EFR 889: Why SSRIs Are Failing Us, How to Reset the Nervous System and What Actually Works for Mental Health with Dr. John How

00:00 - Chase (Host)

The following is an Operation Podcast production. 

00:03 - John (Guest)

This is Dr John Howe. I'm the medical director for Stella. Welcome to EverForward Radio. 

00:08 - Chase (Host)

I've heard you talk about one of the treatments that we're going to get into as quote vacation in a syringe. And before we actually get into what that is, there's some pretty wild stats going on right now in the world, but definitely America with the state of mental health, and I found a recent 2023 poll showed about 50% of a 48.9% of Americans age 18 to 29 are reporting symptoms of depression and or anxiety. So almost one in two people out there is I'm depressed or have anxiety. And in our conversation today, we're going to be discussing what some may argue are dramatic or even radical procedures for mental health, but I would argue that in the current state of America, like we need radical health care reform, we need radical, especially mental health care reform. We need radical, especially mental health care reform. So, before we get into these treatments and different modalities, what is maybe your quote state of the union on mental health in America, if you? 

01:22 - John (Guest)

could address the powers that be say this is what I view as going on as the mental health state of America. What would that be? Well, it's an extremely exciting time. You know. There's a lot of tools that are out there that are becoming more well-known, and we as a population and as care providers are trying to figure out how to use those tools in the most effective way. Some of it is the. You know, the mental health professionals are in some ways, being led by the people that are not mental health professionals or have experience outside of what is traditionally thought of as mental health, and that has to do with the fact that there are legal challenges for different substances in this country, specifically for different substances in this country specifically. 

02:09

You mentioned that half the people are depressed or anxious. Is that because they're just realizing that now? Is that because they always were and didn't know what it was, and now it's become more? It's been okay to say it, I don't know, but I think what it speaks to is that there's a lot of people that feel as though they're not right in some way and they want to find a way to be better, and there is this movement. You know, you've heard this psychedelic renaissance as something that's been talked about. I think that's true. You know, there's there, definitely is, or there was in the not so distant past, this big excitement about what the psychedelics can do. Things kind of got squashed, you know, in the Nixon administration and then Tim. 

02:51 - Chase (Host)

Leary, the war on drugs and now the crushing of MDMA therapy. 

02:56 - John (Guest)

Yeah, I mean there's always going to be this interplay between what is acceptable, what is legal, what is paid for. You know that's by insurance companies, et cetera. We're not talking about that specifically, but it's part of the milieu of this. And where we're going to end up I'm not sure, but I am excited about where it's going to be. Is it that we find that these different molecules talking about any other psychedelics or sedative hypnotics which is ketamine, talking about any other psychedelics or sedative hypnotics which is ketamine how do we use those in conjunction with the therapy modalities that we have out there and with the stellate ganglion block and with TMS and whatever that happens to be when we're going to end up? I'm not sure, but I know it's going to be a better place than we are now. You look at the effects or the efficacy of SSRIs. You know the standard things that's given for for being depressed and it sucks. 

03:50

Like they're not. They're not good medicines. 

03:53 - Chase (Host)

Especially when you try to get off of them. 

03:54 - John (Guest)

Yeah, yeah, then that's another part of it, right? So then you have. You have side effects that aren't great. You don't feel like you're getting a benefit from it. You're just maybe not so sad, but you're not so happy either. You know, no one really wants to feel like they're a blunted version of themselves Not to say that everybody does. 

04:11

There's plenty of people that have some benefit from SSRIs. But I guess where I'm going with this is that to figure out how to combine the things that traditionally have been serving us from a mental health standpoint with the newer modalities. I don't think psilocybin is new, you know what I mean but, like with the other modalities that are becoming more available to the population, whether it's traveling to Costa Rica and getting ayahuasca or whatever that is, to find a way forward and through that and be able to tailor the treatments that are available to any one specific person. That's what's exciting to me. Yeah and I'm not just saying this as a provider Like, hey, chase, I'm going to figure out what we're going to do for you. No, it's got to be a conversation, because there's things that are happening in your head that I can't get to, you know what I mean. 

04:59

And tomorrow's going to be different. So what's the right answer? You've had experience with some of the treatments already. We talked about that briefly. You know like to use ketamine specifically. How often are we doing the re, the redosing? When do you need that? Why do you need that? Is it what? What are the metrics that we're looking at? How do you know that you're ready for another one or not? And is it because you had a challenging thing that happened to you in your life yesterday or three weeks ago, or is it that there's something wrong with your brain? Chemistry Wrong is a bad word. You know what I mean. 

05:28

But like that's the interplay of having people that are educated, that can be advocates for themselves, that understand what's available and how to plug that into them, but then also having care providers that are savvy and open to the different modalities that are out there and no one understands everything about everything, but trying to be curious about it and stay curious about it. That's important to find the mix of those two things. Now, I'm not there yet. I'm not the guy that knows everything about everything. I'm good at what I do and I'm excellent about providing that. Everything about it, everything. I'm good at what I do, and I'm excellent about providing that, and I can have conversations with other providers and patients about how what I provide dovetails in with what they're doing. 

06:13

I think that's going to be the state of the union, as you say, for a long time. Because is it that psilocybin is decriminalized or available and I just keep referencing that because most people understand that but there's Ibogaine, there's Iowa, there's all these other molecules and then the modalities that are currently available, whether it's CBT or EMDR or whatever the type of therapy that is available. You know figuring out the mix. We all just need to know that we don't quite know what the right answer is, and every answer for every person is going to be different. It's a journey. It's fun to be on it, it's exciting to be on it, it's an honor to be part of it and, as a patient, it also gives me hope for what's ahead. 

06:54 - Chase (Host)

Yeah, especially, I think, when we're looking at treating mental health or first understanding, diagnosing, treating and developing lifelong plans around mental health, you have to have hope and I think that's where we're. I definitely want to get into that later. Hope is such a important part of mental health treatment and is where, speaking from experience, where people kind of completely give up or seek answers out of desperation because you have it or you're looking for it. Yeah, not just treatment, not just answers, but but hope before you can even feel better. Again, speaking from experience, getting to a place where you can have hope that you can get better, when especially it's been gone, is paramount. 

07:39

Like that in and of itself, I think, gets you over the hump of poor mental health, even things like PTSD, depression and anxiety. I wonder, right now, do you feel, because so many of these things are more top of mind we're seeing it more on the news and social media things like psilocybin, mdma, different modalities like cell ganglion block, ketamine therapy are we now in a place culturally where it is more acceptable and the science has always been there, or has the science just now gotten to a point and you know, culturally we're playing catch up to? The two have to. Can they work independent of each other, basically, or do they need to be present both? 

08:19 - John (Guest)

Um, it depends on you, where you live and what you're dealing with, I think Right. So, if you're meaning, if you, there are certain countries or regions where modalities are available and certain areas where they're not, and there's also different areas where it's acceptable, whatever that means to the person, to the medical community, if you're asking that group of people's opinion and to the government what's appropriate and what's acceptable. So it's a little yeah, there's going to be variability across the country and around the world as far as what's available and what people reach for. I'm not sure if I'm answering your question. 

08:58 - Chase (Host)

Yeah, no I definitely understand what you're saying. Uh, let's maybe for for this purpose of this podcast, let's keep it focused on America. So let's say do you think, culturally in America, we are in a place where the science has an opportunity to actually shine through and get some stickiness for these modalities, or it's just it's more one than the other and we're not quite caught up with both yet. And do we need both to be present here in America to actually stick? 

09:28 - John (Guest)

It's always going to be a progression. There are parts of what we can offer that can advance. There are plenty of things that are available. We're here to talk about stellaganglion blocks and ketamine those are available. Therapy, that's available. Tms that's available. There's different things that are out there. So, is the science advancing? Yes, is treatment advancing? Yes. Are we in a good place where the milieu of what's acceptable and the state of the science and state of the art is advancing? We are. Would it be nice to have more Sure, but yes, we're moving forward. 

10:05 - Chase (Host)

I like it. I like it Moving forward. We're on the right podcast for that. Your work focuses on quote treating mental health challenges as injuries, not disorders, which I thought was a really interesting lack of a better term here tagline. Is this implying, then, that we have been treating mental health conditions all wrong? And what does treating it like an injury versus disorder really look like in terms of both care plan and success rates? 

10:44 - John (Guest)

manuals in general, of trying to remove the word disorder from a lot of things, because specifically with PTSD, usually something happens right, that's challenging, that puts you on your heels and then that brings about a change in the way that your body, mind, accept the world and interact with it. So that's the injury thing. Depression can come along, anxiety can come along. Those aren't necessarily injuries, although they're usually related to it or can be related to it. But yeah, so there's a thought that maybe a more appropriate term for PTSD would be PTSI, so post-traumatic stress injury. But that's what that specific thing is talking about. 

11:17 - Chase (Host)

Okay, so we've been hinting at it. Let's dive into what is a very new procedure and treatment for PTSD, depression, anxiety, amongst other things I'm sure we'll get into, and that's the stellate ganglion block. And if someone Googles this real quick, they're going to see again what could be considered a pretty radical procedure. Quick, but we're talking injecting something going in, messing around with nerves in your neck to treat mental health. What is this cell like? Ganglion block? Walk us through the procedure and how can someone really get on board with something like this? Um, when it sounds so invasive? 

12:00 - John (Guest)

Sure? Well, first of all, this is something that's been around for a hundred years. We've used it for all sorts of different conditions. 

12:07 - Chase (Host)

This procedure. 

12:07 - John (Guest)

Correct. It's used for chronic pain. It's used for something called Raynaud's phenomenon. It's used for heart arrhythmias that aren't treatable with other modalities. It was used initially by doing it blind. The doctors would find landmarks and do different things with needles to try to get it, to get it where it's supposed to go just just hoping we're poking and prodding in the neck we get the right there's some finger cross indefinitely. 

12:29 - Chase (Host)

I mean, I'm sure that's a lot of original medicine, right? 

12:32 - John (Guest)

but yeah, so it's been around forever, but the first paper that that showed that it helps with mental health concerns came out in 06, so that's kind of the the newness of it. 

12:43

Um, the way we do it now most safely is with ultrasound because, then I can see all the structures in the area and make sure that I can avoid the things I need to and get to where I need to go. I can also watch the medicine. That's nice See if it spreads in the right direction. So yeah, it is to be succinct about it. It's an injection of a local anesthetic next to the nerves in the neck that are part of the sympathetic chain. So your sympathetic chain is the body's part of the fight or flight response. 

13:12

The brain has an analogous structure called the amygdala, and the communication between the amygdala and the sympathetic chain is where you get your sympathetic tone or how much you respond to any one situation. Okay, so I'm using a medicine very much like what the dentist uses to numb up your tooth, but instead of putting it next to a sensory nerve, like the dentist, I'm putting it next to these sympathetic nerves that carry different information. The numbing of those nerves. It lasts for about six hours or so. The actual numbing causes a reset of the emotional set point or, to say it another way, makes it, so your fight or flight response is downregulated or brought back to where it should be, or can one assume that a traumatic event or a poor mental health condition is nothing more than a breakdown in communication of nerves between nervous systems? 

14:13

Or an over-communication may be the way to say it. Okay, yeah. So if your body and your mind interpret the world to be a scary place, for whatever reason, they're gonna up, regulate your weariness Right, it's gonna. You're gonna be on edge, it's gonna be hard to focus, you're gonna have sleep disturbance, you're gonna be irritable. Those are the symptoms, or common, common symptoms, that we see with PTSD, because the body is ready for some sort of insult, hyper vigilance. It serves people that are in the military, it serves people that are in high, you know, in environments that are like that, because it keeps them alive. But when you're no longer in that situation, it just can be detrimental to your mental health and your ability to interact with the world. If everything is out to get you, it's hard to sit there and be cool with your kid and, you know, have a conversation with your wife yeah, yeah, if you're a hammer, everything's a nail, right? 

15:04 - Chase (Host)

Yeah, well, it immediately makes me think of a lot of different ways, I guess, ways to use this. I'm a veteran myself and so, coming from a military background, I could see an amazing advantage to I don't know if this is accurate, but having a procedure like this, like in the opposite, have it turned on to where I am in, just my sympathetic and parasympathetic nervous system are exactly where they need to be. I can just, you know, kind of override my system to be even more hypervigilant. It's almost like a performance enhancing drug or you know a biohack for someone that needs to be hypervigilant. And then can you go the other direction of like, okay, I'm off duty or my tour's over, or I'm out of that situation. You know, I can like turn it off. Are we talking about just like simply a on and off mechanism here? 

15:59 - John (Guest)

Not necessarily. I mean, this is part of in some of the special forces circles they would do this between deployments or they still do. 

16:04 - Chase (Host)

No way, really yeah this is part of in some of the special forces circles. 

16:06 - John (Guest)

They would do this between deployments or they still do. No way really. Yeah, because it's that's exactly what I'm getting at. Yeah, so they would. And you know, the question always comes up, or often comes up if I get this block, is it going to block me, is it going to make it so I can't respond? And the actual actually what? The reason it's called a block is just historical. When I'm doing a nerve block, it means I'm putting the medicine next to the nerve to turn off the nerve. But conceptually, what this does is it unblocks a person. So you still have access to the entire range of your responses. It's just that you're not stuck in the over response. You have the choice to react or act instead of just reacting all the time. 

16:42 - Chase (Host)

So it kind of gives us more of that driver's seat position of do I need to be sympathetic or parasympathetic instead of my body dictating based on the situation? 

16:52 - John (Guest)

Like I know that I need to wait on my body to get on board with the situation. 

16:55 - Chase (Host)

I could just go, this is what I need and I can choose to kind of all systems go. 

16:59 - John (Guest)

Yeah, wow. It gives you the space to choose how to react, instead of having your body just do this thing that is protect, or has been protective in the past but doesn't necessarily serve you now. 

17:11 - Chase (Host)

So then, is there a particular type of traumatic life event that you've seen people have a higher positive response to with this modality, or is it just you know any situation that you know one could find themselves in, where it is that like hard on or hard off. 

17:24 - John (Guest)

Yeah, now, there's not like a type of trauma that this works best for. It could be people that have had, you know, some sort of traumatic event in their childhood and that's what it was. Or someone like yourself who has military service, or someone like me who's an ER doc and you know, gets the vicarious trauma every day, like it can be a big capital T trauma or a bunch of little capital, little, you know lowercase T traumas that happen all the time. And then the other thing is, once you get it, just cause you get the block, it doesn't protect you from future trauma. I always tell people, if you get sued or divorced or something weird happens to you bomb, you know there's life's tough, come on back, cause this, this won't help from what's to come, but it'll help with what has come before. It also puts you in a better way, a better position to receive challenging life events that are coming. 

18:09 - Chase (Host)

Why do you think that is? Is there a systemic answer here or a clinical answer as to why this procedure we can block and the past does not show up the way that it used to? But let's say, even if it isn, is it the same situation or could be the exact, maybe different situation, but same physiological response to like we did in the past? Why does it differ? What's different about the past in this procedure versus the future in this procedure? 

18:36 - John (Guest)

If it is just a matter of turning something on or off physiologically, I see what you're saying and the bad analogy is once a cucumber becomes a pickle, it's always a pickle. 

18:45 - Chase (Host)

You're always a little susceptible, you know, like the things that are challenging to you. 

18:50 - John (Guest)

If you've had something that has resulted in PTSD-like symptoms or the frank PTSD, then you're more likely to pick that up. There's actually some thought that there's genetic connection between people that are more susceptible to getting PTSD because of their genetic makeup, and that's a conversation for another time. But if it's, if that's the case, then you know, I had let's just use an example a person that has had childhood trauma and they have been spun up for their entire life and I do this block on them and now they're in a safe place and they're fine, and then they get divorced, which is hugely traumatic for people. Then they could get very similar symptoms because the body just knows are we in danger or not? It's the kid thing or it's the divorce thing? It feels the same and the pathway in the body is the same. 

19:34

The thing that is thought to be protective, thought to be anthropomorphic that your body does this thing to protect itself and becomes dysfunctional is the same thing every time. So I've helped you with what came before and then something else happened that caused you to have a worsening of your symptoms. I can help you again. There's some people that come in, myself included. I do this every year, every 18 months. 

19:54 - Chase (Host)

You. 

19:54 - John (Guest)

Yeah, I get it. 

20:19 - Chase (Host)

Can't do it on myself, but I get it Now. Is that because you find personal value in kind of every 12, 18 months? You said, just making sure you do that just keeps you ahead of that stress curve, so to speak. Or is it just have like a shelf life kind of thing? 

20:32 - John (Guest)

It depends on the person. But yeah, for in my case things happen, it's tough, my life is great, but it's not great too. You know what I mean. And so to just and I know that I can do this thing to make me feel better if these symptoms are showing up, it's like you know this doesn't apply to me, but you know you need a haircut right, it's like I go in because you know that the barber can make your hair shorter. 

20:53

I'm like these are a problem for me. These are affecting how I'm acting or how I'm reacting, and I know this thing can fix it, so I go in and did it. 

21:00 - Chase (Host)

So the walk us through this kind of actual experiential part. So I go in and this actually transparently, something I'm considering getting done, a procedure I'm getting I'm considering getting done for ongoing anxiety, depression related to PTSD. What am I going to experience? Is it just, you know, I go in, you do what you just mentioned. What comes next? What do I feel? Is it just like an automatic on-off switch and I'm just in euphoria? Or is it now? I'm just in a different physiological state and therefore the work is going to be a little bit different or better. You know, do I need this, coupled with integration with other mental health therapy modalities? People maybe are more used to what comes next. How does it work after that? 

21:43 - John (Guest)

Yeah, it's a great question. Like all the things that we've talked about, this is a tool in the toolbox. It's a treatment that is transformative for a lot of people, but to do it in by itself is probably not the highest and best way to get the best out of this, right? Okay, so to answer your first question, what does it feel like? It ranges from a few minutes after I do the injection. You will feel peace. You will feel as though you can breathe deeply. 30, 35% of people have a very strong emotional reaction. Usually it's tears, sometimes it's anger, sometimes it's a mixture of anger and sadness and happiness. It's very odd. It comes out of nowhere. So I warn people before they get on the table that this might happen to you. If it does, just lean into it because it's part of it. 

22:24 - Chase (Host)

Is it kind of like have you ever done a breathwork session? Is it kind of like that, Just out of nowhere, you're just breathing, heavily, crying and just feel this kind of like cathartic release, unexplicable release. 

22:35 - John (Guest)

But you're not working for it like breathwork. You're just laying there talking to me about how you're feeling and all in the tears or in the fields or whatever it is. You just don't know what it is Now. Usually it's just a general feeling of the emotion. I have had people that started. I had one guy that was a POW and he was like verbally processing battle buddies, which was pretty heavy. 

22:52 - Chase (Host)

What do you mean? Just like talking about the people that had been with him in the POW camps and like the yeah like that almost never happens, kind of like in a PTSD scenario where he was like like was he? Did he actually think he was talking to them or just no? 

23:04 - John (Guest)

he was talking. He was talking to the people in the room. He wasn't dissociated, but he was talking about them and talking about feelings that he was having survivor guilt and things like that in a very, very impactful way. That almost never happened. I've done like 2000 of these procedures and I've only seen that happen one time. Most of the time's just I'm sad and I don't know why, and it's just. You know, the water works, go and it's 15 minutes. You're done with that and feeling better why? 

23:29 - Chase (Host)

sorry to interrupt you here, but this is just, it's fascinating, like, do we have a reason why? Like, why does that happen? Is it just? Is that the secret? Is that the secret place and method to unlock? I mean it's I call the ganglion blocks we're unblocking. Is this actually the place where trauma and sadness and depression and just unprocessed memories and feelings, like literally physically get stuck? 

23:53 - John (Guest)

I don't think that's where they get stuck, but that's kind of the place where we know that we can unlock it and start the reprocessing. It's really bizarre because and then sometimes what can happen, as you'd likely know, like emotions can be stored in the body, so people will start shivering. Sometimes they're not cold, it's just their muscles start releasing things. Or if you've got this knot that's been here for 10 years or whatever, that will sometimes start going because there's emotions stored in that. Like if anyone's had acupuncture or massage or worked in that field, it's not uncommon for people to have just these spontaneous emotional releases when you're getting body work done, so very similar to that. But it kind of is the master switch to that and everything can start releasing and that can last for a day sometimes. 

24:34 - Chase (Host)

So okay, so I go in, I get this procedure done, um, potentially moments after I could be experiencing just this unexplicable emotional release, this kind of you know, this dumping of blocked emotions and bad memories, so to speak. And then is it okay, all of a sudden I'm better. Or is it I need to now work through all of this kind of like in traditional talk therapy, like I don't know where this memory kind of came, so now I need to navigate through it, or is it just, oh, it's out and I'm good. 

25:06 - John (Guest)

It's not a memory, it's an emotion, like you're not processing a specific thing, like I said one time, that's happened. But the times as a patient that I've had this, I'm not thinking about things that make me sad, I'm just feeling sad. I see, and it lasts for as long as it takes you to process it. And again, this doesn't happen to everybody, but this can happen. It's 10 minutes and then you feel tired and relaxed. Now let's take that piece out of it. Let's say you don't have that response. Where you have this very strong emotional response, the most common description is ah, I can breathe deeply now and I couldn't before. I feel like there's a weight lifted off my chest. I feel peaceful, or I feel like the monkey mind is not talking to me, which is very strange for some people who are like I don't know what that means Like there should be a thing going on in my head and it's not which makes them very present and very. 

25:59

you know that that feels good. Yeah, strange to a lot of people, but good. 

26:05 - Chase (Host)

Have you found that with, particularly this procedure, the stellate ganglion block this relief? These kind of next steps that come after the procedure? Are they more typical for someone that comes after doing quote the work of? I've tried a bunch of other things. I've journaled, I've meditated, breath work, talk therapy and I have more kind of top of mind things or a thing that I'm ready to release versus just someone who has maybe more, whether this is consciously or subconsciously, they're admitting it or not. 

26:40

No reason why I don't know why I'm depressed. I don't know why I have anxiety. Does it matter the readiness or the thing that you come ready with or not for this procedure, to get this benefit? 

26:51 - John (Guest)

I think if you have done work before or you have a team around you already, you're going to have a better long-term outcome. Physiologically, what I'm doing by blocking this nerve is turning off the norepinephrine, which is the neurotransmitter that is part of your fight or flight. So I put the medicine in there and that turns off, and it doesn't matter what you've done before or afterward. That feels good. That's the first thing that happens and that happens on the table. The norepinephrine in the sympathetic chain stops. Over the course of about a week, the number of connections between the amygdala and the sympathetic chain decreases and this is kind of to go to what's the next thing, what's the range of things that can happen? 

27:32

You can feel an amazing response right away, or it can take about a week for you to feel what you're going to feel, and over that course of that week the number of neuronal connections decreases and so you don't have as many nerves telling you that there's something wrong. Those are the two ways we think that this procedure helps with modulating the sympathetic response. 

27:54 - Chase (Host)

Interesting. It makes me think about and we'll get into ketamine here in a moment. But anytime I've gone through a ketamine therapy session, whether it's, you know, troche, lawson or IM I haven't done any IV I've always found that I'm very and a good ketamine therapist in a clinic will tell you this be very mindful of your environment after the therapy. You're very susceptible to energy, to mood, to light, to, you know, stimuli, and so I've found that to be very true personally. Is that also the case here? Should, if we go through this procedure, let's say, because I'm kind of in this different block situation, is my world radically different now? Am I more susceptible or less susceptible to things that could or would have normally kind of imprinted on me? 

28:51 - John (Guest)

Yes, it kind of depends on the person, I think on the patient. People that are more in tune with their body and their emotions are probably going to feel a rawness to it if they get a good response, a rawness to their environment that wasn't there. It's not the same as ketamine, where it's kind of a you get a change in perspective. That happens with ketamine when you get the procedure done. It's that you're. You're just more calm and more open to understanding what's happening or seeing what's happening, and that can honestly the and that can honestly the amount of vulnerability that you can feel, or rawness that you can feel, varies person to person and block to block. So the overall answer is yes, be cognizant of what you're doing. 

29:34

Afterward I tell people stay off your phone. I don't want to text from a guy you don't want to hear from, or a news story or something like. I want, today especially, to be as emotionally vanilla as possible. Okay, just hang out and chill. Whether you're going to extrapolate that same recommendation out to a week, that's usually a little big lift for most people. Got to go to work, got stuff to do. You know what I mean. But yeah, I mean highest and best is just try to not have an emotional upset in that time period and be cognizant of what you're dealing with and the things that you're doing from an emotional standpoint. 

30:06 - Chase (Host)

This might be a stretch, but thinking in an ideal world for best imprint possibility and best long-term change for somebody. 

30:17

It makes me kind of laugh and think about. You've seen the movie Office Space. You know the main character. He gets hypnotherapy, hypnotized into thinking. You know his hypnotized into thinking. You know his life isn't that stressful or his job isn't really that crazy and he just kind of goes through life just so nonchalant. And it in the movie, of course it works to his benefit and he has a very chill, happy life. Um, is that kind of what we're talking about here? Are we kind of resetting the psyche in such a way that to really get the most benefit out of it, to be the most just centered to you and your experience and your processing? Is there a preferred timeframe of after a procedure like this? You know we want you, you know, stay at home or off online. 

31:00

No TV, no work, you know what again paint an ideal world scenario here to really maximize that imprint and integration period. 

31:08 - John (Guest)

Yeah, I mean when these are done at, like retreats, for instance. That's, that's the ideal situation where you're like away and you don't, and you know you're already planned. 

31:15

Like everyone knows you're not accessible, you know. And then you can go in, you can be mindful about what you're eating, you can your sleep patterns, who you're talking to, what you're talking about, the environment that you're in. And again, like we see it out to, our standard follow-up interval is a week out, because it takes about a week for whatever's going to happen to declare itself. If you can do that for a week, great. Usually it's not approachable for most people because we do it in an outpatient setting. They come to the clinic, they go home, but yeah, ideally just relax and try to get in touch with what you're feeling for a good seven days afterward. 

31:50 - Chase (Host)

I understand also that this can be used for physical pain application, not just mental health pain or treatment resistant mental health modalities. Is that correct? 

32:01 - John (Guest)

Yeah, that's the traditional use for this. 

32:03 - Chase (Host)

Okay, how can something exist, how can the same procedure work for treating both physical pain and mental health pain? 

32:10 - John (Guest)

Yeah, good question. So normally the nerves that carry pain information are pain nerves. 

32:16

Now every part of your body has sympathetic nerves. Think about the ability to regulate how much blood is flowing to a certain organ or not. That's a sympathetic effect. And so let's say I have a problem with my arm, I break my arm here. When I first do it, my brain is going to hear about it through the pain nerves. If it's going on, if the pain is happening for over a month, then the sympathetic nerves that normally would handle blood flow and the amount of sweat on my skin in that area will start taking up the chorus and take that information to the brain. So now the brain is hearing the pain signal from both the pain nerves and the sympathetic nerves. 

32:53

Oh wow, so the procedure blocks that sympathetic inflow and makes it so that the brain no longer hears the pain signal in the sympathetic nerves. So that's why we can use both. And then also I should finish that this is also responsible for our fight or flight. And this is where the connection between, say, my arm in this case, and the brain is. But it's also my connection between the rest of my body and the response, the physiological response that I have to stress in my brain. So that's why this is kind of the master key. 

33:28 - Chase (Host)

Okay, my understanding correctly. Let's say I'll use myself. For example. I suffered some wild injuries to my back and my hips in service and ever since then I'm in a much better place physically. But I definitely still harbor some mental trauma around that where I have hesitation with certain exercises or movements and you know the thoughts and fear of reliving that physical pain comes up again. Is that because maybe, let's say, if I had this procedure within, I think you said, three months, you know kind of the different nervous systems talking to each other there from a physical injury, if we had a procedure like this within a certain time period of a physical injury, are we cutting off the future potential for the mental and emotional pain side of our nervous systems to really begin to talk shop with the physical side? So could something like this really get ahead of mental health when we're dealing with a physical health pain origin? 

34:25 - John (Guest)

Potentially. You know, when we're using this to treat physical pain, it's pretty common where we'll do a series because at the one time doesn't take care of it entirely and or there's still some kind of a healing process that's going on that's generating pain, so there actually is a problem. You need to know when there's a problem. That's what pain is for right, but it's after the fact, where the pain is now still coming up and it's already healed. That's when it's a problem. So I think what you're asking me is let's say you have a traumatic thing that happens, you break your hip, you break your back. Do we treat the pain, and presumptively, preemptively? 

35:02 - Chase (Host)

do a steli ganglion block on you. 

35:04 - John (Guest)

That's not an unreasonable thing. It's not done and it's not something that we usually reach for, but it's an interesting thought no-transcript. 

35:46 - Chase (Host)

I have body dysmorphia or even hatred or lack of ideal. Um, I don't view myself in an ideal way like I used to because of you know, I had children or I was in a car accident or I had an injury. That next thing you know, 10 years later, that's still my excuse, valid or not, as to why I don't exercise, kind of thing. So we have many people can relate to this. They have a physical injury that turns into this poor mental health state. Should there be a difference in treatment when it comes to varying root causes of mental health If you're in a poor mental health state because of poor physical health or acute injury, versus you witnessed a murder or you were in war or something like that? 

36:29 - John (Guest)

Yeah, yes, it would make sense to try to treat the pain and the mental health problem with the same modalities as possible. Ketamine is another one. We use ketamine infusions IV to treat chronic pain as well. The dose is a little different, the infusion protocol is a little different, but there are those patients who have treatment-resistant depression, which is what we use ketamine for. 

36:51 - Chase (Host)

But doesn't that kind of make more sense? Because ketamine, first and foremost, is an anesthetic. 

36:58 - John (Guest)

It depends on how much you give somebody, whether it's an anesthetic or not? It's an interesting medicine, yeah, but does it make more sense to do that as compared to the stellate? Is that what you're asking me? 

37:04 - Chase (Host)

Yes. 

37:04 - John (Guest)

Yeah, they're both used to treat pain so maybe it seems more intuitive that you would do that. But I think it's reasonable to do the stellate ganglion block. Now the stellate when we're treating pain, it is used to treat the upper limb. So if I've got chronic pain in my arm, my right arm, I do a right-sided stellate ganglion block. If I have left arm pain, I do the left-sided stellate ganglion block because it's kind of cutting it off at the pass where it hits. Now if I've got leg pain, there are similar procedures done in the low spine. So lumbar plexus block or lumbar sympathetic block can be used for somebody that has a leg pain or phantom limb pain. So it's not quite the same, because if I'm treating PTSD we found that it's in the neck that works the best. But let's say you have a back problem or you have a leg problem. I wouldn't use that same procedure to treat leg pain as I would for that. 

37:54

But let's say most people get the most benefit from the right side of stellate ganglion block if we're treating PTSD. So if luckily we'll call it, it's the right arm that hurts. Yeah, I mean, do it Absolutely. 

38:07 - Chase (Host)

Man, it's like so many offshoots are coming to mind for this. But, um, what about? What about long-term benefits? You know you said you kind of go every 18 months. Have you found that just to be personally the sweet spot for you? Or what does the research or clinical evidence show us in terms of maintenance? Because I think, in any modality, any therapy we're doing, especially when it comes to mental health, you can't just like, you can't just do X amount of ketamine sessions or X amount of therapy sessions and you're good for life. 

38:39

You need some kind of maintenance, whether it's in clinic or on your own. 

38:43 - John (Guest)

Is there a? 

38:43 - Chase (Host)

sweet spot with cell like ganglion block for this. And then what about any negative side effects? Once we get a procedure, do we have to always get the procedure? 

38:53 - John (Guest)

No. Yeah so it's different than ketamine in that With ketamine we assume that you're going to need maintenance dosing. With a cell like ganglion block, we don't assume that and there are plenty of people that have had a single procedure and are still doing fine. So we don't ever plan for a redoing of the procedure. It's more when you feel. If you feel that the symptoms that we treated with the procedure are coming back, then come back and see us. 

39:20 - Chase (Host)

So it's more qualitatively based on if and when you get a re-up on this. Not necessarily oh, you had X amount of trauma or X amount of mental health diagnoses disorder or diagnoses excuse me. Therefore, you need X amount of follow-ups. 

39:38 - John (Guest)

Correct. Yeah, it's a point in time. We call it a biological intervention for a mental health problem and it will change the body. It changes the number of nerves, it changes the amount of norepinephrine. 

39:51

And it'll stay that way for most people. If you're in a safe place and you're not having trauma, especially if you had some kind of well, the military is a great example People that are no longer serving. They are not going to be exposed to some of the things that happened when the military right, and if that's what it was your traumatic event, they gave you this problem and you're not doing that anymore. You should be fine, should be. 

40:18 - Chase (Host)

You should be. But I mean, but in any traumatic event you change the environment long enough, like you should have some kind of you know, getting better effects. 

40:23 - John (Guest)

Yeah, yeah, so it really depends on the person and when I'm talking to a person. This is not the first time I've been asked this question. But yeah, there's no protocol. You just know how to get ahold of me If you need me, I'm here and we're all over the country. We can help you. 

40:36 - Chase (Host)

Do you ever worry that something like this people might go? Oh, one makes me feel great, two should feel even greater. I want this every month, every six months. Or is it so do we become so in tune with our emotions and our healing process that it just becomes intuitive as to how much or how little we need? Do you ever worry about someone getting quote hooked on a treatment like this? 

40:58 - John (Guest)

No, and the reason is if you don't need it, you're not going to get anything out of it. 

41:03 - Chase (Host)

I see. So if you do feel like one was good, two or three might be great, and you go back, you're not going to get that same kind of effect. 

41:10 - John (Guest)

Correct, and oftentimes I will tell people if we're redoing your procedure, you're probably not going to get as much catharsis from a redo procedure, and the way I think about it is that, like, the first one took care of everything that was up to, however old you were then, and then the second one kind of takes care of everything in the interim. So if it's been a year, it's just a year worth of trauma, just a year's worth of trauma, you know, as compared to a lifetime's trauma before. It really depends, though, on how much symptom, how many symptoms the person is having in relationship to the trauma. So if they're feeling really, you know, irritable, really on edge, really having disturbance of their sleep, intrusive thoughts, all the things that we see with that, if those, if their symptoms are high, then they can still have that change back to whatever the lower level is. 

41:59 - Chase (Host)

Okay, yeah, again, speaking personally, I've kind of I've been there once or twice very early on in my which I'm going to get into next ketamine therapy. In my ketamine therapy sessions you know I had such profound immediate relief and benefits that I got so excited about. Well, when can I do the next one? If that got me through this blockage? You know this. The next one's got to be even more and true to ketamine and, I think, other psychedelic modalities especially. I found I got what I needed, not what I wanted in those instances. So definitely with ketamine therapy, you know there's the, a certain protocol, but then after that you can go into maintenance and I definitely found following those protocols and following that qualitative, intuitive maintenance worked better for me. 

42:43

But um, let me pass it back to you talking about ketamine therapy, because I have heard also that this couples very well with the stella ganglion block. So maybe for someone I've talked a lot about ketamine therapy on the show, but you know high. Can you walk us through what is ketamine therapy and how is it, or what is going to be therapy as it relates to Stella ganglion block therapy? 

43:04 - John (Guest)

Sure. So the big three mental health problems that we have now is anxiety, depression and PTSD and Stella. Conceptually, when a person comes to us and says I want help, we try to gauge how much of each of those things that person has. If your symptom complex is more toward the PTSD side of things, then usually we start with the stellate ganglion block because that will treat the biggest chunk of your problem or what you're feeling. Ketamine-assisted therapy is really treating depression, treatment-resistant depression. Now we know that there's overspray on anxiety, and that's true of the stellate ganglion block as well. I tell people the stellate does not treat depression. But if you're less anxious and the world's a less scary place, you may not be as depressed because you may be able to get out and go do some things that can help with depression Exercise, for instance, get some sleep would you go as far as saying that it's just like a downstream effect, not necessarily like a treatment for correct? 

44:02

yeah, I I I want to be very clear. I'm not treating depression when I'm doing the stellate ganglion block. So that's also where ketamine kind of comes in, because ketamine treats depression, it treats anxiety, treats ptsd well, but really the thing that we're treating with ketamine is the depression. So if you do the two together and they both affect anxiety, right, so then you're kind of getting all three of the things that most people are struggling with Now. There could be personality disorder, there could be OCD, there could be other things in there. None of these help those things necessarily directly. So we looked at the numbers as far as response rates are as follows with the stellate ganglion block, up to 90 percent of people that have ptsd will get at least a 50 reduction in their symptoms. Wow, with ketamine it's not quite as good as about 70. We'll get get about a 50% reduction of the symptoms or more. 

44:56

Okay, if you take the two together and you do them in within a reasonable amount of time, you'll have for both of those metrics and an additional 20% improvement for your PTSD on the one side and your depression on the other side. 

45:09 - Chase (Host)

That's incredible. 

45:10 - John (Guest)

It's fantastic. 

45:11 - Chase (Host)

Yeah. 

45:12 - John (Guest)

Now, the PTSD, one is durable. The depression one needs the maintenance. 

45:16 - Chase (Host)

Okay, but we know that. 

45:17 - John (Guest)

Like that's just the dance when you're doing this or that. But yeah, they work together very well. Is it because we're influencing neuroplasticity and trimming nerve levels? Yeah, probably. There's probably some interplay there. Ketamine, as you know, causes increased neuronal growth there. You know, ketamine, as you know, causes increased neuronal growth. Stellate, as I told you earlier, decreases the number of sympathetic nerve connections. So if I do, when I take ketamine, does that increase the number of sympathetic nerve connections? Yeah, it will in some way. It kind of does everything. It's more of a shotgun approach, right? So is it better to do the ketamine first and then do the stellate to trim up the bad growth of the sympathetics? Maybe? 

45:58 - Chase (Host)

Kind of like shines a bigger spotlight on to what you can go in and like trim. 

46:01 - John (Guest)

Well, it doesn't make it so I do anything differently. But we do know that ketamine makes more nerves grow or makes the neuronal connections change, neuro cross talk. 

46:09 - Chase (Host)

Correct. 

46:10 - John (Guest)

Yeah, so that's one way of thinking about doing it. The other way is that most psychedelics, or set of hypnotics, when you first go in, if you have no experience, whether recreational or otherwise, it can kind of be confronting. And so if you're in this anxious space and then I give you a medicine that makes, you feel less in control and your sensorium is altered and you're really getting spun up and anxious about that, so you can't drop into that. Then it's probably better that I do a stellate ganglion block on you first. 

46:41

So, you can accept the ketamine experience in a more open way, or whatever psychedelic you're doing. But getting back to the point, putting them together makes the things that we're treating respond better. 

46:54 - Chase (Host)

Is it the same and most people. If you look up ketamine-assisted psychotherapy, the protocol typically is I don't know if it's changed you know six sessions. Six, it's like weekly right? So is it still? If we're doing ketamine at all alone and or with cell ganglion block, is it still the six sessions or is it a matter of you know? Kind of it depends. 

47:17 - John (Guest)

So there's a protocol that we do that compresses them all into a short period of time, in which case we only do four ketamine sessions, so two stellate ganglion blocks if we need that both one on one side and then on the other side and then do four ketamine sessions. Most of the time when I'm doing a six session treatment course, the fourth one is the big one. 

47:38 - Chase (Host)

Why is that? 

47:38 - John (Guest)

We're not sure. But if you ask any psychedelic or ketamine provider or usually each one is different, as you know. But and you may not you may feel worse before you feel better in between these ketamine sessions. But usually the fourth one is kind of the tipping point where you're like, oh, okay, we're on, okay, we're on the right track. The patient feels that, feels an improvement. So the short answer to your question is usually we'll do four. Now sometimes I will say let's do them kind of serially over the course of a month or so, like let's start with the stellates first and see how you do with that and then we'll do the ketamine after that. If you still feel like the depressive symptoms are high enough or you know that you need to treat that, that's a more measured approach. I mean to do all of those in a week. That's a lot. 

48:27 - Chase (Host)

So some people are fine with that. It's a lot on your body and a lot on your life too. You've got to make time. 

48:38 - John (Guest)

And integration is massive in there, like crucial. There's a lot of shifts that are happening. So some people want to know, like, did this intervention do this or did that one do that? Like what which one helped? Yeah? And so if you want that approach or if you just don't want to get, you know the big hammer if you will, if you want to like take your time and go through this because it's available. 

48:53

Just wait, just, you know, come back and see us when you're ready for that. Then that's the more measured approach and that's the one I usually tell people they should do. Some people are in a point in their life where they just want to do everything all at one time, and that's fine. But anyway, different ways of approaching it. 

49:10 - Chase (Host)

I'm so glad you bring that up because I actually had a question around this specifically and you know again, apologies if I'm kind of weaving in too much of my personal life here, but my audience knows especially when it comes to this type of mental health treatment and just life experience, I've always been an open book, especially on the podcast where I share personal experiences and my well-being. Be able to sit down across from an expert and a professional is just like the best personal continued therapy for me, so it's just as much for me as it is for my audience. So thank you guys for bearing with me to paint briefly a picture of where I was when I first chose to go into ketamine assisted psychotherapy for lack of a better term I was at my wits end and I think this is where a lot of people specifically with ketamine therapy it's for treatment resististed mental health disorders or treatment-resisted therapy, where ketamine is supposed to be only after medication or only after traditional therapy, only after all the work and that was me Years of the work. I'd never been on any medication for it, but years of work, years on-again, off-again therapy. I was just I was. So I need something. I need just I need to go in the deep end because nothing else is really working and my life is being stuck. I'm staying stuck because of this traumatic event and, for lack of a better term, I think that one could say I, I and people like me, would choose these kind of extreme air quote here extreme treatments out of desperation. 

50:42

Desperation might not be a bad thing in this scenario. I was desperate for hope. I was desperate for being able to move on with my life. The argument can be made when we act out of desperation, especially when it comes to mental health, physical health damn sure, getting any kind of medical procedure that that's not a good place to make a choice from. Can you argue for getting results that you want for months or even years? You can become pretty desperate when looking for treatment options and when we make choices with our life or our health from a slightly more fear-influenced place, one could argue that it might not always be the best rationale, even if it could be the best treatment for you. Would you agree? 

51:38 - John (Guest)

Yeah, I mean, if you have limited options, you're going to choose less. Well, right, If you're in a spot where you need, if you're desperate. I think that's pretty clear. If I'm not desperate and I can like think about things and have different option way options, I'm in a better spot to make a decision. 

51:56 - Chase (Host)

That's true of any kind of decision. 

52:01 - John (Guest)

But I guess where I would go with this is for the stellate ganglion block specifically. There's not a lot of downside to it. It is a medical procedure. There are some risks associated with it. Like what, it is a medical procedure. There are some risks associated with it. Like what? So? The things that can happen is, if the medicine gets injected into the artery, there are arteries next to it. Then you can have a seizure or you can have a thing where your heart beats erratically, which is dangerous. 

52:26 - Chase (Host)

Yeah, every time you talk about going into the neck, I immediately think carotid. It's like the main blood supply to the brain here. We're good with that. 

52:33 - John (Guest)

We are, because I do a lot of them. You got to know what you're doing. This isn't something just going muck around in there, but with appropriate imaging guidance I am a long way from anything that's going to be. You know the carotid specifically. I see it, I watch it. I can see the needle tip when you're using ultrasound. It's like two tenths of a millimeter accuracy as far as where you can put things so I can get around or next to structures that are important that I not poke easily and confidently. 

53:04

Thank you, yeah, so you know there are some side effects associated with it as well and we can talk about that. They're transient during the time the medicine's in there. But the point I'm getting at is ketamine is a little different because there can be some downsides to it. Not everyone responds really well to it. But when you're talking about the stellate ganglion block, it either helps you or it doesn't. It doesn't make it worse, it never makes it worse that, I think, is what I'm looking for yeah, so it. 

53:34

So I usually tell people it's a procedure that should it be first line, I don't know but it shouldn't be third line. It shouldn't be thought as being dramatic. Maybe that's because I'm comfortable with it. I do it, I've had it, I know what it is. If you find a provider that is also comfortable with it, or come see me, this is something, I do it, I've had it, I know what it is. If you find a provider that is also comfortable with it, or come see me, you know, this is something we do safely, we do every day. Well, I do 70 of these a month, not every day necessarily, but we do a lot of them and we can help you feel better. Ketamine is also a good option, but again, it's not for everybody necessarily. So that's what I would say as far as it's not answering your question option, but again, it's not for everybody necessarily. Um, so that's what I would say as far as it's not answering your question directly. 

54:19 - Chase (Host)

But you know it is for me personally and so I think you know I hope in my audience is kind of getting that same response. Um, we, we talked about a little bit of coupling ketamine therapy with the Stella Gangland block therapy and kind of it working synergistically together. But you know one-off ketamine therapy. Maybe walk us through that a little bit. You know what is ketamine therapy specifically? I know you work in IV drip therapy. Why that delivery approach? What can someone expect during ketamine therapy, particularly for depression and anxiety? 

54:50 - John (Guest)

Sure, and we also offer the intranasal spravato ketamine as well. Um, the studies initially were done with intravenous ketamine and then, as you alluded to, intramuscular, you know, in the muscle injections, trochies, intranasal. There's different ways of getting it into the body. I think if you have the ability to either financially or otherwise do the IV, that's shown to have the best results from the scores that we use to look at depression standpoint. But it is kind of a song and dance to go in and get an IV placed and all the you know have that all done. I'm a medical doctor so I kind of like to stay on the safest side of things We've had, you know, even in the recent history Matthew Perry, for instance. You know that things can happen that are not ideal and so that's my bias. I'll be out there with that Like I like to have people in my, in my clinic when they're getting it. 

55:45 - Chase (Host)

Now the trochies are a little different. Don't take ketamine and get in the hot tub, correct, or use in the bath. Yeah, because it's not it wasn't a ketamine death. 

55:53 - John (Guest)

It was a drowning. Yeah, exactly yeah, which is tragic, but it also needs to be said because there are plenty of people that are getting benefit from this medicine. So do it safely. However that looks for you what to expect with it. Usually it's about a two-hour, maybe a little longer, experience where you're given a medicine and there's a dissociation between your mind and your body. That's kind of the point of it, dissociation between your mind and your body. That's kind of the point of it. And it can range from a light show to kind of just being black, to kind of feeling out of it and light and floaty. It's not always fun. We talk about constructive suffering or productive suffering. Like I know this is helping me. I have agency. I don't feel like I'm a cork on the ocean. It sucks, I've got to sit with this, but I know that I can get through it. 

56:50 - Chase (Host)

Like bad stress and new stress, good stress and bad stress kind of thing. Good analogy, yeah yeah. 

56:55 - John (Guest)

You know. So we can affect that, the way that a person is feeling as they're going through it, either by the dose or by coaching them. We don't do a lot of talking or reintegrating or whatever, like when a person's going through the, the ketamine session you don't do a psychedelic dosing, so there's no like coaching or therapy during that. 

57:18 - Chase (Host)

There are those that do that? 

57:19 - John (Guest)

We don't do that. Okay, if someone's having problems where they feel like it's too much or, you know, for whatever reason, need to help get redirected back on to whatever their stated intention for the session is, then we'll kind of go in and help De-escalate the situation and put them back in a better spot. Doesn't always work. Sometimes we just have to turn off the medicine. That's one of the benefits. 

57:43 - Chase (Host)

Iv you can turn it off as you do. That's with IV. You can really control the dose and put them back in a better spot. It doesn't always work. Sometimes we just have to turn off the medicine. That's one of the benefits of IV. You can turn it off. 

57:49 - John (Guest)

I was going to say that's with IV you can really control the dose you can go more you can less. 

57:51 - Chase (Host)

You can stop pretty immediately. 

57:52 - John (Guest)

It's not immediate, but yeah, it's a lot quicker than IM. 

57:56 - Chase (Host)

Well, yeah, IM, you're on the train. 

57:57 - John (Guest)

You that rocket for as long as it's up there yeah, and and also the way that it presents, the way that you feel it is different the, the profile for the bioavailability. With im you kind of get a big dose and then you come down like this with iv that's why we do boosters a lot with im right sure yeah yeah. 

58:13

So anyway, that's that's what we, what you can expect. And then, after you're done with it, once the medicine is out of your system and you're processing, it's sort of you come back to the point where you're feeling connected to your body and grounded in your body. Usually you're tired afterward. Most people are kind of happy and open. 

58:30

Not everybody, not every time, and it can vary, you know, time to time sort of like breath work, sort of like isolation. It's like sometimes it's very much about the body, sometimes it's very much about the mind, and then sometimes people can feel as though they leave their body. That can be help, that can be nice, that can be terrifying. You know, we try not to make it so. People go all the way to black, where they feel like they're disconnected entirely. That can happen. Is the blackness kind and open and welcoming, or is it scary? You know, this is something that I was reborn in the blackness. 

59:05

Were you. 

59:06 - Chase (Host)

I swear I say all the time and I'll link my other episodes about this, but in my first I am ketamine, ketamine, assisted psychotherapy session I think we worked up to I think it was 75 milligrams, it was like 30 and then a booster after that and in the blackness, completely just complete dissociation, body separated from soul, complete ego, death, reunited with lost loved ones, kind of thing. 

59:34

And anytime I now go through a maintenance experience with ketamine, there are a lot of other benefits when I don't get that kind of same complete blackness, which air quote here you know people might call it K-hole kind of thing is like where I have the most therapeutic benefit. I come out feeling like my mental health has actually improved. I went in with an intention, met that intention and in the darkness, you know, was able to come out of it better, versus other experiences where it's more that kind of flying through space, unique euphoric kind of journey where it has very has like a lightning effect to my mood and to my body. And you know I know that I'm getting the neuroplasticity and brain health benefits. So I kind of get a lot of it out, a lot of out of it, no matter what. 

01:00:29 - John (Guest)

But, yeah, I've only ever got the best benefits from the darkness. Interesting, yeah, and I wonder if that was. You know, ketamine is very personal and I'm not an expert in integration or reintegration with this. We've got a fantastic psychologist, shauna Springer, that works with us, that that's her thing, amongst other things, and so she would be the one to talk to about that specifically. But it's very personal, it's very impactful and it's very common where you get a perspective shift. 

01:00:51

The way that I've described it and this may be kind of ham-fisted is I felt as though the idea of how important I was and how unimportant I was was very clear to me. I was completely unimportant and I was very important at the same time, and that's what I took out of it. And to have to go back all the way to black to see that not really. I've heard and I'm not good enough with meditation or breath work or whatever. But I hear that psychedelics or sedative hedonics are sort of a fast track to the place that you can get with meditation or breath work, and once you've had that fast track, you can find your way back oh yeah, meditation, yes, you probably are more more savvy than I with this, but it's um, that phase shift, that perspective shift is something that is. 

01:01:39

I know I'm not alone, so that's completely different than the Stella Ganglion book. Another reason why I say this is not for everybody necessarily, but the first one it's pretty approachable for most people. 

01:01:51 - Chase (Host)

Would you go as far as saying you would recommend ketamine therapy to the general public as a mental health tool, a regularity tool like one would do, for I journal every day or I do breath work once a month or I see a therapist once a week or once a month, because I I think that a lot of people, the more they can get ahead of mental health, like big T stuff or you work on little T stuff before it comes big T stuff, it has profound benefits, instead of waiting until know a year or five years later and all of a sudden you're going out of your mind or unexpectedly anxious or depressed or like you have triggers out of nowhere, and then you go back and then it's like, okay, now my life is a shit storm, I'm gonna go back and retrace it to that event. Does ketamine therapy hold a place for maintenance, for for just like we would go to the gym kind of thing, for our physical health, for our mental health? 

01:02:44 - John (Guest)

not a blanket recommendation, but sure as hell more than it is. You know there are some people, people with addictive personality, specifically that that can get kind of tied up in this stuff. And there are other, there are other sort of subsets of the population. I would say would be not, not be a good idea, but to have it as the second-line, third-line agent after failing, so let's use Pravado, for instance. Pravado is the intranasal form of this. It's made by a major manufacturer, it's covered by a lot of insurance. 

01:03:14 - Chase (Host)

It's. 

01:03:14 - John (Guest)

FDA-approved, it's covered by insurance, and in order to get it paid for, you have to have failed two other antidepressants in the past. That's really all, and then have no reason to not give it right. So should we put it behind two other antidepressants or should we put it in front of it now? That's a money question yeah right? 

01:03:34

yeah, if it was me and I was paying directly, or it was, let's let's just say it's free for everybody would you put ketamine every so often in your body? As compared to a, an ssri or another antidepressant that that doesn't do as good a work you take every day. It makes it so that you can't get sexually aroused, like not everybody. But there's, there are some definite, some significant downsides to the others and it just comes down to adherence too. 

01:04:00 - Chase (Host)

Right, with I mean with medication, I mean help with a supplement, or even just, you know, trying to eat healthily or exercise regularly. It's all about adherence for lasting change in your life. Having to take a medication every day has to have lower adherence than getting a ketamine therapy experience a couple of times a year, maybe Totally or even just once. 

01:04:20 - John (Guest)

Yeah, and the other part of it, and we're not sure it's hard to separate this. But let's say, usually the places that have Spravata have ketamine. They're kind of nice, Like you go in there, they treat you well, they know your name, they sit in this really comfy chair and put the eye mask on, listen to music. Like that's a pretty awesome experience. Stay there. 

01:04:38

Totally, it's such a vibe but then they're like hey, chase, we remember you. How's it going XYZ? Like there's a connection, a human connection there. Oh, is that important? Yeah, you know, so, is that part of it Probably, but who cares? Like that's the thing I mean. I guess my point being is if you take a pill once a, why wouldn't you do that if it's the right medicine for you? I don't like it, not for everybody, but for a lot of people it's probably a better option. 

01:05:09 - Chase (Host)

It makes me think about and you know, as an MD, I'm sure you can relate to this. You know just the classic white coat syndrome. I'm sick, I have an illness or injury and I go in to see my doctor, my provider, you, let's say, a typical standard American clinic. It's, you know, a horrible experience. The parking is ridiculous, it's a mess inside. Maybe I'm just talking about my own traumatic events at the VA system, but you know it's. You don't know where you're going. You're getting shuffled through the system. 

01:05:34

You go see this person in a white coat, they've got maybe 11 minutes with you and you get a medication, a medication, and like there's such stress and anxiety built around that entire scenario that, even though you're there for the right reason and getting, hopefully, the right medication, it that that environment can have potentially negative effects, even though the medication is right, even it's the right medicine, whereas what you're talking about is what if we took away all of that? And what if, especially dealing with mental health here, you went to a place where you were actually looking forward to it? You know, the parking was easy, the environment was warm and inviting, the people remembered your name, whereas, again, speaking personally, I have to basically tell my entire life story to my provider again because he's overworked or it's a new provider every eight, ten months, kind of thing. Like this stuff matters, does it not? Especially when we're dealing with mental health, and I think this is radically overlooked. 

01:06:32 - John (Guest)

Yeah, and just speaking from all doctors, we wish it were different, honestly, but yes to your point. 

01:06:38 - Chase (Host)

You are doing it different, so thank you. 

01:06:39 - John (Guest)

Yeah, it's easier and anyway, yes, you're welcome. But yeah, to your point. It's a nicer way to do it, it's a more effective way to do it. As long as the funding and the systems are there to support it for those that don't have access to a lot of money, then it makes sense for a lot of people. There's a lot of layers but, yeah, highest and best Absolutely. 

01:07:04 - Chase (Host)

Yeah, that brings up a whole nother aspect. I'm not sure how far this rabbit hole we want to go, but speaking from personal experience like my wife was was a psychedelic nurse practitioner and I happen to know firsthand the cost of a vial of IM ketamine compared to what most people are charging for it. And I understand. Look, we're not a place yet where this is just going to be readily available or prescribed, or you know that price cost has come down. It's a business and it takes especially this kind of medicine. It takes a lot to get up and running and it takes even more to stay, you know, alive. So I get that. 

01:07:46

But cost is always going to be one of the biggest barriers to entry for people that need medicines the most, um, whether that's diabetics or just proper nutrition, you know it's, it's access to care and cost. And when we're talking about mental health, the people that probably need this the most, I'm assuming, have less means or are not as able to get this kind of care. Am I correct there? Or you know what is being done about the people that need the most mental health treatment not being able to because of this barrier to entry being caused? 

01:08:27 - John (Guest)

Yeah, that's hard, and is it that the people that need it the most are less likely or least likely to be able to get it? I don't know, I can't speak to that. I think that one of the reasons that you know depends on how you feel. But no matter how you feel about big pharma, the fact that we have a insurance covered alternative now in the form of Spravato, that's the best answer to access to care that I've got for anybody at this point, assuming that it's covered by your insurance and it's not every insurance, it's not every person. 

01:08:58

But the ability to get it into the bodies of a lot of people really often does come down to funding. And so you know, like you alluded to the intramuscular, the intravenous, it is fairly expensive and you know, for a lot of patients that we're seeing with the intranasal, it's like a $20 copay, you know. So most people can not have Starbucks for two days. Not bad, not a bad idea. So, yeah, that's a multilayered question and absolutely it's a problem. Unfortunately, that's the system that we're all living in and, again, from a doctor's standpoint, we wish it were different, and some of us are trying, and some of us stopped trying and just found an alternative way and that's a whole nother podcast, but it is. 

01:09:48 - Chase (Host)

It is. But you know, I would even challenge my audience member to go If you are considering something like this or you know any treatment you know health therapy is can be very expensive. You know therapy is can be very expensive. You know it can be 50 an hour, it can be 500 an hour. Medications you can have a 50 copay or it can be 500 out of pocket. I would challenge us all to really rethink our approach to our preferred or proposed treatment plan, whatever that modality is and whatever that that medicine is over a lifespan, hell over over a year or a couple of years if you're on an SSRI and I don't know what these cost these days, but let's just say, would you agree that if most people, if you're prescribed an SSRI or antidepressant, you're on it for about how long? 10 years a year, your lifetime. 

01:10:37 - John (Guest)

Yeah, I don't know the total duration on those. Usually it's a long time, though it's years. 

01:10:41 - Chase (Host)

Years. 

01:10:42 - John (Guest)

It's easily decades on a lot of people. 

01:10:44 - Chase (Host)

Okay so let's say what is decades of a $50 copay on a medication that you then you know, maybe you're sitting here and with, maybe it's working, but then also, if you ever come off of it, it's a whole other story. What is that number Now? I know we're talking $50 now over a long period of, and so you know what benefits. Maybe maybe you're a first responder, maybe you're a nurse, maybe you're a military person, maybe you can find I actually went through my first several rounds were a group, so maybe you can go through a group experience typically have, you know, reduced rates compared to a one-off. 

01:11:37

So I think, first and foremost, our health and our life, if we commit to wanting to find a way to make it better, then we can find ways to make it better. We can find ways to get that work done. It's just a matter of what are you willing to commit to, to how resourceful you want to be, maybe how in the beginning I forget your term you know that getting uncomfortable, necessarily uncomfortable. That you stress good, stress the constructive, what did you call it? 

01:12:02 - John (Guest)

Constructive suffering. Constructive suffering. 

01:12:07 - Chase (Host)

Constructive suffering. Here's an opportunity. I would challenge everyone to dive into the constructive suffering, because it is a short-lived, a shorter-lived suffering than what you most likely are going to be dealing with, suffering for the rest of your life. 

01:12:16 - John (Guest)

Yeah. Yeah, it's an interesting space because most people, when they have a mental health expert, they have a therapist and not necessarily a doctor, although you need a doctor to get an SSRI. But that's easy If you just say, hey, doc, I'm depressed, they'll give you an SSRI. I guess where I'm going with this is you need to self-advocate and you need to find the people that either provide this or, to your point earlier, is there funding available? If you are part of some sort of subset of the population that has foundations that are directed at what you did in your past life or whatever, that's a good place to start too and look around for funding. Sometimes, if you go to a clinic that does this type of work, relationships have been forged that will help with that type of thing, but that's always in flux. We work with a lot at Stella. We work with a lot of different foundations, whether it's military or first responder or there's others. Even there's some employers that are offering this as a benefit for their employee. 

01:13:10 - Chase (Host)

All the way. Wow, which is very. 

01:13:12 - John (Guest)

You know has a lot of force out there. Yeah so, but you got to start asking the questions first, and I'm sure your listeners are good at that with just. You know the subject matter that you're looking at. But you got to be an advocate for yourself, because it's not going to come from a doc who wishes it was different but they only have six minutes with you, or a therapist that doesn't really understand it and doesn't know where to send you Right, like, let's say, I want X, y, z. 

01:13:36

They're like I have no idea. I just have a practice here and I do, I do what I do. Idea. I just have a practice here and I do what I do, but I don't know how to get you into that. 

01:13:44

Not good enough. There's a lot of siloing in healthcare in general, meaning like one part of it doesn't talk to another and the only constant is going to be you as the patient and figuring out what's right for you, or at least what you think is right for you. It may not be right, but at least start asking the questions. 

01:14:00 - Chase (Host)

The life we want and kind of getting towards the end here, perfect segue of you know the whole premise of the show living a life ever forward. The life we want is, I believe, fully dependent on the quality of the questions we are willing to ask and the commitment to the work necessary to that life. When you ask questions or you're getting even if you're not asking a question, you're just getting an answer, especially especially when it comes to your wellbeing, your physical, mental, emotional, spiritual wellbeing. I feel like, in not talking about you present company excluded so much of the current healthcare system is we are getting fed answers before we ever even ask any or much less the appropriate question. And is that? 

01:14:44 - John (Guest)

the education system Is that culture? 

01:14:46 - Chase (Host)

Is that, you know, upbringing? Is that just the system in general? Maybe a lot of it has to do with that, but we're at a place now where we don't have to accept that. I don't believe, I choose not to believe that we have to accept that anymore. And I again, speaking from experience, know that change is possible. Healing is possible. First and foremost, hope is fucking possible only by choosing to ask different questions and consistently putting in different work. I firmly believe I would not be here if it were not for that mindset and for this kind of like treatment we're talking about. It gets me all up in my feels but, it's. 

01:15:26

It's so true, it's so true. Well, dr John, this has been incredible. It's very eyeopening for me. I'm very excited to dive deeper into and potentially even going through this experience myself. My last question before my last question is kind of really to bring it home to what we're just talking about Is the public really ready for treatment like this? 

01:15:48

And beyond that, I think what keeps a lot of people from living a life ever forward and changing their life is because not because they don't think it's possible, but the fear of what their life is going to look like when change happens. What is my life going to look like? How am I going to feel when I don't think it's possible, but the fear of what their life is going to look like when change happens? What is my life going to look like? How am I going to feel when I don't feel depressed or when I have hope that separating more from my depression and anxiety and PTSD is possible? I'm living, breathing proof that it's possible. There's a fear associated to actually achieving our goals and achieving the life that we want. Are we ready for this? Is there a promise of? 

01:16:28 - John (Guest)

longevity for something like this for us right now in America. Yeah, I mean, like you said, you got to want it, you got to lean into it, you got to ask the right questions. There are going to be those that are not ready. But are we as a society ready? Yeah, people are already doing it. You know, the fact that I do this as much as I do tells you that there are people that are going through this and getting good results and coming out the other side feeling great. So, yeah, is society ready? Yeah, absolutely. In fact, they're beyond ready. They're tired of feeling bad. 

01:16:58 - Chase (Host)

Oh, yes, yeah, I think we're really at a tipping point. 

01:17:03 - John (Guest)

We're sick and tired of being sick and tired. Yeah, well said. 

01:17:07 - Chase (Host)

Ever forward those two words. What do they mean to you? 

01:17:13 - John (Guest)

I think the thing that came to mind when you asked me, that is, growth is not usually linear, meaning you kind of have to go back to go forward. Sometimes, go in the direction you're pointed, even if it seems like you're going the wrong way, because it probably is just for a short time. Keep asking the questions how can I get to where I'm wanting to go and be generous with yourself if you're not where you think you should be? Show up when you can, um, show up more than you don't, and just know that it's not going to be easy and it's not going to go like you think it should, but it's still going to be okay. 

01:18:00 - Chase (Host)

I always appreciate every answer. There's never a right or a wrong one. So thank you for your interpretation. Where can my audience go to connect with you, learn more about your work and my audience? I'll definitely keep you all posted here on the show and social media of you know my continuing health journey and mental health journey with the Stella Ganglion block and I will definitely say ketamine therapy regular ketamine therapy is definitely going to stay a part of my well-being in my health practices, but this block stuff is very intriguing and and exciting, so where can they go to learn more? 

01:18:35 - John (Guest)

stellamentalhealthcom is our website, and there's a ton of videos on YouTube too, and you guys are just in the US, or in Canada too, or? There is a location opening in Canada I'm not sure it's actually live yet. There's one in Israel, there's one in Australia, oh wow, mostly in the US, you know, across the country, man getting this kind of mental health healing in the Middle East would be amazing. Yeah. 

01:19:01 - Chase (Host)

Man. Okay Well, thank you so much for your time.