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This week we are reaching back to our very first season to resurface a conversation that has stayed with us. And there is a reason we keep coming back to it. There are a lot of conversations about the mechanics of opening a ketamine clinic. This one is about the why behind it. Dr. Glareh Imani is a board-certified emergency physician who opened Nameen Infusion and Wellness in Goodyear, Arizona after more than eight years in emergency medicine. Her background in neuroscience, her personal experience with ketamine, and a deep sense of gratitude shaped the kind of clinic she built and the way she shows up for her patients every day. What makes this conversation stand out is how honest and human it is. Dr. Imani talks about the unexpected challenges of opening a clinic, the patient transformations that confirmed she had made the right choice, and the personal evolution that came with doing this work. She also reflects on autonomy, on what it means to finally be the one making the decisions, from clinical protocols to the waterfall in her reception area. Recorded at the ASKP3 conference in Austin, Texas during our first season, this episode holds up beautifully.  If you are considering the pivot from your current position, or if you are early in building your practice and need a reminder of why you started, this one is for you. What You'll Gain: · Dr. Imani's honest account of what it took to go from the idea of opening a ketamine clinic to actually delivering on it, including what surprised her most along the way · How her background in neuroscience and her personal experience with ketamine shaped both her decision to open a clinic and her approach to patient care · What set and setting actually means in the outpatient clinic context, and how Dr. Imani thinks about the environment she has created for her patients · Two patient stories that capture what ketamine therapy can do when it is delivered with intention and individualized care · What the transition from corporate emergency medicine to clinic ownership actually feels like, including the autonomy, the trade-offs, and the parts you cannot put a price on · How Dr. Imani balances running a clinic, working emergency medicine shifts, and family life, including what she says makes it all possible Episode 66 show notes: 00:00:00 Teaser: "I'm Happier Now Because I Know I Can Help in a Different Way" 00:00:18 Episode Introduction 00:02:03 Background: From Neuroscience to Emergency Medicine to Ketamine Therapy 00:06:13 Her Personal Ketamine Experience and the Decision to Open a Clinic 00:08:19 Unexpected Challenges and the Backup for Everything Rule 00:09:00 Ketamine in the Hospital vs. the Outpatient Clinic: Set and Setting 00:10:33 Safety Standards and Why EM Training Is an Advantage 00:13:00 Patient-Centered Care, Setting Expectations, and the Tools She Relies On 00:15:08 Advice to Her Past Self: Start Sooner and Do Not Do It for the Money 00:18:02 The Power of Autonomy and What Clinic Ownership Actually Feels Like 00:19:40 Personal Evolution: Mindfulness, Journaling, and Resetting Yourself First 00:23:21 Patient Stories: Transformation That Confirms the Decision 00:26:24 Balancing a Clinic, ER Shifts, Family Life, and Why Community Matters 00:28:40 Rapid-Fire Questions Begin 00:37:00 Time Travel: Being a Teenager in Vienna as a Refugee 00:38:22 Gratitude, Resilience, and the Gift of Helping Others 00:40:10 Final Thoughts and Where to Find Dr. Imani 00:40:54 Episode Ending Connect with Dr. Imani at: Nameen Infusion & Wellness website Nameen Infusion & Wellness Instagram 📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast

This Soundbite from the Vault packs three genuinely useful sections into one digestible clip, and each one stands on its own. It opens with something most emergency medicine physicians quietly wonder about before making the pivot: what does it actually feel like to work in a ketamine clinic after years of shift work?  Dr. Nico Grundmann, founder of Ember Health in New York and an emergency physician with an MBA from Stanford, gives a refreshingly honest answer. The schedule changes. The mental model changes. The relationships you build with patients are unlike anything the ER allows. And for the right person, all of that is exactly the point. The middle section pulls back the curtain on what patient care can actually look like. From the first call to the four-visit induction series to long-term maintenance care, Dr. Grundmann walks through the full patient journey at Ember, including their 84 percent real-world treatment response rate and why they believe the care coordination model is what drives it. It closes with the three things Dr. Grundmann would tell anyone opening their own ketamine practice. Not generic advice. Specific, hard-won pillars that have shaped how Ember operates across five New York City locations and more than 2,200 patients treated. What You'll Gain: · An honest account of what actually changes when you move from emergency medicine to a ketamine clinic, including the parts most people do not talk about before making the leap · Why care coordination takes up 30 to 40 percent of the day at Ember and what that means for EM physicians who are used to handing off at the end of a shift  · A clear picture of what the patient journey looks like inside a well-run ketamine practice, from first consultation through long-term maintenance care  · Why Ember's real-world treatment response rate of 84 percent outperforms the published academic data of 75 percent and what Dr. Grundmann believes is driving that difference  · The three pillars Dr. Grundmann would share with any provider opening their own ketamine clinic, built from years of operational experience across multiple sites Episode 65 show notes: 00:00:00 Teaser: "This isn't a role where you clock out and you're done." 00:00:13 Episode Introduction  00:01:25 What Is It Actually Like to Work in a Ketamine Clinic After Years of Shift Work? 00:03:20 Who Is a Good Fit: Longitudinal Care, Fixed Schedule, and Panel Management 00:05:00 For the Right Person It Checks Every Box: What the Fulfilling Version of This Work Looks Like 00:07:58 What Does the Patient Journey Actually Look Like from First Call to Treatment? 00:10:30 Real-World Treatment Response Data: 84 Percent at Ember vs. 75 Percent in Published Literature 00:12:33 Three Pieces of Advice for Anyone Opening Their Own Ketamine Clinic 00:14:36 Episode Ending  Thanks for listening Selected Links From the Episode: Want to go deeper? This soundbite comes from Episode 040 – Episode 40 - Scaling Ketamine Clinics: From Pilot to Five Locations with Dr. Nico Grundmann, where we cover the full conversation including how Nico built Ember from a one-room pilot site to five locations in New York City and the systems thinking behind all of it. Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

Clinical Disclaimer: This episode is for educational purposes for licensed healthcare professionals and is not individual medical advice. Ketamine and esketamine are not FDA‑approved for preventing or treating postpartum depression; any use in this population is off‑label and should be considered investigational and undertaken only with appropriate training, collaboration, and adherence to current standards of care. Postpartum depression affects roughly 10 to 20 percent of mothers and remains one of the most undertreated conditions in medicine. As public awareness of maternal mental health grows, providers in the ketamine and psychedelic therapy space are increasingly asking: is there a role for ketamine or esketamine here? This episode is our evidence-based answer to that question. We walk through the current clinical literature on ketamine and esketamine for perinatal depression, drawing on randomized controlled trials, meta-analyses, and expert commentary from institutions including the Center for Women's Mental Health at Massachusetts General Hospital. The research landscape is more nuanced than most providers realize, and understanding it clearly matters both for patient conversations and for how you think about your practice's scope. One distinction shapes everything that follows in this episode, and it's an important one: virtually all of the existing trial data involves perioperative prevention in cesarean delivery populations, not outpatient treatment of established postpartum depression. Knowing what the evidence actually supports and where the gaps remain is essential context for any provider working in this space. What You’ll Gain · A clear breakdown of what current ketamine and esketamine trials actually show for postpartum depression prevention, and what limited data exist for treatment. · An understanding of why racemic ketamine and esketamine tell different stories in the peripartum literature. · The key ethical and practical considerations for any provider thinking about this population. · An honest framework for how to talk with patients who ask about ketamine for postpartum depression. · Context on what the research gaps mean for where this field is heading. Review the research behind this episode, including full citations for every study discussed, in the Clinical References and Further Reading. 📖 Prefer to read? We turned this episode into a full blog post with structured tables comparing the racemic ketamine and esketamine evidence side by side, plus a research gaps summary you can reference and share with your team: Read the Blog Post Episode 64 show notes: 00:00:06 Episode Introduction 00:02:02 Clinical Context: Defining PPD, Postpartum Psychosis, and Perinatal Depression 00:03:34 Prevalence, Public Health Burden, and Why Cesarean Delivery Matters Here 00:04:40 Why Ketamine and Esketamine Are Conceptually Interesting in This Population 00:05:38 Prevention vs. Treatment: A Critical Framing Point Before the Research 00:06:32 Racemic Ketamine in the Peripartum Setting: Mixed and Conflicting Signals 00:09:22 What the Meta-Analyses Tell Us: Darwish et al. 2025 and Li et al. 2024 00:11:18 Bottom Line on Racemic Ketamine in the Peripartum Setting 00:12:05 Esketamine: Why It May Outperform Racemic and Why This Is Not About Spravato 00:13:32 The Esketamine Trials: From Early Signals to the 2024 BMJ Landmark Study 00:18:51 Treatment vs. Prevention: What About Established PPD? 00:21:29 Ethical and Practical Considerations 00:21:40 Lactation and Infant Exposure 00:22:14 Neurodevelopment Data: The Long-Term Unknown 00:22:35 Informed Consent in the Peripartum Period 00:23:04 The Tension Between Rapid Relief and Premature Clinical Adoption 00:24:10 Clinical Takeaways, Research Gaps, and What Cautious Optimism Looks Like in Practice 00:24:27 What the Evidence Supports: Esketamine Summary 00:25:23 What the Evidence Does Not Yet Support: Outpatient PPD Use 00:25:41 Bottom Line on Racemic Ketamine: Summary 00:26:07 Five Research Gaps the Field Needs to Address 00:27:56 What This Data Means for Ketamine Therapy Providers Right Now 00:30:03 Closing Remarks  Thanks for Listening 📝 For Complete show notes along with the the research behind this episode, including full citations for every study discussed, please visit http://www.ketaminestartup.com/podcast/episode-064

In this episode from the vault, we’re going back to when Sam gave a presentation at the American College of Emergency Physicians (ACEP) Scientific Assembly, making the case for why emergency physicians and clinicians are uniquely positioned to successfully practice in the ketamine therapy space. This is not a generic overview of ketamine. It is a frank, evidence-based conversation directed at clinicians who are feeling the weight of burnout, decreased autonomy, and a healthcare system that is asking more while giving less in return.  Sam walks through the science, the mechanism, the financial realities, and the deeper question of purpose that every provider should sit with before taking the leap. If you have ever wondered whether your emergency medicine training could translate into something more fulfilling, this episode makes a compelling and well-researched argument that it can. What You'll Gain: • A clear picture of the mental health and chronic pain crisis driving demand for ketamine therapy, and why the current standard of care is falling short for so many patients • A walk through the key clinical studies supporting IV ketamine for depression, anxiety, PTSD, and chronic pain, including the landmark 2023 New England Journal of Medicine trial comparing ketamine to ECT • An honest look at the mechanism of action behind ketamine therapy, from NMDA receptor antagonism to neuroplasticity and BDNF, explained in language that makes clinical sense • Why emergency physicians bring a uniquely transferable skill set to the ketamine therapy space, and how that advantage plays out in practice • The financial and emotional realities of running a ketamine clinic, including what Sam wishes more providers understood before they opened their doors • Why knowing your why is the single most important thing you can do before starting a ketamine practice, and how it will carry you through the inevitable hard moments Episode 63 show notes: 00:00:00 Teaser: "This is the why, the purpose, the motivation." 00:00:34 Episode Introduction and Overview 00:01:45 The Mental Health Crisis: Why This Work Matters Now 00:03:48 Burnout and the Changing Landscape of Emergency Medicine 00:04:43 Why EM Physicians Are Uniquely Positioned for Ketamine Therapy 00:05:02 The Clinical Evidence for Depression: From the Berman 2000 Study to the 2023 NEJM Trial 00:07:25 The Clinical Evidence for Anxiety: Dr. Paul Glue's Escalating Dose Study 00:08:20 The Clinical Evidence for PTSD: Single and Multiple Infusion Data 00:09:41 The Clinical Evidence for Chronic Pain: What Works and What Doesn't 00:10:55 Mid-Episode Ad: Free Ketamine Startup Checklist 00:11:44 How Ketamine Works: NMDA Receptor Antagonism and Glutamate 00:12:19 Multi-Receptor Action, Neuroplasticity, and BDNF 00:13:30 Beyond the Mechanism: The Experiential Dimension of Ketamine 00:14:40 The EM Skill Set Advantage: Clinical Experience, Procedures, and Scheduling Flexibility 00:15:24 Emergency Medicine Is a Mindset, Not a Location 00:15:53 Before the How, There Is the Why 00:16:39 The Toxic Waste Pool: A Story About Purpose and Motivation 00:17:23 The Financial Reality: Don't Open a Clinic for the Money 00:18:14 Why You Should Open a Ketamine Clinic: Purpose, Autonomy, and Saving Lives 00:18:55 Patient Testimonials: In Their Own Words 00:20:17 Outro Thanks for listening 🎥 Prefer to watch? This episode was originally a live conference presentation with slides covering the clinical studies, mechanisms of action, and other helpful visuals. The YouTube version brings all of that to life: Watch Episode 063 on YouTube 📖 More of a reader? We turned this presentation into a full blog post covering the clinical evidence, why your EM training is an unfair advantage, the financial reality nobody talks about enough, and what patients say when the treatment works: Read the Blog Post 📝 Complete show notes with resources and  links, please visit https://www.ketaminestartup.com/podcast/episode-063 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

Dr. Lowan Stewart is not just someone who opened a ketamine clinic. He is someone who built the infrastructure for an entire country to access it. In this conversation, Sam sits down with Dr. Stewart, an emergency physician who co-founded the first ketamine clinic in New Mexico in 2016, brought ketamine therapy to Norway two years later, established the first public ketamine treatment unit in Scandinavia, and played a central role in Norway becoming the first country in the world to approve national public reimbursement for off-label ketamine in treatment-resistant depression. What makes Dr. Stewart's story particularly resonant for our audience is how familiar the starting point will feel. An EM physician who loved his work but felt the limits of what emergency medicine could do for the river of suffering flowing through the department. A side project that became a calling. An uphill battle against institutional skepticism that most providers in this space will recognize immediately. He also brings a perspective on the future of psychedelic medicine that is worth hearing. His argument is straightforward: ketamine is not just a treatment. It is the infrastructure that will make everything else, psilocybin, MDMA, and what comes after, possible in clinical and public health settings. Getting ketamine right now is how the field prepares for what is coming next. This is a wide-ranging conversation covering career pivots, pioneering in resistant systems, the mechanics of moving a national healthcare system, and the daily reality of doing work that genuinely transforms lives. What you’ll gain: • The full arc of Dr. Stewart's career pivot from emergency medicine to ketamine therapy, including what pushed him toward something with more systemic and sustainable impact than the ER could offer • A firsthand account of what it actually looks like to be the first mover in a resistant healthcare system, from opening the first ketamine clinic in New Mexico to fighting a formal complaint from the Norwegian Psychiatric Association • How Dr. Stewart built the first public ketamine treatment unit in Scandinavia and the strategy behind getting ten major Norwegian hospitals to implement ketamine therapy simultaneously through a multi-site clinical trial • What Norway's landmark decision to become the first country in the world to approve national public reimbursement for off-label ketamine in treatment-resistant depression means for the global field and what other countries can learn from it • Why Dr. Stewart believes ketamine is not just a treatment but the infrastructure that will determine how ready clinical and public health systems are when psilocybin, MDMA, and other psychedelic medicines arrive • His honest reflection on why this work is worth it, including what it feels like to shift from focusing on the quantity of life in the ER to focusing on the quality of life in ketamine therapy Episode 62 show notes: 00:00:00 Teaser: "Once somebody says, 'I'm alive today because of this treatment,' you can't not do it." 00:00:24 Episode Introduction 00:02:19 Sam Welcomes Dr. Lowan Stewart 00:02:53 Background Overview: Emergency Medicine, Norway, and the Journey to Ketamine 00:08:56 Why Neuroscience: Starting an MD-PhD and the Rat Brains Advice 00:10:09 From Space Medicine Dreams to Emergency Medicine Reality 00:12:14 The Decision Point: Going Away from EM or Toward Something New? 00:15:37 Opening the First Ketamine Clinic in New Mexico: What the Ketamine World Looked Like in 2016 00:17:55 Bringing Ketamine to Norway: Opening Axon Clinic in 2018 00:20:06 Approaching the Norwegian Psychiatric Association and Health Department with the Data 00:26:40 Psychiatrist Skepticism: "I Don't Know What to Do with These Patients If They're Fine" 00:28:29 The Formal Complaint from the Norwegian Psychiatric Association 00:31:23 Establishing the First Public Ketamine Treatment Unit in Scandinavia 00:34:34 Axon Clinic's Acquisition by Awaken Life Sciences and the Ukraine War Impact 00:40:18 Norway's Landmark Approval: National Public Reimbursement for Off-Label Ketamine 00:44:20 The Multi-Site RCT Strategy: Implementing Ketamine Across Ten Major Norwegian Hospitals 00:50:17 Why Ketamine Gets Overlooked at Psychedelic Conferences and Why That Needs to Change 00:55:14 One Piece of Advice for Any EM Physician or Clinician Considering This Pivot 00:58:34 Rapid-Fire Questions 00:59:07 How Dr. Stewart De-Stresses: Cold Ocean Swims and Sauna in Norway 01:02:17 How to Connect with Dr. Lowan Stewart 01:04:03 Episode Ending Thanks for listening Connect with Dr. Stewart at: Clinic Website - Axonklinikken http://axon.no/  Email: [email protected] Linkedin: https://www.linkedin.com/in/lowan-stewart-27349616/ 📝 Complete show notes with resources and  links, please visit https://www.ketaminestartup.com/podcast/episode-062

In this Soundbite from the Vault, we're revisiting a carefully selected segment from a live conference presentation we gave to a room full of ketamine therapy specialists, walking through the exact marketing framework we've built and refined over the years. Not familiar with our Soundbites from the Vault? These are shorter, standalone segments from earlier episodes that we think are worth revisiting: easy to digest and immediately relevant to your practice. This one is a little different from our typical guest interviews. It's practical, visual, and built for providers who are doing their own marketing, outsourcing it, or using AI tools to help, and who want to understand the thinking behind it all. Because the framework matters regardless of who's doing the work. We cover the full ACC model: awareness, consideration, and conversion, breaking down exactly where every marketing effort you're making fits inside it. Then we get into organic content, what it actually is, how to create it sustainably without burning out, and our Venn diagram approach to figuring out what to talk about in the first place. And if you stay to the end, you'll hear why your clinic's online presence may be one of its most important vital signs. If your marketing has ever felt scattered, reactive, or disconnected from any real goal, this framework gives you the language and the structure to change that. What You'll Gain: · A clear understanding of the medical marketing funnel and how every marketing effort you make maps to one of its three layers: awareness, consideration, or conversion · The ACC framework explained through a relatable analogy that makes the patient journey easy to visualize and remember · A practical Venn diagram approach for figuring out what content to actually create, where what your patients want to know meets what is authentic to you · A simple content creation system that turns one video into a blog, social media posts, and micro content across platforms · Why your clinic's online presence is one of its most telling vital signs, and what asystole, bradycardia, and atrial fibrillation have to do with your Instagram account Episode 61 show notes: 00:00:00 Teaser: "What you want to be is in normal sinus rhythm…" 00:00:19 Episode Introduction 00:01:43 What Is the Medical Marketing Funnel and Why Should You Care? 00:02:08 The ACC Framework: Awareness, Consideration, and Conversion Explained 00:02:35 Awareness: How Patients First Discover You and What Content Helps Them Find You 00:03:45 Consideration: Why Patients Compare Their Options and How to Stand Out 00:04:24 Conversion: Making It Easy and Frictionless for Patients to Say Yes 00:05:13 Want More Patients? Start by Growing the Top of the Funnel 00:06:34 What Is Organic Content and How Is It Different from Paid Advertising? 00:07:58 The Venn Diagram: Finding the Sweet Spot Between What Patients Want and What's Authentic to You 00:08:14 What Your Patients Actually Want to Know 00:08:29 Why Authenticity Is What Turns Generic Content Into Content That Connects 00:10:00 From One Video to a Blog, Social Posts, and Micro Content: The Content Creation System 00:12:02 Is Your Clinic Asystolic? Why Organic Content Is One of Your Most Important Vital Signs 00:13:41 Episode Ending and Resources Thanks for listening Selected Links From the Episode: Want to go deeper? This soundbite comes from Episode 035 – The Medical Marketing Funnel for Ketamine Clinics, where we cover the full conversation including a deep dive into the newsletter as a standalone marketing tool for your practice. 🎥 The marketing funnel, the Venn diagram, and the organic content framework are all significantly easier to follow when you can see the slides. Check out the full Episode 035 on YouTube to watch the original presentation with all the visuals included: Watch Episode 035 on YouTube 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-061 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀 Want to fast track launching your ketamine clinic? If so, download our free checklist.

We're taking it a little easy in July, and in the spirit of that, we're launching something new: Soundbites from the Vault. These are shorter, standalone segments from earlier episodes that we think are worth revisiting, easy to digest, and immediately relevant to your practice. For our first soundbite, we're revisiting one of our favorite conversations from Episode 32 with Steve Gelberg, author of Tuning In: Experiencing Music in Psychedelic States.  Steve spent years researching the intersection of music and psychedelic-assisted therapy, and what he shares here has direct practical implications for how you're running your ketamine sessions. This segment gets into something most providers haven't thought deeply about: music isn't just filling the silence. It's doing active therapeutic work, from calming a patient's first fear response as ketamine comes on, to opening access to the subconscious material that makes treatment meaningful.  Steve also covers the practical side, including what types of music to use, why lyrics are generally a problem, and how to think about the classical versus ambient debate without getting dogmatic about it. If you've been using the same playlist since you opened, this one is worth 15 minutes of your time. What You'll Gain: · Why music and psychedelics share a unique therapeutic synergy rooted in how both interact with emotional and subconscious experience · How the right music can calm the ego's fear response during the onset of a ketamine session and support deeper therapeutic outcomes · Why lyrics are generally avoided during psychedelic-assisted therapy and what instrumental genres tend to work best · The case for neoclassical music as a middle ground between classical and ambient for ketamine sessions · How to think about patient-chosen music versus therapist-curated playlists, and why avoiding dogma matters more than finding the perfect answer Episode 60 show notes: 00:00:00 Teaser: "The right kind of music…” 00:00:33 Episode Introduction and Soundbites from the Vault Launch 00:01:32 The Shared Ontology of Music and Psychedelics 00:03:37 How Psychedelics Open the Emotional Sphere of Consciousness 00:04:41 The Unique Therapeutic Synergy Between Music and Ketamine 00:05:08 What Music Is Actually Doing at the Onset of a Ketamine Session 00:05:55 How Music Helps Surface the Root of Depression, Phobias, and Trauma 00:07:01 Music as an Ancient and Primal Human Tool: Lullabies and Soothing 00:08:25 The Case for Healing Female Voices in Psychedelic-Assisted Therapy 00:09:41 How to Choose Music for Ketamine Sessions: A Provider's Guide 00:10:23 The Classical vs. Ambient Debate: Origins and Context 00:11:36 Why Lyrics Are Generally Avoided During Ketamine Therapy 00:12:39 Neoclassical Music: The Best of Both Classical and Ambient 00:13:39 Avoiding Agitating or Overly Dramatic Music in Sessions 00:14:11 Patient-Chosen vs. Therapist-Curated Playlists 00:15:12 Why There Should Be No Dogma Around Music Selection 00:15:48 Episode Ending and Resources Thanks for listening 📝 Want Steve's exact playlists and a link to his book? Everything is in the show notes at https://www.ketaminestartup.com/podcast/episode-060#links

This week, host Sam Ko goes upstream from our usual clinical and business topics to sit down with Dr. Roberto Malinow, emeritus professor at UC San Diego, member of both the National Academy of Sciences and the National Academy of Medicine, and one of the world's leading researchers on synaptic plasticity and NMDA receptor biology. His work has been cited more than 30,000 times, and his recent perspective piece takes a very different view of what's actually happening during a ketamine infusion. The core of this conversation is his hypothesis that ketamine works by selectively weakening hyperactive brain circuits, but only the ones actively firing while the drug is on board.  It's a finding that raises some genuinely uncomfortable questions about the standard set and setting approach, and points to chronic pain treatment as a practical place to start testing these ideas clinically. You'll also hear about the brain's "disappointment center," the lateral habenula, and why it may be hyperactive in depression, the Stanford anesthesia study and what it suggests about brain activity during treatment, and a wide ranging look at consciousness, optogenetics, the gut-brain connection, and what basic science still doesn't fully understand about how psychiatric drugs work. What You'll Learn in This Episode · Revolutionary ketamine mechanism - How Dr. Malinow's hypothesis suggests ketamine works by weakening hyperactive brain circuits, but only when those specific circuits are actively firing during treatment · The disappointment center concept - Understanding the lateral habenula as the brain's disappointment center that inhibits dopamine and may be hyperactive in depression, serving an evolutionary purpose in reinforcement learning · Challenge to set and setting orthodoxy - How activating negative thoughts or painful experiences could possibly enhance therapeutic outcomes · Neuroplasticity fundamentals - How synapses can be rapidly modified and why NMDA receptors are crucial for both strengthening and weakening neural pathways, forming the basis for learning and memory · Rapid vs. delayed therapeutic effects - Why ketamine can work almost immediately while traditional antidepressants take weeks, and what this reveals about different mechanisms of action · Chronic pain treatment implications - How activating pain circuits during ketamine infusions might be more effective than current protocols, and why chronic pain could be the ideal testing ground for this hypothesis · Basic science translation - How laboratory findings about synaptic plasticity and NMDA receptors connect to real-world therapeutic applications in depression, PTSD, and pain management · Optogenetics technology - How scientists can now deliver light-sensitive proteins to specific neurons, allowing precise activation or inactivation of brain circuits to study behavior and memory · Memory manipulation research - Fascinating studies showing how specific memories can be turned on and off using targeted brain stimulation, with implications for trauma and addiction treatment · Consciousness and synaptic function - Exploring the complex relationship between individual neurons and higher-order brain functions, and why bridging these levels remains challenging Episode 59 show notes: 00:00:00 Teaser: Those hyperactive circuits… 00:00:24 Episode Introduction and Guest Overview 00:01:12 Sam Introduces and Welcomes Dr. Roberto Malinow 00:02:41 Background: From Reed College to The MD/PhD Path 00:05:17 Why Basic Science Won Out Over Clinical Medicine 00:06:06 The Lecture That Started It All: Professor Rodolfo Llinás and Synapses 00:06:51 How Ketamine Interacts with the NMDA Receptor 00:07:47 The "Disappointment Center": What the Lateral Habenula Does and Why It Matters in Depression 00:09:16 The Standard Set and Setting Approach in Outpatient Ketamine Clinics 00:10:12 The Three-Part Hypothesis: Neuroplasticity, Hyperactive Circuits, and Negative Thoughts 00:11:49 Written Exposure Therapy and PTSD: Priming Circuits Before the Infusion 00:12:53 Chronic Pain as the Easier Testing Ground for the Hypothesis 00:14:20 Activating the Pain Pathways During a Ketamine Infusion 00:17:23 The Anesthesia Study (Heifets/Stanford): Why the Brain Needs to Be Active 00:18:48 What Would a Human Study Design Actually Look Like? 00:20:41 Animal Study Evidence Supporting the Active-Stimulus Hypothesis 00:21:33 Zooming Out: Synapses, Consciousness, and the Shakespeare Analogy 00:23:18 Optogenetics Explained: Using Light to Control Specific Neurons 00:27:31 What Don't We Understand About Depression? 00:28:29 Lateral Habenula in Animal Depression Models and Dr. Malinow's Own Experiments 00:29:13 The Dystopian Scenario: Using Ketamine-Like Drugs to Wipe Out Ideas 00:31:31 Common Misconceptions Clinicians Have About Synapses 00:32:47 What Surprised Dr. Malinow Most About Studying Synapses 00:35:15 Why Ketamine Works Rapidly While SSRIs Take Weeks 00:37:30 The "Party Trick": Learning Is Neuroplasticity in Real Time 00:39:13 NMDA Receptors and Their Role in Learning and Memory 00:39:47 Optogenetics Research: Turning Fear Memories On and Off in Animals 00:42:08 Glutamate: 90% of Synaptic Transmission Explained 00:43:55 Synapses in the Gut: The Enteric Nervous System 00:45:58 The Gut-Brain Connection and Future Research 00:46:23 Papers Worth Reading in the Ketamine Space 00:47:50 The Psychedelic Renaissance: Psilocybin, the Disappointment Center, and What's Next 00:50:20 Could the Activation Hypothesis Apply to Psilocybin and MDMA as Well? 00:52:57 Rapid-Fire Questions Begin 00:53:19 Time Travel 00:54:19 Hidden Talent 00:54:48 Alternate Career 00:55:42 Advice to 18-Year-Old Roberto 00:56:29 Final Thoughts and Call to Action for Clinicians 00:57:00 Where to Find Dr. Malinow's Research (UCSD Website) 00:57:40 Sam's Closing Remarks 00:58:32 Episode Ending Thanks for listening Connect with Dr. Malinow: Website: https://biology.ucsd.edu/research/faculty/rmalinow Email: [email protected] 📝 Complete show notes with resources and  links, please visit https://www.ketaminestartup.com/podcast/episode-059 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this conversation, Dr. Marc Smith shares his journey from hedge fund trading in New York's financial district to building an integrated ketamine psychiatry practice in California.  After three years in finance doing trading and sales, Dr. Smith made the bold decision to completely pivot his career toward medicine, driven by a desire for purpose and meaning that his financial career couldn't provide. Dr. Smith's path took him through Columbia University for medical school, followed by psychiatry residency at USC, where he discovered his passion for interventional treatments like TMS and ketamine therapy.  His unique perspective, having worked in both profit-maximizing finance and purpose-driven healthcare, provides valuable insights into the challenges of maintaining ethical medical practice in an increasingly commercialized healthcare environment. Dr. Smith's practice, Clear Ketamine + Psychiatry, represents an integrated model where he personally handles psychiatric evaluation, preparation therapy, ketamine treatment administration, and post-treatment integration sessions. What You'll Learn in This Episode · Career transition insights - How Dr. Smith navigated the complete pivot from finance to medicine, including the challenges and rewards of choosing purpose over profit in healthcare · Mental health crisis analysis - Dr. Smith's perspective on factors contributing to rising depression, anxiety, and suicide rates, including social isolation, technology impacts, and healthcare access barriers · Treatment-resistant depression understanding - Why 30% of patients don't respond to traditional antidepressants and how ketamine offers a different mechanism through NMDA receptor antagonism and neuroplasticity induction · Integrated practice model - Dr. Smith's unique approach combining psychiatric evaluation, preparation therapy, ketamine administration, and integration sessions all under one provider rather than outsourcing components · Intentions versus goals framework - How to help patients set internal emotional states they're striving for (intentions) alongside specific, measurable functional outcomes (SMART goals) for comprehensive treatment planning · Ketamine as catalyst concept - Understanding how ketamine works like "jumpstarting a car" to improve mood and motivation, while ongoing therapy and lifestyle changes provide the maintenance needed for sustained improvement · Ethical practice building - Dr. Smith's mission to combat ketamine stigma through evidence-based protocols while addressing concerns about recreational associations and inappropriate use in the field · Private practice autonomy benefits - How owning your own practice allows values-driven decisions that may conflict with profit maximization, contrasting with private equity-driven healthcare models · Business building practical advice - The importance of talking to other practice owners, understanding it's a marathon not a sprint, and knowing your limitations to outsource effectively · Biopsychosocial treatment approach - Addressing biological, psychological, and social elements of mental health through medications, therapy, exercise, sleep, nutrition, social connection, and nature exposure Episode 58 show notes: 00:00:00 - Teaser: Profit vs. Purpose in Healthcare  00:00:35 - Episode Introduction 00:02:03 - Dr. Smith's Background: From East Coast to Medicine  00:02:30 - Career Transition: Three Years in Financial Industry  00:04:12 - Discovering Psychiatry Through Clinical Rotations  00:05:32 - Why Psychiatry: Deep Relationships and Human Connection 00:08:50 - Tools in the Toolbox: TMS, Ketamine, and Treatment Options  00:09:30 - The Leap: Stepping Away from Finance Success  00:11:17 - The Marble Metaphor: Chiseling Away What We Aren't  00:12:46 - Self-Actualization and Gratitude in Medicine  00:14:01 - USC Residency and Academic Reception of Ketamine  00:16:54 - Evidence-Based Medicine and the Slow Pace of Change  00:19:17 - Mental Health Crisis: Social Isolation and Technology  00:22:50 - The Invisible Nature of Mental Health Challenges  00:25:28 - Private Equity vs. Patient Care: The Business Tension  00:30:18 - Private Practice Autonomy and Values-Based Decisions  00:32:15 - Clear Ketamine + Psychiatry: The Integrated Model  00:36:11 - Treatment Protocol: Six Sessions with Therapy Integration  00:37:56 - Ketamine as Jumpstart: The Car Analogy  00:42:00 - Intentions vs. Goals: Internal States and SMART Outcomes  00:46:30 - Ethical Standards and Combating Ketamine Stigma  00:50:15 - Practice Building Advice: Talk to Other Providers  00:52:55 - Rapid Fire Questions: Book Recommendation  00:54:52 - Last Meal  00:55:52 - Pickleball Obsession and the Philosophy of the Game  00:56:50 - Time Travel 00:58:46 - Alternative Career 01:00:04 - Advice to 20-Year-Old Self 01:01:53 - Contact Information and Practice Details  01:03:03 - Final Thoughts: Gratitude and Evidence-Based Care  01:04:20 - Ending and Resources Thanks for listening Connect with Dr. Marc Smith at: Website: https://www.clearketapsych.com Instagram: @clearketapsych, @marcsmithmd LinkedIn: www.linkedin.com/in/marcsmithmd Google Maps: https://maps.app.goo.gl/GCHVy8q183c7WvfLA 📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-058 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this conversation, Dr. Michelle Weiner shares her evolution from chief resident in interventional pain medicine to pioneering integrative practitioner who treats chronic pain through a biopsychosocial-spiritual lens. Double board-certified in Interventional Pain Medicine, Physical Medicine, and Rehabilitation, Dr. Weiner reveals why traditional procedure-focused approaches often fail chronic pain patients and how she discovered more effective ways to create lasting healing. Dr. Weiner's journey started with her background in nutritional science and athletics, leading her through physical medicine and rehabilitation before specializing in interventional pain. But day after day of performing procedures without truly connecting with patients left her frustrated and seeking deeper solutions. Her introduction to medical cannabis as chair of Florida's advisory committee opened her mind to personalized medicine and treating the whole person rather than just diagnosis codes. You'll hear about her unique approach to fibromyalgia, which she reframes as "central sensitization" to empower rather than limit patients. Dr. Weiner explains how trauma and adverse childhood experiences prime the nervous system for hyperreactivity, leading to chronic pain that becomes centrally mediated rather than structurally based. Her practice now integrates cannabis protocols, ketamine therapy, and comprehensive team-based care to address the root causes of both physical and emotional pain. Dr. Weiner also shares her personal ketamine experience during training, including a profound vision that later manifested in real life, demonstrating the spiritual dimension she now incorporates into treatment. You'll also hear practical insights about building an integrative practice, the importance of set and setting, and why true healing requires addressing the person with the diagnosis, not just the diagnosis itself. What You'll Learn in This Episode · Career transition insights - How Dr. Weiner evolved from high-volume interventional procedures to relationship-based integrative medicine and why she felt traditional approaches were "stringing patients along" · Central sensitization framework - Why she avoids the term "fibromyalgia" and instead explains central sensitization to empower patients and create hope rather than diagnostic limitations · Biopsychosocial-spiritual model - How incorporating the spiritual dimension creates awe-like effects and connections that traditional medicine misses, supported by neuroscience research · Medical cannabis integration - Her role on Florida's Medical Cannabis Advisory Committee and how cannabis opened conversations about personalized medicine and treating individual endocannabinoid systems · Trauma's role in chronic pain - How adverse childhood experiences and physical trauma prime the nervous system for hyperreactivity and chronic pain development · Practice building strategies - Practical advice about insurance credentialing, marketing to other providers, creating therapeutic environments, and building multidisciplinary teams · Set and setting importance - Why the physical environment, staff training, and patient preparation are crucial for maximizing ketamine therapy outcomes · Patient education approaches - How she explains that healing happens during the neuroplastic window after ketamine, not during the infusion itself, and why "more is not better" · Team-based care model - Working with coaches, therapists, and specialists trained in pain reprocessing therapy and somatic approaches to support comprehensive healing Episode 57 show notes: 00:00:00 - Teaser: Heart-Forward Medicine and True Passion  00:00:19 - Introduction and Dr. Weiner's Background Overview 00:02:00 - Educational Journey: From Nutrition Science to Pain Medicine  00:05:13 - Colleague Reactions to Non-Traditional Approach 00:08:37 - The Pivotal Moment: From Procedures to Purpose  00:11:04 - Cannabis Integration and Personalized Medicine Discovery  00:13:43 - Biopsychosocial Model and Pain Neuroscience Education  00:17:09 - Trauma Patterns and Chronic Pain Development  00:19:54 - Reframing Fibromyalgia as Central Sensitization  00:23:54 - Adding the Spiritual Dimension: Biopsychosocial-Spiritual Model  00:29:07 - Personal Ketamine Experience and Training Story  00:34:22 - Practice Building: From Employee to Business Owner  00:38:18 - Set and Setting: Creating Therapeutic Environments  00:41:48 - Patient Misconceptions and Education Strategies 00:47:08 - Rapid Fire Questions:  00:53:55 - Advice to 18-Year-Old Self 00:55:34 - Final Thoughts: Pain Complexity and Nervous System Healing  00:56:32 - Contact Information and Practice Locations  00:57:29 - Ending and Show Resources Connect with Dr. Weiner at: Website: www.drmichelleweiner.com LinkedIn: https://www.linkedin.com/in/michelle-weiner-do-mph-276b34b9 Facebook: https://www.facebook.com/drmichelleweiner/ 👉 Disclosure: Some of the links in these show notes are affiliate links. If you choose to make a purchase through them, we may earn a small commission at no additional cost to you. Thanks for supporting the podcast! Selected Links From the Episode: 📕The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk M.D.  📘The Awakened Brain: The New Science of Spirituality and Our Quest for an Inspired Life by Lisa Miller. 📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-057 Follow us on LinkedIn Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this news roundup episode, we're covering four major developments that have emerged in recent months, all pointing toward increased accountability and oversight in the ketamine and psychedelic therapy space. This isn't our typical interview content - it's breaking news analysis that every provider in this community needs to understand. We start with the final chapter of the Matthew Perry case, where Jasveen Sangha, known as the "Ketamine Queen," received a 15-year federal prison sentence, while Dr. Salvador Plasencia was sentenced to 30 months for distributing ketamine outside proper medical supervision.  Then we cover France becoming the first country to formally authorize IV racemic ketamine for adults in severe suicidal crisis, with rigorous hospital-based protocols that raise the bar for clinical standards globally. We continue with updates on Texas Medical Board's proposed ketamine regulations moving toward mandatory clinic registration and stricter oversight, followed by analysis of President Trump's executive order accelerating psychedelic research and creating new federal pathways for investigational compounds.  We wrap up by connecting all four stories to show how legal consequences, international standards, state regulations, and federal policy are collectively signaling that oversight conversations are now happening at the highest levels of government and the field is entering a new era of accountability. What You'll Learn in This Episode · Legal accountability implications - How the Matthew Perry case sentencing creates new precedents for physician responsibility when ketamine treatment moves outside supervised clinical settings · International standards development - France's groundbreaking authorization of IV racemic ketamine for suicidal crisis and what their rigorous hospital-based protocols mean for global treatment standards · State regulatory evolution - Current status of Texas Medical Board's proposed ketamine regulations, including mandatory clinic registration and enhanced oversight requirements moving toward a June 2026 vote · Federal policy landscape changes - Analysis of Trump's executive order accelerating psychedelic research access and what new federal pathways mean for the broader psychedelic therapy field · Clinical framework implications - How France's high-surveillance psychiatric intervention model differs from wellness-oriented approaches and why this distinction matters for field credibility · Oversight trends analysis - Why legal consequences, international standards, state regulations, and federal policy are all pointing toward increased accountability requirements for providers · Risk assessment insights - Understanding where legitimate treatment can break down and how unmonitored use creates legal and ethical liability that traces back to prescribing physicians · Future preparation strategies - What these four developments collectively signal about where field standards are heading and how providers can prepare for increased scrutiny Episode 56 show notes: 00:06 Episode Introduction 01:28 Matthew Perry Case: The Final Sentence 03:47 France Authorizes IV Ketamine for Suicidal Crisis 07:03 Texas Medical Board Update: PKT Rules Still Pending 08:37 Trump Executive Order: Federal Fast-Track for Psychedelic Therapy 10:43 The REMS Advantage: What Regulatory-Ready Looks Like 12:34 Final Thoughts Thanks for listening Selected Links From the Episode: 📖Prefer to read? Check out our related blog post: Ketamine Therapy Regulations Spring 2026: Perry Sentencing, Texas Rules, France Authorization, and Federal Policy Shifts 🎧Listen to the full story about what’s about to happen in Texas: Episode 049 - Texas Medical Board Proposes Comprehensive Ketamine Therapy Regulations - What It Means for the Industry 📋Episode references and sources 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-056 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this conversation, Dr. Ruchir Gupta shares his unconventional journey from established anesthesiologist to successful pain medicine entrepreneur. After 10 years of practicing anesthesia, he made the bold decision to return for a pain fellowship at Mayo Clinic, where he was older than most of his attendings. Dr. Gupta's story shows how strategic career reinvention can create competitive advantages in medicine. By combining his decade of anesthesia experience with pain medicine fellowship training, he identified a market opportunity that others overlooked: IV ketamine therapy for chronic pain patients. While other pain physicians were hesitant to offer ketamine infusions due to unfamiliarity with anesthetic protocols, Dr. Gupta's background made him uniquely qualified to bridge this gap. You'll hear about how his specialized fibromyalgia protocols achieves 80% success rates, his insights about monitoring standards including the "fifth vital sign" of proper patient follow up, and practical business advice about overcoming analysis paralysis. Dr. Gupta's journey from zero to building Mountain View Headache and Spine Institute offers valuable lessons for any medical professional considering practice ownership or career reinvention. His approach challenges common physician assumptions about entrepreneurship and shows how leveraging existing skills can lead to practice success. What You'll Learn in This Episode · Career reinvention strategy: how Dr. Gupta leveraged his anesthesia background to differentiate his pain practice and why returning to fellowship training became a competitive advantage rather than a setback · Physician entrepreneurship barriers: why medical professionals create mental obstacles around private practice that dentists, chiropractors, and other healthcare providers don't experience, and how to overcome this mindset · Clinical monitoring standards: detailed recommendations for ketamine infusion monitoring, including the importance of continuous EKG, pulse oximetry, and blood pressure monitoring for longer pain protocols · The "fifth vital sign" concept: why proper patient follow up and outcome measurement are essential for maintaining medical credibility and avoiding the "med spa" trap in ketamine therapy · Business development approach: practical strategies for practice growth including LinkedIn networking, physician education sessions, and building referral relationships with skeptical providers · Cross-disciplinary medicine benefits: why Dr. Gupta believes future physicians should combine multiple specialties or degrees to offer integrated approaches and differentiated services · Pain and mood disorder integration: clinical insights about treating patients with concurrent chronic pain and depression, including combination Spravato and ketamine protocols 📋 Professional Education Disclaimer: Content for licensed healthcare providers for educational purposes only. Does not constitute medical, legal, or business advice. Always consult qualified professionals for specific clinical and practice decisions. Key Takeaways · Reinvention requires strategic thinking, not just courage. Dr. Gupta's success came from identifying how his anesthesia background created competitive advantages in pain medicine, particularly with ketamine therapy that other providers avoided. · Physician mindset creates artificial entrepreneurship barriers. Unlike dentists and chiropractors who routinely start private practices, physicians have developed cultural resistance to entrepreneurship that isn't based on actual capability or market realities. · Clinical differentiation drives practice success. By offering IV ketamine when other pain doctors wouldn't, Dr. Gupta created a unique market position that generated demand for both ketamine services and traditional pain procedures. · Fibromyalgia responds differently than other conditions. His 80% success rate comes from recognizing that fibromyalgia requires different protocols than CRPS or depression, using shorter duration but potentially higher dose infusions. · Safety standards must match treatment complexity. Longer pain infusions require more comprehensive monitoring than depression protocols, including but not limited to continuous EKG and regular blood pressure checks every 15 minutes. · The "fifth vital sign" prevents med spa perception. Proper patient follow up with objective outcome measures maintains medical credibility and guides treatment decisions. · Cross-training creates competitive advantages. Combining anesthesia experience with pain medicine training allowed Dr. Gupta to offer services that single-specialty providers couldn't safely provide. · Business planning overcomes analysis paralysis. The hardest step is going from zero to one. Once you start a business plan, even imperfectly, the momentum builds and subsequent decisions become easier. · Multiple marketing channels compound results. Success came from combining LinkedIn professional networking, direct physician outreach, literature sharing, and educational presentations rather than relying on single strategies. Episode 55 show notes: 00:00:00 - Teaser: The Physician Mindset Problem 00:00:31 - Episode Introduction 00:02:14 - Dr. Gupta's Background 00:02:34 - Education: From Political Science to Choosing Anesthesia 00:06:14 - The Decision to Pursue Pain Fellowship 00:08:23 - Fellowship Experience: Being Older Than Attendings 00:09:51 - Turning Setback into Asset: The Ketamine Opportunity 00:13:21 - Starting Mountain View Headache and Spine 00:16:59 - The Physician Entrepreneurship Mindset Problem 00:21:37 - Building Referral Relationships and Practice Growth 00:25:18 - Pain Fellowship Training: What's Missing 00:29:35 - Fibromyalgia Protocols and Success Rates 00:34:27 - Pain vs Mood Disorder Treatment Approaches 00:36:17 - The "Fifth Vital Sign" and Medical Standards 00:40:45 - Monitoring Standards and Safety Considerations 00:50:06 - Business Planning: From Zero to One 00:54:17 - Marketing Strategies That Actually Work 00:56:05 - Rapid Fire Questions: What's on Your Desk 00:57:42 - Relaxation and Pickleball with His Son 00:58:04 - Hidden Talent: Writing Historical Fiction 00:59:22 - Time Travel: Ancient Rome 01:01:04 - Alternative Career: Finance and Building Businesses 01:01:28 - Contact Information 01:02:04 - Final Thoughts and Show Resources Thanks for listening 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-055 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

🚨 Content Warning: This episode contains discussions about mental health challenges including suicidal ideation, psychedelic substances from cultural and therapeutic perspectives, and occasional strong language. Listener discretion is advised, as some content may not be suitable for all audiences. Please prioritize your well-being while listening. If you or someone you know is struggling with mental health challenges, the 988 Suicide & Crisis Lifeline provides free, confidential support 24/7. Call or text 9-8-8 to connect with trained crisis counselors. In this unique episode, we step outside our usual clinical focus to gain a cultural insider's perspective on how psychedelic therapy is perceived in the broader public consciousness. Comedian Shane Mauss brings an invaluable viewpoint as someone who has been immersed in psychedelic culture since 2016, touring extensively and observing how public attitudes have evolved around these treatments. Shane offers a cultural timeline of how psychedelic perception shifted from 2004 when even mentioning mushrooms on stage was taboo, through the Michael Pollan watershed moment in 2017, to today's complex landscape where ketamine therapy exists alongside telehealth services, recreational use, and the lingering effects of celebrity deaths on public perception. Drawing from his years of cultural immersion and personal experience, he provides insights that help clinicians understand the broader context their patients are navigating. This conversation covers the cultural challenges ketamine providers face in a world where recreational and therapeutic ketamine coexist, where anesthesiologists are questioned about their legitimacy in the therapy space, and where the Matthew Perry tragedy continues to influence public perception. Shane shares his personal ketamine treatment experience and explains his perspective on why ketamine serves as the best "first psychedelic experience" for most people. Perhaps most valuable for providers, Shane offers crucial insights about maintaining scientific rigor in an industry increasingly influenced by wellness culture hype, emphasizing the critical difference between evidence-based practitioners who hedge their bets and wellness influencers who make unfounded claims. What You'll Learn in This Episode · Cultural evolution timeline - Shane's firsthand observations of how psychedelic perception shifted from 2004 taboo through Michael Pollan's 2017 cultural impact to today's medicalization era · Public perception landscape - The complex cultural context your patients navigate, from recreational associations to celebrity death fears to wellness industry hype · Recreational vs clinical disconnect - How street users avoiding K-holes while clinicians may seek deep therapeutic experiences can create public confusion about treatment goals · Shane's personal ketamine journey - His first clinical session and why it surprised him after 21 years of psychedelic experience · Industry disruption insights - How telehealth ketamine services changed the landscape around 2022-2023 and created new competitive dynamics · Celebrity death impact analysis - Shane's perspective on how the Matthew Perry tragedy creates disproportionate fear around statistically safe treatments · Science vs wellness culture - The crucial distinction between evidence-based practitioners and influencers, and why scientific humility builds long-term trust · Rapid intervention advantages - How ketamine's acute treatment capability makes it valuable for interrupting emerging mental health episodes · Evolutionary psychology perspectives - Shane's exploration of why modern isolation amplifies ancestral mental health mechanisms and creates therapeutic opportunities Episode 54 Show Notes 00:00:00 - Teaser: Science vs Wellness Hype 00:00:40 - Introduction and Content Warning 00:02:27 - Shane's Background and Comedy Journey 00:05:30 - The Evolution of Standup Comedy 00:08:00 - Psychedelic Culture Timeline: 2004-2026 00:13:00 - Michael Pollan's Cultural Impact 00:18:00 - Current Public Perception of Ketamine Therapy 00:24:22 - Shane's Personal Ketamine Experience 00:35:06 - Ketamine vs Classical Psychedelics 00:38:00 - Default Mode Network and Suicidal Ideation 00:46:33 - Evolution of Depression and Modern Society 00:54:32 - Advice for Clinicians: Education and Ethics 01:02:24 - Rapid Fire Questions 01:09:30 - Evolutionary Purpose of Altered States 01:14:30 - Shane's Projects and Where to Find Him 01:20:14 - Episode Wrap-up and Resources Thanks for listening Connect With Shane Mauss: · Shane’s Website - check for a live show near you! · Here We Are Podcast · Instagram · Youtube Trips Comedy Specials: · First Dose (Full Comedy Special) · Second part of Trips 4/19 Youtube May 19th 📝 Complete show notes with resources and links, please visit www.ketaminestartup.com/episode-54 Follow us on LinkedIn Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In Part 2 of our conversation with Charles Miller from Scenic City Neurotherapy, we get into the practical side of his controversial "collective lie" thesis from Part 1. Charles walks through his MSKIT (Minimally Stimulated Ketamine Infusion Therapy) approach, explaining when he believes therapeutic integration should actually happen: weeks after treatment during the neuroplasticity window, not during altered states. He addresses how he manages patient expectations around epiphanies and insights, arguing these are retrospective brain noise rather than therapeutic mechanisms. You'll hear Charles use memorable analogies—from cheese obsessions to rollercoaster highs—to explain why he believes the psychedelic experience itself isn't doing the heavy lifting. He makes the case that ketamine is upgrading synaptic function, not providing mystical cures, and that the real work happens when patients are sober and doing therapy afterward. Through detailed audio sidebars, we explore the crucial relationship between BDNF and sleep (and why post-treatment rest matters more than most clinics acknowledge), and examine the metabolite pathway that creates ketamine's addiction potential. Charles also shares his vision for the future of ketamine therapy, advocating for greater scientific rigor and proper medical oversight while critiquing the growing trend of unqualified providers administering ketamine. If you're questioning whether the approaches many of us have been using actually serve our patients best, this conversation will give you a lot to think about. What You'll Learn in This Episode · Patient education strategies - How to remove performance pressure by explaining "you can't make this work better or worse" and framing treatment as physiology, not psychology · Managing epiphanies and insights - Charles's perspective on why experiences are retrospective brain noise rather than therapeutic mechanisms, and how to validate without overemphasizing · BDNF and sleep optimization - The critical relationship between post-treatment sleep quality and neuroplasticity consolidation that many clinics overlook · Ketamine's addiction pathway - Understanding the hydroxynorketamine metabolite mechanism and why "more is not better" with dosing protocols · Pain protocol applications - How he incorporates NAD, lidocaine, magnesium, and anti-inflammatories for comprehensive chronic pain treatment · Future field vision - Charles's call for greater scientific rigor, proper medical oversight, and evidence-based protocols over speculative experiential approaches Key Takeaways · Therapeutic integration may be more effective up to weeks after ketamine treatment when the neuroplasticity window is active, rather than during altered states when processing capacity is diminished · Patient education could focus on removing performance pressure by explaining ketamine as physiological process rather than psychological work, helping patients understand "you can't mess this up" · Ketamine experiences might be retrospective rather than revelatory, reflecting existing knowledge without noise rather than generating new insights, which suggests focusing on post-treatment integration work · Sleep quality in days following ketamine treatment could significantly impact neuroplasticity consolidation, as BDNF release during rest helps lock in synaptic changes initiated by treatment · Ketamine's addiction potential may stem from the hydroxynorketamine metabolite binding to opioid receptors at high doses, supporting protocols that emphasize "more is not better" dosing approaches · Mental health symptoms might represent accurate emotional responses to synaptic dysfunction rather than diseases themselves, with ketamine enhancing processing speed and accuracy rather than changing brain content · Providers could benefit from understanding ketamine's "dirty drug" pharmacology, including sodium channel blocking effects that contribute to dissociation and can be addressed with targeted adjuncts like lidocaine Episode 53 show notes: 00:00:00 - Teaser: This Is Not Magic, This Is Science 00:00:17 - Introduction and Part 2 Setup 00:01:54 - When Therapy Should Actually Happen: Physical Therapy Doesn't Occur During Surgery 00:02:48 - Optimal Timing for Therapeutic Integration: The Weeks That Follow Treatment 00:05:31 - The Science Behind Post-Treatment Rest: BDNF Release and Sleep 00:07:25 - Audio Sidebar: BDNF and Sleep Connection 00:09:29 - Managing Patient Epiphanies: The Cheese Story and Brain Noise 00:13:30 - Mental Health as Synaptic Processing Speed 00:16:45 - Why Experience-Driven Treatment Would Require Daily Ketamine 00:18:04 - MSKIT Protocol: Minimally Stimulated Ketamine Infusion Therapy 00:22:12 - Minimally Stimulating Environment: Binaural Beats and Brain Noise 00:25:30 - Pain Protocols and the "Dirty Drug" Concept 00:26:57 - Audio Sidebar: Ketamine's Metabolite Addiction Pathway 00:30:31 - Future Vision: Greater Rigor and Medical Oversight 00:34:56 - Rapid Fire Personal Questions 00:42:55 - Final Thoughts and Episode Wrap-up Thanks for listening 📋 Professional Education Disclaimer: Content for licensed healthcare providers for educational purposes only. Does not constitute medical, legal, or business advice. Always consult qualified professionals for specific clinical and practice decisions. Connect with Charles Miller & Scenic City Neurotherapy: Website Instagram LinkedIn 📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-053 Follow us on LinkedIn Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this first part of what became a two-part conversation, we sat down with anesthesia provider Charles Miller from Scenic City Neurotherapy for a discussion that challenged so many assumptions about ketamine therapy. Charles presents what he calls the "collective lie" in ketamine therapy - the argument that the obsession with psychedelic experiences and mystical insights for a growing segment of providers in our industry is not just misguided, but actually making our patients worse.  He walks through the neurobiological evidence showing that the real therapeutic action happens days after treatment during the neuroplasticity window, not during those profound moments when patients feel like they're talking to God or having life-changing realizations. You'll hear Charles critique the research methodologies that seem to support ketamine-assisted psychotherapy, explaining why group averages can mask poor individual outcomes and why the frequently cited KAP studies may actually show lower success rates than standard ketamine protocols. He also shares refreshingly honest advice about starting a clinic - including his decision to open with folding chairs rather than go into debt for impressive furniture. We're also trying something new with this episode: audio sidebars. As we talk, we’ll pause to provide additional context about complex concepts like psychoplastogens, research study limitations, and the cutting-edge science behind separating therapeutic effects from psychedelic experiences. Think of these as educational moments designed to help you fully understand and enjoy the episode. This conversation will make you question whether the approaches many of us have been using actually serve our patients - or if we've been chasing the wrong mechanisms entirely. What You'll Learn in This Episode · Charles's entrepreneurial journey - How he started Scenic City Neurotherapy with minimal capital and his advice for keeping overhead low during startup · The "collective lie" concept - Why Charles believes the field's emphasis on ketamine experiences actually reduces treatment success rates · Neuroplasticity mechanisms - Detailed explanation of the NMDA-glutamate-BDNF pathway and why the therapeutic window occurs after, not during, ketamine administration · Psychoplastogens vs psychedelics - Understanding David E. Olson's groundbreaking research on compounds that promote neuroplasticity without hallucinogenic effects · Research methodology critique - Analysis of popular KAP studies and why methodological flaws may be masking poor individual patient outcomes · Evidence-based positioning - How to counter the "ketamine is just anesthesia" criticism with solid neurobiological science · Experience vs neuroplasticity - Why Charles argues that focusing on insights and visions during treatment may be counterproductive Key Takeaways · Ketamine may function primarily as a psychoplastogen rather than a classic psychedelic, blocking NMDA receptors to trigger neuroplasticity cascades instead of flooding serotonin receptors like traditional psychedelics · The therapeutic neuroplasticity window occur days to weeks after ketamine administration, when BDNF-driven synaptic remodeling takes place, not necessarily during the acute dissociative experience · Research comparing ketamine-assisted psychotherapy to standard protocols could show mixed results, with some studies reporting lower individual response rates despite promising group averages · Providers who overfocus on experiential components during treatment may inadvertently create performance pressure that could reduce patient outcomes and increase perceived treatment failure rates · Startup ketamine clinics might benefit from beginning embarrassingly small with minimal overhead, focusing resources on essential clinical equipment rather than impressive lobbies or furniture · David E. Olson's psychoplastogen research suggests that neuroplastic benefits might be separable from psychedelic experiences, supporting approaches that prioritize physiological mechanisms over experiential components Episode 52 show notes: 00:00:00 - Teaser: When Patients Feel They Failed 00:00:17 - Introduction and Episode Setup 00:02:06 - Charles's Journey into Ketamine Therapy 00:04:30 - The Entrepreneurial Leap 00:06:00 - Startup Advice: Think Embarrassingly Small 00:08:30 - Evolution of the Ketamine Field 00:10:00 - The "Collective Lie" Concept Introduction 00:12:30 - Neurobiological Mechanisms 00:16:30 - Psychoplastogens vs. Psychedelics 00:24:00 - David E. Olson's Revolutionary Research 00:27:27 - Audio Sidebar: Psychoplastogens & David E. Olson 00:30:00 - Research Critique: KAP Study vs Real-World IV Ketamine Data 00:34:27 - Episode Wrap-up Thanks for listening 📋 Professional Education Disclaimer: Content for licensed healthcare providers for educational purposes only. Does not constitute medical, legal, or business advice. Always consult qualified professionals for specific clinical and practice decisions. Connect with Charles Miller & Scenic City Neurotherapy: Website Instagram LinkedIn 📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-052 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.