Episode 7: A Conversation with Dr. Teresa Anderson about Ketamine and prTMS

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Hello everyone and welcome back to Authentically Connected with Dr.
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Rachel Fast.
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Thank you so much for being here and for listening.
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As always, anything that I share here is for informational purposes only and is not meant to replace advice or direction given by your own doctor or personal therapist.
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With that being said, I am so excited to introduce my guest today.
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Dr.
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Theresa Anderson is a psychiatrist.
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Owner and founder of the, Anderson Clinic in Cincinnati, Ohio, and also podcast host of psych waves.
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Dr.
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Anderson, thank you so much for being here.
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Thank you so much for having me.
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So I thought we could start by just getting to know you a little bit.
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maybe even back to, you know, your choice to go into psychiatry and your decision to open your clinic and the kind of work that you do there.
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So, you know, all of that.
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Just background info.
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Um, so I am originally a western Kentucky girl.
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I did my, um, medical school training at University of of Kentucky in Lexington, and.
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Then my, uh, residency training at University of Cincinnati University Hospital downtown.
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I always wanted, knew I wanted to be a doctor, probably ever since I was about eight years old.
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Um, my primary care doc was this super crotchety, grumpy old man who like, didn't like anybody except for me.
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my mom had a multitude of autoimmune diseases and so we were probably in his office like every other week.
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And so every time I visited him, he gave me some little.
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Trinket or book or, model of the anatomy of the foot or wrist bones or what have you.
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And like the next time he'd see me, he'd quiz me and I thought he was the smartest dude ever and I wanted to be just like him.
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I went into medicine.
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Not really knowing what direction I was going to take.
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I was interested in radiology for a while.
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I was interested in pathology for a while.
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But, eventually I did rotations at the VA hospital in Lexington and the VA hospital in Cincinnati.
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you know, just really fell in love with the veterans and especially those who had suffered with post-traumatic stress.
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And part of the reason is one is I'm a literary person.
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I love people's stories and I love people's backgrounds and, you know, what makes them tick and what makes them think.
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another reason is that, you know, just seeing how these folks were suffering and how the original trauma wasn't actually the thing.
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The thing that nearly killed them originally wasn't the thing that was killing them.
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Now, the thing that was killing them now was the stories they were telling themselves about the thing, right? what it meant to have been in that situation.
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And a lot of people personalized it and there are lots of ideas of shame and loss and guilt.
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You know, for our general audience, guilt is.
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I screwed up.
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You can take ownership, you can change directions.
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The next go around when you make a decision.
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Shame is, I am a screw up.
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It's an identity statement, right? And so these folks felt like it meant something about them as a person or their character, or that because this happened, they were a bad person or feeling the nasty adjective, right? And so when they started talking about.
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What was happening, and we could sort of get them to the idea of not even a positive state, but a neutral state.
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What if, know, what if it was an accident? What if it's sort of our play space in therapy, right? What if it was an accident? What if wrong place, wrong time? What if was just their time? What if, what if, what if.
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If we could get them to a neutral space of, well, maybe it's not that I'm a bad person, it's maybe that I didn't make a bad decision.
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Maybe I'm not a, horrible whatever, nasty, fill in the blank additive, then we could frequently get them to the positive again.
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Uh, and so I kind of look at it as a temperature scale, right? So we're going from everything in the world's my fault.
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I'm a horrible person too.
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Well, maybe I'm not a bad person, but I made a bad decision.
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Or I'm not a bad person, but you know.
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Bad things happen to good and bad people, and then we kind of could move along that trajectory and just to see their lives do a complete 180, when that internal narrative was changed, it was just mind boggling and really cool.
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So, yeah.
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My main focus of treatment, in several modalities is treatment resistant depression and PTSD.
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So for that reason.
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Yeah, with that experience and seeing just what can happen when you tune into people's stories and help them, reframe them in ways that serve them, rather than cut them down it, it's incredible what can happen.
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And would love to hear more about the kinds of treatment that you use at your clinic for people with treatment resistant depression and PTSD.
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Sure.
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So, I was trained in my residency mainly with psychodynamic psychotherapy.
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I did some postgraduate training in psychoanalytic psychotherapy, and then a little bit of CBT work.
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The type of therapy that I offer.
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We also do the traditional medication management, but um, we also offer ketamine infusions for folks who are treatment resistant, who tried a number of oral antidepressants and those have failed them.
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And we also do personalized transcranial magnetic stimulation, which is a mouthful of prTMS.
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And so, uh, we were the first in the state of Ohio to offer ketamine infusions intravenously, and we are the first in the state of Ohio or Kentucky to offer prTMS.
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Incredible.
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I would love to hear more about Ketamine.
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It's something that I've had my own personal experience with and also professionally I'm training to be able to provide Ketamine assisted psychotherapy.
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I believe strongly in what this medicine can do for us, and I.
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I'd love to hear how you got to be the first provider in the area and, and what it does for people.
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how I got to be, that really was a matter of right place, right time.
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was, coming off maternity leave and I was approached by a group outside of Boston who's interested in helping physicians add this to their sort of repertoire.
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I had heard really awesome things about the research, but I always assumed that you had to be affiliated with a hospital to do it, and so.
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I was a little tentative in that regard, but when I learned that because it's used at such a low dose and over such a long period of time that its safety was ridiculously high, you could actually offer it on an outpatient setting as long as you had either a nurse or nurse practitioner or A-C-R-N-A available.
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And as long as they were trained, uh, in ACL S, which is, you know, advanced cardiac life support, something happens if your throat constricts or if your heart, you know.
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Starts beating out of control.
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We can deal with it, that sort of thing.
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But that sort of thing happening is ridiculously rare.
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and I tell folks, ketamine is a bit of an odd actor in that, you know, technically it is an anesthetic, but we don't give it at anesthetic doses, right? And so if you were to have a motor vehicle accident and break your arm and they needed to set the bone, if you went to the er, you'd be given two to four times the dosage of ketamine that we are giving you for mood purposes.
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And it would be given all in one bolus, like all at once.
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And so your head would psychically dissociate off to Mars.
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You wouldn't see anything.
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You wouldn't hear anything.
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You wouldn't remember anything.
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And you'd wake up and you're like, ah, my arm has a cast on it.
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That's interesting.
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You, wouldn't connect.
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For this we're using a quarter of that dose over the course of 45 minutes to an hour.
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And with that you might get a sense or a feeling of mild dislocation Uh, a lot of my patients have told me that they sort of feel like it's, a state where you use laughing gas when you do a dental procedure.
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And so you're like, huh, moving.
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Am I moving in? Or is it moving on its own? Like that weird sense of dislocation, right? But you're always in control of your thoughts and your body.
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Um, the idea being that.
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Maybe we can dissolve some of the defense mechanisms and the ego barriers that keep us from being able to deal with things because especially, and again, my primary focus is PTSD, especially in PTSD, one of the biggest symptoms have is avoidance, right? that's a touchy subject.
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I don't wanna look at it, I don't wanna talk about it.
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I don't wanna deal with it.
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I'm just gonna push it over here and shove it down, or keep myself occupied doing something else, or.
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Drink or drug it out of my head or doom scroll until I forget about it sort of thing.
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And so this doesn't allow for that to happen, and it sort of brings it to the forefront.
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So for some people, they can actually feel a little worse before they start to feel better in the first visit or two.
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that's called flooding when things are just kind of coming at them because their defenses are no longer holding back the gigantic amount of symptoms that they've been sort of avoiding.
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But, folks tend to respond to it really well.
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in some cases there might be mild or mild headache.
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In rare cases, there can be throat constriction or elevated blood pressure.
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But again, we've been doing it for nine, almost 10 years now, and we've had a couple of blood pressure emergencies, and that's about it.
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Really tolerated well and safety profile is ridiculous.
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a couple of cool things about ketamine is you don't have to stop taking your current antidepressant.
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maybe working that's like kind of 75% of the way, but not all the way there.
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Or you're maximized on the dose and you can't go any higher.
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That's one nice thing.
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Another nice thing is that Ketamine has very different mechanisms of action from our current oral antidepressant setup.
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So typically, if you look at.
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Oral antidepressants, when they're prescribed, they're gonna be hitting one of three neurotransmitters and that's gonna be serotonin.
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Your happy, feel good chemicals, dopamine, which is your reward pathway or norepinephrine, which is the, gets you up and gets you motivated.
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Chemical.
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It's also the same chemical.
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It's part of fight or flight, right? And so, ketamine actually works on glutamate.
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And no oral antidepressant out there works on glutamate, and so it's much more rapidly acting and glutamate iss everywhere in the brain.
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In some areas, it acts like an on switch.
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In some areas it acts like the breaks, and so depending on what you're needing, it can really help revers things.
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Quickly.
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The other really cool thing is that it's been shown even after the first visit, whether or not you feel subjectively better.
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it's actually making connections in between the neurons that's what I think is super cool in that, you know, if there's more communication, just like with your computer, if you have too many tabs open, right? You can't process as quickly.
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it streamlines everything.
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And where like you're communicating more, you're increasing your processing speed, you're increasing your ability to make sense of things, which is why Ketamine assisted psychotherapy is so fantastic as sort of hand in hand with doing the ketamine.
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So while your defenses are down over the next couple of days, you can make those connections easier and you don't go to try to stuff it down or avoid it or ignore it or do something else to distract yourself.
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So.
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incredible.
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Everything that you're describing is, is aligned with what I've been learning and also when I've had my own therapeutic ketamine experiences.
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There's both the during experience where.
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You're still present, but there's like this dissociation, this distance that's created as the default mode network.
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And the brain is turned off all of the thinking, active go, go, go.
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That's behind the scenes or front and center when you're quiet and all of a sudden you've got enough distance from whatever is going on or whatever shows up to say, oh, isn't that interesting? Isn't that curious? And then for days after, weeks after, really it's, oh, that happened more easily than it used to, or, oh.
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Yeah, that link wasn't there before, but now it makes total sense and so it's incredible.
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What, what have you seen in terms of the outcomes for your patients who have this PTSD and treatment resistant depression? absolutely incredible.
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If I hadn't seen it myself, I would've thought it was a bunch of hoku, honestly, because you know, in two or three visits we have people who are non-functional, who aren't working.
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start wearing makeup again and start going to work again.
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Start talking with their families again.
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Participating in Hobbies Life again, I decided, I saw a recipe on Pinterest and I wanted to give it a try and just go to Kroger and pick up the items and go cook it.
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Like what? This has not been happening for several months or years, and it's a really cool thing to see.
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It gives people hope that.
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Things could get better.
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What the awesome thing too is, you know, people need boosters from now and again, sometimes once a quarter, couple times a year.
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but for the most part, if people can see a glimmer of hope and they start.
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Having more, what we call behavioral activation, just doing the things.
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'cause you could, that's a hell of depression, right? You can see all the things that you need to do on the horizon, but you can't make yourself do it right? And so if you start doing those things, then you're going to reinforce a positive neurochemistry.
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And the positive neurochemistry reinforces wanting to do those things.
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And so that really helps sort of people out of the abyss just long enough to.
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Take it and run with it.
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Right? And so we've seen a good 70 to 80% symptomatic reduction in both PTSD and depression.
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40 to 50%.
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Uh, with OCD, we've had some with, complex regional pain syndrome also improve some.
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Now we don't give it like the dose of pain clinic doctors do, um, but even that little bit can have anti-inflammatory properties and anti-pain properties.
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What about people who are dealing with generalized anxiety or, right, they don't fit into the criteria that you've described already, but they're also really uncomfortable with the idea of taking a daily medication.
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They're not already treating it.
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Is that something that you work on? because ultimately it can lower your sense of fight or flight.
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Which is kind of ramped up in those folks.
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and it can sort of put distance in between you and the feeling, I, I kind of liken it to when couples fight and argue, like in the midst of an argument, you might call each other names or say things you don't mean.
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And then like 15 minutes later when your amygdalas have calmed down and your frontal lobes have blood flow to them again.
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Why the crap? Did I say that that was so rude? Or maybe I ought to address this in a different way.
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Or maybe we can come to it from a different direction because you're able to get some distance from it, right? And Yes.
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the midst, you can't see the forest for the trees, and so it gives you that just a little bit of distance to say, you know what, yeah, I might have a panic attack on the road, but that's what shoulders are for.
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I can pull off or pull off on an exit at a gas station, call my mom, or call my spouse or call a friend, or whatever.
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Or do some breathing exercises and panic attacks don't last all day.
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They'll last a few minutes.
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I'll be okay.
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I can get back on the road.
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It's not a big deal.
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Right? And so once again, getting that distance, providing that sort of sense of separation between the emotion and the idea, also providing some real world, Hey, I do feel better, so I do think I can do this.
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Mm-hmm.
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Absolutely.
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Now, do you provide any Ketamine assisted psychotherapy in your practice? We don't as of yet.
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So we have a nurse practitioner who's going to be training in that.
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But as of right now, we farm it out to folks like you.
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Got it.
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Awesome.
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I know within your practice it's intravenous, ketamine.
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Are there any other forms of ketamine that you provide? And what about people who are very uncomfortable with.
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Yes.
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So, SPIVA is intranasal s ketamine, and frequently insurance companies will cover the cost of a couple months worth of treatments.
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If we have a situation where the person is diagnosed with treatment resistant depression, and they have tried and failed at least two, maybe three different oral antidepressants in two different families.
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so, where insurance won't.
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Touch IV ketamine, they will approve spiva if those criteria have been met.
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Um, and so Sava is a great option for folks who are either needle phobic or who really need help with the insurance coverage.
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Uh, the ole caveat is, uh, slightly increased frequency of visits for a period of time, and you have to have a driver the same way with the IV ketamine.
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So.
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Got it.
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So you have to take it for longer, you have to come more frequently, but it's a wonderful option if IV medicine doesn't work for you.
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How does the efficacy compare? It's close to the same, but slightly under, just because the method of delivery decreases the bioavailability, so.
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Again, it's to be expected and, and again, in the same thing, I wanna address this too.
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A lot of folks are like, well, I could just get Ketamine at home.
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Now that's incredibly dangerous.
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It's incredibly dangerous.
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You could be monitored by a person from afar or three states away.
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What are they gonna do if your throat closes up? They can't do anything, and I believe one of the major companies has already had Against them for this very reason because a person has died Hmm.
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it.
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Um, because part of the issue is they're usually not always, but usually sublingual lozenges, you're supposed to keep it under your tongue for as long as you're with your provider.
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And they say, take it out.
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Well, if they're starting to feel better, there's nothing going to keep them from putting it back in their mouth again.
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Right.
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Or it.
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Or we don't know how you're gonna respond to it, Hmm.
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In my mind, it would be a lot safer if it was under medical supervision.
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I couldn't agree more.
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Thank you for clarifying that.
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This is not meant to be just like a, oh, I feel better when I do it.
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Let me do it on my own whenever I want.
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That's a problem.
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Plus the oral.
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The oral version is such a lower rate of absorption because your liver chews up like half of it.
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And so, you know, with the IV 100% of what we give you is what your brain sees and utilizes, and so.
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can use this much.
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And so the side effects are like this, right? And so with this bravado, they have to one and a half times the dose to have the same efficacy.
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With the oral, it's three to four times the dose.
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And so you see, as you know, every time we do a step up in dose, there's also a step up in risk and a step up in side effects.
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And so to me, it's just not worth it.
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It's not.
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Absolutely.
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What I'm hearing is that because of the way that Ketamine impacts the brain by increasing bioavailability of glutamate and, regrowing neurons and healing neurons that have really been negatively impacted by what's been going on, it feels as though it's medicine.
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But my understanding is that it's more of a catalyst for change than it is the healing medicine itself.
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It.
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Yeah, it really is.
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And so it's not necessarily regrowing neurons, but it is.
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they're seeing is, uh, at least in animal models, even after the first intravenous infusion of ketamine, they start seeing an increased density in dendritic spines.
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And those are little tree branches from the neurons that sort of connect the neurons to each other.
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And so it's, it's a catalyst for increased communication between the neurons.
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It's not necessarily regrowing the neurons, but it is, it is a situation where it's increasing the communication between the neurons.
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Yeah.
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So.
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Thank you for clarifying.
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Yeah, no problem.
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It is amazing how much what goes on inside of our brains also mirrors you know, a tree outside, right? The, the branches that need to be there in order to absorb the sun and be able to, have the nourishment that it needs.
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Just, just like a tree.
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We are that same way inside too.
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I would love to talk some more about P-R-T-M-S because it's absolutely fascinating.
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And then I would love for listeners to hear about it.
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Absolutely.
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So, TMS or transcranial magnetic simulation was developed, I wanna say in the 1980s, as sort of a kinder, gentler version of ECT or electric convulsive therapy.
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And the idea was that you can create, a magnetic field around the skull.
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Once it passes through the skull, it turns into electrical energy because magnetic fields can pass through anything, right? And so the hope was that.
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wouldn't have to crank the juice up so high, so to speak, and it'd be like a kinder, gentler version.
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so people wouldn't have to be intubated or sedated, wouldn't have to miss work, wouldn't have to have short-term memory loss as sometimes happens with ECT, which is still the gold standard by the way, uh, if medications fail.
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So, but it took out a lot of the side effect profile of ECT, It's sort of a one size fits all, treatment in terms of they treat at one position the dorsal later prefrontal cortex, and it's a spot on the brain that is the least likely to induce seizures when it's electrically stimulated.
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So it's a good place to simulate it, right? But the problem is, is they're giving the treatment at a frequency of 10 hertz.
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And what does that mean? So.
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Our brain's resting engine idle, so to speak, is our alpha wave.
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We have delta waves, which are what we are when we're in sleep mode.
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We have theta waves, which is what we're, when we're halfway between dreaming and wakefulness.
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Our alpha wave is our resting zen, contemplative, meditative, awake, and alert, but not interacting.
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So it's like the um.
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Mm-hmm.
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of state, right? Um, our beta is what you and I are in now.
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I hope eyes open, talking, moving Yes.
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sort of thing.
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Gamma is like being chased by a bengal tiger.
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And so goal for TMS was to treat at the person's alpha wave state.
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And so the average human alpha wave is about 10 hertz, and that means that you sample the world around you with all of your senses 10 times a second.
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Which is really cool to think about.
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Yes, it is.
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as your computer's processing speed.
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Okay.
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But the problem is it had a similar efficacy as to oral antidepressants, which has only worked about a third of the time.
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About a third of the population has an alpha of exactly at 10 Hertz coincidence, not So.
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Dr.
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Kevin Murphy outta San Diego.
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There's a pediatric radiation oncologist by trade.
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He neut kiddos, brain tumors, right? finding with a lot of these more targeted treatments, the kiddos were living a lot longer, but their quality of life sucked, right? They Hmm.
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Acted depressed, but they weren't responding to antidepressants and they kind of colloquially called it chemo brain.
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And so.
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He's like, here we have this really fantastic treatment in TMS, but it's a one size fits all.
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It's like if you had breast cancer and you went to your oncologist and like, I'll just give you the medication for colon cancer.
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I'm like, no, no, it's not the same thing.
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Right? so if your brain is functioning better at 11.5
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hertz, giving you a 10 hertz wave would actually slow you down by a factor of 15.
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Hmm.
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or if you were close to a dementing illness and you're running at an eight, you may never get to a 10.
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So it Right.
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and irritating to you, right? And so his idea was why don't we see, first of all, how fast your internal processing speed is.
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things first, let's see how fast does your wave need to be? the second thing, let's look at an E, EG to see your brain speaking the same frequency across the board? Hmm.
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What if I fell out of a tree when I was 12? And I looked and I acted a DHD because my frontal lobe was going eight hertz, but the rest of my brain was going 11 medications can't treat for that Mm.
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because if you give me a medication, it's gonna speed me up globally, right? So the front's gonna be like, yes, I can think.
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And the back part of your brain's gonna be like, what the hell? I was already going fast enough and now I'm agitated and irritable.
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And that could account for.
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Some of the folks who have the response of the stimulants that they do is maybe they're not truly a DHD.
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Hmm.
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Part of their brain can benefit, but part can't.
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I know at least 90% of the time when I have a patient who we've labeled as treatment resistant depression, we get an EEG on them and like nine times outta 10, they are concussed.
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How can you tell on an EG that they were concussed? Because the healthy part of their brain is going, the healthy speed, the part of their brain that was concussed is going the slower speed.
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It shows up as a Hmm.
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wave.
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Isn't that That is wild.
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It's fascinating.
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a runner and you tweak your knee, you can't go as fast as you went before.
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Right? Mm-hmm.
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'cause you blow out your knee and so you can only go as fast as that injured part allows you to go.
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And so if, if the neurons have been physically traumatized, they're gonna slow down to preserve function without killing themselves.
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Hmm.
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so they're slowing down to preserve function.
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And sometimes have somebody who had a car accident 20 years ago.
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Sometimes the wave will make it over too close to where their healthy wave was, not quite.
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And so you get some cognitive dissonance, you get some decision fatigue.
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You get, do I do this? Do this is sort of analysis paralysis, right? Because they're literally, the brain is functioning on two different channels.
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Oh, that is fast.
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And it makes so much sense why a global treatment like a stimulant or even an antidepressant isn't going to have, a balanced effect when different parts of the brain need different things.
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Exactly, and so what's really fascinating to me is I, I think this is going to prove to be.
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One of the most widely underdiagnosed problems that we have in mental health today, because, I mean, the brain is like unset jello.
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It's so soft, you know? And you could have a car accident, maybe you're only going 30 miles an hour and you were T-boned.
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But going from 30 to zero is going to cause some damage.
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And so it just like shaken baby syndrome, that sheer force in the axon just kind of, they lose their legs, right? And Hmm.
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it's really.
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I think important to recognize how much this can play a part, not only in childhood development and student athletes, but also like you may not have had a mental health history and you get a concussion and all of a sudden you're depressed, anxious, and you look like you're a DHD, and maybe you're not sleeping well.
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Maybe you did have a mental health history and the concussion makes it worse.
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These are all pieces of information that we can take into account.
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Subjectively, like a, a provider can know all of this stuff, but how to actually treat it is the important piece here because you can know it, but then what do you do about it? exactly.
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So with our, with our treatment, we get an e, EG in office.
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And it's a wireless headset, so it only takes like 20, 30 minutes, not like two hours in the hospital.
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Right? and we get a compressed version of that information that we can kind of see what your alpha waves are doing or not doing, or if you're producing alpha waves and where they're at and how fast they're going and whether or not, you know, is the front part of the brain going as fast as the back part of the brain or vice versa.
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But also, you know, with our treatment.
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Because we know exactly where we're aiming, so to speak.
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We don't have to use the high amplitude that standard TMS does.
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So causes less headaches, almost no risk of seizure.
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We could treat right over the motor strip.
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So people with mild cerebral palsy or recovering from strokes can actually benefit in terms of motor coordination.
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and it help.
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What that person needs.
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So let's say you had depression and A DHD, then we'd focus our treatment here and here.
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You know, if, let's say you were recovering from a stroke, most of our treatment is gonna be focused on here.
325
00:27:32,702.0105331 --> 00:27:37,802.0105331
And so of liken our treatment to a sniper instead of a bomb blast.
326
00:27:37,802.0105331 --> 00:27:41,903.5105331
It's very specific and not a lot of collateral damage, right? Yes.
327
00:27:42,2.0105331 --> 00:28:06,74.9660987
Tell people, we're like why does this type of treatment work? Well, if we're trying to enhance a person's healthy alpha wave, what we're doing is we're stimulating your entire brain at that healthy alpha wave speed, which is different for you than it is for me, and that will cause the neurons that are going too fast to slow down the neurons are going too slow.
328
00:28:06,74.9660987 --> 00:28:07,883.7605431
Recruited to so.
329
00:28:08,397.0293946 --> 00:28:13,47.0293946
I liken it to let's go to the gym and only work out your right bicep 24 7.
330
00:28:13,47.0293946 --> 00:28:15,147.0293946
What has to get bigger? Your rib bicep.
331
00:28:15,147.0293946 --> 00:28:20,607.0293946
Now if you sit around and do absolutely nothing all day, your right biceps gonna be huge and everything else is gonna atrophy.
332
00:28:20,967.0293946 --> 00:28:21,777.0293946
And that's the point.
333
00:28:21,777.0293946 --> 00:28:26,637.0293946
We want to kind of knock out those guys that are too fast and causing anxiety.
334
00:28:26,907.0293946 --> 00:28:36,147.0293946
We wanna knock out those guys that are going too slow and causing depression or from concussion or from drug and alcohol use or from poor sleep, and we're gonna bring 'em back to your healthy.
335
00:28:36,777.0293898 --> 00:28:37,347.0293946
alpha wave.
336
00:28:38,283.5293946 --> 00:28:42,723.5293946
That's incredible and I'm not sure I entirely caught how that actually happens.
337
00:28:42,723.5293946 --> 00:28:53,585.6085244
How does the slow get sped up and the fast get slowed down? So, so we, magnetically stimulate your brain at different areas according to what your EEG says.
338
00:28:54,545.6085244 --> 00:28:55,92.1085244
Your it.
339
00:28:55,175.6085244 --> 00:28:57,995.6085244
So let's say Rachel, you had a speed of 10.8
340
00:28:57,995.6085244 --> 00:28:58,535.6085244
hertz.
341
00:28:58,595.6085244 --> 00:29:02,525.6085244
Okay? Then we are going to dial in the machine 10.8
342
00:29:02,525.6085244 --> 00:29:08,945.6085244
hertz at different locations in your brain that you might need so as to recruit all the neurons to go 10.8
343
00:29:08,945.6085244 --> 00:29:09,335.6085244
hertz.
344
00:29:09,335.6085244 --> 00:29:16,775.6085244
So that time that you fell out of a tree when you were 12 and the front part of your brain is going eight hertz, it's going to forcibly make it fire.
345
00:29:17,675.6085244 --> 00:29:18,605.6085244
At 10.8
346
00:29:18,605.6085244 --> 00:29:25,55.6085244
hertz while it's being stimulated, so it's not coaxing it or please do this, or I'll give you a cookie.
347
00:29:25,55.6085244 --> 00:29:25,565.6085244
If you do this.
348
00:29:25,565.6085244 --> 00:29:34,642.1085244
It's, no, it's forcibly requiring your brain to fire its neurons at that speed, whatever your speed is, That's incredible.
349
00:29:34,732.1085244 --> 00:29:35,632.1085244
That is incredible.
350
00:29:35,677.0955036 --> 00:29:40,447.0955036
just like physical training of the muscles, right, over time, you get stronger.
351
00:29:41,197.0955036 --> 00:29:45,877.0955036
the training starts increasing your metabolic capacity to do other things.
352
00:29:45,877.0955036 --> 00:29:49,687.0955036
Outside of that, in the training, you might notice, Hey, I can hop over a fence now.
353
00:29:49,687.0955036 --> 00:29:53,947.0955036
Or, Hey, I can kick butt at pickleball now and I couldn't get across before.
354
00:29:53,947.0955036 --> 00:29:56,257.0955036
Hey, now I can run laps with my kid.
355
00:29:56,257.0955036 --> 00:30:02,17.0955036
Or like, you couldn't do those things before you went to the gym and started running on the treadmill and started doing weight training.
356
00:30:02,17.0955036 --> 00:30:04,57.0955036
Right? Now, you can do other things.
357
00:30:04,207.0955036 --> 00:30:08,377.0955036
What happens is the brain sort of takes over healing itself after that period of time.
358
00:30:08,377.0955036 --> 00:30:09,37.0955036
You come in daily.
359
00:30:09,847.0955036 --> 00:30:11,767.0955036
through Friday for about six to eight weeks.
360
00:30:12,157.0955036 --> 00:30:13,897.0955036
More if you have multiple issues.
361
00:30:13,897.0955036 --> 00:30:18,7.0955036
But we do a repeat e, EG every week just to kind of see how the brain's responding to treatment.
362
00:30:18,7.0955036 --> 00:30:23,47.0955036
If we need to tweak it so it's moving in the right direction, we'll double down and keep doing what we're doing.
363
00:30:23,197.0955036 --> 00:30:26,47.0955036
If it's not, then we'll tweak something to try to push it forward.
364
00:30:26,407.0955036 --> 00:30:34,504.7777952
And so, but it's just like physical training in that we can see results in real time and it allows for the brain to kind of.
365
00:30:34,819.8949827 --> 00:30:36,349.8949827
it and run with it after the fact.
366
00:30:36,769.8949827 --> 00:30:42,319.8949827
We've seen frequently folks coming back for quarterly checkups, haven't had treatment.
367
00:30:42,709.8949827 --> 00:30:44,914.8949827
PDEG looks even better than the last time they left us.
368
00:30:46,224.8949827 --> 00:30:47,486.3949827
Isn't that That's incredible.
369
00:30:47,486.3949827 --> 00:30:47,876.3949827
Yeah.
370
00:30:47,876.3949827 --> 00:30:49,916.3949827
The body continues to heal over time.
371
00:30:50,156.3949827 --> 00:30:55,496.3949827
It sounds like it's a big, commitment upfront to be able to do this, but it's not long.
372
00:30:55,706.3949827 --> 00:31:00,386.3949827
Like, you know, 20, you said 20 to 30 minutes people can drive themselves, so it's doable.
373
00:31:00,404.8949827 --> 00:31:01,484.8949827
not, they're not impaired at all.
374
00:31:01,484.8949827 --> 00:31:01,684.8949827
So.
375
00:31:02,846.3949827 --> 00:31:03,416.3949827
Wonderful.
376
00:31:03,416.3949827 --> 00:31:04,61.3949827
And then I.
377
00:31:04,804.8949827 --> 00:31:14,734.8949827
for insurance to cover 36 treatments are the same as bravado, treatment resistant depression, tried and failed at least two different antidepressants and two different drug classes.
378
00:31:15,214.8949827 --> 00:31:23,404.8949827
Um, but obviously you could pay for it out of pocket as well if it's a matter of PTSD or OCD or concussion or other illnesses.
379
00:31:23,753.2219975 --> 00:31:32,303.2219975
Have you seen a difference in efficacy of ketamine versus uh, P-R-T-M-S, even though I know it's apples and oranges, but just in your anecdotal experience.
380
00:31:33,691.7219975 --> 00:31:39,541.7219975
So we've had a much higher rate of success with P-R-T-M-S, but acutely ketamine is the way to go.
381
00:31:39,541.7219975 --> 00:31:41,186.7219975
So if you have somebody who's actively suicidal.
382
00:31:41,866.7219975 --> 00:31:43,576.7219975
Or non-functional.
383
00:31:43,966.7219975 --> 00:31:48,436.7219975
Like I said, ketamine can be the thing that lifts 'em outta the abyss, but it does so temporarily.
384
00:31:49,246.7219975 --> 00:31:55,96.7219975
you can't wait, right? P-R-T-M-S, it might be a week or two before you start feeling better as opposed to a visitor two.
385
00:31:55,486.7219975 --> 00:32:06,466.7219975
And so if it's more of a chronic condition or you've already had the ketamine and you wanna kind of keep improving, it will help treat the initial issue, not just symptomatically.
386
00:32:07,448.2219975 --> 00:32:08,558.2219975
That makes so much sense.
387
00:32:08,558.2219975 --> 00:32:12,158.2219975
Really just depends on what's going on and what your needs are.
388
00:32:12,158.2219975 --> 00:32:13,748.2219975
But they both have tons of efficacy.
389
00:32:13,748.2219975 --> 00:32:20,408.2219975
I was about to say, we've had our highest rates of tests with PTSD because in certain areas of the brain, you're going both too fast and too slow.
390
00:32:20,408.2219975 --> 00:32:28,538.2219975
So you see the folks who have PTSD, who have the hypervigilance, who are always on guard, always waiting for the next danger to befall them, waiting for the other shoe to drop, and then.
391
00:32:28,898.2219975 --> 00:32:33,608.2219975
You'd only be hypervigilant for so long until your adrenals like give up the ghost and say, screw you clown, I'm outta here.
392
00:32:33,608.2219975 --> 00:32:35,18.2219975
And then you're depressed and you're nonfunctional.
393
00:32:35,18.2219975 --> 00:32:38,78.2219975
And so both the brain going too fast and too slow at the same time.
394
00:32:38,378.2219975 --> 00:32:51,158.2219975
We've had close to an 88% reduction in symptoms, Wow, and yeah, studies that a Texas show that like a side by side comparison with TMS and peer TMS, the.
395
00:32:51,158.2219975 --> 00:32:57,368.2219975
VA veterans with PTSD had a 20% reduction in trauma scores with a standard TMS over six weeks.
396
00:32:57,368.2219975 --> 00:33:02,824.7219975
And the PR TMS group had a reduction of 88% reduction in symptoms, trauma that's incredible.
397
00:33:03,728.2219975 --> 00:33:08,548.2219975
I know with depression anxiety, it's more the 70, 80% range, very similar to the ketamine.
398
00:33:09,118.2219975 --> 00:33:10,558.2219975
Um, with OCD, it's 50% or so.
399
00:33:11,254.1351643 --> 00:33:20,986.5488987
Why do you think this is not more widespread? P-R-T-M-S specifically? I believe because it's more of a grassroots scenario, like Dr.
400
00:33:20,986.5488987 --> 00:33:26,836.5488987
Murphy is more of a clinician than a researcher, and so he's been busy treating patients.
401
00:33:26,866.5488987 --> 00:33:34,756.5488987
He doesn't have mega bucks university funding, and he doesn't have like big pharma funding and all this other kind of good stuff.
402
00:33:34,756.5488987 --> 00:33:36,436.5488987
And so it's literally just been.
403
00:33:37,501.5488987 --> 00:33:44,971.5488987
Clinicians have seen, folks have seen, other doctors have seen, and they kind of get on board with it, and it's sort of like spread in that way.
404
00:33:45,391.5488987 --> 00:33:57,301.5488987
Um, but yeah, so many even clinicians in our area are like, wait, what are you doing? What is this? again, the, the biggest issue is, you know, we don't have big university dollars to market it and, and spread the word, but it's.
405
00:33:57,301.5488987 --> 00:33:59,551.5488987
Some of the coolest things I've ever seen.
406
00:33:59,641.5488987 --> 00:34:00,256.5488987
when Dr.
407
00:34:00,256.5488987 --> 00:34:12,451.5488987
Murphy showed me a video of his own son who, uh, is on the autism spectrum, going from non-functional and kind of being asked to not return to his school because of behavioral outbursts to being.
408
00:34:12,451.5488987 --> 00:34:19,141.5488987
A speaking, polite, socially appropriate individual who is now at university studying to be a mechanical engineer.
409
00:34:19,141.5488987 --> 00:34:20,941.5488987
I was like, holy crap.
410
00:34:21,678.0488987 --> 00:34:22,248.0488987
Wow.
411
00:34:22,381.5488987 --> 00:34:25,801.5488987
it, I was like, okay, I don't, I don't care what we have to do.
412
00:34:25,801.5488987 --> 00:34:29,641.5488987
We have to do this because it's, it's one of those situations where you feel like you're.
413
00:34:29,641.5488987 --> 00:34:33,871.5488987
Gonna be in the next wave of evolution of how things are treated.
414
00:34:33,961.5488987 --> 00:34:39,871.5488987
And for so long I feel like psychiatry was like, we've been throwing spaghetti at the wall and seeing what sticks.
415
00:34:40,321.5488987 --> 00:34:43,861.5488987
'cause the brain's sort of a big black box, right? And this is like, it's not it.
416
00:34:43,921.5488987 --> 00:34:47,701.5488987
We can see this is working, this is not, this is how we can tweak it.
417
00:34:47,701.5488987 --> 00:34:48,511.5488987
This is really cool.
418
00:34:49,418.0488987 --> 00:34:50,438.0488987
Oh, gives me the.
419
00:34:50,558.0488987 --> 00:34:50,888.0488987
Chills.
420
00:34:50,888.0488987 --> 00:34:57,698.0488987
It really is exciting stuff and even though it is not more widespread and widely available, it certainly is in Cincinnati, Ohio.
421
00:34:57,698.0488987 --> 00:35:03,908.0488987
And so I'm so appreciative that, uh, we could get the word out even more so people become even more aware.
422
00:35:05,669.2210501 --> 00:35:13,247.7210501
Is there anything else, that you wanna share about your practice or about the work that you do, that you want people to know about? Yeah.
423
00:35:13,247.7210501 --> 00:35:13,547.7210501
You know, we.
424
00:35:14,804.0917907 --> 00:35:17,204.0917907
We treat people like family, not another number.
425
00:35:17,204.0917907 --> 00:35:24,224.0917907
And it's part of the reason that I didn't wanna work for a big university outfit because I feel like you have to wait so long to be seen by the doctor.
426
00:35:24,224.0917907 --> 00:35:25,334.0917907
You have to get in with a therapist.
427
00:35:25,334.0917907 --> 00:35:27,344.0917907
And sometimes that can be months long wait.
428
00:35:29,339.0917907 --> 00:35:31,559.0917907
They don't remember anything about you anyway.
429
00:35:31,739.0917907 --> 00:35:39,629.0917907
And with us, you can typically get in to be seen in a couple weeks and you know, you have direct contact with your providers.
430
00:35:39,629.0917907 --> 00:35:46,568.9889417
It's me and two nurse practitioners, an infusion nurse, so depending, or uh, P-R-T-M-S tech, depending on which direction you go.
431
00:35:46,628.9889417 --> 00:35:48,856.0353662
But, You have access to us directly.
432
00:35:48,856.0353662 --> 00:35:54,796.0353662
You know, we can get back to you with your questions being answered, or medications being refilled in a day or two usually.
433
00:35:54,796.0353662 --> 00:36:01,366.0353662
And so because we're a small outfit, we really the time to get to know you and we care about you as individual.
434
00:36:01,366.0353662 --> 00:36:10,636.0353662
Our offices are set up like, kind of like a nice living room instead of cold clinical detached weirdness from the seventies.
435
00:36:10,636.0353662 --> 00:36:12,646.0353662
You know, have seen a number of those like.
436
00:36:13,233.5709613 --> 00:36:15,573.5709613
This orange upholstery from 1968.
437
00:36:15,573.5709613 --> 00:36:15,863.3518847
Cool.
438
00:36:15,863.3518847 --> 00:36:18,631.8518847
sounds like my clinical training, to our offices.
439
00:36:18,691.8518847 --> 00:36:20,183.3518847
Um, I can.
440
00:36:20,311.8518847 --> 00:36:26,641.8518847
So we, we do our best to try to maintain a warmer, friendlier, more humane environment.
441
00:36:27,638.3518847 --> 00:36:44,518.3518847
I couldn't agree more, having sent multiple loved ones your way to be able to make sure that they have the care that they need, and having participated in some of that care, I just, I cannot speak highly enough about you and the work that you do and the, the incredible service that you provide and yeah, I do believe.
442
00:36:45,193.3518847 --> 00:36:55,753.3518847
What you just described about people feeling like, they're treated like family and that you really care and that it's comfortable and really tuned in to people's needs and comfort level.
443
00:36:55,753.3518847 --> 00:36:57,223.3518847
I, I cannot say enough.
444
00:36:57,223.3518847 --> 00:37:07,423.3518847
And also I'm, I'm super interested in diving more into learning about P-R-T-M-S and getting the word out even more because ketamine, I mean, I'm already, that, that ship has already sailed.
445
00:37:07,423.3518847 --> 00:37:11,623.3518847
I am a complete cheerleader for what that medication, what that.
446
00:37:12,358.3518847 --> 00:37:14,98.3518847
What that medicine can do.
447
00:37:14,158.3518847 --> 00:37:22,978.3518847
But it's so cool to find new things that work and really dive in deep, but then we gotta make sure people know, which is why we're having this conversation right now.
448
00:37:22,978.3518847 --> 00:37:22,998.3518847
And I.
449
00:37:22,998.3518847 --> 00:37:23,598.3518847
Absolutely.
450
00:37:23,718.3518847 --> 00:37:27,558.3518847
And I love, I love too, like our whole staff is just the coolest.
451
00:37:28,998.3518847 --> 00:37:34,38.3518847
admin is so sweet and personable and kind and welcoming and friendly.
452
00:37:34,488.3518847 --> 00:37:39,918.3518847
And Brent, who does a lot of the ketamine and s bravado, uh, infusions and intranasal stuff.
453
00:37:39,918.3518847 --> 00:37:51,626.2861461
He sort of grew up at Children's Hospital so literally this guy could be falling raining down fire and he would say, we should probably find shelter relatively quickly.
454
00:37:51,678.3518847 --> 00:37:55,68.3518847
And that tone and cage is like nothing perturbs that man.
455
00:37:55,428.3518847 --> 00:38:07,428.3518847
And that's like the perfect, like you, you could be screaming, freaking out, nervous is all, get out and he'll just sit there, talk to you and hold your hand and be like, okay, we're good.
456
00:38:08,463.3518847 --> 00:38:09,963.3518847
If you need a few minutes, just let me know.
457
00:38:09,963.3518847 --> 00:38:11,13.3518847
I'll get you something to drink.
458
00:38:11,13.3518847 --> 00:38:15,879.8518847
And just like, I have felt that energy and I know exactly what you're talking about.
459
00:38:15,879.8518847 --> 00:38:22,659.8518847
And what a wonderful, uh, space holder, right? A person who can hold space to make sure that you're okay no matter what.
460
00:38:22,989.8518847 --> 00:38:26,199.8518847
Although hopefully people aren't screaming too much in your office.
461
00:38:26,913.3518847 --> 00:38:27,333.3518847
no.
462
00:38:27,333.3518847 --> 00:38:40,623.3518847
Every once in a blue moon, but no, we, we've had some, you know, nervous Nellie here, but you know, kind of unsure about what to expect and lots of anticipatory anxiety, right? Because you don't know us from Adam and you don't know is this safe, and you don't know what it's gonna feel like.
463
00:38:40,623.3518847 --> 00:38:43,443.3518847
And then after that first visit, they're like, oh, hey guys.
464
00:38:43,683.3518847 --> 00:38:45,749.8518847
You know? It's Yes, it's exactly.
465
00:38:45,873.3518847 --> 00:38:47,223.3518847
it normalizes things, you know.
466
00:38:47,814.8518847 --> 00:38:48,264.8518847
Yeah.
467
00:38:48,264.8518847 --> 00:38:52,824.8518847
And that's so important to feel comfortable, especially when you're gonna be coming back repeatedly for a while.
468
00:38:52,824.8518847 --> 00:38:55,644.8518847
But that does, I think, build so much comfort.
469
00:38:56,64.8518847 --> 00:39:02,684.8518847
Going from how nerve wracking it can be to start a new process, a new treatment process with new people in a new place.
470
00:39:02,684.8518847 --> 00:39:09,614.8518847
But I think people get over that very quickly with you guys because it just feels like, you know, oh, that's my family over there too.
471
00:39:09,614.8518847 --> 00:39:15,134.8518847
The ones who take really good care of me and make sure that I can get back to living my life in the way that I want to, which is the goal of all of this.
472
00:39:15,938.3518847 --> 00:39:17,978.3518847
Yeah, we're, we're very real.
473
00:39:17,978.3518847 --> 00:39:19,778.3518847
We don't put on a lot of errors.
474
00:39:20,74.8518847 --> 00:39:20,364.8518847
Yeah.
475
00:39:20,558.3518847 --> 00:39:23,768.3518847
What you see is what you get, which is really nice.
476
00:39:23,848.3518847 --> 00:39:26,848.3518847
I mean, we're professional obviously, but at the same time, it's like I.
477
00:39:26,848.3518847 --> 00:39:27,868.3518847
Kinda the golden rule.
478
00:39:27,868.3518847 --> 00:39:39,538.3518847
You know, if I were freaking out and if nothing had worked for me and I felt like whatever this treatment was, was my last hope and I'm coming to you freaking out, I'd be like, if you're calm, cool, collected, but friendly and warm and welcoming.
479
00:39:39,538.3518847 --> 00:39:41,578.3518847
I was like, okay, maybe things will be okay.
480
00:39:42,354.8518847 --> 00:39:43,44.8518847
Exactly.
481
00:39:43,284.8518847 --> 00:39:43,854.8518847
Exactly.
482
00:39:43,854.8518847 --> 00:39:47,454.8518847
And that's what we all deserve, is to be received in that way.
483
00:39:47,484.8518847 --> 00:39:56,934.8518847
And I am so appreciative that you've taken the time with me to explain all of this and share about yourself and your practice and the very important work that you're doing, and how can people find you.
484
00:39:57,754.3779587 --> 00:40:03,394.3779587
So you can find us online@www.andersonclinic.net.
485
00:40:03,844.3779587 --> 00:40:09,94.3779587
You can find my podcast wherever you listen to podcasts, apple iTunes, Spotify.
486
00:40:09,144.3779587 --> 00:40:10,884.3779587
We are called Psych Waves.
487
00:40:12,384.3779587 --> 00:40:20,514.3779587
if you are more of a social media person like Facebook or TikTok or Instagram, we are at Anderson Clinic, sensei with a Y.
488
00:40:20,874.3779587 --> 00:40:26,394.3779587
And if you're old fashioned and use the phone, you can call us at (513) 321-1753.
489
00:40:27,75.8779587 --> 00:40:27,945.8779587
Awesome.
490
00:40:27,945.8779587 --> 00:40:31,395.8779587
I, uh, appreciate all of that information and I love your podcast.
491
00:40:31,395.8779587 --> 00:40:37,665.8779587
Psych Waves has been so interesting and informative with all these different topics, so I can't recommend it enough.
492
00:40:37,665.8779587 --> 00:40:41,805.8779587
And thank you so much, Theresa, for taking the time to be here with me today.
493
00:40:41,855.8779587 --> 00:40:47,105.8779587
I have really enjoyed our time and sharing about the very important work that you're doing.
494
00:40:47,471.2295212 --> 00:40:48,485.8779587
So take good care.
495
00:40:48,534.3779587 --> 00:41:06,54.3779587
pleasure and it's always such a joy to meet with other people in this space who do something slightly different from what I do to know how we can help patients in different ways, but also how just on a personal level we can help each other literally with our extended families and friends.
496
00:41:06,54.3779587 --> 00:41:07,494.3779587
So that's, it's lovely to know.
497
00:41:08,240.8779587 --> 00:41:08,940.8779587
Exactly.
498
00:41:09,75.8779587 --> 00:41:20,190.8779587
I, I know that I have single handedly boosted your, I keep sending people your way, people in my personal life and my professional life because once you know that help is available and you trust.
499
00:41:21,100.8779587 --> 00:41:22,505.8779587
Yeah, another one of Rachel's.
500
00:41:22,685.8779587 --> 00:41:23,375.8779587
Exactly.
501
00:41:23,375.8779587 --> 00:41:28,265.8779587
So, um, I'm open as well if there's anyone in your life who I can help, who you work with.
502
00:41:28,265.8779587 --> 00:41:32,165.8779587
But really, truly just, I think what we have talked about today will help people.
503
00:41:32,285.8779587 --> 00:41:33,275.8779587
And so thank you.
504
00:41:33,275.8779587 --> 00:41:34,985.8779587
Thank you, thank you for your time.
505
00:41:35,309.3779587 --> 00:41:35,709.3779587
absolute pleasure.
506
00:41:36,331.3982955 --> 00:41:37,891.3982955
everyone, thank you for listening.
507
00:41:37,891.3982955 --> 00:41:39,721.3982955
I really appreciate your time as well.
508
00:41:40,51.3982955 --> 00:41:42,421.3982955
And, uh, until next time, take care.