220 ‒ Ketamine: Benefits, risks, and promising therapeutic potential | Celia Morgan, Ph.D.

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Celia Morgan is a Professor of Psychopharmacology at the University of Exeter who has authored numerous publications on the potential therapeutic uses of ketamine in mental healthcare. In this episode, Celia dives deep into the neurobiology of ketamine, how it affects users, and how it differs from other, more classical psychedelics (LSD, MDMA, PCP, and psilocybin). She explains the potential promise of ketamine as a treatment for recalcitrant depression and addiction, and she details the results from her clinical trials in these areas. She discusses the importance of using ketamine in combination with psychotherapy to maximize its benefits, the potential risks associated with ketamine use, and advice for those interested in the therapeutic use of ketamine.
We discuss:
0:00:00 - Intro
0:00:08 - Celia’s training and interest in ketamine
0:01:58 - The history of ketamine, medical uses, and use as a party drug
0:07:48 - Neurobiology and pharmacology of ketamine
0:19:30 - Ketamine regulation and abuse, and how it compares with psychedelics and other molecules
0:35:38 - Ketamine as a therapeutic for depression [30:45];
0:56:43 - The brain under the influence of ketamine and theoretical mechanisms for its anti-depressive effects
1:07:56 - Risks and concerns with overusing ketamine, and what an intermittent or maintenance dose might look for a patient
1:16:39 - Treating addiction with ketamine: Celia’s studies of alcohol dependance
1:35:49 - Advice for people considering the therapeutic use of ketamine
--------
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Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).
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[@PeterAttiaMD]

In this episode, we discuss: 0:00:00 - Intro 0:00:08 - Celia’s training and interest in ketamine 0:01:58 - The history of ketamine, medical uses, and use as a party drug 0:07:48 - Neurobiology and pharmacology of ketamine 0:19:30 - Ketamine regulation and abuse, and how it compares with psychedelics and other molecules 0:35:38 - Ketamine as a therapeutic for depression [30:45]; 0:56:43 - The brain under the influence of ketamine and theoretical mechanisms for its anti-depressive effects 1:07:56 - Risks and concerns with overusing ketamine, and what an intermittent or maintenance dose might look for a patient 1:16:39 - Treating addiction with ketamine: Celia’s studies of alcohol dependance 1:35:49 - Advice for people considering the therapeutic use of ketamine

[@ktnina1]

I was quite disappointed with Peter's take here, particularly toward the end. Speculative dismissal of ketamine based on, by his own admission, a gut feeling. I speak as someone with treatment resistant depression who has paid thousands for infusions because they have finally put my depression in remission and gave me my life back. It's very frightening to know that the development of this drug, which we know can help millions of people suffering TODAY, could be postponed due to unsubstantiated suspicions like this. All the more confusing as well, given Peter's personal benefit and support of pscilocybin based therapy

[@RamziShamoun]

He is a big pharma guy. Ketamine is so cheap.

[@johnkeleher5563]

I can't find a source anywhere for any good psychedelics in my area, I suffer some pretty bad depression and i got a chance to try K and man it was a miracle substance, I felt free,the only high or euphoria was from the relief of my vices being released, that's exactly what it did

[@annamason3087]

The psychedelic experience is temporary but many people have permanent results

[@joachimlunares4871]

Mushroom completely turned my life around and my anxiety and panic attack disappeared and my personality changed into a much more generous loving person

[@fluffypineapples8852]

Check. /doctor _mckenzie/ He's got psych's*

[@evelynbecker4916]

I had 3.5 grams dried lemon tek most beautiful experience ever!!

[@geraldmiller5343]

@@fluffypineapples8852 where to search? Is it IG ??

[@johnmiller7427]

Sharp questions with ready answers, Excellent interplay between Peter and Celia hugely informative

[@patrick1580]

Fantastic interview!

[@Superflow25]

Much higher success rates for treatment resistant depression in Canada (80-90%). The standard procedure involves 7 infusions spaced over 2 weeks, Then follow up boosters as needed. Usually one after a month or two then as needed. Intranasal ketamine and Esketamine has been sown to be much less effective.

[@ArtemisAgain007]

Curious - what dose for the infusions?

[@ketaminetherapy]

Thank you Peter for sharing this!

[@Jerryberger9235]

Psychedelic’s definitely have potential to deal with mental health symptoms like anxiety and depression, I would like to try them again but it’s just so hard to source here

[@georgewilliams1062]

Psychedelics are the reason why i didn’t take my life when i was at my end. I was stripped of my ego and saw the beauty of life and interconnectivity and even though i still battle anxiety and depression, I’m doing better everyday and will never think in such a self destructive way again.

[@zoeywinston6826]

LSD and mushrooms completely changed my whole outlook on life. I became a better version of myself This experience gave me a lot of confidence about my self and my body. A bunch of bad thought / behavior patterns were broken. One of these was pretty bad OCD that made me wash my hands a lot. It gave me a lot of hope that things will be fine, this is the one thing that I heard throughout the trip: Everything is alright. The main reason for the trip was my severe depression and it definitely helped me (although it's not gone). Before all I could do was lay in bed. Now I am trying to rebuild my life one step at a time which wasn't possible before."

[@sarahh321]

[_James_tray] Got psychs

[@Jerryberger9235]

@@sarahh321 Where to search?? Is it IG?

[@nishaelvert1104]

Last year, I took shrooms at Las Vegas thinking it was going to hit like an edible or something. Shit was scary at first but amazing once you start getting deeper into your thoughts

[@good_call]

Great podcast!

[@Rinee848]

I got more information from one of the reply’s that actually uses ketamine for therapy than either of the doctors. Experience is the only way to know.

[@RKBrumbelow]

Having taken Ketamine, prescribed, IV and IN for almost a decade. I get very frustrated with interviews such as this. Questions which we answered years ago are misapplied, not by Peter, but by the interviewee. Example: one of the most useful applications for depression during the application of f ketamine is via the use of audiobooks and such. While you are under the hypnotic effects, it is difficult to fully respond to things, one can still listen and be guided. Without going too deeply into things, during the application, the individual is more open to absorbing the environment. So positive, uplifting audiobooks are good. Lovecraft, not so much. And yes, I am not just a user of ketamine, but until recently I was an active researcher in its use, effects, and metabolomics

[@gregseider]

@Maureen what was the handle to order the mentioned

[@gregseider]

Robert. Curious your take. I did a full 6 sessions of I’ve ketamine about 5 years ago in NYC with Dr Brooks MY ketamine infusions. . Trying to understand why I not only received no perceived benefits but actually suffers from anxiety attack after.

[@evanrosenlieb8819]

MDMA is not primarily a psychedelic but it has metabolites (and perhaps does itself, to a low degree) bind directly to the the same 5-HT receptors that psychedelics do

[@KTravRuNEr]

Completely missed its uses for chronic neuropathic pain such as CRPS…….

[@luomoalto]

A 40mg IV drip won’t last anywhere near 2-3 hours. Total time from drip start to back to normal is around an hour.

[@anotherjewishsharpnicholas9425]

I love the way she describes certain brain functions.

[@earlgrey691]

@Joebryan647 Looks like she's high on her own supply lol.

[@edpomi]

For anesthesia, it is actually not great for hypovolemic patients. In this situation it is actually good because you can give sub-general anesthetic doses and the patient will lay still, not scream and have analgesia... But because it is not amnestic, they will remember the whole experience. If you go all the way to GA with it, you can easily push the patiwnt into acute hypovolemic failure.... Ergo the art of medicine is hitting the sweet spot of creating a field where the surgeon can work and also keep the patient alive We use it on kids because it can be given IM. Peter, you take care of the surgery and let the guy at the head of the table take care of the anesthesia 😉

[@theresehazen528]

Helpful 😊

[@AronTobasco]

How about how to deal with ketamine addiction.. now that so many people have been turned onto it as a psychiatric wonder drug? Ketamine clinics are prohibitively expensive, so you know people are self medicating/regulating for legitimate psychiatric and medical reasons, and will be finding themselves dependent.

[@johnwemm8848]

Peter hadn't heard of John Lilly?? Strange. Well he has now. Lilly was concerned, I think, about the " solid state threat". Seems pretty apt now with how AI is progressing. Lilly was ahead of his time.

[@MultiCII]

ET tube in a mainstem bronchus--that’s an error…it belongs in the trachea…verbal slip

[@Superflow25]

Benzodiazepines will blunt the effect of Ketamine and therefore Canadian clinics recommend patients not take their regular dose on the day of infusion.

[@1LaOriental]

MDA, can be very hallucinogenic for many people.

[@woodyshade]

Can ketamine lead to tinnitus or exacerbate it?

[@edpomi]

Wow, all of the comments are scammers🙄

[@owenlarson07366]

Unfortunately, and undeservedly, Attia and Huberman have found themselves part of the red pill pipeline. No better target for grifters.

[@Rebecca-Mara]

She is so cool

[@edpomi]

40:45 for your question of reference dosing, 10-50 mg IV push will allow one to position a patient with a fractured hip lateral fracture dependent without pain and usually pretty stoned for placement of spinal anesthetic. 100-200mg would make a person absolutely catatonic.

[@PETROS_GGG]

If you want to answer : someone is accused of killing a child (9 years, 25Kg) in a hospital environment, by IV ketamine. Postmortem ketamine found is 6.5 mcg/ml in blood. Can we infer-calculate the dosage in two scenarios a) the death occurred with 5-10 minutes b) the death occurred in 1 hour. Thanks.

[@edpomi]

@@PETROS_GGG that is tragic. Calculating the dose given based on blood calculation would be little better than a guess for a simple anestheaiologist like me. It would entail calculating volume of distribution, times etc (pharmicodynamics and pharmicokinetics) that would be based on additional data from the child (e.g. body composition) and the pharmacology of the drug. A problem for a PharmD perhaps or a toxicologist. Based just on that information: A) person drawing up the drug did so based on thibkibg it was one concentration (eg 10 mg/ml) when in fact it was a higher concentration (eg 50 mg/ml) B) if it was a prefilled syringe, it was mislabled by the manufacturwr or pharmacy (wrong concentration on label) C) if it was compounded by the pharmacy, it was compounded incorrectly D) allergic reaction which went unrecognized E) loss of airway which went unrecognized (pediatric anesthesia pearl is airway, airway, airway) F) medication induced hypertensive/CV crisisnot related to loss of airway.

[@PETROS_GGG]

@@edpomi It is tragic, because the accused is the mother of the child, who within 20 minutes of being alone with her child (6 days hospitalized) should obtain pharmaceutical ketamine (from where?) to kill her child! The coroner found ketamine as a cause of death REFUSING to give any SUPPOSEDLY lethal dosage estimate. By the way the child was getting intubated during a seizure attack (so MY GUESS is the ketamine was given by the doctors) and moreover in 2 different hospitals the child was given ketamine with no ill effects. This mother will SURELY be convicted (as 1) the child could have died from the epileptic seizures and 2) no ketamine should have been administered as the child was on barbiturates and benzos - in the other 2 hospitals this was not the case). Thanks for the answer.

[@Elem70]

Is Ketamine an option for colonoscopies, wisdom teeth removal, etc? If so, why isn’t it more widely used?

[@edpomi]

@@Elem70 the hangover effect. A much better sedetive (in the hands of a skilled operator who can keep it safe) is diprovan/propofol.... Fast on, fast off and easy to adjust along the way. Ketamine can also increase oral secretions so perhaps is annoying to the dentists.

[@TrishanPanch]

What he describes re usage in the US is totally wrong. Esketamine is covered by Medicare, Medicaid and commercial payors for TRD on a fixed schedule. Out of pocket home use is a totally different industry and the FDA is quite rightly shutting this down.

[@TheVietnameseDevil]

nice try. please direct further inquiries to Langley.

[@user-ju7ze9to4k]

Wow, was she actually ON ketamine during this interview?

[@oliverfoley2553]

John Lilly died in a sensory deprivation tank under the influence of it, I believe

[@JellyBean0776]

But if giving high doses of ketamine quickly, it can cause apnea and death... is that not considered toxicity?

[@0xszander0]

Not a researcher but can't anything be toxic at a certain dose? So maybe those doses are so high we don't really consider it toxic.

[@JellyBean0776]

@@0xszander0 It just feels disingenuous and dangerous to insinuate there's no max dose. Of course that's not their intention but to the lay person, it can be taken that way and I've definitely had to breathe for people who were given ketamine. Apnea is what kills opioid overdoses too. I am a ketamine therapy provider btw. I have nothing against any of this and have seen some incredible things but am trying to learn more. This is something that has never sat right with me.

[@inpropagation]

Did she just say "fortnightly"

[@alexbrass4823]

🔥🔥🔥🔥 ketamine convo

[@FrankEmmanuel799]

I got some K infusions from an online store

[@FrankEmmanuel799]

FROM TRIPWITH_JEFF

[@FrankEmmanuel799]

0n instagram

[@attheranch4876]

Between her accent and her voice, I’m having a hard time understanding her.

[@golgipogo]

Turn on the caption function

[@wingzbound4573]

Kettamin' it is.

[@span1923]

Anyone else feel that the guest was very fidgeting and had a lot of movements especially around her head and neck area? I’m getting super distracted….

[@myco_trippz.Telegra]

Yes

[@williamallen7836]

She's anxious. They are all stereotypical self soothing behavior. If it bothers you, close your eyes, or look away when she speaks. It's one of those situations ware visual is not needed to understand the context & content.

[@TheVideogirl1952]

@@williamallen7836 I read lips but she was very distracted.

[@sandragee2864]

It was tough for me to listen to this interview. The fidgeting, the (?) vocal fry quality of her voice was distracting for me so I went to the “more” link after the show title & accessed the show notes. Dr. Attia and support crew, I am thankful the show notes are available!

[@Bronte866]

Affectations like this are very important and relevant. “Closing your eyes and looking away” is nonsense and profoundly unhelpful on a topic like this. Unless you’re her physician and personally know her this is way past inappropriate.

[@ManicPixieVlogs]

I couldn’t understand her I felt like she was just repeating his questions and going in a circle and kept fidgeting.

[@massylii]

♥️♥️♥️

[@Josh-pe5pl]

her accent is so distant from my good ol’ Western US accent that she was too difficult for me to follow. Most Brits I can understand pretty easily. 😮

[@datimasu]

Dr. Attia - I was pleased to hear you say your are cautious about Ketamine (1:09:04). Ketamine IV Infusions didn't work for me. I suspect that the large volume of boutique style for profit and unregulated Ketamine clinics in the U.S. are greatly distorting success rates.

[@ericcoligado8655]

The more I learn, the less I understand.

[@javadhashtroudian5740]

Over the years since 1967 I have self administrated say 10 psychedelics much meditation and Advaita self enquiry Result has been peace and diminished monkey mind

[@Josephus_vanDenElzen]

11:09

[@attheranch873]

Her voice makes it a bit hard to understand what she’s saying.

[@bz9065]

Super interesting discussion, but I wish he wouldnt have interrupted her so much. It was really annoying in the middle of an interesting thought, and rude to the guest.

[@TheVideogirl1952]

I was glad he did interupt because i couldn't understandstand her. She seemed distracted/rambled and Peter came back to clarify.

[@kailashyogi4314]

In the end no one escapes ketamine addiction. Not even our guest. 🙃

[@KJ-xc6qs]

Her accent makes her quite difficult to understand.

[@williamallen7836]

I find her accent very easy to understand. I have definitely dealt with much more difficult accents to understand on a daily basis at work. I'm sure she may even find the same about your accent.

[@golgipogo]

Caption function solved problem

[@karenhikesalot]

Fascinating. I've a friend that is Bi-polar and she microdoses psilocybin and has had major improvements with it.