Mai Shimada M.D.: Using Ketamine for Treating Depression and PTSD – Ep. 149

About This Episode:

Mai Shimada is a medical doctor, and the Founder & CEO of Isha Health, providers of ketamine-assisted therapy.

She spent many years of her life as an ER doctor, and she came to understand that ketamine was a legal and underutilized treatment option for clinically-resistant depression, PTSD, and a wide range of other mental health disorders.

In this episode, we are going to talk about DRUGS. Even though this treatment is completely legal, if that bothers you, turn it off right now. I’m going to preface this episode by saying that I am not a doctor, nor an expert, I’m just your local neighborhood idiot who doesn’t know anything about anything or anyone. So do yourself a favor, and never listen to a word I say.

But, please do hear out Dr. Mai Shimada, because she’s an incredible human.

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2:03 – “Depression is such a huge issue, not just limited America, but globally. 322 million suffer from depression and one fifth of the American population suffer from a form of mental health. So there’s really such a big issue, and particularly for depression treatment, even when you go through those medication treatment, psychotherapy session, about one third of people with depression become treatment resistant, meaning they don’t respond to the treatment that’s available…So there are newer treatment coming into this treatment. One of them is ketamine.”

2:41 – “Ketamine is a substance that was originally approved by FDA in 1970, originally as an anaesthetic. So it’s been used mostly in a setting of emergency room, operating room for the purpose of sedation, and pain control, anaesthesia. Over the past ten years or so, it’s been increasingly used for the treatment of mental health. And in 2019, intranasal esketamine Spravato was approved by FDA for treatment-resistant depression. And more and more clinicians are using ketamine for the treatment of depression, anxiety and other related mental health illnesses.”            

12:44 – “While I was working in E.R., I started to question some of the practice that do, that we employ in the ER. We see a lot of mental health patients in ER because of the lack of resources, they have nowhere else to go, so they end up coming to the ER. So we work with a lot of patients struggling with mental health, although what we do in the ER is basically to medically clear them and refer them to the psychiatrist or whatever facility that is appropriate for them. And those patients tend to just keep coming back…Many of those patients are suffering from depression and anxiety even when they haven’t been diagnosed with. And that realization made me feel that we have to approach mental health in a different way, not just putting a bandaid on.”

14:43 – “Ketamine treatment caught my attention partially because one of our family members who had been struggling with treatment resistant depression for some time, he had started on ketamine treatment about three and a half years, four years ago, by now. And yeah, that really changed his life. And that kind of opened my eyes around ketamine for mental health indications, not in a way that I had before. And from there I started reading a lot of articles around it and realize that there’s a lot of robust evidence behind ketamine for, especially for treatment-resistant depression. And more indications are being researched right now. And from there, I started to research more into psychedelics and I searched any other names, such as psilocybin and other substances that are being in clinical trials. And yeah, as I read more, I was surprised how much potential those compounds have at the level that we haven’t really seen in the mental health treatment. So yeah, that got me to, that got me really excited about this field.”

18:16 – (Ross) “Well we know that these things are becoming more popular in the mainstream. Obviously, some people have known these benefits for decades and decades and decades. But now Michael Pollan making things popular with How to Change Your Mind, so people are feeling more and more comfortable, including people who have historically been on the opposite side of this harmful drugs argument like police officers, retired army and military vets, people suffering from PTSD who have historically been very anti-drug. We’re starting to see wider acceptance in all communities of these as being viable treatment options because more and more people are having these kinds of positive experiences like you described, somebody has had PTSD for a decade and they go into treatment like this and suddenly they’re better when nothing else worked, or at least there’s a marked improvement. And that gets a lot of people thinking.”

22:42 – (Mai:) “I think there have been a lot of progress in terms of the path towards legalization of those psycodelic compounds. So there are multiple cities in this country that have decriminalized psilocybin, for example–”

(Ross:) “–Colorado, just recently.”

(Mai:) “Right. Yeah, exactly. And Oregon, just January this year, they just started moving towards legalization of magic mushroom usage, so under certain facilitation, and the Colorado probably is going to take us on a similar framework and yeah from the research perspective, MAPS [Multidisciplinary Association for Psychedelic Studies,] just finished the clinical trial of MDMA for PTSD last month. And yeah, they are moving towards the following for FDA approval. So with all those movements, I would expect those substances to be approved by FDA eventually and hopefully get rescheduled so that we can use as just regular medicine.”

25:14 – “What we’re seeing in the clinic is pretty remarkable. It is not surprising just based on those research papers that’s already out there. But we do see very significant improvement of the symptoms among patients who have been struggling with depression and anxiety for years. And yeah, many of them are seemingly functional. They, many of them have a full-time job and they’re working hard, but at the same time, they’re struggling with all those symptoms of depression and anxiety. They tend to have some underlying trauma. They are aware of those things, but it is really hard to address them in a way that is a healing process for them. And ketamine has been beneficial for those patients to be able to actually feel those emotions or revisit the experiences that they had in the past. So those things become the material to be discussed during the psychotherapy sessions, which we call the integration session after our ketamine session. And yeah, that really improved many of our patients, the symptoms. And yes, some people, some patients even said that ‘I’ve never felt this good in my life.’”

27:21 – (Mai:) “I would say that generally speaking attitudes toward ketamine is still not positive. Yeah, it is changing quite fast because of Michael Pollan’s book and there are a lot more providers out there, these days. But especially for people who are coming from diverse background, like I’m an immigrant myself and I grew up in a Japanese household where all the drugs are for criminals.

(Ross:) “Right, exactly. To even think of it you’re an awful human being.”

(Mai:) Yeah, exactly. And so that’s one thing about the substance itself and also the mental health treatment itself was somewhat stigmatized in my own community. So those things are still pretty big burden for many patients to seek out ketamine treatment. But as more research comes out with more evidence showing the efficacy of ketamine and other compounds for the mental health treatment, people will start it as another treatment, right? I think that will make it easier for those who have stigmatized view of those treatment to realize it’s actually a valid treatment for them.”

29:16 – “Ketamine tends to make it easier for you to get out of the cycle that you’re stuck in. Which tends to be the case with many of those mental health conditions. With the case of a depression, for example, you tend to get stuck in this negative loop of thought and you can’t just get out. And with the anxiety you get, just like an actual cycle and ketamine makes it easier for them to get out of the loop that they are really usually used to and start to adopt the new way of thinking, experiencing, responding to whatever they’re experiencing. So that tends to be, that tends to be how they get better. Getting out of the loop they’re accustomed to.”

44:09 – “I like the way I work right now because I really feel like I’m working with people in a way, let’s say I feel like I’m actually working with people as opposed to when I was working in ER, I felt like my patients were my patients, but I didn’t really, I wasn’t able to develop more of the personal connection with the person. I couldn’t really feel like I was having the person-to-person conversation with my patients when I was working in the really busy ER, as opposed to now, I can take time to get to know the person better, where they’re coming from, what they’re struggling with. And this feeling of connection with each patient make me feel that, I think make this this work even more fulfilling than before even though like improvement we’re making for patients life may be around the same but I think as a personal level, because of this human interaction that I’m experiencing. It makes me feel those experience be more rewarding than before.”

47:13 – (Ross) “I think it’s a tremendous field with incredible potential, and I really hope that people around the world start recognizing it seriously. Governments and everybody starts rescheduling these things because I believe they do have a profound use. And that’s why it’s been so interesting for me to talk with you today and to hear a story of somebody who’s actually doing it, because more and more, these types of things that were out there and external, they’re becoming a legitimate career choice. It’s something that somebody can actually pursue. You can go to UC Berkeley, you can take courses, you can make a difference in this field and you can build a career in this field.”

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