MEDEVAC to Mental Health: Ketamine – 80 % Suicidal Thoughts Gone in Days | Dr. Grundmann

What if relief wasn’t months away, but days? We sit down with ER physician and Ember Health cofounder Dr. Nico Grundmann to unpack how IV ketamine delivers fast, measurable change for people living with depression, PTSD, and suicidal thoughts—especially veterans and first responders under relentless stress. No hype, no mystique: just clear protocols, clinical guardrails, and results that hold up to scrutiny.

Dr. Nico explains why modern science views depression as stress- and trauma-driven neural pruning, and how a focused series of four infusions over two weeks can regrow synapses in emotional regulation circuits. The outcome isn’t euphoria—it’s alignment. Joy returns when life warrants it; grief shows up when it should; apathy loosens its grip. We also dig into the “neuroplasticity window” that follows each session, when therapy becomes easier and more effective, helping people integrate insights and sustain change.

We address the tough questions head-on: safety, misuse, and the difference between clinical dosing and recreational patterns; why benzodiazepines can blunt benefits; who should avoid treatment (e.g., schizophrenia); and how ketamine compares to SSRIs, alcohol, and emerging therapies. Access is changing fast: the VA now offers IV ketamine in many states, some insurers are coming on board, and reputable clinics can help with out-of-network reimbursement. You’ll hear a stark statistic—an 80% drop in suicidal ideation within a day for many patients—and a grounded reminder that maintenance is normal, not failure.

If you or someone you love is struggling, this conversation is a practical map: what to ask, how to find credible care, and how to pair ketamine with therapy to get the most out of that critical two-week window. Subscribe, share this with someone who needs it, and leave a review to help more people find real, evidence-based hope.

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Chapters

• 0:00 Meet Dr. Nico And Ember Health
• 4:06 Why Ketamine Entered The ER Toolkit
• 7:41 Veterans, Stigma, And A Crisis Of Suicides
• 13:16 Language Matters: “Psychedelics” Or Care
• 19:36 A Firefighter’s Turn From The Bridge
• 23:26 What The Evidence Actually Shows
• 29:06 How Treatment Works: Dosing And Reset
• 33:36 Therapy, Neuroplasticity, And Two-Week Windows
• 38:16 Substance Use, Safety, And Misuse Risks
• 43:56 Pain, Dissociation, And Limits
• 48:56 What Ketamine Is—and Is Not
• 53:26 Beyond Ketamine: Emerging Molecules
• 57:56 Access, FDA Labels, And Insurance
• 1:03:26 VA, Coverage Momentum, And Costs
• 1:08:16 Expectations, Maintenance, And Relapse
• 1:12:56 How To Find Credible Care Near You
• 1:17:56 Final Stats, Hope, And Next Steps

Transcript

Mark McGrath: 1:53

So, Punch, we're out in Manhattan at the invitation of a previous No Way Out guest, Dr. Anna Yusuf. Introduced me to a now mutual friend. So she and I have a now a mutual friend in Dr. Nico Grunman. Dr. Nico, welcome to No Way Out. I appreciate being here. I'm excited to have the conversation. Kind of kind of a quick intro, but we uh we want to get right to it. Sure. Give us just the brass tacks of who you are and what what you're doing, and we want to have a really good conversation with you.

Dr. Grundmann: 2:21

Absolutely. I'll try to keep it succinct because I'm I'm not known for my brevity attack.

Mark McGrath: 2:25

That's okay.

Dr. Grundmann: 2:26

Neither are we. So I'm Nico, Dr. Grundman, technically. Um before all of this, I had a whole career working for the Harvard AIDS Institute doing international public health. So like ministries of health work in Sub-Saharan Africa, setting up HIV programs for mother-to-child transmission of HIV drugs and all the policies kind of things on that on that aspect of the world. Um spent a bunch of years in Cambodia, helped set up some pediatric hospitals in that country, in the rural parts. Realizing all of that, that I liked clinical medicine. I liked actually working with people. Um and so I went back to med school, did an MD MBA out at Stanford, focused on emergency medicine and not kind of hospital systems. And that is what brought me to New York City. Um, reason I'm on this show right now, talking to you guys, is as an ER doc, we use an enormous amount of ketamine. It's a pretty common anesthetic, procedural sedations, shoulder dislocations, laceration repairs, stuff like that. So back at Kings County, when I worked on the trauma center, we'd use it three, four times a shift without really blinking. And unfortunately, we treat a lot of depression in the emergency department, particularly folks who don't have other good avenues. It's not a great place to treat folks who are depressed, as well as those folks who are suicidal or who have tried care in a way that is not ideal from actually being able to help them. That juxtaposition was something that used to really bother me. And um I was on shift in West Virginia seeing a bunch of the data in the kind of academic world around how ivy ketamine was being used to address depression and suicidality, and how, at least from the kind of studies, it looked really good and almost too good to be true in terms of something that could be a viable tool for folks. So I called the woman who's now my wife, and she was a management consultant at the time, so kind of the smart shop here, and we talked through like, hey, what would this actually look like if we if we tried this in real life in New York City? This was 2018, what would a practice look like? How could we actually deliver this care to people and can we actually prove it? That had us launching what we run now, which is called Ember Health, or a service center for Ivy Academy for Depression. It's literally the only thing we do. The practice started with me and my wife in a little corner office here in Brooklyn Heights, where it was a pilot site. We treated a couple hundred people as I was still working in the ER, kind of one foot in both worlds. And we saw it really work. And so in that kind of 2019-2020 pre-pandemic, we realized that there really was value to this option that patients were doing, in fact, slightly better than the clinical trials were suggesting. And that we could figure out a way to staff it with nurses and docs and stuff. And so we really leaned in. And our practice now has five locations here in New York City. And this is full-time what we do is a collaboration between mental health providers whose patients need this and us who can give them the ketamine safely with a focus on the experience. Treated about 2,500 people here in the New York City region, uh, done just shy of 40,000 of these infusions across our practice at this point. Um, and have not intentionally, but have ended up being the largest provider of IB ketamine in the country at this point, in terms of reviewing this, which is how we met.

Mark McGrath: 5:32

That's how we uh that's how we met. Um and it struck a chord with me. And then when I shared with Ponch that we had met as both both of us are veterans, and our our two business partners are veterans, and most of our inner circle and closest friends are veterans, and we know a lot of vets that have dealt with PTSD, they've dealt with depression trying to reacclimate back to civilian life. Um, and unfortunately, a lot of them have have ended their lives uh prematurely. So uh a big exploration that that we've undertaken, and it's one of the first things Ponch said to me when I when I joined AGLX a few years ago, uh he's talking about uh uh let's just say alternative therapies for for veterans. And I was like, well, that's that's wild, like you know, Timothy Leary shit. And um the the more and more my education curve crunched, the more I realized that this is valuable because there aren't many veterans, especially those that have served, I'd say I don't know. I think in general, uh most veterans know somebody that took their life or they or they had one of their troops take their life. Um, and it's very important to us when the numbers range anywhere from 22 to 44 a day veterans that are that are taking their life prematurely. My mentor, in fact, that helped influence me to go to the Marine Corps was in Vietnam and and he killed himself just in the last you know 15 years. Just the trauma just stays with him. And you know, and you almost think that the the sort of staple prescriptions that people are getting, that there's other ways, and you're certainly doing that, and that that's of course uh of severe interest to us. Talk about it, talk about it in that sense, because that's you know, many of the people that are listening are going to be veterans or know some veterans that have gone through this or been through this and and and would like to learn more.

Dr. Grundmann: 7:22

I mean, you're hitting on all the very reasons we wanted to open our practice and kind of get this out there for folks. Um for our for the people we work with, 55% of them, so basically half of them, have had a suicidal thought in the two weeks before we start caring with them. Like that's our normal. That's not an exception. But the reality in the US veteran community, especially, is that people are suffering. I think the stats these days are close to like one out of seven adults, all adults are dealing with a depressive disorder of some kind. Um, not even getting into teens and how it's affecting teens as a kind of societal level. And veterans in particular, as you're highlighting, are just being put under stress and trauma and then kind of thrown back into those lives and those experiences with the kind of day-to-day and then it and it can be really, really hard. The reality is the existing options outside of these new things that we're talking about today don't work very well. I mean, it's a real shame, but we've had six decades of using things like SSRIs and talk therapy, and they help some people. They're not worthless, but the numbers that we tend to quote for SRIs, for example, they they seem to help about one in three people they're tried for. For those, one out of three, awesome, and that's good. And for two out of three, it's not doing it. Um if it is working or working partially, they've got all the side effects that come with those, and people are very vocal about the side effects of things like Prozac. So those were the very things that we were really frustrated with. Um and we we kind of were in 2018 when we were talking about this to use the term psychedelics as the kind of bubble or as a field hadn't started yet. So this is kind of pre-that conversation. Uh, you use the word novel interventions. I think, yeah, novel interventions, psychedelics, these are all that's why I said Timothy Leary shit or Sergeant Pepper's Lonely Hearts Club band or whatever. Well, that was one of the biggest things that we dealt with when we first opened our doors. Because we we work with a lot of us. We work with a lot of like FDNY firemen and there's just a large group of people for whom these uh interventional treatments, as they can kind of be clumped together to be called, are really necessary. But it's also a group of people that can have some fear around this. And and psychedelics as a term can have a lot of stigma behind it. Um it's actually I I joked earlier, but um we don't have that word on our website. We talk about ketamine treatments, we talk about depression, people who need help and who will have an altered state of consciousness for sure. Like I'll probably dive into this in this conversation, but it's normal for people to feel and think very differently than they normally do when they're in our office, when this med's in their body. But we don't want people to avoid care just because they're worried about that kind of loaded term when this actually is the most logical thing for them to use.

Brian "Ponch" Rivera: 9:56

So I'm a little curious, Doc, um, as to why um you think um that the word or term psychedelics is shunned and why you took it off the website. What in our past um created that?

Dr. Grundmann: 10:10

Um just from your perspective with a lot of For us, for the practice and the stance we took, it wasn't something that we did like in a vacuum talking to ourselves in the back room. It was when we talked to patients. So when we actually talked to the people we were treating, we learned that most of the people who were starting with us were, quote, psychedelically naive. They didn't, they didn't they had never tried anything that had an altered state of consciousness in the past. They'd never used drugs or psychedelics, etc. They were coming to us because they tried everything else. And this is what their doc was saying is the next thing to try as an option for. Now, conversely, 40% of our patients have had some sort of prior although state of consciousness, something like an MDMA experience, LSD, mushrooms, et cetera. And for those folks, we're we'll use that language, we'll talk about set and setting, we'll talk about all of that. No matter what language you're using, our day-to-day in the office is all about making sure that people are psychologically supported. So we do intention setting, we do music therapy, we do aromatherapy, we've got a person in the room at all times, so you're not like alone during this experience, you've got a human next to you to help. But we kind of tee all of that up in a way that for that 60% of folks isn't going to make them nervous about the war on drugs or the language around um US healthcare and health policy and the um zero or one strike, zero strike type stuff that people have lived through, particularly people in the um service fields have lived through, where there's not a huge tolerance for this, um, or at least there didn't used to be a huge tolerance for this kind of stuff. I muted.

Mark McGrath: 11:39

Yeah, I mean that's this the stigma is not it's not a healthy stigma in the United States. And I think that when you think of you know, the most recent friend that I had that I lost as a brother Marine, because just a year and a month ago, he swallowed a whole bottle of his prescription SSRIs. And I always I always think, and we've talked about this on the show with a lot of other guests that have that have helped educate us on psychedelics to include Dr. Anna. You know, you hate to think that he was one one trip to your clinic away from resolving his demons, or you know, he was he was one trip away or something like that from helping. So when you see that out there as an alternative, what what do you I mean, let me maybe maybe I'll ask it this way. Here in New York, we have for both, we're we're both living in Manhattan here. So here in New York, you as you mentioned, we have FDNY, we have NYPD, we have 9-11 survivors, we do have a ton of veterans. What are some of the transitions that you've witnessed that you've seen with with people, especially those that are in chaotic, nonlinear environments like fighting fire or or keeping the subway safe and that sort of thing?

Dr. Grundmann: 13:41

Where to start? One of the stories from back when it was just me and my wife here that still sticks to me this day is a young firefighter, his dad had been a firefighter, he was a fire is a firefighter. But he'd taken leave because he just couldn't handle mentally everything that was going through. And when he called us, he had been standing in the edge of a bridge and had a wife, had young kids. His the reason it's so memorable for me is he was my age and his kids were my kids' ages. I got a four and a six-year-old. Um and he was about to jump because he just couldn't he intellectually knew the good stuff in his life. He could name those things, he could name that this was gonna hurt people and that it didn't make sense. But he felt that there was no purpose for being around. And I remember his first couple treatments, he was terrified of this. He many of the stigma things were things that he was very conscious of. He was worried he was gonna get kicked out of the department, that he wasn't gonna be able to work, even if this did work, that he wouldn't be able to return to his job because he was worried about how they would think about what he went through. But literally it was what, 12 days later, 13 days later, after that um first treatment, where he his stance of uh committing suicide felt preposterous two weeks into this. It was just such a quick change. Like days before the world just fundamentally shifted for him back into the place that made a lot more sense for everything around. And that the speed of it, the the the degree of it is just something that kind of stuck with me. Um, because he was a person who had all the reasons to be uh viewed as somebody who should be okay. A family, kids wasn't struggling financially, had a uh long history of family around him, like all the things you think should support somebody, but clearly don't all the time, um particularly for people who are under chronically high stress environments. And yet we could change that. We could actually get it back to the place that he felt it should be.

Mark McGrath: 15:44

How many treatments say in a case like that, how what's what's the normal prescription? The reason I ask is because we we had Norman Uhler on, who'd written the book Tripped, and he talked about how the uh how LSD was originally intended to be like a one-time use mental health drug that you would never need again. And of course, if you know you're a shareholder in a in a pharmaceutical company, that that's not that's that's that's not good. You know, we don't want that.

Dr. Grundmann: 16:14

Um Yeah, there's there's a lot here because um one of the things I have challenged with, this is not an exaggeration. Ketamine is the single most studied medication for clinical depression in the last 30 years. That is not something you would expect, given how we talk about these treatments nationally.

Mark McGrath: 16:33

Prozac number one?

Dr. Grundmann: 16:35

No, no, no. Ketamine is number one. Well, ketamine is number one. Oh, I thought you said the second most. I'm sorry. Zoloft is number two. Number two. We have 50% more studies on ketamine than Zoloft. So it's not like an experimental thing. It's not a crazy new age thing. It's literally the thing that the world has studied the most. But that's not how people talk about it. People think about it. The other novel treatments, things like MDMA, psilocybin, ayahuasca, like we're learning a lot, those are earlier in treatment. And I think that's one of the big things to know about this whole space is that these things can be super helpful.

Mark McGrath: 17:15

Can you qualify that when you say earlier in treatment? Because other because some people would immediately attack what you just said and say this stuff's been around for thousands of years. For sure.

Dr. Grundmann: 17:25

And the use of it amongst people is generationally old. The US healthcare systems. There we go. Okay. Now it makes sense. U.S. healthcare things go through clinical trials, phase phase two, phase three. By the time they're in phase three, it's like big groups of people, large numbers, all the academic stuff about randomization, and phase three from like you can go to your doctor and get this in the US without looking askance, were closest to psilocybin as the next thing. They just announced that they're trying to get that FDA approved, hopefully in 2027, seems to be the indication for it. For now, it's what your community does. If they want that, they got to go to a state that allows it, which is like an exemption to this, or they got to travel out of the country. Um, but that you can't go to your doctor and and just ask for it.

Mark McGrath: 18:15

I mean, we've we've always been very clear on the show when we broadcast about this very topic. And we've had Parch, what are we up to now? I say Dr. Nico is probably like our 10th, 11th guest to talk about this very very topic. I'm sure you would join us in saying we we do not in any way endorse or condone the you know the recreational use of these things because the value of these things to actually help people is so tremendous and almost to the point where it's the way our civilization, everything is gone from where it came from when this was something like, you know, as you would say, like this has been used for generations, you know, this is in many cases an extreme awakening, which actually does seem to have a positive benefit for humanity when applied, as you're applying it, was applied as as Ponch and I have known people that have applied, you know, learned it to help with their uh with their with their trauma things like that.

Dr. Grundmann: 19:11

Yeah, I mean, that's one of the things. So I'll I'll talk, you I'll answer your question about like how much, how often, what's the schedule, because that is important to think about. To to double click on the point you just made, a lot of these are tools. These are things that can be really helpful as larger care plans, as a larger like set of things you're working on. But what these don't do is serve as some sort of magic silver bullet. It's not as if it the MDMA stuff is the one that we have probably the most well-published data on, because that almost got FDA approved last year. And they did a lot of trials on it. And those trials, those studies, that like well-structured Ivory Tower academic stuff, what it was showing was that it's not taking MDMA that all of a sudden has people letting go of their prior trauma. It's that doing 60 hours of psychotherapy, where a couple of the times in those therapy sessions you get MDMA and you really bond with your therapists, that that makes a difference. And that just gave this in a vacuum, you just told somebody go take this on a Saturday and and talk to us on Monday, like that's not gonna help. In fact, for some of these things, that can be MDMA less so, but for other disease, that can be quite destabilizing if you don't have the kind of care team around you, if you don't have the wraparound support for how to handle stuff, particularly prior trauma can come up in these, even prior trauma can come up, and you really want to make sure that that's handled well. Because just reliving trauma is not inherently helpful. You got to process that, you've got to talk about that, et cetera.

Mark McGrath: 20:39

Do you find, and we'll get back to the quiet. Well, actually, why don't we answer that first? What's the number the number because this other question I guess I was gonna ask is ties a follow-up to that, but what what what would be the number of times you would think?

Dr. Grundmann: 20:51

So for ketamine, what those crazy number of studies have shown is that it is a fantastic tool to reset the brain, to regrow the neurons that stress and trauma killed. And to be clear, that is what depression is these days. Like our modern understanding of clinical depression, it's the consequence to the brain of stress and trauma over time. You're stressed, you have trauma, which is internal stress, so to speak, leads to the death of neurons in very specific regions. Those are the regions responsible for emotional regulation. That loss of those neurons, that neural pruning, leads to a state where your brain just stops trying to feel because it's just had too much negative. And so you become apathetic, you don't care, you become very negative. Um, and then where ketamine comes in is the treatments of ketamine, what people do these days, what people should do these days, is a burst of treatments. We do four in-office IV treatments spaced out over two weeks, so two a week for two weeks. And those four treatments regrow the neurons that had previously been lost. Literally reverse the prior damage neurologically. We can see this in in mice, we can see this in humans with hypomRIs, and that you then are back in a frame of mind, in a kind of neural structure state where your brain handles emotions appropriately. That's the part to kind of hone in on is that this does not make you feel good. Success with ketamine and many of these other tools is that you emotions make sense. This works, you go do something enjoyable, you feel joy. That emotion is warranted for activities that are supposed to do that. And you don't feel joy when you're depressed and you do something that's supposed to be enjoyable. What depression is is the mismatch. But similarly, ketamine can be enormously helpful. And then if you have a tragedy happen, you will feel sad. That emotion can be warranted in real life, in humanity. It's not a pleasant emotion, but it's an appropriate emotion at times. And the big difference is that you don't get stuck in that negative state when these systems, when the brain is working.

Mark McGrath: 22:56

What is so this would be my follow-up question, then. So when you when you bring someone in for treatment, let's let's just use a veteran, because that's that's that's very real for Ponchine to think about, but um, and for many of the people listening, you know, in addition to SSRIs, they also might have a Jack Daniels problem or um uh you know, that kind of a thing. Like I wonder, do those things go in conjunction with effective therapy, like coming off of say, uh, I was just watching a fact of podcast about a Navy SEAL that was addicted to fentanyl. You know, like are those sorts of things. Um imagine in your intake, you're you're taking account for the person's whole picture. Correct.

Dr. Grundmann: 23:41

Yeah, so for us, and and I will admit, not all providers do this instead Ember. We only take individuals into our care who meet the kind of medical definition for depression. So major depressive disorder, bipolar disorder are the two most common things we treat. A ton of our patients have trauma backgrounds. That's where our veteran community comes in a ton. We about a third of our patients have frank PTSD. So pretty normal for us to have people dealing with both. And in those people, particularly the PTSD group, these things tend to move together. So as your depression lifts, your PTSD symptoms get better. You're less reactive, you're less vigilant all the time. The other thing is uh one of the best tools for PTSD is therapy, but therapy is nearly impossible to do when you have PTSD. You just can't engage, you can't participate, you can't actually act on this stuff because the whole issue is that the the trauma itself is preventing you from uh performing and thinking the way you would want to. And this is where ketamine has this really unique value is that when these treatments for the folks that we take care of for folks with trauma and depression both, well, as a result of the ketamine, they're able to engage. They're able to participate, they're able to actually show up in that therapy session and not just kind of shut down the conversation, but actually open up and to talk about stuff. And what the studies have shown, and and we think this is true with the other new substances, but it's definitely true with ketamine, is that for two weeks after each of these ketamine treatments at the IV sessions, therapy is literally more effective than it would have been. Not like a hand-wavy statement, but like studies, trials show that it's easier to do therapy and that the therapy is more effective than it would have been. Because the brain is more neuroplastic. Because the new neurons and you can harness that neural growth for adaptive change.

Mark McGrath: 25:33

Does Ember offer the therapy in conjunction, or is it or is it would be someone's getting therapeutic treatment elsewhere, then come to you and then go back to that, or how does that allow it's a personal choice.

Dr. Grundmann: 25:45

I see. We felt really strongly that there are plenty of folks who've been under decades of therapy, and me telling them they need to be in therapy to do this is gonna be counterproductive. Because if you've worked with if you're dealing with somebody who's who's been in therapy for 20 years and it didn't work for them previously, and we're saying I'm gonna add a roadblock to you getting this treatment that might help until you get back into therapy, that that can be counterproductive. So our stance is that we do need an outside mental health provider. We're not gonna do treatments in isolation. So you have to have at least a therapist, psychologist, psychiatrist, primary care doctor. Somebody has to be working with you. That person, for kind of perverse incentive reasons, can't be a number employee. Like I don't want to feel like I'm making a diagnosis and recommending a treatment because that sets up some bad incentives. And I did morally that was the right, but specifically to answer your question, people don't need to be in therapy. We're not going to block you from treatment if you're not. But we're also very clear that if you are in therapy, your outcomes will be better. So it's it's not required for this to work. The drug will still do its neural regrowth thing, and you will likely feel better from just that. But you can make even stronger improvements if you're willing to engage. And what we often see is people start with us not in therapy because of all their prior tries. Or and actually now they are willing to do therapy once they start feeling better. So they'll actually like add therapy on as they go forward. And then for us, we'll work with those therapists. So we'll either, if somebody doesn't know anybody, we can recommend people that have experience with this. If they already have a therapist, we partner with that therapist and talk to that therapist, like, hey, here's what to pay attention for. Here's what's going to be different after treatment that you should um help partner.

Mark McGrath: 28:20

How about in cases where there is some kind of substance abuse where someone's an alcoholic or you know hooked on opiates or whatever?

Dr. Grundmann: 28:27

Yeah, so 7% of our patients have a substance use disorder. It is 7 or 7-0. 0-7. 7%.

Speaker 2: 28:35

0-7, okay. Yeah.

Dr. Grundmann: 28:38

Um I'm gonna try to do the short version. Put it in layman's terms, I'm a marine. So people are looking at using ketamine to treat substance use issues. Uh there's a big trial in the UK right now where they're actually looking at ketamine for alcohol use disorder. Especially giving folks who've been drinking too much ketamine helping them become abstinent and decrease their drinking because of that ketamine. That looks like it's gonna pan out. It's not published yet, but like the conversations seem to be that it's pretty effective. What we do know is in smaller studies, uh, ketamine seems to help with cocaine use disorder, opioid use disorder, methanthetamine use disorder. Those are a couple dozen people. They're not huge, but it does seem to work. Now, again, it's not just getting ketamine, and those things are better. It's ketamine plus psychotherapy, absence education, whole, a whole care plan. The really tricky part with ketamine is ketamine itself can be a drug of abuse. Like you can use ketamine.

Mark McGrath: 29:38

Tell us tell us more about that. Well, well, I guess tell us more about that. But the first question I was gonna ask, because you said like opiates, like, is it safer for like say heroin addicts than methadone? Like, is it is it a safer alternative?

Dr. Grundmann: 29:51

Yeah, it depends on what you mean by safer.

Mark McGrath: 29:53

Well, I mean, like people get hooked on people get hooked on the anti-drug as fast as they do. I guess that's what you're gonna talk about now, like how people get hooked on on the ketamine. Does it have addictive qualities too? It depends on how you're using it.

Dr. Grundmann: 30:06

So ketamine is as an individual treatment a lot less dangerous than opioids. It is essentially impossible to die from taking too much ketamine as a single drug. If you were sitting in the emergency room and I was to give you 200x the 200 fold the amount of ketamine that I was supposed to, I accidentally somehow gave you a crazy dose of an elephant size, um, you wouldn't die. It would be uncomfortable. I might I might need to um make sure to watch you for a while.

Mark McGrath: 30:38

You might go out and write a symphony.

Dr. Grundmann: 30:41

But it wouldn't stop your breathing. It wouldn't like crash your heart rate or stuff. Whereas with opioids and methadone, you give too much of those and you will die. You'll just stop breathing. And and they are they will kill you. And so in that way, they're very different drugs. And that's the reason ketamine became so popular back in the Vietnam War is ketamine's kind of peak use in Vietnam, where it's a battlefield anesthetic. You could give it yeah, so this is how ketamine became such a common thing across the world is that in active war zones, ketamine is a great drug to give to evacuate somebody out because it doesn't crash your blood pressure and it doesn't stop your breathing. So you could have like an amputee or uh you can have an event that led to an amputation. You could slug somebody with ketamine, extract them from the battlefield, but not need to put a breathing tube in while you did that. So they're paralyzed, they're unconscious, they're they're sedated, but they're not at risk of dying from that sedation. And that's really what took so ketamine was invented back in 1970. It's an old drug. And it was in those early kind of Vietnam War type uses that people first got some hints that, like, wait a minute, it seems like there's a little bit less PTSD in this group that we gave ketamine to. Seems like these people are actually not dealing as badly with some of the stuff that they went through that we would have expected. And those were those were hints. Those were not like very clear things, but it's some of what led to this early research back in 2000 about like, well, is there a mental health aspect of this? And then I can get the original studies bore out that actually, yeah, this does have a bigger effect than people were expecting on those emotional systems.

Mark McGrath: 32:21

But it's not, but like with surgical anesthesia, you could there's a toxicity level of that. You could turn somebody off pretty fast. I mean, isn't that what they do in the lethal injection chambers, right?

Dr. Grundmann: 32:31

Well, and this is where it's all about the type of drug you're using. Uh-huh. Ketamine is unique as an anesthetic in that it is one of the only anesthetics that does not have a toxic amount that will kill you from giving you too much. And this is why back in my ER days, like it was a great drug to use. I worked at Kings County Hospital in New York City. It was an amazing medication for Kings County because EMS would bring in somebody who was like a paranoid schizophrenic who had a break, and we didn't know what was going on. We didn't know if they'd taken something or if this was just an aspect of their schizophrenia or if they were intoxicated or what was happening. But you could give them a whopping dose of ketamine to calm them down and put them to sleep and not be worried that it was going to hurt them. Um, those doses, by the way, just to be clear, are wildly different than the mental health doses. Um, it's the same drug, but the amount in your body for a treatment like the one that we're doing in our office is something like 10 or 100fold lower the amount that we'd use in surgery. Interesting. So tiny, tiny doses of the same drug.

Mark McGrath: 33:31

I I guess in certain cases too, you probably have patients that are allergic to anesthesia, right? Or and they would Use ketamine as the alternative there.

Dr. Grundmann: 33:38

Yeah. Less common, but definitely a thing. Definitely a thing. People can be allergic to everything.

Mark McGrath: 33:43

So you you mentioned paranoid schizophrenics, and that's an interesting term. Certainly, those of us that live in Manhattan are not unfamiliar with seeing many of them. I mean, it's it's a general term I always use is air fighters. I mean, these are people that are shadow boxing with somebody and screaming at somebody that only they can see and none of us can. Is ketamine an effective treatment for paranoid schizophrenia?

Dr. Grundmann: 34:07

Not for schizophrenia. It won't help with the schizophrenia. The reason we'd use that in the ER is if we were worried the person had schizophrenia. I see. And we needed to calm them down, it would be a nice way to calm them down. It's not going to help the schizophrenia. It won't hurt it either, but it has no effect on that. Generally speaking, for mental health, we try to avoid giving ketamine in like an ember health type environment to somebody with schizophrenia. Because at low doses, it'll lead to that altered state. And if you purposefully give somebody a break from reality who's already predisposed for really bad breaks from reality, that can be a really uncomfortable experience with a lot of safety and staff and stuff.

Mark McGrath: 34:49

What about for people that suffer from neuralgia or neuropathy?

Dr. Grundmann: 34:54

Interesting thing to think about. Again, I'm going to put on that data hat that I have to use in modern medicine. We don't have enough data for long-term pain issues. Some people swear by it. Some people talk about it as the only thing that helped. And there are some small studies that it can help with chronic pain, but the current consensus is that it's not clear enough that it's helpful for it to be a generally advised treatment.

Mark McGrath: 35:18

Well, I I mean, because you know we're we're a cannabis state here, right here in New York now. So I know that historically it was a medical thing where people would use cannabis to mitigate like their pain from glaucoma or whatever. You know, like whatever pain is is ketamine in that case uh an alternative to those sorts of things.

Dr. Grundmann: 35:38

So ketamine, so there's a distinction I'm gonna make between short-term pain relief and long-term pain relief. Okay. Ketamine is really good at short-term pain relief. I see. The way a different way to think about what ketamine does is ketamine is what's called a dissociative anesthetic. Slightly hand-wavy statement here, but basically you can think of ketamine as kind of taking the body and the brain and giving them some distance between. And so you kind of separate your consciousness from your physical sensation. And that's why it works as an anesthetic. A big enough dose, they're split. A person's aware it's a different way of thinking, but they're they're conscious, but they are feeling nothing. You can do an amputation or a surgery, and and and they won't know this what's going on. Low doses, you kind of fuzz the peripheral sensations, or you or you start to give a little distance to the body from the brain. You might be aware that you have a hand, but you're not very bothered by something when the ketamine's there. The challenge with using ketamine for pain is that while it works well in the short term, it doesn't seem to help much with long-term pain relief. And when we talked about the ketamine misuse and abuse, daily use of ketamine can be really problematic. And so people who use ketamine every day will start to develop side effects. Like what? High doses of daily ketamine can be really bad for the bladder. You can start seeing cystitis, and it can get bad enough. You like need your bladder cut out if you take really terrible doses of this regularly. High doses can be neurotoxic, and so you can end up with people with cognitive impairments. This is where ketamine abuse and ketamine use in a medical setting are so important to distinguish between. I never recommend people just try ketamine at home.

Mark McGrath: 37:22

Was ketamine ever I'm not familiar with ketamine as I never heard the Beatles talking about taking ketamine to help with their creativity or artists. Like it's not like those sorts of altered states of consciousness that one might experience with LSD or psilocybin or something like that. Ketamine's different.

Dr. Grundmann: 37:40

So whether so outside of talking about psychedelics as something that have stigma, therefore we don't use the language, even though we do have an alternate state, the whole like nerd debate around is ketamine a psychedelic at all. Um psychedelics are mind-expansive tools. Again, who you talk to about what is a psychedelic, you'll get a lot of different answers. Generally speaking, ketamine is more of a dissociative, as I mentioned. It like separates you from your body. Whereas a lot of these other substances will do things like purposefully shift your perspective of a reality. So most ketamine experiences are very inward-facing. People in our office are lying back in a chair, they've got an eye mask on and headphones on, and they're they're quite active in their own thoughts, but that's not because the world's wavy around them or they're seeing interesting colors and stuff. Inner eye facing inward type thing.

Mark McGrath: 38:31

Does it, you mentioned cognitive impairment? I mean, did does ketamine have any uses for things of cognitive decline like dementia or Alzheimer's?

Dr. Grundmann: 38:40

Um the biggest thing is that so I'm gonna I'm gonna hit two points and they're gonna be related. Depression causes huge cognitive decline and impairment. People use the term brain fog pretty regularly. That's like a very common way of living through depression, is that the world is just fuzzy, it's hard to think, it's hard to motivate, et cetera. And so in that way, ketamine is often cognitively improving for people who have depression, in that by treating the depression, their ability to focus, their executive functioning, their ability to like think critically is measurably better, like not hand weightly better, like you can study it and it looks better. That's very important to distinguish that between ketamine removes the issue of cognition, depression, versus saying that ketamine enhances cognition. That is less clear. We we think maybe it would be nice if that's true. And there's a lot of people who are thinking about neuroplasticity and tapping into neuroplasticity, and that's why the longevity community has some interest in ketamine, because you can see how that could make sense to be cognitively enhancing. But again, from like a US medical system and evidence-based perspective, we we wouldn't be able to make that statement uh with confidence. Um, although we can say very confidently that it undoes the cognitive impairments of being depressed or dealing with trauma. One point to make on the abuse side of things. So I talked about that bladder issue, the cognitive issue, those are real. It goes back to how much ketamine in what ways. People with those bladder issues usually end up taking grams of ketamine. The pills are usually like one gram or a couple of pills to get to a gram, all the way up to like seven to twelve grams of ketamine a day. And they usually do that around daily or a couple times a week. Treatments for mental health, for depression, and and PTSD, like the ones that we give in our office, those are 50 milligrams of ketamine. And we give that on average once every six weeks. So grams, milligrams, that's not necessarily easy to conceptualize. And not for Americans, no, because we don't know the metrics of that. We'll talk about it as coffee people resonance, and it actually kind of works. So if you were to take the abusive doses of ketamine and call it abusive doses of coffee, you'd be talking about drinking like one to two hundred cups of coffee a day, every day. Wow. Whereas you'd be drinking one cup of coffee every six weeks when using this figure depression. So same drug, how you use it and how often you use it and how much you use make all the difference in terms of the effects and the structure.

Mark McGrath: 41:19

I've had three, I just had my third cup today as we started. I I feel I can't imagine two hundred.

Dr. Grundmann: 41:24

As an ER doctor, we we used to joke about hours of sleep plus cups of coffee should always equal ten. Okay. Eight hours of sleep, two cups, probably good. Four hours of sleep, six cups, probably gonna make it. I don't know. Ten cups of coffee.

Brian "Ponch" Rivera: 41:42

I I remember having coffee strapped as an IV. No, I didn't I didn't drink coffee in the Navy, believe it or not. But uh and I haven't had caffeine in four days this week.

Mark McGrath: 41:53

Got a headache. Um yeah, I mean, I guess it was interesting you pointed out the the Vietnam angle um in the in the development of ketamine, because yeah, I I guess I haven't heard you know Joe Rogan or Graham Hancock talking about uh the you know the ancients using ketamine, the way like they've been using LSD or you know, ayahuasca or you know, lysurgic things that lycurgic acid out of tree nuts or whatever.

Dr. Grundmann: 42:18

So so ketamine is synthetic in the sense that people make it. Um GMA is the same thing, you you make it. Um and it didn't we didn't know about its mental health effects until the early 2000s. So it's kind of a much later than a lot of the Timothy Leary stuff that people realize it might have these effects.

Mark McGrath: 42:40

So you don't go to a ketamine ceremony.

Dr. Grundmann: 42:43

I mean you're gonna make a ceremony around it, there's arguably less historical weight to that ceremony. That's funny.

Mark McGrath: 42:48

We can start starting a tread here in the the five boroughs with a ketamine ceremony. Well that's fascinating. Well, I mean it's it's good too, because I think you know, as much talk on on psychedelic therapies that we've done, we really haven't ketamine ketamine at all. Like I said, Norman Oller came on to talk a lot about LSD and its history, which I think the other day there was some anniversary of Albert Hoffman uh discovering LSD. Bicycle desk. Yep. And then the iboga treat, you know, the ibogain.

Dr. Grundmann: 43:18

Yeah, we're paying a lot of attention to that kind of stuff, because you'll notice we're not called ketamine health. We're ember health as a practice. Because our stance is that I actually kind of don't care what the tool is, as long as the tool helps somebody feel better. And because we work with normal doctors, normal therapists, because I interact with the DEA and the FDA, because we've got kind of doctor guidelines, we do follow very clearly the US medical system to do this. And that is a blessing in that it allows people to tap into care in our communities. You don't need to go somewhere to do this.

Brian "Ponch" Rivera: 43:55

I want to uh I want to uh anchor on that for a moment. So ketamine uh according to the DEA or to uh is is it a schedule one drug like like a boga? Uh schedule three. Okay, see there is medical use of it, right? You can use it. I mean, it's valuable. Okay.

Dr. Grundmann: 44:11

And and it's because it's an anesthetics. 2025 most common use of ketamine uh globally is as the drug to give during a C section. Uh if you don't have a defedurage. Wow.

Brian "Ponch" Rivera: 44:24

Okay. So let me ask you this. A reason you're using it is because it's accessible. It's correct. You can use it. The government says you can use it. So and I just heard you say we're amber health, right? We're not ketamine health. Correct. So that's signaling to me when you're when uh the laws permit you're going to expand to other things. Am I hearing you guys?

Dr. Grundmann: 44:45

Yeah, we don't have any reason to think that this is the only thing that helps people. Okay. There's other stuff that could be really helpful that looks like it's going to be really helpful, particularly these new novel drugs that are coming out. Five MEO DMT is one that we're thinking is really exciting because it's a similar thing to what we do. It's a 20 to 40 minute drug session in office, 90-minute visits is what we do right now. And so you can actually see a world in which if that does bear out. We're big fans of 5MEO DMT, by the way. It can have a lot of use for folks. And and if paths continue the way they look like with the FDA, like that'll be something we can offer in Brooklyn. Um, and and we can have it in our sites because we're already set up to help folks in this way. And this is that becomes just another tool for getting them to feel the way that they should.

Brian "Ponch" Rivera: 45:32

Okay. Okay. This makes a lot of sense. I see the progression here. And and ketamine clinics, I know there's popping up all over the place. Uh I don't want to call you guys that, but the way you're looking at the world right now is as these things become more accessible and and legal for use, you your clinics will more than likely bring these on.

Dr. Grundmann: 45:52

And then can you the devil's in the details in the sense that some of these substances act very differently?

Speaker 2: 45:58

Yeah.

Dr. Grundmann: 45:59

Like uh we're probably not the right place for an eight-hour philosophy session. Yeah. Yeah. Team isn't really the right team. Yeah. Our visit structure doesn't really make sense for that. So there are going to be some aspects of this that depends on the molecule, depends on the experience. But conceptually, absolutely, in the sense that the easiest way to frame this, I didn't like the fact in 2018 that people had to leave the country to do stuff, or that people had to be um going to practitioners that may not be very above board, or that might be sound of sketchy, or that might actually be doing things in a way that doesn't have good data for it. And seeing that that was how they were accessing care. And the reality is in the US, there's very little right now that we can use in this way. Ketamine is pretty much it. Ketamine's really the only substance in this general group of things that you can go to your doctor and say, I think I could get, should get this. I think I'm depressed, and can you help me find a place? And and they'll be able to give you without risking their license a place to go to. If you go to your normal doctor and say, I'm curious about psilocybin, the doc's got to be really careful about how they answer that, because if they answer it incorrectly, the medical board, I mean, you've got to use these harm reduction frameworks and then speak in kind of almost code, um, which I get it. I'm certainly not going to argue against the US healthcare system because I work in it, but it's frustrating that that's where people have to kind of dance around. And so when we put together this practice, we we wanted it to be a place where people could tap into this treatment in a way that was just totally above board. Um FDNY, for example, they know that if their team is getting treatment, they're gonna pause them on active um provision of services for a 24-hour window, and then they're gonna go back to care and they're gonna go back to doing what they do. And it's above board, and there's no sketchiness to accessing this. It's just part of what you do for your mental health. And and we want to kind of normalize it in that way even more because people often avoid it thinking that it's gonna prevent them from getting a job or it's gonna come up on their record in a way that's gonna be um shameful or or prevent them from doing the work that they want to do. And that's just not true these days.

Brian "Ponch" Rivera: 48:06

Now I can't remember which if it was ketamine or MDMA study is happening inside the VA and inside a they're they're actually uh uh looking for active duty and reserve uh participants to join. Uh d are you familiar with that? Which okay.

Dr. Grundmann: 48:19

So ketamine in the VA is no longer under study. Ketamine is actually offered in the VA. Okay. So 22 states, the VA will offer what we do at Ember, IV ketamine for depression. And the VA will cover it, pay for Ivy ketamine for depression. So if you're an act if if you were part of the VA system you and you are dealing with depression, you should ask your VA doc about whether you can tap into this, because in in about half the states in the country, they'll give it to you. And and if it's they'll talk you through if it's the right option. But you won't have to go leave and go find it somewhere else. You'll be able to get it as part of your VA community. Um I think it's more than 22 states where they offer spravata, which is like a ketamine derivative that have different slightly different conversation, but related. And so it is um the VA and the DOD both put out a joint position statement in 2023, about two years ago now, saying, hey, ketamine works. If you're gonna use it, here's how to use it, and here's the protocols to follow. And so the VA DOD have guidelines on how to use this in the normal U.S. healthcare system.

Mark McGrath: 49:27

We'll have to look in, I'd be curious to know the success rates within the VA just only because so many of the guys I know that are having problems. They're in the VA system.

Brian "Ponch" Rivera: 49:36

Well, I I think it's like not well known, Moose. Uh I see. Yeah, so so I I mean this is pretty new. So when I was in the Pentagon talking about these things, uh Rachel, I don't know if you're familiar with Dr. Yehuda, uh, Rachel Yehuda. Um yeah, so we a lot of this was pretty new 2022, 2023. So when I became familiar with this, uh I was asking folks in the VA to take a look at it and then working with uh an organization called Veterans Military Health Leadership Coalition and folks inside the VA to really look at it. And so we had a lot of good insights as to what's going on and and where the blockers are inside of our government. And and it it to be honest, and and we talk about systems driving behaviors. A reason why this isn't happening is uh well, two things, in my opinion. One is the cultural uh war on drugs that we had uh growing up. I mean, that's that that drove us all to believe that alcohol is better than anything in the world. That and the fact that we have a you know you go get alcohol anywhere on any base in the mil in the U.S. military. And then our songs. Yeah, it's in our songs. Um and and then just uh, you know, you're not gonna make money off of this. Uh uh pharmaceutical companies, in my opinion, can't make money off of a healthy client, right? Yeah. Healthy customer.

Dr. Grundmann: 50:52

So many points to go into on that. I I just cross-checked July of 2022 was where the VA and the VOD guidelines, then they updated it in January of this year, like active happening, actively rolling out. Uh landscape's changing quickly. You talk about pharmaceutical stuff, I'll try not to put on a tinfoil hat here. That's okay for our crowd. We've got those two. So ketamine, as I mentioned, it came out in the US in 1970. This drug's been generic. No company owns ketamine. And it went generic in 2000. It went generic in the year that we learned that it helps depression. You'd think a generic drug, great, anybody can use it. So you'd think that it would be a helpful thing for it to be not under Johnson A. Johnson or Merck or whoever. But the reality is that the FDA has in its history never once approved a new indication for a generic drug. Uh excuse the health policy nerve sector here. FDA says, drug pharma companies, you make stuff, you tell us what it's good for, you prove that it's good for that thing. Um, and that's what happened in 1970. Somebody said, Here's ketamine, we made it. It seems to work really well for anesthesia. Here's all the studies, and the FDA says, we agree or not, and we approve ketamine on label for anesthesia. In the US healthcare system, doctors can use drugs off label, they don't have to use it for the reason the FDA said that they're going to. And so ketamine is off label for clinical depression. The reason that's a problem is that uh drug companies, generally speaking, have to pay I'm sorry, uh insurance companies, generally speaking, have to pay for things that are on label. Drug companies do not have to pay for things that are off label. They get to choose if they're going to pay for those or not. And so in ketamine's case, there are very few doctors in the country in psychiatry who say that ketamine doesn't work. They might argue about the how or the who or how much or long-term, etc. But generally speaking, the field has accepted that this drug works really well. The challenge is very few people, very few insurance companies are paying for it. And you're dealing with this fact that to get this, even though you can get it in Brooklyn and Manhattan, you have to pay for it out of pocket. VA is an exception. VA will cover it. Um Blue Cross Blue Shield is actually paying for this in two states because they're starting to recognize that like this is nonsense. This works, it's cheap, we should just pay for it. It's better alternatives. But it's been a very difficult journey to get it covered. And actually, what I spend a lot of my days doing is coverage. Most of my kind of day-to-day is publishing data, dealing with insurance companies, showing them that they should cover this because it's good for their people and that's a lot less expensive than the other things they already pay for. But it's not, you are you are correct. Stigma and narrative are big problems when it comes to ketamine. I would almost argue the biggest problem is the fact that insurance just doesn't pay for it and treat it like any other drug because it's generic.

Brian "Ponch" Rivera: 54:04

This is important. This is the first time I've heard this perspective. I mean, this this is I'm not doubting it. Really? To me, this is driving a lot of the the use usage of it. I mean, or the non-use of it. And then the other side of it is the non-use of psychedelics, or if you want to call them, but whatever we want to call them these days. Alternative therapies. Is a stigma. You know, when when I had a there was an event here four or five weeks ago, and I went there to see a bunch of guys I flew with, and they all looked at me like I was crazy, like, ah, here comes that guy that talks about the toad and Abigail and psilocybin, he's a freak. And they're then they start telling me about all the brain damage they have, and I'm like, uh, guys, you Yeah. This black guy's yeah. You do have brain damage. We all do.

Mark McGrath: 54:48

I mean, that's another that's another thing. Uh we were recording earlier with uh a monetary economist and talking about how some of the some of the classical theory talks about business leaders getting seduced by phony price signals so they go into the wrong things. You can see how a lot of these guys that would criticize Potts for those things, you know, are seduced by this pervasive whatever it comes from that uh that these things are bad or these things are are taboo and things, but without understanding that they actually can really help people in the in the right conditions with the right the right kind of treatment, the right kind of therapy. And that's I guess that's kind of the challenge I would throw out there to the veterans listening. I I was there, I admit I had the psychedelic stigma.

Brian "Ponch" Rivera: 55:32

But we should go a little bit deeper than that, man. You're Catholic, you're you're much more Catholic than I am. I'm Catholic.

Mark McGrath: 55:38

I try, but well, I've well, so nowadays I think that a lot of the the the visions and things like that may have been psychedelic induced, right? Now from my my extensive autodidactic research, but not historically. Like anything that you think that these things are drugs and they're bad, and you know, the drug companies wouldn't do anything bad because they're trying to help you and they're trying to treat you. Um and you know, I'm a gen extra, I'm 49, and I I remember when the Grateful Dead were still around, I still love them. And you know, my brother went to something like I don't know, 82 fish shows. So like psychedelics were for those people. But then when you grow up as a especially serving as an officer, and then you you hear about someone that you were in command of hanging themselves, you know, or you hear about a friend of yours that uh you know can't go anywhere. Like I have a I have a friend, he you know, he couldn't go through doors unless he could see on the other side of it because he had been in the Battle of Fallujah, like he had a real problem with with doors, and he would put his hand on the door and say, I'm not in Fallujah, because he's used to like he was traumatized by could be nothing, could be a bomb, could be a terrorist, could be a kid, could you know you have no idea. But then the the the deeper my education got, and Punch was a big help for me. This because when he talked at my first we we'd been collaborating online before we started working together, and the first time we met in person, he started talking about psychedelic therapies. I'm like, like LSD, like drop an acid and go to a fish show. Like, but then the immediate connect for me was knowing people that had taken their life and and and the veterans, every one of them was on pills, every single one of them was on pills and Jack Daniels and fentanyl, you know, opiates are are also a very big problem with veterans. So as that's that scenario has become more and more grave, not just in the veteran community, but just in general, I'm open-minded enough to think that, hey, let's let's look at something that's actually working. And then when um when Norman came on and and and really broke down the history of LSD and where Albert Hoffman worked was the Novartis or whatever was the antecedent to Novartis. I mean, these were pharmaceutical guys, you know, he was looking for a way to create a mental health solution that had had a completely different people took it in a completely different direction. I think that the more people educate themselves on these things, the more they realize that that these things are not meant to kill you. I mean, you even described ketamine. It's not it's not meant to kill you. Alcohol will kill you. Alcohol is on all the Super Bowl ads, it's in the military songs, it's in it with sponsor for the class six store on a on a on a on a base, you know, constantly having alcohol sales. And every time, Ponch, I'm sure it was the same with you, with sailors as it was for me with Marines. 0.99% of incidents that I had to deal with Marines getting in trouble had uh alcohol involved. Yeah.

Dr. Grundmann: 58:30

I mean, we told you about that shift that I called my wife afterwards to get this going. That was in West Virginia. That was in Beckley, West Virginia. I would talk about opiate deaths. I mean, I would I would call several opioid deaths each shift I worked. It would be pretty normal to have multiple times somebody brought in, usually already dead, because they'd overdosed every shift I worked. And this is a little bit why I mentioned at the beginning, like we don't call ourselves psychedelics, we don't have psychedelics on the website, because I agree with everything you're saying that this kind of artificial distinction between a pharmaceutical drug and a and a recreational and a other substance that we somehow have okay things in society to use. Like, those are very important conversations to have and to break down stigma around. And I also think you you might not always reach people by trying to educate them. You're just gonna have people whose walls have been built up over so long that it's just really hard to change their mind. But you also don't have to talk about this and force it into the psychedelic framework. Psychiatrists are kind of getting around this. You might have heard the term interventional psychiatry. That's gonna umbrella a lot of these new drugs or these new next generation interventions are gonna fall into interventional psychiatry. The way to kind of skip this debate. We're talking about the same thing, but we're using different language about it in a way that's trying to normalize and trying to make people recognize how it'll be helpful.

Mark McGrath: 1:00:00

You know, Punch mentioned the Catholic Church, I I think of the rampant alcoholism amongst clergy. Is is alcoholism something that ketamine has has had an effect on?

Dr. Grundmann: 1:00:11

We have, again, that study that's in the UK, they're thinking it could be really helpful for alcohol use here. We certainly have a lot of clients, patients, who talk about how by treating their depression, their desire to drink goes away.

Mark McGrath: 1:00:26

How about how about cases of like physical trauma like CTE and NFL, or uh we I I can't think of her name, Punch. We had her on the show with Daphne. Tebec traumatic. Yeah, the TBI and the and the with aviators when they're you know they're crashing a plane into a ship and they go through these physical things. Does ketamine help in those areas?

Dr. Grundmann: 1:00:47

Maybe if they have depression and those things are an issue, yes. If they have TBI and they're not depressed, maybe. Uh again, there's a lot of really cool research that's happening right now. People are looking at like Alzheimer's, traumatic brain injuries.

Mark McGrath: 1:01:04

Well, what about CTE? And that's a big topic with football. We're all football fans, I guess, but like you know, what about in CT?

Dr. Grundmann: 1:01:10

Similarly oriented is right now the kind of US standards are that you can have depression plus whatever else, mental health issues, trauma, brain injuries, et cetera. And we would talk about ketamine as a viable option because it falls under the depression main issue bucket. The other things that ketamine could be, so ketamine's been looked at for anxiety disorder, trauma without depression. There have been some studies on ketamine. Suicide we haven't talked about as much, but that's something to actually go back to because it's an important point with ketamine. There's a lot of good data on ketamine for suicide if you don't have depression. Um, as mentioned, there was a there was a hum in it that people were looking at ketamine for COVID and long COVID because there's some interesting theory on why that could work. While I'm a big proponent of that early days work, small numbers of studies are hard to then say this is the good treatment to use this for. So when we talk about what we're trying to do for our practice, we're we're trying to treat tens of thousands of millions of people. Literally, there's somewhere between depression in the US is one out of seven adults. That's like 40 million people. This treatment could potentially help 40 million people. To do anything with millions and millions of people is you need to be very buttoned up. You need to be very confident that what you're doing is the right thing to do. If you're wrong one in a thousand times and you're treating a million people, you're gonna hurt a lot of people. And so you just need to be this goes back to like my old life of of uh health policy and population level statistics and and making sure that you're uh well aligned in the kind of things at scale for what you do. Our stance is that you need a lot of proof that something is helpful before you're willing to say it's the right thing to do for anybody with that issue. That's fascinating. Now let me hit on something for suicidality because clearly um in in the veteran community is involved with our patients. Yeah. So suicide is really fascinating with ketamine because it appears that ketamine seems to help suicide differently than it helps depression. What I mean by that is that you can give a single dose of intravenous ketamine, what we do, these kind of slow 40 minute infusions with a doctor watching you, one dose of ketamine will drop suicidal thoughts by 80%. Wow. So the day after your treatment, four to five people aren't feeling those suicidal thoughts.

Mark McGrath: 1:03:41

What about when suicide is a coincidence of a substance like uh like a SSRI that that like uh um that says that suic you may have suicidal thoughts? What about those those cases? So I I guess what I mean by that, like what if what if somebody's on something like that for neuropathy? Sure. And they they get suicidal tendencies and then they get ketamine while they're taking, I don't know.

Dr. Grundmann: 1:04:07

Prozac or whatever. Yeah. Something like that. Or yeah. So the cool thing about ketamine, unlike many of these other drugs coming down the pipeline, is that ketamine plays well with other mental health drugs. So you don't stop your Prozac on ketamine. You don't stop your well-nutrient or anything else you're taking at all, really. Ketamine is not harmful to mix with other psychotropic medications. Oh, interesting. Benzos makes ketamine work a little bit less well.

Brian "Ponch" Rivera: 1:04:34

When you say benzos give us the lame benzodiazepine, that's what uh slider got damaged on big time.

Dr. Grundmann: 1:04:40

Gallium, um, clonopen, out of an carbamezeapine or related, slightly different.

Mark McGrath: 1:04:48

Yeah.

Dr. Grundmann: 1:04:48

Gabapentin. It's what the VA hands out like candy.

unknown: 1:04:52

Yeah. Yeah.

Dr. Grundmann: 1:04:56

It's literally one of the most prescribed drugs in the country. It's an anti-anxiety medication. Benzos are not going to hurt you if you take them with ketamine, but benzos will make ketamine less of an antidepressant. Or work with people and their doctors to talk about like how to tweak the meds. The thing that MSI is, so psilocybin, for example, very different. If you're on an SSRI and you take psilocybin, like that can actually be quite bad. You can have something called serotonin syndrome and things that can come up. So that's another aspect to realize is that when people seek care for this, we they don't have to jump through a bunch of hoops about changing meds. And this can actually be done in conjunction with those other meds. And most of our patients end up using ketamine and something else over time because what they care about is how they feel, um, and therefore they can get to feeling better and then have something else that might also help them along that journey.

Mark McGrath: 1:05:54

So when you look at uh CDC, it says about 178,000 people die per year from excessive drinking. How many people die per year from ketamine therapies? As a monotreatment? It'd be it'd be zero. Well, I'm just like, you know, again, I I guess I'm trying to draw the draw, maybe it's an extremist, but like I'm trying to draw the point of like people that think these things are out there and crazy. Uh, you know, as you mentioned, these things are not these are heavily studied and and safe. You know, anybody can walk in and pile up on liquor, and that's about 178,000 people a year dying.

Dr. Grundmann: 1:06:31

Yeah, benzos kill you more than ketamine do. The thing is, the only way that ketamine consumption would cause you to die is if you use it in a non-monitored setting. So Matthew Perry died from ketamine, the friends actor, because he took ketamine in a hot tub by himself. Um, and he also took surgical doses of it. He took another 20-30 time of it. Yeah. So the friends actor overdosed on ketamine, but it wasn't the ketamine killing him, it said he was in a hot tub and he took an anesthetic. Right. So he drowned basically. Correct. Yeah. Yeah, it wasn't the ketamine itself causing his heart to have an issue. It was that no one was there for him. He took an anesthetic, went under the pool, and drowned. So I don't want to pretend that these things are perfectly harmless, because I do think very careful with this is why these medications, ketamine, for example, is used in office with the doctor watching.

Mark McGrath: 1:07:28

But when you go you go to an NFL game and you see at a tailgate and a fight breaks out, it's not they're not on ketamine, they're they're on alcohol.

Brian "Ponch" Rivera: 1:07:36

Yeah, I I've seen I'm sharing a graph right here from I don't know if this is still valuable with this. But this is uh when you look towards the left, crack is uh pretty bad, right? And about a three from the left of that is alcohol, or three from the right of that is alcohol. And I don't I don't know where ketamine lies in here, but it look like it's in the middle. And then yeah, you get cannabis. So and what I'm showing for our listeners is is is I can't remember where this is from.

Mark McGrath: 1:08:00

Um these are recreational uses, so not not not medically monitored like what Dr. Nico's talking about.

Dr. Grundmann: 1:08:07

I would actually strongly argue that ketamine harm to use or harm to the self being worse than benzos, which you can die from from taking too many benzos. I've seen graphs like this and I agree that the concept is correct.

Brian "Ponch" Rivera: 1:08:20

Yeah, it's a lot worse. Yeah, I agree with you on that. I I uh one of my good friends has uh he he's an advocate for not using benzodiazepines, and and there's a reason why, and his his he's pretty messed up from that. Um so yeah, I don't think this is accurate, but this kind of lays out all like when I sit down with the girls and go, let me show you where alcohol and crack are. Um you know, and I'm not saying go use, you know, hey, go use LSD, or that's not what we're saying.

Dr. Grundmann: 1:08:50

Well, and that the last part I want to emphasize because I realize we haven't talked about this yet, is everything I've shared so far about ketamine and how helpful it is, those are kind of facts at this point. Again, and it's literally the most studied drug for depression. I'll send you guys that resource for the posting of this because it's not an opinion. It's like a Yeah, that'd be great. Fact. The other thing to realize is that ketamine, nor any of these other tools that we're talking about, they're not gonna make the person immune to getting depressed later. Let me talk about that a little differently. So psilocybin or ketamine or whatever else, like they'll help with a reset. They'll help get your emotions feeling well, and we know that best with ketamine. But as a person, even when you're reset, you can have new trauma, you can have the processing of old trauma, new stress. And it is possible for your brain to get depressed again. The people who are kind of susceptible to depression, the people who became depressed, do have to be aware that give enough time after one of these treatments, your brain can go back to that old state if it's being stressed again. And that's okay. That's not a failure of you or a failure of the treatment. It's frankly not even that a big of a surprise. It's kind of expected that give enough time and enough new wearing down, those issues will come back. But what I do want people to be conscious of is that these are not kind of treat and release silver bullets that work once and you never have issues in the future. It's that they're tools to use when those symptoms flare, when those things become difficult, when the suicidality becomes something you're actually thinking about and acting on. Um and that over time you'll probably need to have another treatment, and that's okay. But what we hear a lot about nobody blinks about staying on Prozac for years. They probably should, but but it's considered normal. And people get very bothered by the fact that, well, like the ketamine helped for six weeks, but then six weeks later my symptoms started going back. Okay, yes. And one treatment six weeks from now, go another six weeks feeling better, one treatment six weeks from that, go another six weeks feeling better. Like, that's okay. That's that's to be expected. It's not a failure, it's just a different way of thinking about it. You don't you don't take these things every day, but you might need them in the future, and that's not a bad, it's just a different way of thinking about how you manage that.

Mark McGrath: 1:11:16

I guess a natural question that I come up with all of a sudden is that, you know, you mentioned the DEA. I think when you look at that chart that Ponch just showed, they they be in every single saloon and bar in the city because of what alcohol actually does versus ketamine. It's interesting that ketamine gets a special treatment in the facetious sense than than than the alcohol does.

Dr. Grundmann: 1:11:39

Yeah, there's I I will certainly not claim that the classification the DEA uses for drugs is is perfectly logical. Yeah. Um we we just know that's not true. It is the realities of the US, and and we can talk about trying to change those realities, but this is where as a single person, and me and my wife as two people, like we had to choose which battles we were gonna try to address this issue. And and while I am a big proponent of people doing the work about education and policy and war on drugs and decriminalization, my skills weren't in that. My skills were in like being a really good doctor, talking to somebody who's depressed and and understanding their story and and kind of helping shift some of those perspectives they were having back into a positive alignment. And so what I can do is I can work in a system and help figure out ways that, okay, you're suffering today and you don't have time to change a DEA classification and you need to get care today. Well, here's a here's an environment that we can build out where you can access that care today. And as the policies change, we'll tweak the environment, we'll shift what we do. But at least for now, that this doesn't need to be something that people jump through hoops to get, we can kind of force fit it to the current US healthcare system in a way that allows access for those who need it.

Mark McGrath: 1:12:57

So so bring us home with this. We'll and we'll wind down here, but bring us home with this. So you're you're a veteran, you're listening to this. We've learned now that this is available through VA in 22 states. So that means in you know, 27 or so, whatever 20, 28, they're not. I can guess what states those are. If it's illegal in my state or is not offered through VA in my state, can I come to New York and or can I go to a I guess I could cross state lines and go to VA, but like, you know, do you treat people from out of state, you know, or out of the country, you know, if it's against the rules in New York, I would actually just look in your community.

Dr. Grundmann: 1:13:33

Because there are ketamine providers in all 50 states. Okay. Even if the VA isn't doing it, there are others who do. I see. Okay. There's a group called the American Society of Ketamine Practitioners, ASKP3. And that has a directory of uh providers that are following centers of excellence guidance, kind of following the standards that do exist. All 50 states, you can find a provider that's local. I would do a little bit of research just to make sure that they're kind of in this for the right reasons.

Speaker 2: 1:14:04

Yeah.

Dr. Grundmann: 1:14:05

There are some practitioners of ketamine and some ketamine clinics, so to speak, that are a little bit less um buttoned up or less well-intentioned. And you do have to be a little bit careful about who you work with. Same with anything that's kind of. But that is not something that you need to necessarily travel very far from. And I think that's actually what emphasizes this is available even in your own community. For us, for Ember practice specifically, so we'll treat anybody in the tri-state area. We do require people to have a outside mental health professional. So you do need to be working with a therapist, a psychiatrist, a psychologist. We'll connect you to folks if you don't have a team yet in place.

Mark McGrath: 1:14:42

But what we want somebody If somebody's using better help, like you see that amalgamate lately, like more people are using better health documents.

Dr. Grundmann: 1:14:49

It's a little bit in the weeds about who they're working with at better, but yes. I see. Yeah. But then yeah, the the the best path, like in a perfect world, what you do is you talk to your provider, the person who knows you really well, and says, Hey, I'm thinking about this. Does that seem like a good idea? And in the world, they'll give you guidance. I will admit many psychiatrists, therapists don't know a lot about this, so they're not going to be able to necessarily answer very well. A good place to start is bringing up with the people who know you and see what their thoughts are and where to go. And if you're not getting good answers from the people who know you, then start doing your own research about what's happening nearby, get that kind of consultation. Um, because it is going to be something that you'd be surprised how relatively straightforward it is to find.

Mark McGrath: 1:15:34

Yeah, I mean, just going on your website, it seems extremely straightforward as far as procedurally and what it costs, you know, what it what it would cost for somebody.

Dr. Grundmann: 1:15:42

That's the other big thing to think about is access to this right now is still more limited for cost than I'd like it to be. Um most insurances don't cover this yet. Again, VA is an exception. So if you're lucky enough to be in one of the states where the VA covers, that can be a really good option. But if you're not, then you do have to think about whether this is something you can tap into. Um for Ember, for what we do, we have a really good success rate with people getting out of network reimbursement. So people's insurance won't pay me as a doctor directly because it's still not yet covered. But they will pay the person back for the care they get with me. We end up seeing that um, I won't go into stupid US healthcare stuff. Um our our visage fee, like what we charge a person, is $550 a treatment. We are the lowest, if not amongst the lowest, uh who charge we charge the lowest in New York right now. So a lot of clinics charge like $800 or $1,000 a treatment session, which is any kind of nonsense. Um the reason we price it where we do is it's the kind of lowest we can afford to charge people and still pay our staff and still make our nurses and our doctors are able to do this work. Um and if you have out-of-network health insurance, what the person ends up paying is about $165 a treatment session. Uh so that becomes pretty accessible. Again, you gotta dance through the US healthcare system a bit to do that. What my advocacy work is, what the kind of main spend of my personal time is these days, is that I work on trying to get insurance to pay with us. Um and so we have some stuff going live in January in New York. So if you've got an employer who pays for your health insurance in New York, you might try getting covered by Amber. That'll launch in a couple weeks, and we'll be more public about kind of whose companies are available for that. We're working with Medicare, what's called the Center for Medicaid and Medicare here in the Northeast to try to get ketamine covered by uh Medicare here in the Northeast. Six states Medicaid already covers ketamine. There's already a couple states where people in Medicaid programs can get ketamine paid for. Um and then we're starting to see the the commercial insurances, the the blue crossings of the world pay for this, et cetera. So hopefully everything you just heard about kind of insurance is different in two years is where it is now, and it is a lot more available. But it is the thing to be conscious of is that right now to access this does require more means than I would want it to. And that's something we're trying to change.

Mark McGrath: 1:18:08

I would close by just saying if you're again depressed, and you know, we've talked a lot about psychedelic therapies here. We're not talking about recreational use, we're talking about getting legitimate, honest help. You're worth it. If you're a if you're a veteran listening, you know, if you're a person that's depressed, veteran or not, you're worth it. And but we hope that you look into these things and understand and learn that there's a lot of things out there available for you to take advantage of. Life is worth living and you're you're certainly worth the uh the time. So, Dr. Nico, thanks so much for uh for coming on and and sharing this with us because I think it's very important.

Dr. Grundmann: 1:18:45

I appreciate that. And and yeah, actually, one similar shout out just to say how worth it. Um so we talked about like this is helpful, but let me give some numbers. So people who go through ketamine treatments, the intravenous stuff that we're talking about, four out of five of them have their depression lifted. So it's not that it might work for you, it's that it's expected to work for you. If you're suicidal, as mentioned previously, it's you're gonna reduce those suicidal thoughts four out of five times. Most people's suicidal ideation will resolve within the matter of days. You're not waiting weeks, hoping it kicks in in a month or two later, with that's how most other drugs work in terms of take a pill every day. You're talking about knowing within a really short time frame. 10% of the people we help will literally wake up the morning after their first treatment and notice a difference. And so some people, this can be almost it feels almost instantaneous that life kind of turns around. Even if you're not confident it's a good idea, like you can probably afford to wait two weeks. And you can probably give yourself two weeks to like see how it does. And if you do feel better in those two weeks, it can be the difference between like living a normal life and really suffering. I mean, I just would encourage folks to consider that if they've been having trouble. Wow.

Mark McGrath: 1:19:59

I mean, that's a that's a that's such a high note to end on. I mean, it is again, we we hope that somebody we're we hope is listening to this and and takes this uh takes this up. And if you don't, if it's if it's not for you and somebody that you do know, particularly in our our veterans and others who've experienced trauma or depression, to have a look into this. If you're trying to reach somebody or connect with somebody, this is something hopefully that can hopefully offer hope.

Speaker 2: 1:20:22

Yeah, for sure.

Dr. Grundmann: 1:20:23

In the show notes, if you guys have them also give my direct email because I'm always happy to talk to folks directly.

Mark McGrath: 1:20:28

Perfect. Yep, and we'll of course have your uh your members uh link up and anything else you want to share with us. So for the purposes of recording, Dr. Nico Grumman, thanks for uh for joining us.

Dr. Grundmann: 1:20:38

My absolute pleasure.

Mark McGrath: 1:20:39

Thank you guys for having me.

Brian "Ponch" Rivera: 1:20:40

Thank you.