51)
And so, as you might imagine, this network is heavily implicated in our sense of identity, so much so that it's been dubbed the seat of the go. And what we see in people with depression is that the DMN tends to be overly active. And this overactivity is with, um, sort of increased self-referentiality. We can even say self-centeredness, and with excessive and painful obsessions or ruminations. And so when the DMN is deactivated, with something like ketamine or with the other psychedelics, there is an immediate decrease in these kinds of ruminations and sort of self-centered obsessions. And that might be one of the sort of mechanisms of action for why ketamine is an antidepressant, right? So this again maybe goes back to what I was saying earlier about mystical experiences. Where the more we are thinking about our individual selves, our histories, our goals, where we want to go, our opinions, right?

Sherry Siddiquim - 2 (00:44:51 --> 00:44:58)
Like, the more we're, quote unquote, selfing, the more separate that we feel from the rest of reality.

Sherry Siddiquim - 1 (00:44:58 --> 00:45:01)
And in a way, that is depressing.

Sherry Siddiquim - 2 (00:45:01 --> 00:45:26)
That is lonely. That is isolating, right? And so when the system kind of loosens up and becomes deactivated, we might start to feel more connected, more a part of something bigger rather than, again, distinct and separate selves. And for that matter, distinct and separate selves that we may perceive with a lot of self-loathing and criticism.

Sherry Siddiquim - 1 (00:45:26 --> 00:45:55)
And people often think about self-centeredness as this very haughty, arrogant, sometimes confident way of being in the world when really, like, the more people think about themselves and the more they're sort of focused inward, the more that people tend to feel unhappy and self-critical and kind of stuck in themselves.

Sherry Siddiquim - 2 (00:45:55 --> 00:46:01)
So that's how the sort of deactivation and DMN way of thinking about this goes.

Dustin Grinnell (00:46:01 --> 00:47:07)
That makes sense. I remember reading this book years ago by the philosopher Bertrand Russell. He wrote a book called The Conquest of Happiness. And the first half of the book is like, here's what I see as the causes of unhappiness. And the second half was like, here's what I see as the causes of happiness. And yeah, a major theme in the book was unhappiness is pretty much driven by self-focused orientation. The more you're focused on yourself and your own your own ambitions, your own preoccupations, the more you're focused inward, the tendency is going to be unhappier. Versus flip that around and focus yourself externally. Focus on your projects, focus on being with friends and loved ones, focus on helping people out, focus on your pet, you know, be externally focused. The more you can change that orientation from inward to outward, the better off you're going to be. And that's almost exactly what you just said.

Sherry Siddiquim - 1 (00:47:08 --> 00:47:19)
Yeah, yeah, I totally agree with that. And I think in some ways that really flies in the face of where we are culturally, right? You know, certainly there are positive things that come out of that, right?

Sherry Siddiquim - 2 (00:47:19 --> 00:47:27)
So there's a way that, like, for example, the concept of self-care, right? We're constantly hearing about, like, self-care, self-care, self-care, self-care.

Sherry Siddiquim - 1 (00:47:27 --> 00:47:59)
And that's anything, you know, from to like taking a spa day, to journaling or whatever it might be. And I think in some ways that's good, right? That's like a corrective for certain ways of like neglecting the self that are really not helpful. But I think what it misses is that if you sort of like take that to the extreme and all you're thinking about is like taking care of yourself, you start to lose connection with like how do you How do you help other people? What's going on outside of you?

Sherry Siddiquim - 2 (00:47:59 --> 00:48:12)
How do you, again, put yourself in this broader context rather than like kind of putting yourself in the center of your universe, which again, maybe counterintuitively actually doesn't lead to happiness.

Sherry Siddiquim - 1 (00:48:12 --> 00:48:30)
So it seems like there's sort of a balance to be struck between self-love and, and appropriate self-concern and, you know, self-care, um, on the one hand and sort of excessive self-concern and self-absorption on the other.

Dustin Grinnell (00:48:30 --> 00:49:23)
Yeah, I remember my therapist saying once that what this 50-minute session does is create this like construct in your life, where you come in, you do this thing of analysis and introspection, pulling things apart, and then you leave, and you go back to your life. I almost feel like self-care, self-orientation, hardcore introspection is best to be done in constructs. Like, do it in that 50-minute session, then then go back and live your life. Or do it in an hour of journaling and then go back and live your life. If you want to talk to a friend and unload something and get their perspective, just do it for an hour and then move on. It's almost like if you can just do it in these little cabins or compartments and then just go back into the river of your life, that's best, rather than letting it consume you every day, every night.

Sherry Siddiquim - 1 (00:49:23 --> 00:49:55)
You know, that's when you get in I really appreciate that way of framing it. I think that's absolutely right. And I also think that there's a difference between therapy and journaling on the one hand and like thinking about something on the other, right? Where therapy and journaling can sort of like, you move forward, like you're kind of getting the ideas out and you go from one to the next to the next to the next. And then hopefully you hit a point where it's like, okay, I got what I wanted out of this experience. And like you said, I can move on with my life.

Dustin Grinnell (00:49:55 --> 00:49:55)
My life.

Sherry Siddiquim - 1 (00:49:55 --> 00:50:11)
Whereas thinking can just become like circling on the same idea over and over and over again, you know. And like, I think it's sort of a weird bug of the mind where like every time we have a thought, we're like, wow, here's this new way of thinking about this.

Sherry Siddiquim - 2 (00:50:11 --> 00:50:26)
It's like, no, I have had this thought 10,000 times before. This is like not helpful. Like circling and analyzing the same thing over and over again is actually not productive. So I think that's distinction I would make.

Dustin Grinnell (00:50:26 --> 00:51:13)
I also feel like the kind of self-care, particularly like in journaling or just introspecting, it works up to a point, but where it stops working is where self-deception happens, or you're not able to get enough perspective or life experience to see past a certain point. And that's when, like, it's helpful to have, like, a therapist who can you know what you're actually not seeing? Right? Do you know what I've seen over these past few months? Whenever you bring this up, you always talk about it this way. And you say, oh, shit, that's right. And then you say, oh, if I talk about it that way, it must be— so you're making connections. And I feel like you can't make those connections and find those threads alone.

Sherry Siddiquim - 2 (00:51:13 --> 00:51:15)
For sure.

Sherry Siddiquim - 1 (00:51:15 --> 00:51:22)
Absolutely. And I think this also goes back to our earlier conversation about like, did you frame it as obsession versus clarity?

F (00:51:22 --> 00:51:23)
Yeah.

Sherry Siddiquim - 1 (00:51:23 --> 00:51:38)
Where on our own, we might just have a very narrow perspective and just keep running around ourselves, where the role of a therapist might be to say, hey, have you looked over there? Or have you considered the possibility that this thing and that thing might be connected?

Sherry Siddiquim - 2 (00:51:38 --> 00:51:42)
And sort of expand our perspective a little bit.

Dustin Grinnell (00:51:42 --> 00:52:15)
And then after you make this big insight, you make this nice connection, you just go back to your life. You just go back to work, you know. Yeah. And something has gotten sorted out, you know. And then that's the thing that's always so mysterious about the psychotherapeutic process.

It's like something got unknotted. I don't really— there's— I don't know the mechanism. It's some— but cognitively, psychologically, something got unknotted or unstuck. And you just feel better spontaneously as a result of pulling things apart. And and finding connections.

Sherry Siddiquim - 2 (00:52:15 --> 00:52:16)
Yeah, magic.

Dustin Grinnell (00:52:16 --> 00:52:59)
It is a little magical. So as we kind of come on to the back nine of this conversation, I was wondering if we could talk about ketamine in the, in the context of psychotherapy. And I think that's where you really have a lot of thoughts on it. It's this idea of integration. So if someone takes psychedelics in the context of trying to heal from something, or ketamine, and they may sit with you do over multiple sessions, and they pull that experience apart, and you try to help integrate insights that, that they have or make connections into their life. And so, yeah, talk about ketamine in the context of psychotherapy and in this process of integration.

Sherry Siddiquim - 1 (00:52:59 --> 00:53:17)
Happy to. So like I said earlier, ketamine therapy by itself can work really quickly to lift depression and/or suicidality. But by itself, the results are not going to endure.

F (00:53:17 --> 00:53:17)
Right?

Sherry Siddiquim - 1 (00:53:17 --> 00:53:20)
So that's where psychotherapy can come in.

Sherry Siddiquim - 2 (00:53:20 --> 00:53:26)
And that's where this concept of integration, which I'll say a little bit more about, cuts in.

Sherry Siddiquim - 1 (00:53:26 --> 00:53:31)
I'll also say that there are different approaches to working with ketamine. Right?

Sherry Siddiquim - 2 (00:53:31 --> 00:53:37)
So the first is what we talked about, which is like the medical or the biochemical approach.

Sherry Siddiquim - 1 (00:53:37 --> 00:53:37)
Right?

Sherry Siddiquim - 2 (00:53:37 --> 00:53:42)
Where the The focus is more on changing the chemistry of the brain.

Sherry Siddiquim - 1 (00:53:42 --> 00:54:14)
The second is a more psychological approach. So there's a model called ketamine-assisted psychotherapy, which I practice in my practice. And the idea with KAP is like, yes, there are biological benefits from ketamine, but another thing that the ketamine is a super important and valuable tool for is reaching psychological site. And so the way that CAP is typically practiced is the client comes into the therapist's office, right?

Sherry Siddiquim - 2 (00:54:14 --> 00:54:20)
And that therapist might be a psychiatrist, it might be a psychologist like me, or a social worker, and so forth, right?

Sherry Siddiquim - 1 (00:54:20 --> 00:54:25)
And they take the ketamine. Usually they take it as a lozenge.

Sherry Siddiquim - 2 (00:54:26 --> 00:54:44)
Sometimes they'll take it intramuscularly. And the therapist will be present with the patient as they're going through their ketamine experience. And the therapist can do things like, you know, set up a meditation beforehand to help the person sort of enter their experience.

Sherry Siddiquim - 1 (00:54:44 --> 00:55:00)
The therapist and the patient can, you know, spend a few sessions developing what the person is hoping to get from the medicine. And then once the person sort of takes the ketamine in the session, either they will be, you know, and it's person-dependent, right?

Sherry Siddiquim - 2 (00:55:00 --> 00:55:14)
Either they will be sort of in their own world with their eyes closed the entire time, or they can talk to the therapist. And there's a way that, like, you can actually conduct therapy with the person under the influence of this medicine.

Sherry Siddiquim - 1 (00:55:14 --> 00:56:07)
And then as they come out, people might want to talk and kind of process what happened there, right? So within this model, the ketamine is seen more as sort of a tool tool that facilitates the psychotherapy rather than a medicine that a person kind of takes and perhaps in isolation. And then the third approach, which has some similarities certainly to CAP, is the psychedelic approach, and that tends to be a higher dose of ketamine. And that can also happen in the therapist's office. It's often taken intramuscularly And with a dose this high, the person is going to be sort of so immersed in their experience and possibly so kind of dissociated that they're unlikely to want to talk.

Sherry Siddiquim - 2 (00:56:07 --> 00:56:18)
But these psychedelic experiences are, you know, more likely to lead to a mystical experience, right? The dissolution of the ego and so forth.

Sherry Siddiquim - 1 (00:56:18 --> 00:56:25)
So I kind of wanted to give that as the big picture. But with all of these approaches, I think therapy can play a part.

Sherry Siddiquim - 2 (00:56:25 --> 00:56:38)
You know, if someone's doing the medical approach, they might go in for an infusion and then a day or two later come into therapy and talk to the therapist about what they experienced. So this is called the process of integration, right?

Sherry Siddiquim - 1 (00:56:38 --> 00:56:44)
And integration means we talk about, like, what did you take from your ketamine experience? What did you learn?

Sherry Siddiquim - 2 (00:56:44 --> 00:56:51)
What did you see? That's question one. And then question two is, what are you going to do with what you learned?

Sherry Siddiquim - 1 (00:56:51 --> 00:57:26)
So if the insights that you had in this experience were true and valuable, what's going to look different in your life now? So for example, let's say a person has this insight that I realize how important it is for me to get to see my grandchildren grow up someday and how meaningful that would be. The lifestyle change they might make is like, I am going to work with a dietitian to figure out how to have a healthier diet so I can live a longer life, or I'm going to quit smoking or whatever it might be.

Sherry Siddiquim - 2 (00:57:26 --> 00:57:44)
But that piece of integration is a really, really important one in helping people kind of take the fruits of the ketamine journey and kind of do something with it in their life and have it enrich their lives.

Dustin Grinnell (00:57:44 --> 00:58:07)
To add like some more color to the conversation, is there like a patient that sticks out in your mind that you can anonymize? Who you felt like maybe it's with in the context of ketamine, like had a very powerful experience, if you can share like what realizations were had and how did their life actually change for the better?

Sherry Siddiquim - 1 (00:58:07 --> 00:58:21)
Yeah, so there's one patient that comes to mind who is a person who struggled a lot in her relationship, her romantic relationship with men.

Sherry Siddiquim - 2 (00:58:21 --> 00:58:35)
And a lot of that was tied into her first romantic experience when she was in high school. She was dating somebody who she was like very, very attached to and later found out was cheating on her.

Sherry Siddiquim - 1 (00:58:36 --> 00:58:40)
And this was like a huge, huge betrayal of trust for her.

Sherry Siddiquim - 2 (00:58:40 --> 00:58:54)
And there's a way that as our work together progressed, we started to see that like that experience in her formative really led to a sense of mistrust with men as she grew older and into adulthood.

Sherry Siddiquim - 1 (00:58:54 --> 00:59:17)
So she had a pretty difficult depressive episode, which kind of led her to go into ketamine therapy. And sort of coincidentally, the day of one of her infusions, she found out that this first boyfriend of hers had died in a terrible accident..

Sherry Siddiquim - 2 (00:59:17 --> 00:59:51)
And a few hours after she found this out, she went in for the infusion. And in the course of this ketamine experience, she said that she went and found the spirit or the soul of this person, and she had, like, a conversation with him. And she said that she forgives him, and she really felt like she was with him and that that sort of ended up occasioning this huge emotional release for her to be able to sort of forgive him in this way.

Sherry Siddiquim - 1 (00:59:51 --> 01:00:47)
And this was a really powerful, very real experience for her that really did shift something in terms of the way that she related to men, in terms that she related to her memory of this person and this event. And, you know, sort of parenthetically, this is something I think about a lot, like whether this person like actually entered another realm and went to find the spirit of this person and communed with them, whether this was in some way, quote unquote, real, or whether this is a situation that a very creative mind produced for the person to be able to heal in this way, I think is an interesting question. But in a certain way, it's irrelevant because at the end of the day, the person was really, really helped by this.

Sherry Siddiquim - 2 (01:00:47 --> 01:01:00)
And again, at the end of the day, this felt like a very real experience. So that's sort of a standout experience with a patient who I have spoken to, and I know that she doesn't mind my sharing.

Dustin Grinnell (01:01:00 --> 01:01:44)
I've heard of situations, even in alternative therapy, where you kind of, even hypnosis, you go and kind of look at your inner child and give them a hug and things like that. Yes. Is it a supernatural thing happening? Have you reached another dimension? Probably not.

It's more that you've mind traveled and reached a new perspective, which happens to be healing. I wonder about this person's life now. Are they in a healthy relationship? Are they a little bit more trustful? To what degree can you actually overcome such a traumatic experience?

Sherry Siddiquim - 1 (01:01:44 --> 01:02:18)
Or— Yeah, yeah. So I don't want to go too much into the details of this person's life as a way to protect their confidentiality. But I will say in a more general term, I think we all love stories where it's like, then the person took the psychedelic and this thing clicked and then everything was solved and they got married the next year or whatever, like this, where I think the reality is much more complicated and there are things that are beyond a person's control, and I just don't think it's neat like that. Right. True.

Sherry Siddiquim - 2 (01:02:18 --> 01:02:35)
Other than to say in a very general way that I do think that this impacted my patient's way of interacting with men and made her, at the very least, more aware of the mistrust that she brings to some of these relationships.

Dustin Grinnell (01:02:35 --> 01:02:44)
Yeah. And awareness in and of itself is you're seeing the problem, so now you can kind of get ahead of it a little bit and maybe even think up solutions.

Sherry Siddiquim - 2 (01:02:44 --> 01:02:45)
Yeah.

Dustin Grinnell (01:02:45 --> 01:02:45)
Yeah.

Dustin Grinnell (01:02:45 --> 01:02:58)
Can you give a sense of the effectiveness of ketamine therapy in 2024? Like, what is the research saying? What data do we have moving from anecdotal to kind of like to, you know, the scientific process?

Sherry Siddiquim - 1 (01:02:58 --> 01:03:45)
Is it working on a bigger scale? Absolutely. So I'll quickly highlight just a few studies that have demonstrated ketamine's effectiveness in treating both depression as well as suicide Like I mentioned earlier, the first major breakthrough came in the year 2000 in a study led by John Krystal and Dennis Charney. And this study demonstrated that just one low dose of ketamine could produce significant reductions in depressive symptoms in people with refractory or treatment-resistant depression. And that these effects appeared within hours and by themselves themselves, so without therapy, these improvements lasted for about a week.

Sherry Siddiquim - 2 (01:03:45 --> 01:03:52)
So this was the landmark study that kind of opened the floodgates for more research.

Sherry Siddiquim - 1 (01:03:52 --> 01:05:05)
So we'll skip ahead now to 2017 when another pivotal study was published in the American Journal of Psychiatry, and this study specifically looked at ketamine's effects on acute suicide reality. So the researchers found that a single infusion of ketamine significantly reduced suicidal thinking within 24 hours in patients with major depressive disorder as well as suicidal ideation. So as you can imagine, this was groundbreaking because it suggested that ketamine could be a life-saving intervention for people who are at immediate risk of self-harm because it offers a much faster-acting alternative to traditional treatments. And of course, for someone who is at imminent risk to themselves, sometimes that extra time can actually mean the difference between life and death. Fast-forwarding again to 2019, so this was when esketamine or Spravato was approved by the FDA as a nasal spray for treatment-resistant depression.

Sherry Siddiquim - 2 (01:05:05 --> 01:05:14)
And this approval was based on several clinical trials, including a 2018 study published in JAMA Psychiatry.

Sherry Siddiquim - 1 (01:05:14 --> 01:06:42)
So that study found that when esketamine was combined with an oral antidepressant, it significantly improved depressive symptoms in patients who, you know, until then hadn't responded to other treatments. So this one was a milestone because it brought ketamine-like treatment, so esketamine, into the mainstream and gave patients a more accessible option. So I'll highlight just one more recent study which was published in the New England Journal of Medicine in 2023, and this study compared the effectiveness of ketamine to electroconvulsive therapy, or ECT, again for the treatment of refractory depression. Now, ECT has long been considered the gold standard for severe depression that doesn't respond to medication or psychotherapy, and it is pretty effective, but it can be pretty uncomfortable and has some bothersome side effects like temporary memory loss. So this 2023 study found that ketamine infusion infusions performed just as well as, if not better than, ECT for patients with refractory depression while also having fewer unwanted side effects and generally just being less invasive.

Dustin Grinnell (01:06:42 --> 01:06:51)
So if someone is interested in exploring ketamine therapy with a healthcare provider, where would you suggest they, they begin that journey?

Sherry Siddiquim - 1 (01:06:52 --> 01:06:57)
I think talking to your therapist can be really helpful and saying, you know, this is something I've heard about.

Sherry Siddiquim - 2 (01:06:57 --> 01:07:01)
Do you think it, it's something that might be helpful for me?

Sherry Siddiquim - 1 (01:07:01 --> 01:07:16)
You know, I will say not every therapist is going to necessarily know much about this treatment or be friendly toward this treatment, but at least amongst the therapists I know, people can provide some information or provide some referrals.

Sherry Siddiquim - 2 (01:07:16 --> 01:07:20)
There are some clinics in Brooklyn that I work with and I refer to.

Sherry Siddiquim - 1 (01:07:20 --> 01:07:51)
So I think that might be a good place to start. I think people can probably just directly go to a ketamine clinic even without being in psychotherapy, which again, I wouldn't recommend, but that's another possibility. People can certainly talk to their prescribers, psychiatrists, and so forth. And then I also want to kind of give a plug to a very, very helpful resource, which is Dr. Raquel Bennett's Kriya Institute.

Sherry Siddiquim - 2 (01:07:51 --> 01:07:55)
So that's spelled K-R-I-Y-A Institute.

Sherry Siddiquim - 1 (01:07:55 --> 01:07:56)
Institute. Dr.

Sherry Siddiquim - 2 (01:07:56 --> 01:08:28)
Bennett is a psychologist out in California who is a ketamine expert, and she has very generously compiled a website full of different resources, articles, videos, all kinds of information about the use of ketamine for treatment-resistant depression. So I think, you know, if people want to just learn more, that's a really, really good place a start. I'll also say that the 3 different approaches to ketamine therapy that I described is based on her work.

Sherry Siddiquim - 1 (01:08:28 --> 01:08:37)
So those are some good resources. I myself am going to start offering ketamine-assisted psychotherapy in my practice.

Sherry Siddiquim - 2 (01:08:37 --> 01:08:52)
So if people live in the New York City area and want to speak to me about that, they can go to drsherry.com, D-O-C-T-O-R-S-H-E-R-R-Y.com. And just contact me that way.

Dustin Grinnell (01:08:52 --> 01:09:05)
Great. I guess last question. What's your hope for this therapy for ketamine in the use of treatment-resistant depression? Where, where would you like things to start going toward moving forward?

Sherry Siddiquim - 1 (01:09:05 --> 01:09:18)
I am hoping that ketamine is recognized as a powerful tool in clinicians' toolbox, right, in terms of what we can offer our clients who are really suffering with depression.

Sherry Siddiquim - 2 (01:09:18 --> 01:09:24)
Depression, and particularly depression that is not responding fully to other forms of treatment.

Sherry Siddiquim - 1 (01:09:24 --> 01:09:42)
And when I use the word tool, I really, really want to highlight that this is not a one-size-fits-all solution, right? There are people who this treatment is either not appropriate for or who don't really benefit. And I also mean that it's not, you know, the silver bullet.

Sherry Siddiquim - 2 (01:09:42 --> 01:09:47)
You take it once or you go through a you know, 2, 3-week course and you're done, right?

Sherry Siddiquim - 1 (01:09:47 --> 01:09:50)
That this is something that can be really helpful.

Sherry Siddiquim - 2 (01:09:50 --> 01:10:27)
And this is something that can make it easier for people to implement changes in their lives that, you know, those changes are what make them happy in the long run or what alleviate the depression in the long run. So as we move forward, I hope that the public is able to kind of receive that message and that it's a source of hope for people who have, you know, struggled with depression sometimes for years and years and have not been able to get out of it despite, you know, doing everything else within their control.

Dustin Grinnell (01:10:27 --> 01:10:50)
Yeah. Well, really want to thank you for coming on and talking about this. I hope, you know, listeners can find some insight on this, uh, this really important area, and maybe they can find your work. And if they're in the New York City area, maybe they could think about working with you or reach out. So that's all the questions I have. And so I just want to say, Sherry Siddiquim, thanks for coming on and talking about this.

Sherry Siddiquim - 1 (01:10:50 --> 01:10:53)
Thank you so much, Dustin.

Dustin Grinnell (01:10:53 --> 01:11:15)
Thanks for listening to this episode of Curiously. I hope you enjoyed this conversation with Dr. Sherry Siddiquim. If you enjoyed this podcast, please consider leaving a review. They encourage people to listen and help attract great guests. If you like what you've been hearing and would like to sponsor the podcast, podcast, please consider supporting me on my Patreon account. Thanks again for listening, and stay tuned for more conversations with people I meet along the way.