<p><a href="https://peterattiamd.com/celiamorgan/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220829-pod-celiamorgan&utm_content=220829-pod-celiamorgan-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220829-pod-celiamorgan&utm_content=220829-pod-celiamorgan-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220829-pod-celiamorgan&utm_content=220829-pod-celiamorgan-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Celia Morgan is a Professor of Psychopharmacology at the University of Exeter who has authored numerous publications on the potential therapeutic uses of ketamine in mental healthcare. In this episode, Celia dives deep into the neurobiology of ketamine, how it affects users, and how it differs from other, more classical psychedelics (LSD, MDMA, PCP, and psilocybin). She explains the potential promise of ketamine as a treatment for recalcitrant depression and addiction, and she details the results from her clinical trials in these areas. She discusses the importance of using ketamine in combination with psychotherapy to maximize its benefits, the potential risks associated with ketamine use, and advice for those interested in the therapeutic use of ketamine.</p> <p>We discuss:</p> <ul> <li>Celia's training and interest in ketamine [2:15];</li> <li>The history of ketamine, medical uses, and use as a party drug [3:30];</li> <li>Neurobiology and pharmacology of ketamine [8:15];</li> <li>Ketamine regulation and abuse, and how it compares with psychedelics and other molecules [18:15];</li> <li>Ketamine as a therapeutic for depression [30:45];</li> <li>The brain under the influence of ketamine and theoretical mechanisms for its anti-depressive effects [48:00];</li> <li>Risks and concerns with overusing ketamine, and what an intermittent or maintenance dose might look for a patient [57:15];</li> <li>Treating addiction with ketamine: Celia's studies of alcohol dependance [1:04:00];</li> <li>Advice for people considering the therapeutic use of ketamine [1:19:45];</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Avoid Unsupervised Ketamine Use
Never take ketamine at home unsupervised, especially at high doses, due to the risk of complete dissociation from your environment, making you vulnerable to accidents like drowning or inability to respond to emergencies.
2. Combine Ketamine with Therapy
To maximize and extend the antidepressant effects of ketamine, ensure it is administered alongside psychological therapy, as this approach has shown to significantly prolong the positive response.
3. Target Therapy to Neuroplasticity Window
Schedule psychological therapy sessions approximately 24 hours after ketamine administration, as this period is when the brain is most plastic and able to form new connections, optimizing the learning of new thought patterns.
4. Avoid Daily Heavy Ketamine Dosing
Refrain from daily heavy doses of ketamine, even if low, as this can lead to dose escalation, cognitive impairments, reduced hippocampal function, and a general ‘dullness’ or loss of life’s ‘spark’.
5. Be Aware of Bladder Toxicity
Understand that repeated high-dose ketamine use can cause direct toxicity to the bladder lining, potentially leading to severe physiological problems like the need for a cystectomy.
6. Ketamine for Alcohol Addiction Protocol
For alcohol use disorder, consider a protocol involving three ketamine infusions (0.8 mg/kg, 7-14 days apart) combined with 11 hours of manualized psychological therapy, as this demonstrated significant abstinence rates at six months.
7. Alcohol Addiction Therapy Focus
In therapy for alcohol addiction, focus on identifying risky situations, preempting relapse, envisioning a life without alcohol, challenging thinking biases, planning, journaling, and using mindfulness techniques to manage cravings.
8. Question Frequent Ketamine Dosing
If considering ketamine treatment, question the necessity of frequent, long-term dosing (e.g., twice-weekly for life), as this model can be disempowering for patients and may not be necessary for sustained benefit.
9. Recreational Ketamine Harm Reduction
If using ketamine recreationally, always start with a very small dose, use it in a safe place, and ensure a sober person is supervising, as the drug can be cut with other substances and cause complete dissociation.
10. Recognize Non-Pharmacological Addiction Factors
Understand that strong intention, overcoming treatment hurdles, consistent monitoring (e.g., ankle tags), and social support/human kindness can significantly contribute to abstinence in alcohol addiction, even without active drug or intensive therapy.
11. Avoid Psychotherapy During Ketamine Influence
Do not engage in intensive psychotherapy during the acute influence of ketamine, as patients are too dissociated and their memory is impaired; focus on support during this phase and therapy afterwards.
12. Consider Additional Ketamine Doses
If initial ketamine infusions (e.g., three doses) for depression do not yield a response, consider additional doses, as some evidence suggests a fourth dose might increase the response.
13. Understand Ketamine Dose Effects
Be aware that ketamine’s effects vary significantly by dose, ranging from mild stimulant properties at low doses to profound dissociation and hallucinations at higher doses.
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