Ketamine for Mental Wellness? New Territories for Mental Wellness and Sanity

Contact Laila Contractor, MD: http://www.lailacontractormd.com

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Transcript

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Welcome back. And with great excitement, I get to introduce an extraordinary guest and Sherpa, as I call them here on my mental wellness podcast. As Dr. Lila contract is an extraordinary mental wellness and soundness of mind specialist, Doctor contractor received the dual board certification in general psychiatry and Child and Adolescent Psychiatry at the Western psychiatric institute in clinic, which is one of the largest psychiatric hospitals here in the country. And ranked as the number one I believe even in terms of research grants funded by the National Institute of Mental Health. And so Dr. Lai, like got really to be mentored there by those who conducted that cutting edge research. And later on, she added in addition and integrative psychiatry Institute Fellowship, which was through the University of Colorado School of Medicine, so that she could really offer her patients affect different research based alternative to traditional treatments. So also, I was very honored to hear that she recently taught at an at a psychiatrist at Cambridge health Allianz Hall Hospital, which is affiliated with Harvard University. And then as inspiring Dr. Layla also walks in the footsteps of her grandfather, and her great aunt, uncle, who her grandfather was a physician in India and who really role modeled courage and compassion, through empathetic listening to Dr. Laila, and hearing about your great uncle was Mahatma Gandhi's personal physician for 15 years. It's truly a remarkable family history that reflects that a passion to serve patients with compassion, and by listening to them. And so it's not a surprise to me that she added a year long training in compassionate inquiry method for treating developmental trauma by Gabor Ma Tei. So, it was such a pleasure to recently hear you share a little bit about your work Dr. Laila, and in particular the passion to really about the ethical use of ketamine. So as I can pick your brain here, and I'm sure I will be learning a lot. Now, you know, I was barely aware that the use of ketamine has been part of medical treatments, for example, like anesthesia and pain management when people said a broken bone but what drew your attention as a physician and certified expert until the use of ketamine as a treatment option. So my background is in treating people who have experienced trauma. I was also mentored by a gentleman named Dr. David Brent, who did a lot of the seminal research for suicide in adolescents and suicidality and adolescents, as well as mentored by Dr. Lisa pan. So my background kind of lent itself to it. And when I got introduced to the, in the more general term of psychedelics that ketamine falls under being a dissociative, psychedelic, when I experienced it for the first time, I couldn't believe that as somebody who feels like they're a specialist in the area of trauma, and never experienced this. So it seems in a weird way, it's like a big leap for us to use this. You know, for adolescents or for kids, but really ketamine, as you eluded, is used in many setting settings. It's used in pediatric ICUs. She's an inpatient, it's used for sedation with MRIs, it's used in pediatric oncology, when we do lumbar punctures in kids, you know, bone marrow biopsies, interventional radiology, orthopedic procedures, like setting bones, and believe it or not, even in neonates, there's papers to show so, you know, there's a theory out there that it's a horse tranquilizer, but really, if any of your kids have any experienced any one of these chances are that they've actually already had ketamine and actually at much higher doses than what would be used in an adolescent. But what really drew my attention is the research that we have behind it that it very quickly decreases depressed mood and suicidality. And that's what really caught my attention. As far as using an adolescents, because the reality of the situation is if you get admitted to a site, if your child gets admitted to a psychiatric hospital, and we start them on one of our traditional antidepressants, it can take up to four to six weeks for you to feel the maximum effect at any one dose. And the research actually also shows that within the first 30 days of being discharged from heart being hospitalized psychiatrically is when you're at the most risk for suicide. Right? Such a critical period. So, and I'm so grateful you're taking the perspective, even as a as a parent myself, you know, really to get a bigger picture. That there are other options out there, in particular, for those most vulnerable, you know, time spans, when there is a person in a crisis. So, what would you want the parents to be aware of when or should they decide to go the route of such a treatment as you you've shown it as already been used in other settings, but what What should parents take into consideration. So, if you are considering, you know, and again, the indications, I want to remind you again, ketamine, the use for ketamine, and depression is still considered what we call off label, which means that it, it hasn't been necessarily approved. To be used for, you know, depression, or post traumatic stress disorder, or OCD or eating disorders, there's some things that are being researched. So you have to be aware of that. However, we are seeing that it has greatly improving, greatly improving mental health, but with anything you have take some cautions, or parents who are considering this for their kids and has to be done. Just like our regular antidepressants, in conjunction with therapy. This is not a panacea, this will not solve everything. And there are specialists trained in what we call ketamine assisted psychotherapy. So even currently, with my patients, you know, especially with families who want you know, pay, families are eager, especially if their child is not doing well. And as long as if the kid is not in immediate crisis, I usually try to slow the parents down. Because there's a lot of benefit benefit to doing a lot of preparation work. And what we know from the little research that has been done so far, and will Phil Wolfson who's like the OG of ketamine, it needs to be done in the context of family work. This is a hard pill for a lot of parents to swallow. Because when when I tell them that they all of a sudden in their heads, they feel like I'm blaming them, or that they're the cause. But really, the kid in any family system, who isn't struggling often is the messenger for a greater picture of what's maybe not working. And most of the time with pretty much every parent I work with, they're doing their best. We're all doing their best. I have three kids, I will tell you on the daily I am trying to do my best. Yes, and parents can be especially hard on themselves. Right. I mean, we, myself included in the the burden of the responsibility to have these children launch successfully. Yeah. Is is an understandable burden. They are so so with if they're like, you had a very extensive training as well with regards to substance abuse, as your as a Substance Abuse Mental Health Administration fellow is what are like specifics, potentially to consider if there's anything like a risk of substance use disorder in the family history that anything to in particular to watch for. Yes, and no, I mean, here's the thing if you're going to a clinic that provides ketamine I'm not, I wouldn't say that there would be such a great risk, let's say for addiction where we run the slippery slope is I believe more? Well, first of all right, like you could go and you could it is potential that there there is a potential for addiction. Should that be a reason to not use it? No, I think you just have to be more cautious and more visual Lin with those, you know, patients who may have these family histories or maybes struggling themselves. Truth be told, like there are programs and research studies now going on and opiate detox, using ketamine. And so the right context and the right space is a very powerful medication that could help people actually get off substances. I think, unfortunately, things like what happened to Matthew Perry, you know, scared people, but that actually brings up a lot of questions of this at home ketamine use, and liberal. And what people actually don't realize is that he unfortunately had about 10 times the amount of ketamine that should in a system at the time of death, he also had benzodiazepines on board as well as opiates. So it was really tragic and really unfortunate. The reality is that he was unfortunately not using it in a way that it should have been used. Absolutely, and that brings us back to this idea of having really like a, have a trained professional monitoring and really walking. Yeah, so even for my patients who I would prescribe, let's say, sublingual, so to do ketamine assisted psychotherapy, we will often give, you know, a sublingual, a rapidly dissolving tablet, but it's also on the professional. So like the company that I use, will send, you know, the trophy to the patient, it they call them trophies are rapidly dissolving tablets, that packaging has a combo lock, and the therapist has the combination. Because let's be true to be told, if I if you are feeling horribly depressed and frequently suicidal, and you knew there was a medicine sitting there that could at least give you temporary relief. Who wouldn't take that? That's right. So it's also on the professionals to make sure that we're not setting our patients up for an addiction. And so, yeah, 100% I think that's what I loved about even the previous description of that brought me to invite you here is that the care that you do have towards having this substance, if it is, you know, if it is indicative for it to be getting the improved treatment outcome to be handled with such great care and balance. And so it's kind of like bringing me to that question of like guidelines that are there or that are being developed with regards to the administration of of this. of ketamine. What have you witnessed, or perhaps even spearheaded? Yeah, so it's a little bit like the wild wild west out. There are groups like the American Society of ketamine providers, that is actively working on, you know, protocols based on 10s of 1000s of patients that these, you know, providers have used. I'm part of a group actually, specifically looking at protocols for adolescents. And like the ethical use in adolescents, you know, certain things that were fine, and it's a multidisciplinary board. So, I mean, there's pediatricians there, there's ER doctors there. We have trauma surgeons, with therapists. It's truly a multidisciplinary approach. Because many people use ketamine anesthesiologist use ketamine, outside of, you know, psychiatry, but we're really looking to develop protocols and some of the things that we see and is that adolescents may not need as much as we think. So you know, the typical protocol at a clinic would be going two to three times over two to three weeks. It's a little bit of an arbitrary protocol. But that's typically how it's done. With adolescents, it seems like as least disruptive as we could be to their personal life would be better. So oftentimes, they may only need once a week. And again, in the context of family work is where you see the most improvement. And frankly, that's generally speaking, that's not unique to ketamine treatment, you know, the kids, kids are a part of a family unit. And as much as we can help support the parents and the siblings and anybody who's involved in the caregiving, the kid, the kid is going to have a much better outcome. But yeah, what we see is that, you know, kids may not need it as much because one of the things that ketamine or even other psychedelics do is they reopen this critical window period where we have a lot of flexibility in our thinking we're able to really switch perspectives, but Allison's are already there. This is the period we're looking at. And so I think it's important that, you know, people come together, but Yeah, unfortunately, I wouldn't say they're set protocols like this is what you do this is it's a lot of learning from our colleagues and learning from like, you know, Renegades before me. I've been doing this for some, for longer periods of time. Yeah. And I think the learning piece, that's what I really love about your approach, that it's really an exploration. And that that gives me kind of this, maybe like a segue to, to looking at the development of the research in this area. Is there maybe something that I mean, you've done so much research in other areas, or just with regards to children and adolescents in suicidality? And that passion that you have for those evidence based treatment? Is there anything that you observe in the research on ketamine any kind of pattern? Or? I don't even know if this is a good question. Yeah. So it might be too broad, but anything that you you will notice, when you look at research on on ketamine use? Yeah. So I mean, as I said, what Dr. Phil Wilson shows again, doing it within the family context, that's really Adela fron who's another amazing researcher, who, you know, does the overlap of eating disorders and psychedelics, it is done within the family context. There is a real pediatrician at Rady Children's, which is affiliated with UCSD. And she's part of our group. She's doing research now on when adolescents come acutely suicidal to the emergency room. And we enjoy doing and giving them ketamine right then and there. And so she is studying that, and I think that's actually a really novel, excellent approach. can we prevent kids from even being hospitalized? Can we acutely just decrease or wipe out their suicidality? So they can actually do the intensive therapy work, they need to get better? Which then begs, I think, another question of like, can we, if we do cut it mean, and it may sound radical, but hear me out? If we can get these kids to ketamine in the context of family and individual work? And it works quickly? And they do well. Can we even not put them on medications long term? That's fine. Because that is the other concern I have with those young bodies and and having the traditional route. You know, what, and then with all these questions, that there still are out there just from from the typical approach to stabilization. So yes, I mean, that is, that is truly a an amazing introduction, if we think about prevention of, you know, going into, you know, a more intensive setting. And instead using the willingness to do the work, you know, from a different starting point it because I think, you know, having two teenagers myself, the motivation, right can be so fluctuating to engage and it sounds like having the children's or other adolescent emerging adults supported in a different way may help them actually maximize their own mastery, you know, if they would get that support early and get through some of those underlying topics in a way quickly, and what a what a wonderful path we put on. So wow, yes. So now, if you know what the research that you that you described, and you know, as a parent, and always trying to learn, is there something that when parents want to learn more about the research on ketamine for you? Is there a certain maybe your website or type of literature that you would refer them to so they can educate themselves? Unfortunately, there's really a paucity of information there really isn't a lot. In fact, I'm myself. I'm working on kind of a booklet to give parents to get a better understanding about ketamine how it works. I'm developing One for children. And I will say this is adapted from Dr. John Moo's own work, he has an amazing clinic up in West LA, and really is an amazing practitioner in this space. And so, you know, he's given it to me, and I'm trying to make it appropriate for parents and kids, essentially. But it's, again, it's just really important to do this, I think, you know, with the psychiatrist with the appropriate therapy, because what we do find is, within a couple of weeks, if you don't have any therapeutic support, often you can go back to where you were, or possibly even worse, what keeps ketamine going and what keeps ketamine so effective is, again, the ketamine assisted psychotherapy piece. And working with somebody who will help you prepare for your journeys, as they call them. And then the information that comes up during the time. And working with that, to help you get better or help your kid get better. That's, that's what's helpful. The medicine itself, similar to regular antidepressants, if I just give a kid and antidepressant, but don't teach them the skills of how to change some of the ways they're thinking how to change their perspective, to look at things differently, how to handle the conflicts that are in their life that are affecting them, I'm doing them a real disservice, because they're not, they're not necessarily going to improve once that medication stops, or I'm putting them at risk for having to stay on medicine wait longer than they need to be because I haven't taught them anything else. So they haven't gone, and then the therapy and the deeper work. So I hear you describe that the integration of the effort is, as we already know, is remaining key. And, and I cannot thank you enough for having that holistic approach and the care for the integration at the forefront. As indeed, I do think that even from my very niche work and in a different field, though, as I as I see it that with that more holistic approach. It really solidifies the treatment outcomes. And that's what we want to ultimately see with any effort that patients I feel, entrust us with, right? Can they get what's really the maximum benefit from that. So truly, thank you so much for making the time to share and I will share with the listeners your contact information if they want to reach out to you directly. And, again, thank you so much for your efforts and for your contributions in this important Eric, thank you so much for having me.