Podcast: Play in new window | Download
Subscribe: RSS
Today on the show I have Dr. Rothstein with the Atlanta Ketamine Center. We talk about this relatively new way of helping people with depression, addiction and more.
Find the Atlanta Ketamine Center Here:
www.atlantaketaminecenter.com
404-709-2103
Info@atlantaketamine.com
Dr. Rothstein is co-owner and Medical Director of Atlanta Ketamine Center and a board-certified emergency physician that has worked in the Atlanta area for the past decade. Dr. Rothstein enjoys spending time with his wife Joanna (who is a nurse at Atlanta Ketamine center as well) his two children and his three crazy rescue dogs.
Transcript:
Betsy:
Welcome to the Art of Living Big podcast. My name is Betsy Paik. I’m an author, a speaker and a trainer of NLP and hypnotherapy. And I’m focused on helping you understand and design your life with the power of the subconscious. This podcast is designed to help you think differently about what could be possible for your life. Now let’s go live big. Hi, everybody. Welcome to the show.
Betsy:
Welcome to the art of Living Big. I’m really excited today because I have a really special guest. And I know, you know, every time we come to the show and I have a guest, I’m always excited. But this one for a few different reasons. And I really hope that as you’re listening today, it can help you or perhaps somebody that you know. So maybe it can be a show that you share that really helps someone. So today I’m really honored to have Doctor Rothstein with me. He is the co owner and medical director at the Atlanta Ketamine center.
Betsy:
You may have heard me talk about the Ketamine center briefly a few episodes ago. Doctor Rothstein is a board certified emergency physician and the co owner of the Atlanta Ketamine center, and he’s worked in the Atlanta area for the past decade. He’s also got a wife, Joanna, who I really love, love, love and a couple of kids and three crazy rescue dogs, which, you know, I’m always a fan of someone that rescues dogs. So I have a rescue dog myself. So welcome to the show.
Dr. Rothstein:
Thank you very much. And as I mentioned, what a cool podcast. And I really appreciate you having me on.
Betsy:
Yeah, I’m really excited, you know, because I feel like the conversation that we’re going to have today can really, really help people. And I think it may be something people have never heard of, but it may be something that they’ve heard of before. But it was scary or unknown or, you know, felt like maybe a little, little fringy, if I can say that, like, because it’s new. Right. And so I would love if you could tell me a little bit about the Atlanta Ketamine center specifically. I chose it for some really specific reasons, but, and we can talk about that. Why I think it’s the very best in the whole area. So if, if you’re, I’ll say this disclaimer before we start.
Betsy:
If you are interested in this, come, come to the Atlanta Academy and center. Come to Atlanta. It’s an area where there’s tons of hotels and places you could go and stay, and I will bring you out to lunch. So, okay. So tell me a little bit about the Atlanta Ketamine center and what ketamine is, what this is.
Dr. Rothstein:
Thank you very much for the nice words. That really means a lot. Just a quick background of ketamine. We as a medical community have been using it for a long time in the medical setting. I’m an ER doctor. We use it in the ER almost daily or daily for sedation. If I need to put somebody’s hip back in place or put their shoulder back in place or reduce a bone or really emergent situations, if we need to intubate a patient, we’ll use it for full anesthesia. My colleague, Doctor Lazarus, as an anesthesiologist, uses ketamine all the time in the operating room in conjunction with other anesthetics, something that, in fact, it’s on the who list of essential medications and something that we use very, very frequently in the hospital setting at larger doses for anesthesia.
Dr. Rothstein:
Dating back to the seventies, kind of during the Vietnam War, we started to realize that it can help a lot with PTSD and other things for mental health at lower doses. But that kind of fell off the radar for a little bit in the medical community until the past couple of decades, when there’s been just an explosion of research that has shown it’s a benefit for mental health at much lower doses and also benefit for chronic pain and a number of other conditions. Over the past couple of years, Doctor Lazarus and I came together and opened Atlanta Ketamine center as a way that we could help patients outside of the hospital setting in giving much lower doses of ketamine, called sub dissociative doses of ketamine to help patients with mental health and chronic pain and a number of other conditions.
Betsy:
Okay, cool. So it’s been used for a long time. So when I say this seems new, it’s not really new, it’s really, really, really old. But the way that you’re using it with just like, a micro dose almost, right. Would you say that is my ketamine?
Dr. Rothstein:
Exactly right.
Betsy:
Okay.
Dr. Rothstein:
Exactly right. Yep. So ketamine is. Yep. It’s a medication we’ve been using forever, but this use of it is, is relatively new. And really over the past decade, but really, over the past two decades, where we’ve been seeing more and more, uh.
Betsy:
Research on it, I I’m always fascinated. Is it just like, okay, so is it just like somebody had depression and they needed their hip replaced, and then they got the hip replacement, and then they were like, wow, I feel better. Like, like, how did they even, like, is that how it happens? I’m always curious how these things.
Dr. Rothstein:
That’s part of it, and part of it comes from back in the seventies, where we would start to see some recreational use of it and seeing that it could help with patients and make patients feel better. But anecdotally, both in my own experience and in the medical community, that’s exactly right. We would give ketamine and we would see somebody come out of their hips back in place and they feel better. And also, hey, you know, where’s my wife? I really love her. I really want to see her. This new outlook on life, for example. And so we see that kind of anecdotally, and eventually we started doing more and more research on it. Some of the earliest studies were back in the early two thousands with learned helplessness with mice, where we would see that low doses of ketamine would be given to mice and they would have a much.
Dr. Rothstein:
They’ll be much more motivated to survive in dangerous situations than the control groups. And that’s kind of where it took off from there, then started moving more and more into studies with patients, with people. And also as more and more doctors and research centers and clinics like myself started publishing their results, we started just to see that the really beneficial effects that it could have.
Betsy:
Yeah. Like really big shifts with people. And so, you know, I have talked on the show a couple weeks ago about how I brought my daughter to get ketamine infusions at your facility, and she’s been on the show before, if anybody’s interested. I think it was like episode like 253. I think she was on. I’m just. That’s from my memory, but I think that’s right. So if anybody wants to hear about her mental health journey, she is an adult and she talks really openly about this.
Betsy:
There’s never been any shame in our household about mental health. Things like we hear sometimes out in the world. It always was like, we’re always working towards ways and new ideas to help her and support her in her journey of getting better. And so, you know, I had heard about ketamine. I think probably my daughter was like, 16 or 17, and I heard about it, and there was no. There was, like, one person, I think, doing it in Georgia. And at that time, it just. It was really hard to get, like, I think I reached out to them and they were like, well, if she hasn’t tried all this other stuff.
Betsy:
But now things have shifted. And I had a girlfriend that mentioned it to me, and then I was on a walk one day and I was like, oh, my God, why don’t I find out about that? And so I did some searching and found you guys. So I would love for you to talk about the differences between what you do, which is like a ketamine infusion. Tell us what that is. And sometimes you see, like, I get ads on Instagram for ketamine. Like, that they’ll send to your house, like, you know, pills or whatever that they’ll send to your house, which I don’t have depression, but I was like, maybe I do need that, but tell me what the difference is between those things.
Dr. Rothstein:
Sure. So we at Atlantic Ketamine center, we only do iv infusions, and we feel that’s the best way of doing it. One, there is a number of papers that show that that really does actually have the best outcomes on depression or other mental health illnesses where we could show the most improvement. The nice thing about iv ketamine is it’s 100% bioavailable. So when you get it through the iv, we know the exact dose that you’re getting, and you’re monitored by either myself or Doctor Lazarus. And we could go up or down in real time on the rate that you’re getting the infusion. Depending on how you’re feeling, or if there were something adverse to happen, we could stop the infusion and treat that in real time. We feel that’s the best way of doing it while we’re closely monitoring you with your vital signs and checking in on you every few minutes with my wife Joanna, who is our nurse over there, as well with the outpatient stuff.
Dr. Rothstein:
So there’s bravado. There’s the intranasal ketamine, and that is FDA approved, but it’s FDA approved for treatment resistant depression that you’ve tried a number of different modalities, and it’s not helped. And then there’s also trochees and ketamine tablets and dissolving sublingual ketamine. So those can help, and there may be a place for those, but the bioavailability is much more limited on that, down to, like, the 20% to 30% range. And so that’s also taken at home, which we feel is not the safest way of getting ketamine. And, of course, there’s been some news articles of some bad stuff happening with people taking it when they’re not being monitored. Or of course, patients may not know the dose that’s appropriate for them, and they may take too much of it. And, of course, ketamine does make you feel good.
Dr. Rothstein:
And so there is, you know, there is room for, there’s a recreational use, an illicit use of ketamine, and that’s putting some of it out on the street where people can misuse it as well. So we feel that iv ketamine or something like Spravato or a different ketamine is best given in a clinic setting with a provider or doctor. They’re monitoring you appropriately, and that’s what the American Ketamine provider society recommends and what a lot of the, a lot of the bodies recommend for most safe administration of ketamine, our processes, we recommend getting six infusions over the course of, somewhere in, over the course of about three weeks, somewhere between two to four weeks, ideally. And I could talk a little bit about why the literature believes that that’s best. But each infusion can help patients feel better during their infusion and then in the immediately after that. But to have the most effects from neuroplasticity and having some rewiring and new ways of seeing things, we see that best with the six infusions or at least a few infusions over the course of a few weeks.
Betsy:
Yeah. You know, when I was looking, you know, because anytime you’re choosing something for your kid, you’re like, we’re going to do the safest way to do this. Plus, I’m. I’m like a scaredy cat with anything. Like, I don’t take any. I’m nervous about everything. So, you know, when I chose it, this is how I was thinking of it, you guys. So I was thinking of it, like, can you do the pills or whatever? Like, you can, but then you’ve ingested it.
Betsy:
Like, so then if something’s going sideways or she’s just not having a good experience, right? Because I don’t want her to suffer any more than she already is. There’s nothing I can do until her body metabolizes it. So I think of, like the, the ketamine center when we went and doing it with the infusions is like using a gas stove. So you can turn it up or you can turn it down, and as soon as you turn down the gas, then it’s. It’s done. So if the water’s boiling over, you don’t have to just let it boil over till it evaporates. You have some sense of control there. And that, for me, like, as a mom or even if I was going to take it myself, that level of control, I think, makes a ton of sense just from a perspective of being comfortable.
Betsy:
But then also from a clinical experience, too.
Dr. Rothstein:
Absolutely. And of course, we also have a number of other medications there where we could treat if somebody’s blood pressure gets a little bit too high or they feel anxious, then we have some anti anxiety medications and. Exactly right. We tailor each infusion to each patient, and over the course of the six infusions, we kind of get an idea of what dose within the therapeutic range is best for each patient. And that’s been a nice thing as well. Kind of getting to know patients over the course of their, over the weeks as well.
Betsy:
Yeah, yeah. And, you know, when somebody is in the experience, can you kind of, and I can share kind of what I witnessed as somebody watching or what my daughter explained to me, but can you kind of tell me what. So somebody comes in, they call you up and they schedule, I’m going to do this. If they’re out of town, could they do two weeks? Like, could they do three and three so that they get the two weeks in?
Dr. Rothstein:
Yep, they can. Yeah, absolutely. We actually do have some people that come in from out of town and do stay in hotel rooms those nights. So that’s one thing we do. You can’t drive after infusion. We recommend that you are not doing anything, that you have to make any major decisions and preferably not working that day or operating machinery, et cetera. So we want you to have, it’s a relaxing experience and we want you to be able to relax the rest of the day as well. So we do have some people that come in from meditat and stay in a hotel, the experience itself.
Dr. Rothstein:
So we give what’s called sub dissociative levels, or we get you right to that level where you start to dissociate a little bit under close monitoring, of course. So patients that when we say dissociation, patients may feel like they are not quite in their body or they could feel the visualize themselves thinking or see themselves thinking from a different perspective. And so that’s the immediate effect. And we have really relaxing chairs and calming stations on our tv as well as music and lighting. So make that as pleasant of experience as patients can have. So there’s some thought.
Betsy:
I want to butt in. I’m going to interrupt you for a second. I think that was really, like, cool part of it. And, you know, you guys, when I was saying about how I keep saying you guys listeners, how I was saying how I chose the ketamine center for a specific reason. Right. There’s a couple places in Atlanta you can do it. I drove out of my way to get to you guys, because the facility was so nice. And so when you come in, you know, it’s.
Betsy:
I mean, the doors locked. It felt like a safe environment. Like I was going into a safe environment. It was a really nice waiting room. I know this is silly, you guys, but I, like. Like, first, I fly first class. Like, I. I want to feel like, okay, this is nice, right? Because it’s scary, right? So anytime you’re going to something scary, I want.
Betsy:
And then when you go in, like, the. The chair is the kind of chair that’s electric, and it leans back and you can relax the lights, right? So you’ve got some, like, mood lighting in there. Just kind of helps to help you relax, and then you get. You help. People can pick what they want to do. So on the big screen tv there, they can go to Peru or go to the beach or. And y’all know my daughter would not pick the beach as her visual because I was like, choose the beach. Choose the beach, because I’m a big beach fan.
Betsy:
No, she had to always go to Nepal or something. So, anyway, we went through flying through Nepal. So the experience itself is calming. And then you gave her a little pill to just relax her. Right? Wasn’t it like a little pill you gave her?
Dr. Rothstein:
Yeah, just a little volume. Yep.
Betsy:
Exactly.
Dr. Rothstein:
And a Zophran to help to prevent nausea.
Betsy:
Okay. Yep. And then you put an iv in. So she had a cuff on, a little beeper thing on her finger. She had a remote for Joanne if she needed anything. And then you put the iv in, and that is really when it began, and it starts really quick. It’s not like if you were drinking. I know that’s probably not a great comparison, but if you were drinking, you’d have to drink a couple drinks right before you felt anything, unless you’re me.
Betsy:
And then it’s like, one sip, but. But it, like, immediately she could feel it and. And just felt super relaxed. So if somebody. I’m sure people metabolize stuff at a different rate, you have the ability to give them more or less to keep them in a zone. Is that what you try to do?
Dr. Rothstein:
Yeah, exactly. And thank you for saying such nice things. And that’s something that we’ve really worked hard on. And kind of our vision a couple years ago when we started this was to have that exact thing that you described where patients feel very comfortable coming in, because that is a huge part of it, is to get in that right frame of mind when you’re getting this infusion and I think Joanna is incredible about helping our patients get into that right frame of mind as well and in monitoring our patients closely. So it does matter the different dosing, depending on what medication some patient may be on, we may adjust the dosing a little bit because they can slow how quickly it goes through or quicken how quickly it goes through. And again, that’s a nice thing about iv, but ketamine has a generally pretty short half life. And usually by that night, the ketamine itself is really not in your system anymore. But one of the cool things about some of the research that we’re seeing is in a good way.
Dr. Rothstein:
We think that one of the metabolites gets trapped within your synapses in a good way and helps to provide further benefits. Even when the ketamine and you’re not feeling the effects of it, that ketamine infusion anymore, it will continue to help you down the road. That’s one of the thoughts about with SSRI’s or some of the other medications, which can be life saving and really help patients and is life saving.
Betsy:
Tell us what an SSRI is.
Dr. Rothstein:
A serotonin reuptake inhibitor. So many of the antidepressants that are on the market, there’s also snris, for example, like wellbutrin. And so these all are more historic, or not historic, but in recent times, medications were used for antidepressant, for anti anxiety.
Betsy:
Okay.
Dr. Rothstein:
Those medications can take a few weeks to really take effect. So one of the nice things about ketamine is we see a stepwise improve. We hopefully see a stepwise improvement with each infusion that patients get. And there’s a lot of work being done with ketamine just being given as a one infusion for perhaps a patient that is in a psychiatric facility and is having severe suicidal ideation. One ketamine infusion can oftentimes just get them kind of out of that spiral and get them to a place where they could be a little bit better and respond better to their other medications.
Betsy:
It’s a modern interrupt, almost exactly.
Dr. Rothstein:
Right? Yeah. Good way of looking at it. So that one infusion with each infusion. But the first one, for example, you may. With the effects that you’re getting in the acute setting where you’re getting the infusion may give you. It gives you euphoria and makes patients feel good. That in itself makes patients feel better. Then we start to see, after each infusion, where we start to see the new pathways being built and some of the NMDA receptors on your neurons increasing which is involved in learned behavior and also in forming new pathways.
Dr. Rothstein:
That’s where we start to see them build up over the few weeks, over the time with subsequent dosing. So each infusion is going to hopefully make you feel better during the infusion, while it’s building up and helping you feel better long term.
Betsy:
And it’s creating, like you said, it’s connecting these new neural pathways, which helps you to. I mean, neural pathways, that’s how you learn, right? You’re learning by creating those. So you’re starting to get new ideas, new thoughts come in. So whereas just in my own experience with my daughter, there will be a lot of circular thinking, this, I felt like, started to shoot her out of that, where then she was starting to think about what else could be possible. And, you know, she was saying things like, okay, maybe I want to go back to school, which, you know, she went to college for a couple years and left, and it made her start. And I was fine with that if she wanted to leave. Like, it’s not for everybody, but I always felt like she loves to learn, but she was so low that that didn’t feel, like, fruitful. Like, what’s the.
Betsy:
What’s the point? And so I noticed she was having these thoughts, like, well, maybe I could do that, or maybe I could do this. And also, it was like, maybe I could go to Nepal. And I was like, damn, this television.
Dr. Rothstein:
That sounds great.
Betsy:
Yeah. I was like, we’re going to the beach. So I think that I saw that. I’m also curious if you can talk to the research that’s been done with addiction and using this, because I almost feel, and I don’t, and I am nobody. I’m not, but I almost feel like, in some ways, depression feels to me sort of like an addiction. Like, it becomes. You’re so used to it, and our feelings are a chemical reaction, right? So you’re getting used to that chemical. You’re getting used to that feeling.
Betsy:
And to move outside of that sometimes, I think, can feel scary because you’re so used to feeling it. So talk to me a little bit about the addiction piece and what we’ve seen.
Dr. Rothstein:
Yeah. So you’re exactly right. And just, I’m so glad to hear that she doing better and having better hope about the future, because that is a big thing about depression, is the lack of anticipating a better future. And then that cycles and takes people away from wanting to do something to give them a better future or something that they enjoy, whether that’s, you know, playing a sport or exercising or reading or watching a movie or whatever it is that somebody enjoys. They just don’t have the energy or the will to do that because they don’t. Just, like you said, they don’t see the point in doing that. And then those activities also make people happy and have a value and anticipate a better future. And so one of the great things about medication or therapy or ketamine, whatever it is that could get you out of that rut as you get activated and get that energy to anticipate a better future and want to do things that you may otherwise like doing, that also helps get you out of depression, doing those activities.
Dr. Rothstein:
So that’s really, really wonderful to hear. And you’re exactly right. It is. It’s a spiral with any spectrum of anxiety, with depression, et cetera. It is almost like you get addicted to that feeling and there’s no point in getting out of it. So in terms of ketamine for addiction, one really interesting thing, there’s a lot of stuff on ketamine with smoking cessation, and we have a lot of people asking about that. Yep. And so there’s probably a little bit more conclusive stuff that needs to be done.
Dr. Rothstein:
But anecdotally, I’ve seen patients that it’s helped with that alcohol addiction, both in the acute withdrawal phase, can help, and then also with cravings down the road, it can help with that. And a lot of literature being done. I also see patients, again, anecdotally, and I think there’s a couple things out there on this that patients come in and they say, you know, I’m an, I’m an everyday marijuana smoker and I just rely on that. And I kind of want to see if this helps. And I’ve seen at least quite a few patients come in, and after they finish their series, we see them maybe for a booster or maintenance infusion a few weeks down the road and they’re saying, you know what, doc, I’m not smoking anymore. And they kind of describe that as a clean reset. And that’s another thing that patients tend to describe after they’re getting their infusions. I just feel kind of clean.
Dr. Rothstein:
I feel like I’ve reset. And so I think in terms of the physiology of how it works, to be frank, I’m probably not terribly clear on that. I think there’s a lot of work that needs to be done on that, but I think it’s, it has a lot to do with the same pathways as NMDA. But on that note, one of the other ways that ketamine works is it does have action on one of the opiate receptors. One of them are natural opiate receptors, the mu receptor and also Kappa receptor. That’s how we know that ketamine works for a lot of chronic pain, like chronic regional pain syndrome, and also in the error when we could use it for terrible things like sickle cell pain crisis, where patients have been on opiates for a long time and nothing’s helping, or even for sickle cell, excuse me, or even for kidney stone pain. So we also use it at even lower doses to help with pain. And so it’s a good alternative to opiates.
Dr. Rothstein:
And that’s actually one of the ways. Just speaking about myself is over the years working in the ER, I’ve headed a number of committees for alternatives to opiates and opiate use disorder. And ketamine just keeps coming up and up and up in our meetings about ways to help patients not using opiates. Of course, ketamine, again, can have some recreational value and can be used illicitly because it does cause a euphoria and has some benefit on our natural opiate receptor. But there’s a lot of thought about that may be why it helps with certain addictions. And also that kind of branches off into opiate addiction as well, where we could use it to help patients with that as well.
Betsy:
To help with that. Yeah. Which is really cool. My daughter, and I know she’s okay with me saying this because we’ve talked about it and she’s been on the show talking about this, but she has binge eating disorder and she’s been diagnosed with that for many, many, many years. And after the first session, that just stopped. So it just hasn’t come back. You know, I. You know, we talked the other day and she was like, what am I supposed to do at night now? She was like, that’s what I did at night.
Betsy:
I’m like, well, I don’t know, we gotta get you some other hobbies. You know, we can teach you how to knit or something. I don’t know. But. But it was so funny to me because that’s not why we went. And in fact, that wasn’t even anything I thought would be impact like that. That disorder has always been secondary to everything else we were working on with her because the other stuff was so immediate. And so that, to me was, it just was such a funny thing because we were like, oh, my God, I didn’t even know that could be a thing.
Betsy:
And now that has really been alleviated. Will it ever come back? I don’t know. But after the first session, it was different. That first session, she had a really big lift. Like, that felt like such a big shift for her. That’s when I was like, oh, this was a really good idea, even if nothing else happens, just that outcome in itself was so, I mean, that’s impactful for the rest of her life, impacts her health the rest of her life.
Dr. Rothstein:
That is really incredible and so heartwarming and just hearing that makes everything worthwhile. So that, I’m really happy to hear that. And I think a thought on that, and I hope that, and I am sure that in the coming months to years, we’re going to start to see things like that. Ketamine working for research coming out that ketamine works for eating disorders and a number of other things. And of course, there’s overlap between, there’s comorbidities between depression and eating disorders and anxiety and a number of other things. So I think that the way that it works behind that is probably a combination of all of the above. And there’s also something, a lot of stuff that it works on. It has some anti inflammatory effects as well.
Dr. Rothstein:
I think that there’s probably a combination of a lot of its methodology, perhaps in patients like your daughter. But that is really wonderful. Wonderful to hear.
Betsy:
Yeah. Yeah, it was pretty cool. So tell me, if somebody comes, they do these. And how olive did it was. We did it over three weeks. We did two sessions for three weeks. And then tell me what people typically need. And I know typically is a hard thing to say because everybody’s different, but typically, what can you expect after that? Do you have to keep coming? Do you, you know, what’s that look like?
Dr. Rothstein:
Yeah. Everybody is different. So when patients graduate from their six infusions, we have a whole celebration for them. They got a cap and gown. I’m just kidding. But everybody’s a little bit different. What we tell patients is we want to wait at least one, maybe two weeks, but usually, at the minimum, one week after you finish your series of six infusions. And if you feel like you need to come in for a booster or a maintenance, then some patients come in one week later, and then they maybe for a few weeks after that and then start to taper down to every few weeks or every month, and then to get to a point where perhaps they don’t need to come back again or maybe once a year after that for a maintenance or for a booster infusion.
Dr. Rothstein:
Some people don’t need to at all. Some people follow up with their psychiatrist or our primary care doctor, and they could even get down on some of the other medications they’re on and they never need to come back. And some people like to come back a month later or a few months later. So everybody’s a little bit different. There are some people that need a little bit more intensive follow up, and we do see some people coming in every week for a few weeks after they finished their course of six infusions. But the majority of people were seen coming back maybe just a few months later to get a booster infusion or maintenance infusion, we call it, to kind of get them back to where they were.
Betsy:
Yeah. Yeah. That makes sense. Does it? Is it? And this is my brain, like, trying to think through, like, a level. So you tell me if this is way off, but the lower you are, the more you’d have to do to get to, like a baseline and then to feel better. Like, like if you’ve been really low for ten years and you come in, could you expect that you do those first six, but then you might need regular ones every couple weeks just till you get.
Dr. Rothstein:
Yeah, I think everybody’s a little bit different. And I think it depends a little bit more about the degree of progression that patients have, have gone through throughout their, their course of their infusions. But I think that’s really fair to say that generally speaking, if you’re starting at a lower point, you may need a little bit more subsequent infusions afterward.
Betsy:
Okay. Yeah. Yeah. You know, I think of celebrities that we know and have heard of over the years that have depression, you know, and, you know, Robin Williams and Kate Spade and, you know, I think about these Anthony Bourdain, you know, my daughter is obsessed with Anthony Bourdain, and he’s her screensaver on the, on her phone. And that always really scared me because he unalived himself. And I was like, I don’t want that to be her, like, goal. You know what I mean? Like, that’s her. But I do think about also people like Matthew Perry who used ketamine, if I’m not mistaken, and had really good success with it.
Betsy:
I mean, that, you know, we saw a huge change and he talked pretty openly about how he had sort of overcome a lot of his depression and mental health struggles. Am I right? He used ketamine. Yeah.
Dr. Rothstein:
Yeah. So, incidentally, I’ve read kitchen confidential by Anthony Bourdain. It’s one of my favorite books. And I’ve read Matthew Perry’s book as well before he passed away. And, yeah. So Matthew Perry, unfortunately, had a bad outcome where it sounds like recreation use or inappropriate dosing of ketamine he took at home and then drowned in a hot tub. So we monitor you, and that’s, again, why we don’t like the home dosing. We like to do it under or strong and under monitored dosing.
Dr. Rothstein:
But, yes, it sounds like before he did that, he was getting once weekly. I may not be right on this, but from what I’ve read, once weekly, give or take iv infusions. And it sounds like that was helping him quite a bit. And then, of course, he struggled with, and I don’t know him, of course, personally, but struggled with, you know, addiction and a number of other things. And it sounds like I did not use it appropriately at home. Yeah, but it sounds like that was helping him quite a bit. And somebody like Anthony Bourdain. Yes.
Dr. Rothstein:
If this was around, you know, or more available at that time, you know, I could only speculate, but perhaps he’d still be with us. But I do agree with you, one interesting person, because I love Anthony Bourdain as well, and I love kitchen confidential, and I. It’s so hard because I don’t want to glorify, you know, or promote the end result, you know? And it’s such a sad story. And what a wonderful person, both of them.
Betsy:
You know, what’s really interesting, and this is, like, a kind of a weird side note, but anyway, people that listen know that I have lots of weird side notes, but my weird side note about that is she’s had him as her screensaver, like, for years on her phone. Like, she just loves him. She’ll watch, like, anything on YouTube. Um, you know, anything we. Anytime we can talk about him. But since the ketamine, it started to shift to her talking about wanting to be like him as a chef and traveling and, like, the conversation around him changed as opposed to, like, before she would read, like, stuff people would write about him after he was gone and about his daughter and do, you know. Do you know what I’m saying? Like, she would focus on the end, and now she’s focusing on, like, how she could be like him, carry on. Do you know what I mean?
Dr. Rothstein:
Like, in good way.
Betsy:
Yeah, it was kind of. I. That was kind of surprising to me. Like, just a couple weeks ago? Yeah. Yeah, just a couple weeks ago, she spent the night at my house, and, I mean, we were up late, and she was talking about all this stuff, and I was like, this is a totally different Anthony bor. Like Anthony Bourdain conversation. So I, you know, it shows up. I feel like the ketamine shows up in places that I didn’t expect it, and I attribute it to that which may or may not be right.
Betsy:
But we’ve been struggling with this for a decade, and I know the patterns, and this is a new pattern, you know?
Dr. Rothstein:
Yeah, that’s really incredible. And a new way of seeing something that she was interested in beforehand, and now a new. And that’s probably the best ways I could describe the benefits that we’re seeing patients get from ketamine. A fresh way of looking at something they may have already had an interest in, but in a positive way now.
Betsy:
Yeah. Yeah, totally. Yeah. Super, super interesting. You know, the thing that. And I’m. I’m trained in neuro linguistic programming. I’m really fascinated with the unconscious mind and with our identities.
Betsy:
And one of the things that I’m curious, and this is me more asking you maybe as an individual, although you might have a perspective on it from a doctor, but I believe that when we have an identity, who we are, not our roles, not like, I’m a mom, I’m a wife, but who we are, our identity, I am kind. That’s a really strong thing. And sometimes that gets me in trouble because I won’t have strong boundaries or do you know what I mean? Because the thing to be kind like that is an identity of who I am that I really value. And if somebody threatens that, I will cut you. You know what I mean? Like, I’m kind. Damn it. So one of the things that I have really been noticing is that with my daughter, there is this. When I will comment on, wow, this is so different.
Betsy:
Like, you’re really getting better. She’s holding on to the identity that she’s sick. And she’ll say, no, no, I’m sick. I’ve been sick for a long time.
Dr. Rothstein:
Yeah.
Betsy:
Okay. So I’m curious, do you have thoughts on that, even just from your perspective? And you might not. I don’t mean to put you on the spot with that one, but please.
Dr. Rothstein:
So I think that that’s. There’s. This is what I tell all of my patients. The people that I see do best with this are ones that are going through their infusion process in conjunction with therapy or a psychiatrist or somebody who’s going to help direct these new pathways and these new ways of thinking to ensure they go in the positive way. And then also, just like you said, that’s a cycle, and that’s your identity that’s you know, hopefully, we’re cycle a lot of the negative thoughts and making some new pathways with that. But just as you said, that becomes difficult to break that identity. And who have you.
Betsy:
Who do you think you are?
Dr. Rothstein:
Yeah. So there’s a big role for therapy or ketamine. We call it ketamine integration counseling and ketamine integration therapy, which we do have at Atlanta Kennedy center. We have a few options who can come to our clinic and be with you during your infusion and go through some of those thoughts or follow our patients up. So I think that speaks to a strong role, which I’ve always endorsed in my role as an emergency physician and throughout my life, role of therapy and especially inpatient ketamine infusions to really help direct into the right direction and break some of these old identities as they start to form new ways of seeing themselves.
Betsy:
Yeah. Yeah. I think that’s such an important piece. I had messaged, olive has a therapist, and I messaged to the therapist, but, of course, she’s an adult, so the therapist doesn’t really message me back. But I was like, I don’t care. I gotta still message her and say, can you work on identity? Because I can see that happening. And I think we all do that. Like, I think that’s a natural thing.
Betsy:
Like, this is who I am. And, you know, most of all of life, she’s had this. And so that’s like, how? So I have been saying, when she says that, I say, like, well, who would you be if you weren’t that? What would you do if you weren’t doing that? You know? And I can see her, like, kind of thinking, and then she’s like, nothing. I wouldn’t be. Stop asking me. She doesn’t like it when I use my medicine on her. But I do think that there’s something valuable. And, you know, I think everybody that’s listening, and I.
Betsy:
And I think about this myself, too, that the. The places where we’re stuck now in our lives, whether we need ketamine or not, but who are we being? And who would we be if we didn’t have that problem? Is always a good question to ask as we kind of move through things and seek to grow and to be better.
Dr. Rothstein:
Yeah. And I’ll just. On a little bit of a not quite extreme note, I’m an emergency doctor, and I have been for 13 years, and now I’m also being known as a Ketobean physician. Right. That kind of, which is a great thing. And I. And it’s a great thing to tell people. But, you know, I think we all struggle with reinventing ourselves through a thread and, and being known as something else.
Dr. Rothstein:
So here you say that. Yeah.
Betsy:
Yeah. I love a good pivot, though. I love a good pivot. Anytime I can pivot, I love it. Well, good. This was so, so great to have you here. I appreciate you so much. And I appreciate we, y’all, we had a couple of audio issues in the beginning, but Doctor Rothstein dealt with me and my, am I fixing things.
Betsy:
So thank you. Thank you.
Dr. Rothstein:
That was my fault. I think sometimes computers are doctor proof, or at least Doctor Rothstein proof. I have Doctor Lazarus, who’s much more tech savvy than me, in the office.
Betsy:
Well, good. I’m so glad to have you here. Thank you. Thank you for being here. And I appreciate you so much. And I appreciate you as a podcaster, but also as a mother. So thank you.
Dr. Rothstein:
My pleasure. And I’m very happy to hear the improvement that we’ve seen with all of it. And also, yep, we’re Atlanta Ketamine center. And please, you guys could email us at info atlantaketamine.com anytime. And we happy to speak with any of your listeners. So thank you very much.
Betsy:
What’s the website? Give us the website and I’ll put it in the show notes, too.
Dr. Rothstein:
Yeah. Atlantacatamine.com, atlanta academy.com, atlantacademy.com. Atlanta Academy. Excuse me.
Betsy:
Yeah, and I’ll atlantaketaminecenter.com and anybody can just, you can dm me on Instagram and I’ll send it to you, too.
Dr. Rothstein:
Just Google Atlanta Ketamine center and we’ll come up.
Betsy:
Yeah. Okay, good. Thank you so much.
Dr. Rothstein:
All right.
Betsy:
All right, everybody. Thanks so much for being here. And I will see you next week.
Dr. Rothstein:
Okay?
Betsy:
Hey, thanks so much for listening to today’s show and thank you for sharing the show with your friends. I love when you guys do that. I appreciate it so much. And thank you for leaving me a review on iTunes. I know that it matters because when I go to find a podcast, I always look to see what the reviews are. So it really means a lot to me that you take a minute to, like, figure out how to even make that happen. Now, if you want to find me, find me on social media. I’m usually on Instagram starting out on TikTok.
Betsy:
It’s just my name, Betsy Paik. And that’s my website, too, betsypake.com. And you can find out all about the work that I do, having me speak for an event that you might be helping to plan or getting trained inside my alchemy institute. But to make it really easy, if you want me, just shoot me a DM. Shoot me a direct message on Instagram and I will be at your service. Thanks again for listening, and I will see you all next week.
