Alternatives – Ketamine Therapy

[Jaunty Guitar Music]

Mike: Welcome, everybody. This is Avoiding the Addiction Affliction brought to you by Westwords Consulting and the Kenosha County Substance Use Disorder Coalition. I'm Mike McGowan.

Mike: Perhaps you've seen the billboards, they're in a lot of places, or articles online about ketamine therapy. Seems like just a little while ago we were discussing ketamine as a drug to avoid.

Mike: About a year or so ago, we had a conversation with DJ Quam, my guest today, about his recovery. When I heard that he had tried ketamine therapy, I asked him to come back and talk about that experience and he generously agreed.

Mike: Welcome back, DJ, how are you?

DJ: I'm doing well. How are you?

Mike: I'm great. Now we're going to put a link to our last podcast, which I think was like a year and a half or so ago, at the bottom of this. But just so that people who are too lazy to go back (chuckle) and listen, refresh us a little bit.

Mike: How long have you been in recovery now?

DJ: I have been sober from alcohol for just about four years. January will be four years.

Mike: Congratulations. That is great.

DJ: Thank you.

Mike: And that was your drug of choice as I recall, right?

DJ: Yeah. And actually, yeah, I mean, that was my drug of choice and I didn't, I didn't actually use really any other illicit substances.

DJ: Yeah, I was pretty vanilla in the sense that I just had alcohol.

Mike: (chuckle) Well, okay. So since you went through that, I assumed since we're talking about ketamine therapy, you hit some kind of a little wall. Like what made you want to consider ketamine therapy? What was going on?

DJ: I have you know, an actual, you know, diagnosed history with depression and anxiety as probably many people do.

DJ: In 2018, I was actually hospitalized for a pretty you know, acute anxiety situation. So I've always kind of known that my I'm somewhat at risk for, you know, very stressful situations triggering. It's usually anxiety type attacks. Other times it kind of puts me into a depressive funk. But earlier, yeah, I guess earlier this year, 2024, I had you know, nothing too out of the ordinary, but at work I got a new boss.

DJ: I wasn't really clear how I stood with my new boss and, you know, of course work was, was stressful and, it was, it was just building, you know, compounding, compounding. And, you know, even though I'm, I am, I am and was, and continue to be sober, but, you know, I was not necessarily making time for, you know, some of my outlets, you know, downhill skiing for me riding my bicycle, rock climbing, et cetera.

DJ: So I just remember one day I was walking my dog with my partner. And we had driven to a park and something that the dog, the dog was just like, not behaving real well on the leash. And long story short, I ended up having like a full blown panic anxiety attack in the backseat of the car at like the local park really from nothing other than like the dog just kind of doing his normal thing.

DJ: He wasn't behaving anything kind of out of the ordinary and had kind of long suspected that even though I'm on an antidepressant, that it wasn't quite enough. I cycled through CBT, Cognitive Behavioral Therapy. I'd probably seen three different therapists over the last five or six years. And, you know, they were modestly effective.

DJ: But I'd been in and out of CBT therapy for the better part of the last 10 years. And especially after my hospitalization, of course, that was a condition of my discharge was to, to follow a plan. And I did for probably two or three years, but I just knew like this depression and anxiety wasn't really going to be fixed with talk therapy.

DJ: And so my partner is you know, his day job is in healthcare. Now he's not a psychiatrist, so he doesn't necessarily follow all the literature on ketamine. But he at least was aware of the fact that ketamine has an off label use for treating depression. And so he kind of encouraged me to look into it, not necessarily suggesting that I do it, but ultimately, you know, I'm a engineer scientist by education.

DJ: I do a lot with clinical and medical work in my day job. So I had read quite a few, it's pretty well cited, you know, well well published articles on ketamine therapy. And it was the evidence in terms of its efficacy on depression was pretty clear that the sort of the variable tends to be the how it's administered.

DJ: That tends to be the more you know, kind of up in the air variable piece, but that's kind of where I landed. I kind of ultimately just hit a wall in my depression and after sort of, you know, an informed thoughtful process that honestly took probably three or four weeks before I kind of went from panic attack to.

DJ: You know, like actually filling out the online form. It was probably four weeks of, should I do this? You know, of course it's not covered by my insurance. So it was like, do I want to spend this much money on it? And all of that. So kind of a very long answer to your question, but that was, that was it.

Mike: Oh, that's great.

Mike: In fact, it answered some of the other questions. So you did your own stuff. And because you can find access to it. So you didn't go through a physician or a therapist, but there are these online therapeutic things.

DJ: Yeah.

DJ: So I used a service called Mindbloom, which is... I did quite a bit of research in terms of which of the online providers had a protocol that was, you know, well validated and well sort of cited.

DJ: And I felt comfortable with the one called Mindbloom, which actually turns out to also be one of the longest... Like they've been around the longest, at least as far as I could recall.

Mike: Did it make you at all nervous that the FDA still hasn't certified it for official use?

DJ: I would say no. You know, so the FDA still regulates it as a drug, right?

DJ: So it's a class, whatever, I think class two. So it's still, you know, the physical chemical is still regulated. So that was going to be my first concern is like, am I going to be taking something that's like, you know, way stronger or somehow, you know, had some sort of other unknown compound in it? So the fact that it's regulated by the FDA in terms of its compounding. And then of course I was working with an actual pharmacy that, you know, has a registered pharmacist, you know, signing off on it. So that was my biggest piece.

DJ: In terms of the comfort with the FDA not having sort of cleared it for the use. You know, there's a lot of drugs out there that people get prescribed every day that if you actually look at the prescribing label, you know, I think when it started, Viagra was for blood pressure, right?

DJ: So that didn't necessarily concern me. And I also, you know, felt like I had enough of my faculties to say, you know, I'm comfortable taking that, that risk. And of course you try it once and, you know, there's no one forcing you to do a second dose if you don't like it, right? So.

Mike: Did they prescribe you the oral, did they prescribe you the nasal spray?

DJ: So I did the sublingual, which is under the tongue. And they also prescribe an anti-nausea med so that you take an anti-nausea med like an hour ahead of when you expect to actually dose. And they actually tell you, like, it's sort of formulated to dissolve in that's typically done under the tongue, but they said that and all of the videos, they actually recommend you put it between your cheek and your lower gum.

DJ: And so it's very controlled. You only let it kind of linger for seven minutes and then you spit it all out. So it's all through the tissue, the gum tissue is where all the sort of transfer of the pharmaceutical agent happens. And so it's pretty controlled.

DJ: They make it very clear. Do not swallow. And I have a story about that where I accidentally did not on my first dose. It was much later, but I accidentally swallowed a little bit and it does make a difference. So yeah, it's in that sense, it's very controlled.

Mike: Well, okay. Tell us the swallow story before I get into the rest of it.

DJ: Yeah.

DJ: It was just very, it makes it much more intense, right? So the uptake curve of, for as long as the medicine's in contact with your tissue, they understand like how much of the medicine enters your bloodstream. But when you swallow it, you can basically like double or triple your dose.

DJ: And so what had happened is my dog ended up like jumping on the bed. And you, I, you, they recommend that you actually wear like a sleeping mask that completely covers your eyes. They recommend you wear noise canceling headphones. Cause the program is coordinated to like a soundtrack.

DJ: So you're pretty much sensory deprived of what's going on around you. But my dog got into the room, jumped on the bed and it startled me enough that like, basically I got a small swallow of spit it's seven minutes. A lot of spit builds up. Didn't swallow everything, but enough that kind of felt somewhere between like drunk and hungover for probably a good four hours, which was a very unusual.

DJ: This was not my first dose. In fact, it was my seventh or eighth. And so I had very much accustomed to from the standard experience was you put the medicine on your tongue, you let it sit for seven minutes, there's a 1 hour, like little soundtrack that you listen to, and it's pretty much that by the time the soundtrack ends.

DJ: You're back to normal. And so the, this experience with the swallow where it like lingered for about four hours was like, okay, I don't want this to repeat this. And in fact, I actually put off any other sessions for a while. Cause I was like, it was just kind of a, you know, it kind of like getting a almost like food poisoning where you're like, that was just such a nasty experience, but that is not normal.

DJ: Let me emphasize that.

Mike: So it is one of those that when they talk about it online and in the articles, the literature, they say, this is where the ketamine therapy can help. It helps with depression. It helps if you're already on an antidepressant. And they said, you know, it just speeds the process somewhat.

Mike: So how long between the doses and how many did you end up taking?

DJ: So the way it worked with my provider, you buy it in packages, right? And so the packages that you pay for through this service obviously includes all of the prescriber, so sort of the doctor. You do Zoom sessions with them and they do, you know, they obviously go through a eligibility criteria in terms of you know, they screen for if you've had been prescribed any other narcotics, they screened for depression and suicidal ideations.

DJ: There's a pretty strict protocol they follow, but once you are delivered the medicine. You know, this whole thing is predicated on the concept that ketamine induces neuroplasticity, which is this concept that when you are on ketamine and for a short window afterwards you can essentially rewire parts of your brain.

DJ: And so a big part of the service that I used was, sure, you know, they send you the medicine, but it's very structured that in conjunction with the dosage of the medicine, you meet with a guide. And I think in a lot of ways, the guide is a term they use because it's someone who isn't necessarily licensed to be a therapist in your state because a lot of this is like... I worked with a guy who was based in Utah, and I think in Utah, he is a licensed therapist, but because I was in Wisconsin, they couldn't call it therapy.

DJ: So they kind of give it another name, but it's essentially, they call it a processing hour or something where you sort of work through your sessions. And essentially you're using that. neuroplastic window to kind of rewire the connections and basically start to unwire the things that are sort of short circuiting into depression, and then you rewire your brain into things that are a little bit more healthy.

DJ: And so the first six sessions, they have you do in pretty rapid succession. So the first six that I did, I finished in a course of maybe a little less than six weeks, somewhere between five and six weeks. And then I chose to add on another six. As sort of like an add on package. And I did that more like once a month, my second six, I did more like month to month and like kind of like a maintenance sort of concept.

DJ: The service is pretty rigid about your first six being done in a pretty rapid succession. Cause they have some science that says that they, if you. Kind of put them back to back, like every five to seven days, you maximize the neuroplastic window, and then once you've sort of hit your peak, then you can kind of go into maintain mode.

DJ: And that's what I was doing in the second six.

Mike: When you first did it, were you alone, alone? Did you have anybody supervise you?

DJ: No, no. So, I mean, obviously this is on the honor system, but the first session, it's sandwiched where you start with a guide on Zoom and they kind of, they go through, again, some safety things like they send you a blood pressure monitor and you have to show the guide that your blood pressure is in control and there's some other factors that they do in terms of safety checks.

DJ: You have to have a friend or some sort of person with you who has to be a, you know, my partner had to like come onto the camera on Zoom and the guide, they had a conversation about kind of safety. In terms of like, if something happens, here's what to do. And then I go back with the guide and they kind of give you your final instructions in terms of like, okay, you put the ketamine under your tongue and then you hold it for seven minutes and you spit it out.

DJ: Then you actually do the first ketamine session where my partner was checking on me, I think once or twice during the one hour, don't quote me on that exact number. And then you finish with the guide. So your first session is the better part of like two hours long because you start with the guide 60 minutes with the medicine, and then you have like a processing session afterwards.

DJ: After that the remaining five sessions you do on your own, but they are done where you log when you've been taking the medicine and then you work with your guide. I did a lot of my sessions over Zoom. I think they offer kind of like text or chat based processing. They call it integration. I chose to do it over Zoom.

DJ: That was my preference. And at that point, like I said, it's kind of self paced. But they give you prompts to remind you, you know, to stay on schedule.

Mike: Well, now there's a couple of really big questions out there. First, what do you think, how'd it work?

DJ: It worked.

DJ: Yeah. I mean, my partner would be the first to tell you like, my mood was pretty dramatically improved.

Mike: Almost right away?

DJ: Maybe within the first two, maybe three sessions.

Mike: Really?

DJ: Yeah. Very, very rapidly. You know, it's been a few months since my last session. I'm actually thinking I might up again, like re up and sort of buy another six. Again, more like maintenance.

DJ: I don't necessarily feel like my depression has, you know, resumed into some terrible state, but I can kind of see that my mood has started to dip and I think I kind of want to keep it at a steady state. But yeah, it definitely worked. And for me, the real trigger to go after the ketamine therapy was for depression.

DJ: Although I would say it, for me, the ketamine assisted therapy has had equal benefit on both the depression, but also kind of leveling out the anxiety.

Mike: Have you measured that against the fact that now it's turning into winter and there's always that layer added to it or now your boss has been your boss for a while.

DJ: Yeah, that's interesting

DJ: I mean, I'm sure there's some of that. No, I'm also a freak that I'm a downhill skier. So I actually love the winter So the winter tends if anything, I tend to have my depression state during the summer when I can't go skiing.

Mike: Oh, okay.

DJ: But no in general I'd say I've been in the same job for a number of years now where I kind of have enough cycles to kind of be able to distinguish, okay.

DJ: Kind of separate out the boss effect versus the depression effect. And in general, I would still stand by like, yeah, it's worked. I think I would say, you know, there is a certain amount of mindset impact where if you. You know, you have to have kind of intentions. That's the one thing, at least the service I used, to make a very strong point to really make sure that your mental head space is in a very neutral to positive place before you actually take the medicine, because that's kind of how you rewire your brain.

DJ: If you go in, and just take the medicine and you're in this nasty, cynical, negative, whatever mood you're going to basically reinforce or at least kind of make it more likely that you're not helping. So there's a big process where like you sit down and you don't just pop the medicine right away.

DJ: You actually kind of start with, okay, it's journaling. Then you set an intention and then you pick your soundtrack. And then every ketamine session ends with some journaling. Some of that is simply just like recounting the visuals that you saw and then it kind of flips into how do you actually integrate that with some of your goals for therapy, right?

DJ: Because that's, again, the service I used, that was a very big component. It's, yeah, the ketamine is a tool to help you with a broader set of goals. And that is very well documented in sort of my, frankly, my chart, right? And they also like, I know for a fact, because they also are looking at like my prescription history to make sure I haven't been prescribed a large number of other controlled substances.

DJ: And I believe that if I had been having a lot of controlled substances that I may not have been a candidate, but I didn't have any problems kind of navigating the, you know, the medical legal side.

Mike: Well, and it does have some disassociative properties, and I think when you said you swallowed it, you went there.

Mike: So my other questions, and I think this is relevant for the conversation, is as a recovering person, when you experience that altered sense, I'm sure you've had some folks say, don't go there.

DJ: You know, well actually I, so I, you know, I'm in AA, I think we've talked about that before.

Mike: Right.

DJ: And I did actually talk to my sponsor before I agreed to do it.

DJ: And kind of said, is this a really bad idea? Is it an okay idea? Now I was pretty well sold on the idea when I went and talked to my sponsor. But I was sort of like, going forward with a, if there's a red flag here that I haven't seen, please raise it. Otherwise I'm going to go ahead. I think in general, my rule with myself, as someone who was in recovery, like I only did it.

DJ: I only took the medicine when my partner was home and was aware that I was doing it. And of course, they only send you six doses at a time, and it's very controlled, right? So now, if I had really gone off the deep end and really developed an urge and a craving for ketamine, could I have gotten more? I don't know, probably.

DJ: But I chose to, you know, kind of stick to it as a therapeutic regimen. And I had that rule with myself that I would only be taking the medicine when my partner was like, well, A, just like in the house for the sake of like safety, but also like aware that I was taking the medicine so that it didn't become a drinking in the garage situation.

Mike: Well, and you said that when you swallowed it accidentally, it left you feeling intoxicated, more or less.

DJ: Yeah.

Mike: And that was your drug of choice, so. You mentioned your sponsor. You didn't bring it up in an AA meeting to take a vote, though, did you?

DJ: No, I did not. It was one on one.

Mike: I wonder what would happen if you mentioned it.

Mike: I would love to be there for that conversation.

DJ: I don't know.

Mike: Some people would probably, like your sponsor, say, well, as long as you're safe, go for it. And other people would be like, you know.

DJ: I think there's also like a, you know, in the same way that there's like kind of a stigma about being in recovery, I think there's also a stigma about using ketamine for more legitimate things.

DJ: That's not like recreational. I actually, I work with a professional coach and I mentioned this to my professional coach and it was very clear that she had a different view that she did not feel like this was something that she would ever agree to. And, you know, that's okay, you know, it's just someone else in my kind of, my day to day life that's like, okay, well, that's how you feel about it.

DJ: For me, it was very helpful. You know, I, I'm not going to make my health and wellness decisions based on what my professional coach says, but,

Mike: Well, we just had a discussion. I had a discussion with somebody earlier today about this, because we had somebody on a while back talking about going to Mexico for ibogaine, right, therapy. To get off of opiates. And, you know, the world is a different place. It's no longer black and white, which is why we're having this discussion.

Mike: Does it, so, you know, you know yourself well, so you may need a tune up for lack of.

DJ: Yeah.

Mike: But does it also leave you open to other alternative forms of therapy.

Mike: When you talk about the brain we were in, I'm thinking of things like EMDR and some of the other things we've talked about.

DJ: Yeah. I also did EMDR in therapy and it was effective to a point. Honestly, more gave me a headache than anything else.

Mike: Did you tap or what were you doing?

DJ: No, my therapist did the finger thing.

Mike: OK, alright.

DJ: Yeah, I mean, in general, I'd say I'm pretty open minded. I'm also, however, like very much. Show me the proof that it works. And you know, I think that's one of the reasons where I kind of fell out of favor with CBT was like, I've just done this so many times and I've tried very diligently to pick different therapists who have different sort of approaches and inevitably the results were only ever okay, right? The results were never like earth shatteringly profound. They were okay, and I feel comfortable saying that because like I my sister's a therapist. I know I've gone to a lot of therapy and I'm pretty confident to say that for me as an individual, CBT, if it was the only thing available, yeah, I would still do it.

DJ: But knowing that there's other things. I'm happy I tried it. Now would I, you know, go jump on some new, you know, pharmacochemical agent that had very little evidence? No, probably not. You know, ketamine was kind of a known entity in the sense that It's been known for quite a while that ketamine had an anti depressive effect.

DJ: I think it's now really kind of entering that mainstream of like, A, a doctor can prescribe it to you. It used to be that doctors couldn't even prescribe it. And there was like a safe supply chain in which to procure it that came with the wraparound services like that I had. And to me, that was the sign that it was probably, you know, okay to jump into that pool.

Mike: When you got it, did you get it from a local pharmacy?

DJ: No, it was shipped from, like, New Hampshire or something. Yeah. No, I don't remember what all the laws are that regulate that, but, like, it wasn't, like, shipped in the dark of night. It was, you know, pretty openly disclosed what it was. So, I don't necessarily, again, know the laws, but it didn't come from a Wisconsin pharmacy.

Mike: I think it's just fascinating. I'm so glad you could have this conversation. And I'm, first of all, I'm glad that it has helped with the depression. And you're still on your other meds, right?

DJ: Yep. I'm still on a what is it? Lexapro Escitalopram.

Mike: And it just, it acted like a boost for you.

DJ: Yeah, absolutely. Definitely.

Mike: Well, like all things, we keep learning all over and over again, right?

DJ: Indeed.

Mike: Yeah.

Mike: DJ, thank you for so much for being with us and talking about this. As you all know, I'm going to put links on the podcast, not only the DJ's podcast, but also a couple that have articles about ketamine. So that if you want to do a little bit of your own, it gives you a start for that.

Mike: You can all join us whenever you're able and until you're able, stay safe. Live well and keep an open mind.