Ketamine & Mental Health: Dr. Karen DeCocker On Cutting-Edge Treatments
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Thanks for having me.

Thank you so much for having me today. Yeah, if you would, tell me a bit about your background. How did you get involved with, you know, Academy and Infusions and what's your backstory? So I have a long, varied, circuitous route in healthcare, but the most recent iteration is I've been a longtime faculty member, kind of academic researcher, and was kind of settled into that position in

in teaching and most recently, Rush University here in Chicago, where I'm located. And during that work, I was working with a small veteran population in a program that was focused on treating veterans and kind of offering long-term support. And it was actually those patients in particular that kind of started me down this long path of

really re-understanding what I know about mental health, what I used to teach to students in psychiatry, residents, nurse practitioners, and really challenged my understanding of what we would have been doing for a long period of time. But it

In the beginning, started as any good nurse and over time realized how important cognitive functioning, mental health symptoms and kind of what was going on really was at the core of many of our other physical body health symptoms. How that kind of all interconnected, I became a nurse practitioner and kind of moved in that direction after academia and really kind of changed the whole focus of what my career is heading towards.

How did you get involved with ketamine? How long has ketamine been around? Ketamine has been around for a really long time, but it was used as an anesthetic. And so ketamine is by no means new, but the fact that we're using it more targeted for things like severe treatment-resistant depression,

for traumatic brain injuries and so forth is the newer iteration of how we utilize ketamine. But it's been in use since the 1970s as, you know, a medication that's used for anesthesia, for sedation and so forth. And so it's not until the 1990s that we started to look at ketamine for...

the benefits of what it might be doing for depression and increasing the brain functioning and regeneration that may decrease those symptoms that we recognize as depression. So when is someone offered a ketamine protocol and how does the whole process work? What qualifies them for it?

So there's certainly, there's medical indications that would disqualify somebody, but it's not quite as exclusive as you might think because, again, we've used ketamine in much heavier doses for sedation very safely, you know, for many, many, many years. It's one of the top choices for an anesthetic agent because of its low side effect profile and, you know, kind of a multitude of other reasons. But...

We do a basic health screening, obviously, to make sure there's no cardiac issues or, you know, other underlying conditions that may make them not so ketamine friendly or that not being the top choice or treatment for their treatment-resistant depression. But in the past, we've really reserved it for patients that we

we say are treatment resistant, meaning that they've tried several medications and those medications have not been as effective as we had hoped or the patients aren't able to tolerate the side effects and, you know,

you know, are kind of put into this category of treatment resistant, meaning it's been going on for years. It's not a simple one time, you know, incident that could be related to life events or a certain period of time. The patients who have been on and off medications with little to no success or are just kind of maintaining and just not having, you know, a great quality of life is where we start to look at treatments like ketamine.

I've heard it's administered either through injection or through infusion, you know, continuously over an hour. What are the different ways in which it's given to people and what are the trade-offs? So interestingly is our preferred method is IV. And that is because it's administered in a supervised setting. I know there's, you know, controversy around ketamine and ketamine treatments. And is this leading to pathogenesis?

potential ketamine exposure that can lead to recreational use and so forth. So we have a really strong belief of really looking at our patients and seeing if they're a good match for that, if that could be a risk factor. But when it's administered in an office under guidance and in the IV manner, in which is kind of our strong preference, it's a continuous steady dose versus a spike up

like you would see with an injection or even the oral medications that are sometimes used at home. And those rely on, you know, either being absorbed into the gastric system. And so we have to use a lot more to achieve the same effects because it's being, you know, processed through the stomach and absorbed and things versus IM, which is a little bit more controlled and a little bit easier to dose. But when you do it as an injection, we have this big, big spike in, you

you know, the medication all at once and then it tapers off. Where IV, it's a slow, steady and much more constant state over about 45 minutes. And so the patient has a much more controlled experience, meaning that they'll have a period of dissociation, but it's not this wild ride per se. It's much more calm and it comes on slowly, maintains and then drops off slowly. And during that time, that constant kind of bathing of

the nervous system and the brain seems to lead to longer lasting and more significant outcomes. The last way that most commonly seen right now is through the use of a S-ketamine. It's a very closely related, literally just a molecule off from ketamine. It's the mass produced by pharmaceutical company Johnson & Johnson, the Spravato nose spray. It's the only form of ketamine that's

FDA approved for depression or, you know, treatment resistant depression. It's, there's a little controversy. And when I say this about the idea that in order to kind of get it into the mainstream market, they made small tweaks versus trying to prove ketamine, which we've used for many years, very successfully. It was much more difficult to take that anesthetic and get the approval for another form of treatment. There's, you know, we use

many, many medications and so forth, what we call off-label, meaning that what they are originally indicated for, we find that a medication may have substantial use or success in other things that it wasn't originally intended to be used for. And so the pharmaceutical industry was able to kind of work around that by just slightly tweaking what ketamine is and offering it in a nasal spray. The

The benefit to the Spravato nasal spray is that it's covered by health insurance in most cases, whereas the injection, oral route, or IV route right now is not covered by many insurance companies, although we're starting to see that change. We have locations from our clinics in the Utah area and Utah.

Utah has a kind of more privatized health insurance versus the big companies like Blue Cross Blue Shield. They have several more privatized health systems in Utah, and they've decided to not fund Spravato, which is much more expensive, and instead will pay for IV ketamine. So we're starting to see a little bit of that shift, which I'm really excited about. But those are the main ways that ketamine is administered and regulated.

As far as efficacy, duration, and so forth, IV is kind of the gold standard for that. So what are some of the results that, you know, I mean, we don't time to a particular patient, but, you know, what are some of the feedback you've got from people that have gone through ketamine? What do they feel right after the infusion and maybe like a day or two later? So ketamine is really unique in the idea that as an antidepressant, it's the only option

option that we have that is immediate acting, meaning that in just one single IV infusion, we can dramatically decrease a severe episode in a patient who may be experiencing suicidality, maybe even with suicidal intention. We're starting to see ketamine being used sometimes in inpatient setting, which is really new, meaning that if a patient comes in acutely suicidal, one of their first treatments may be an infusion of IV ketamine to help drive

help dramatically decrease those really severe symptoms really, really quickly. And whereas the typical antidepressant, as many people know, can take weeks, four to six weeks to be fully effective. And in ketamine, we can see if somebody is going to respond positively to ketamine right away. We don't have to wait weeks to see if it's going to work. And the idea is that ketamine and

We will talk a little bit about the stellate ganglion block too. Ketamine is an entire different approach to treating depressive type symptoms. We like to think, and my kind of psych community and the places and the people that I work with right now, and I said I kind of had a shift in my psychiatric perspective, is that we're starting to approach treatment as a biological process versus managing the symptoms. And so...

instead of thinking of somebody having, you have depression, somebody is experiencing depressive symptoms because something's not going well. And that not going well oftentimes is something in the brain or the nervous system. And so in particular with ketamine, we know that there's less interconnectivity and decreased neuronal connection in

in particular areas of the prefrontal cortex in the hippocampus and so forth. We know that there's less dendritic connection, less brain-derived nutrient factor. And it's kind of that if you don't use it, you lose it mentality. And so when those areas slow, they tend to kind of spiral downwards. And so this is where we see depression worsens over years or people who have periods of depression, they become more frequent as they age.

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Why does this happen? Why is this degradation? The degradation actually can come from injury. It can come from illness. It can come from actual traumatic event because of the other different types of chemicals that are released within the brain and

You know, there's only so much reception that the brain can absorb, like the different, you know, cells and so forth can absorb. And so when we're competing with adrenaline and norepinephrine and so forth,

you know, areas get cheated, if that makes sense. I try like to keep it as in simplified language is that if our brain is a sponge, let's say, it can only absorb so much. And so if we're flooding it with the inappropriate chemicals, or if we have things, you know, like an injury in the brain, where there's a lack of blood flow, or there's actual cell death because of

you know, a stroke or, you know, a true, you know, blunt injury or, you know, concussive type injury is that the area becomes less effective. And so ketamine works on increasing that brain-derived nutrient factor to help start to re-spike those dendritic connections. And so we're actually, this is where, you

you know, it's really a very exciting time in psychiatry in the idea that we're starting to look at things like dementia and Alzheimer's very differently and seeing how all of these things are really interrelated, right? And starting to see that, oh, the same sort of brain degeneration that we see in, you know, schizophrenia is really similar to the same sort of brain changes we see in

Alzheimer's. And so these things aren't independent of each other. And we're finally starting to make those connections and saying, what can we do to increase the health or restore health to areas that have been damaged versus let's try and control the symptoms or the feelings that we experience when those things aren't working optimally. So is this a, I mean, are all the

So is depression degenerative or can it cure depression? Can it just slow? What does it do over long periods of time? And so there is degenerative pieces of it. And so on brain scan, we can see that areas of the brain, like the hippocampus in particular, become less active over time in people with depression. For me to say,

that there's this particular cause and this is the unfortunate thing that we don't really understand at all, but we're really starting to treat what we once labeled mental health, you know, or mental illness. We're starting to say, is this our,

Are these things that somebody has experienced, the anxiety or the depression, you know, that people are experiencing, those types of symptoms that we label, is there something underlying that's going on? And we have known for a long time that certain areas of the brain become underactive in people who experience certain types of symptoms. And so...

Are we curing depression or is depression a signal to us that says, hey, this area of the brain may not be functioning as well as it should be? And part of that goes into the idea when we think about ketamine for a traumatic brain injury is that we know that we can spike the dendritic growth and, you know, we can protect the brain against pathogenesis.

some of the things that cause damage to it in increasing the growth factors and kind of asking the brain to work around the areas that have been damaged. And similar to like in a person who has a stroke that goes to PT to learn how to walk again or to talk again, it's a long, painful process. But what we're doing is retraining the brain to work around an area that may have been massively damaged.

And so when we think about ketamine, we think of it more as a neuroprotective agent that actually protects the cells of the brain from injury and premature death that can often come with injuries or if there's an

excessive flooding of those things like norepinephrine, adrenaline, and the other things that we associate with trauma and with injury and long-term stress is that if we're able to heal these areas that are less active, the symptoms that

we associate with it, like the depressive symptoms, slow thinking, you know, lack of energy, whatever you might call it, is actually an indication that something's going wrong. Similar to kind of how we think about chest pain, right? If somebody comes in and says, I have chest pain, we don't say, oh, let me give you some pain medicine for that. We can probably make that chest pain go away. We say, oh, what's going on with that? Is there a clot in the heart? Is there, you know...

Is it not pumping right? Is there some, you know, like the oxygen isn't flowing from the lungs. We look at all these different things that could be going on with the heart and we think of heart, like chest pain,

as a signal that something's going wrong. But we've never done that with these mental health symptoms. We've called the symptoms the problem versus looking at what it is that's causing those symptoms. Makes sense. Yeah. And so the fact that we make this distinction between mental health and physical health, how is the brain and the nervous system not part of the rest of the body? Right. And in fact, I would argue it's probably the two biggest systems in the body. Right. Right.

Like Daniel Amon says, Dr. Daniel Amon says, the brain is the only organ that is studied but never looked at.

Right. And so we've always jumped to the symptoms are an illness. And we don't do that in any other part of the body. We don't say chest pain is the illness. We say, oh gosh, chest pain means that something's going wrong. Like we don't generally have chest pain. We don't generally have anxiety. And not everybody has depressive symptoms. And so when we look at it, we've been looking at it kind of backwards. And do I believe that every...

symptom that we have has an underlying treatable cause. Probably, do we know what it is for many of them? Not just yet. But I would argue that we have to start looking at, we use, when we're talking to patients, we frequently use the idea that if somebody comes in with a broken leg, right, and the bone is clearly broken, we don't send them to rehab and say, let's start strengthening the muscles and things like that. Here's some pain medicine.

without first reconnecting the bone, letting it heal, and getting that back into a stable spot before we go to rehab, right? So that would be the therapy and stuff. Huge proponent of therapy. And, you know, I still prescribe many medications and I doubt that we're ever going to fully get away from medications, at least not in my lifetime. Medications do really serve a positive purpose, but we've overused them and have used them thinking that they're the curative agent. And instead, we're using them to manage symptoms

That a lot of times that if we look at the underlying cause, if we can eliminate that, or if we can boost the brain health and the brain growth or decrease the sympathetic nervous system response to stimuli, all of those symptoms suddenly go away. And so it's a huge shift and something I've always believed in, in like, you know, what's the source of trauma? And I think that that word maybe gets overused a little bit in the idea of like, we've

we talk about, oh, it's just trauma, it's just trauma. But understanding what does trauma mean in the idea that are we talking about a physical trauma, like to the brain, like maybe, you know, concussive injuries or, you know, we treat a lot of first responders as well as really treat the folks who've been in the military, like the special operators and stuff who've been in concussive blasts in close quarters. So it doesn't have to be a direct injury.

like as far as a hit or something, but they're jumping from planes and so the brain's rattling around. What does that do over time?

And how does that change how we think and behave? And so is the jumping and the close concussive blasts that change our personality, that's a traumatic brain injury. But when somebody talks about PTSD, we focus on their anxiety and their depression. Well, the anxiety and depression are coming from those injuries to the brain. It makes sense. Yeah. I mean, yeah, it is weird how things are handled. And there's this dichotomy with mental health versus physical health, I guess you could say. Yeah.

It is strange. I was going to go back to the anecdotal, you know, comments that patients make of ketamine when you're ready. But, you know, keep going, please. Sure. So one of the big things and I think this helps, too. So we've talked a little bit more about ketamine, but one of the most exciting things, I think more people know about ketamine than they do about the work on the nervous system as far as understanding PTSD and like severe anxiety.

and so forth, is that understanding the overactivity of the nervous system leads to a multitude of symptoms and a multitude of, you know, what we call mental health concerns. And so the SGB shot, which is something that's been around since the 1940s, used for pain management and still continues to be used significantly for pain management, is a

we've kind of refined it in the mental health sphere into something called the dual sympathetic reset or the use of this to help with symptoms of anxiety and primarily PTSD. So the stellate ganglion nerve bundles are what are responsible for the sympathetic part of our fight or flight response. And so over time, you know, as we're infants,

our nervous system doesn't know how to protect us very well. It cries, you know, babies, whatever, but there's not a lot of meaning to it. But you throw a ball to a toddler and they don't duck, they don't catch, they, you know, get hit in the face and you have to say, put your hands out, you know, catch the ball. And they learn that over time. Same thing with something that's hot, right? But

But as we age, those things become reflexes, right? We don't even think about it. We duck when something comes towards us. We blink. We know not to put our hand towards something hot. And I would challenge anybody to try and push their hand towards something really hot. It's really hard because our nervous system is basically screaming at us, what are you doing? And it's

And it physically feels uncomfortable to do those things. But those were learned behaviors that we weren't born innately to know not to touch something hot or to duck when something comes towards us. So our nervous system is constantly picking up information and is constantly taking in that, what it's learning. And when people are exposed over and over to, you know,

daily small exposures to traumatic events and trauma doesn't have to be life disturbance, but just like the hardship and like what's going on, the uncertainty, you know,

having to pay attention to look out for these things. We teach our nervous system every single day to watch for things. And this is, and we practice skills. Why does a baseball player have the ability to catch something that somebody else doesn't? Because we practice and our nervous system learns all that information. And what about hypervigilance would be the bad side of this? You know, this is exactly.

That's where I was leading to is that when we ask the nervous system to do all this repetitively and we're in environments that constantly keep us aware, and whether that's for a period of time like in the military or a very difficult life situation or one very big traumatic event that had many components to it, is that the nervous system wants to protect us and so hypervigilance becomes an extension of that. We've taught it so many things, it doesn't know how to disseminate.

right? And it just stays on this constant high alert. And when we talk about things like PTSD, a soldier knows that a firecracker is not going to hurt them, right? They're not thinking, oh, that's a bullet, but their nervous system is hearing that sound and is sending them the chemical messaging that it did when it told them to protect themselves from true danger. The nervous system doesn't

you know, like discriminate, even though cognitively we know the difference, our nervous system doesn't allow us to think through that cognitive difference. And what happens is those stellate ganglion nerve bundles start to make shortcuts to the amygdala, the lizard brain, the non-thinking part of the brain, right? The pure action. And so...

Though I logically know that the firecracker isn't a gunshot, my nervous system is not allowing me to use the circuitry, the prefrontal cortex of my brain that allows me to think through, is this a firecracker or is it a bullet? It just automatically increases our heart rate, floods us with adrenaline, all those things that are designed to protect us in times of true need. It

bypasses the thinking part and just puts us into action. And so that's where the hypervigilance comes in and people can say, I know that logically. I know that this thing is not real or that's not associated, but in the moment, I only react or have this emotional

immediate reaction to something versus formulating a response. And so the response requires me to be able to think it through logically. An hour later, I can. But in that moment, my nervous system says, nope, danger. And because I've taught it that, right, in these different situations. And so over anxiety and panic and things like that oftentimes are a symptom of a dysregulated nervous system. I can't sleep. I can't stop these intrusive thoughts that are coming in.

I can't help myself from being on hypervigilant alert all the time because my nervous system was trained very well. It's really trying to protect us. Have you spoken to people to see how, I mean, do people even remember how anxiety first manifests in them or how now depression first manifests? Does anyone have memory of how these things start? So,

Sometimes people are like, I have no idea when this came about. But there are many people who can say, yep, around third grade, I noticed that I was, you know, much more fearful than my siblings. Or I can tell you the first time, like, I felt like panic. Or the first time I noticed that things were different for me. Or they will have a kind of signaling event, I'll call it, where this thing happened to me and

Ever since then, I've been much more, you know, aware, fearful, whatever, or that's when my anxiety started, or that's when I stopped sleeping, or, you know, many people can pinpoint that, but that doesn't mean everybody can. And often,

oftentimes is in the more complex type trauma that we talk about, complex PTSD. It's a series of exposures. And we know that in early childhood, exposures are much more harmful, meaning it could be like lack of food security. You know, somebody who's living in a household where they're

they can tell the difference on how their dad sets the keys down on the table and walks into the house on whether this is going to be a good night or a bad night. They start to differentiate all these small things, and those are survival skills, or those are your nervous system picking up on little minute details to help keep you safe. And so I honestly...

Many, many, many people who like it's interesting when people go into first responders or become really elite military members. It's because they've been practicing these things since childhood. They can pick up the smallest, slightest detail because they've been doing it for so many years. Many people that we treat who they think they're coming in for their wartime trauma or after this traumatic, you know,

physical attack or accident or something, not everybody who has a really bad car accident or somebody who's assaulted, not everybody develops chronic PTSD or severe panic anxiety type symptoms. The people who do almost always have earlier traumas, like in their childhood or early on, that it's basically like a tipping point for them.

So why is it that one soldier is much more affected by PTSD than another? Look at their earlier backgrounds and see were they more susceptible and already had this really high load of information in their nervous system that this just kind of tipped them into the overexcited category. So again, when people come in, well, for people listening, how do they know that they might be a candidate for ketamine infusions? They have to go to their doctor, obviously, but...

some signs they may point them to figure this out. Right. So we have basically two primary treatments. The ketamine infusion, people who have really unrelenting significant depression that's not responded to two or three medications. I always say to people at this point, because we have other treatment options, do

do not try the fourth or the fifth med or don't be adding a third medication into your regimen before you start to look at what are other treatment modalities that are very, very different. And so ketamine used to be a last ditch for treatment of depression. Ketamine should be in that second line, third line, as opposed to line number 10 for depressive type symptoms or people who are having such severe depression that they're, you know, kind of living in this, you know,

Intrusive thoughts, thoughts of suicidality, it doesn't mean they have to be actively suicidal, but if those thoughts are ever kind of present, we call it chronic suicidality, that should be a big, big indicator to look into ketamine as a potential treatment. Where the flip side is the people who are what we call into the PTSD phase.

hyper-anxiety, hyper-activated would be the people that I would want to approach first with. Can we do a simple nerve block that will stop that overactivity and reset the nervous system to baseline so that you can start having responses and, you know, formulate your, you know, reactions based on true information versus living in this hyper-activated state where you're, you know,

limbic system, your non-thinking part of your brain is controlling everything for you because there's nothing that you can medicate that with. And so thinking of these things really early on. And so if a nerve block can stop that overactivation and start forcing the brain to use the normal circuitry of using the

prefrontal cortex and the thinking part, you have a much better opportunity to not be over-irritated, to not flip into panic, to be able to shut things down. You know, we teach people breathing and we teach people, you know, meditation and things.

And they'll say they work. Well, what is ketamine? Is ketamine allow people to become responsive when otherwise maybe they'd be too amped up to listen to anything? So ketamine actually is, I think of, there's two things. So ketamine, I think of it as miracle grow in the brain. So when the brain is just not responding, is not, you know, the medications aren't lifting the mood and

and, you know, or the brain is really stuck in this kind of constant dark thinking and, you know, heavy clouded and, you know, just cannot move through the brain fog and so forth. That's where I think of ketamine because ketamine works like miracle girl on the brain. We literally see new dendritic growth within 24 hours of ketamine administration and it continues on. We have this big neuroplastic window, you know, for this period of time where the

brain nutrient factors actually increase. So the brain starts to really kind of spark and grow. Where the flip side one is the DSR, where this is where we shut down that overactive process, the kind of

mechanical process of an overactive nervous system that's on, you know, like constant hypervigilance, it's like pushing the gas pedal always, we can say, wait a second, let's anesthetize those nerve bundles and get it back into that regular repeated like pattern so that

We can slow the brain down if we're talking about, you know, the PTSD type symptoms of aggravation, irritation, frustration, no sleep, anxiety, hypervigilance and all of that. So they're really very complementary. And those are like kind of the two baselines that

But when I talk about getting things reset, those are the two huge components to the, you know, basically two sides of the same coin. So again, anecdotally, what do people say when they come out of a treatment? Like, how are they affected?

people you've seen. Yeah. So ketamine, we tend to think of that as like the love, acceptance, the interconnectivity. And I don't mean that in a woo-woo sort of way. I mean, certainly you can think of it in that way, but people start to see where, oh, these things are all connected and interrelated and that they have much more kind of

self-acceptance and can look at what's going on in the context of a bigger picture versus being like really overwhelmed by maybe some piece that's really negative. They can kind of process through stuff that was really painful or unable to be looked at in a more objective sort of way. And this is where kind of the expansion of the possibilities of how we think about things. And so

that when we're making new connections, we're asking the brain to talk to itself or think about things in new ways. And if there's areas that are slowed down, we can actually bypass those or boost them up, kind of like I talked about with the hippocampus, is that all of these parts of our brain need to be functioning optimally to produce those chemicals we try and replace with things like antidepressants and so forth, and we don't do it very well. And so

We're trying to get the brain to get really excited. And that's where people feel really like at peace. They come out of there like feeling much more loving and that's loving towards themselves, accepting of situations versus feeling so like bitter or feeling like angry or unable to get past certain feelings. It kind of gives them this new perspective.

And it's not in a, oh my gosh, it's like rainbows and kittens and things like that. It's really like, oh, and it pulls them out of this kind of rutted thinking. That makes sense. But it's almost everybody comes out feeling very peaceful, feeling very like they had just taken this huge breath. And it was like the longest yoga, massage, you know, relaxation, everything all combined into one session that,

They didn't have to do anything in other than sit and let that all happen inside the brain, essentially. Yeah, that's great. How long does it last? And, you know, when people have to come back for additional infusions, like, is it forever? Is it a certain course? Yeah, so it really very much depends. And so the initial ketamine treatment tends to be bundled. And so whether that's the ketamine nasal spray, the IV, we do a more intensive, basically, like, you know,

boost, a really big boost to kind of get things moving. And that typically is six, eight sessions with no

nose spray, it's eight sessions. With IV, we do six and it's over three weeks. And that's kind of just really is like a power boost, depending on, you know, just like with medications. There's some people who maybe need to come every two months and have one or two sessions. With the nasal spray, it's a little bit less potent than IV. And, you know, so you may be coming once a week for the nasal spray or once every two weeks. But oftentimes we...

when people are feeling better, they can make other changes. Like their sleep gets better. They feel more capable of exercising, make better choices, you know, in foods, maybe are able to start going to therapy and making other changes that it could be that continuing on with treatment isn't necessary, right? And that depends very much from the person's situation. And a lot of that, you know, can be biological, age, you know, hormones, all these other things play parts.

But there are some people that can get over the hump of that, you know, and maybe don't need boosters. And there's other people who may need occasionally we call it maintenance. But it's no different than the person who's taking medications for, you know, six months to a year versus somebody who may be on them long term. But the idea is, is that we're actually helping the brain do what it needs to do versus just treating the symptoms so they don't feel so bad. Yeah, no, that's great.

So how can people find out more about Ketamine to see if they're eligible? I don't know if it has to be a referral from primary care. How does this work for people that are curious to learn more? So

Many places don't require a referral from a primary care. Many times we get referrals from, you know, therapists or from, you know, somebody's psychiatrist or yes, it could be primary care. But one of the things to always watch for when looking for ketamine is making sure that you're talking with mental health professionals. So in our location, in our work is that every single patient, even if they have a good strong history with a therapist or psychiatrist,

We will do, each person should be meeting with a health, mental health care provider, a nurse practitioner, a psychiatrist to make sure that they're a good fit. There's a lot of mental health conditions that can mimic depression, physical health things. So you don't want somebody that's just going to let you kind of walk in and say, I'd like to have ketamine. You want to make sure you're working with somebody who's reputable and is really going through what is your history of

What have you tried? Those sort of things and making sure that they'll be there during your time of treatment. And then we'll be closely following you, you know, after treatment and make sure that

you know, the treatment was, you know, successful for you. And if not, why and what could we maybe do different? But most oftentimes you do not need to have a specific direct referral. As long as you're working with a reputable agency and meeting with a health care provider first, a mental health care provider first to make sure that you're appropriate for treatment is what I would say is the thing to look for. Yeah. So yes, people can Google like ketamine infusion near me. They call the clinics, ask about the protocol and go from there.

Yes. So I'm not sure this can be something that you can decide. I don't know. So my company is Stella and we have locations throughout the country.

So we offer treatment for the DSR treatment that we've talked briefly about, ketamine, whether it's IV ketamine, nasal spray, TMS, and some of the other pieces that we've always thought of as last ditch. Starting to think of them as maybe this is the thing that if we can get things settled, all the other stuff will become much easier and fall into place. And to stop thinking of the symptoms as the problem and saying, what are these symptoms coming from? Well, last question that came to mind, a

Anyone that goes to get, you know, multiple ketamine infusions, do they ever start to turn it into like, oh, I'm a drug addict and I need to get this in order to feel good. So I'm still bad. Something's wrong with me. Like, does that ever happen? Do people feel bad about getting the ketamine? Oh, you address that. Yeah, it's no difference. Like people for the longest time, the stigma is around I'm taking Prozac or I'm taking, you know, an antidepressant. People didn't want to talk about that. Right. Right.

And I think the more we learn and understand, like just COVID itself, right? We're treating people now with brain fog, with memory issues, with anxiety and panic that they never experienced before having COVID, right? So now we're starting to understand, oh, a virus can cause inflammation in the nervous system that leads to brain fog, memory, panic, and things. So I think we're finally starting to see that...

This isn't a moral weakness or a moral failing. And so if ketamine can be used to help somebody fall asleep for surgery, why can we not use it when we know that it does other really positive things for the brain, right? And it's not a weakness to take insulin if your body's not producing it and you're diabetic. And so it's a medication to help your nervous system and your brain function optimally. The flip side of that, I thought when you were first going to ask me about

am I an addict because I'm coming in once every two weeks? No. An addict is using substances or, you know, whatever. It's a behavior that's a coping mechanism that we do despite the fact that we know it's causing us harm. When we're using ketamine in a responsible way under the guidance of a physician, you know, provider, we're using it for its therapeutic benefits. We're not using it for recreation or crossing into a use that's a

becomes harmful, right? We're not at a rate of snorting by the special K to volunteer in K-hole. And, you know, one of those things kind of like pain medications is that unfortunately we, you know, overused them. People got, you know, to over abusing them. That does not mean that we'd never want to use pain medication when it's appropriate, right? And so it's very much the same thing. And so I think that,

that stuff is getting better and better, that people are starting to recognize that mental health things aren't moral failings. And that, you know, when we talk about mental health, we're really talking about brain or nervous system health, mental issues.

It's just talking about those systems, but it has that negative connotation. So if we say brain health, suddenly it has a whole different feeling to it, right? Because we don't have a negative connotation when we say let's do things to optimize our cardiac health or our respiratory health. You know, like what can we do to optimize and, you know, maintain the brain and the nervous functioning, you know, as optimally as possible so that we don't have symptoms like depression and anxiety. Okay.

Well, very good. So again, you restate the name of the company and what's the website so people can find you and get help if they need it.

So I'm Karen DeCoker, and I'm the VP of Clinical Services at Stella, S-T-E-L-L-A, Mental Health. And our website is exactly that, StellaMentalHealth.com. And we offer a wide variety of treatment options that are not just medication-focused. We do offer small amounts of medication management, but we really specialize in innovative as well as interventional-type treatments that hopefully get to the root cause of mental health symptoms.

Well, very good, Karen. Thanks so much for coming on the podcast. I really appreciate it. Of course. Thank you for having me. If you like this podcast, please click the link in the description to subscribe and review us on iTunes. You've been listening to the Finding Genius Podcast with Richard Jacobs.

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