out of the space station is maintaining this immense, complex engineering miracle for decades. and we need to know how to do that if we're going to have, you know, settlements on mars or, or deep space for human systems. and that depends on the people inside. don't, don't let you know to support and co operation has a long history. the life of people in the space at the international space station is really sitting a very good example of how people should be living on earth, lead premium. all of this, just a month before the release of the 1st feature film shot in orbit on the station by a director, an actress from russia, was about a fictional health emergency in space colon baker algio. ah, this is al jazeera and these are the top stories,

a gathering of foreign ministers from the g 20 group of nations and india has ended with no agreement on how to stop the war and ukraine. u. s. secretary of state antony blinkin met his russian counterpart. so guy lever off for the 1st time since the start of the conflict. lincoln said moscow has shown no interest in engaging and pace. present zalinski is before the 10 point plan for adjusting durable peace . the united states stand ready to support ukraine through diplomacy to end the war on the spacious, president, putin, however, has demonstrated 0 interest in engaging saying there's nothing to even talk about unless and until you kind accepts, and i quote, the new territory realities while doubling down on his brutalization of ukraine, president fled him, a potent says, the ukrainian sabotage unit shot civilians on russian territory close to the border . the governor of the brianne screech and says a group cross from ukraine and open fire on a car. one person was killed at child wounded cave denies the allegation,

saying it's a classic deliberate provocation. ukraine is blaming russia for a strike on a residential block in the southern city of separation that killed at least 4 people. several others were injured. the attack destroyed many apartments in the 5 story building. can body in opposition later kim soccer has been found guilty of treason and sentence to 27 years. house wrist sako was arrested in 2017 and charged with trying to overthrow the government in collusion with the you with he has always denied the accusations broad group say the case is part of prime minister hon. since if it's to suppress all opposition, the station master on duty during choose days train crash and grace has appeared in court facing charges, including negligent homicide. a freight train collided with a passenger train in the north of the country, killing at least 57 people. an official from tennessee,

as main opposition party has been arrested. the another party said police detained be lose. it's the latest arrest and a crackdown on critics of president case saeed. those are the headlines. the news continues here on al jazeera after the strain which is up next. talk the law a will. the law when with neither side, willing to negotiate is the ukraine war becoming a forever war is america's global leadership, increasingly fragile. what will u. s. politics look like as we had to the presidential election of 2024, the quizzical look us politics the bottom line did with welcome to the stream at sabbath dean. ketamine therapy is quickly gaining popularity and seen as a life saving option for people suffering from treatment resistant mental health

disorders like depression. but in the us, many are raising concerns that increased availability of ketamine is out pacing oversight of the drug. and they say than more research is needed. so today we ask is ketamine therapy the future of mental health treatment. and of course we want you to join the conversation as always. so be sure to share your thoughts and questions with us on you to ah, johnny us to discuss all this from boston, dr. robert meisner, medical director of the ketamine service and mclean hospital in philadelphia, dr. hannah mclean, a physician, psycho analyst and founder of sound mind center and from los angeles journalist for tessa latifah, who has documented her own experience with ketamine therapy online as well as in her writing. and thank you so much for being with us. such a fascinating topic. i want to start robert by kind of asking you how does ketamine

work in this instance and why is it so useful for treating depression or is it thanks for having me and thank you for your interesting the topic. so we don't know precisely how academy works biologically, but we have a, a reasonable working hypothesis. and the key concept in that hypothesis is something called synoptic genesis. so now the genesis describes the brain's ability to essentially create new or novel connections that may not have been there before . so how does this happen? we think it involves something called an, an m d a receptor and, and way through which ketamine antagonizes or prevents that receptor from operating as it usually does. that then leads to a cascade or a flow of other messaging molecules which communicate with each other. that leads to more and more what we call quote,

down stream effects in the cell. you may have heard things about b, d, f. for example, a very popular object of study right now is well as interleukin in the immune system. there are many 2nd messenger other molecules down stream of this and m da receptor that ultimately through glutamate to be think in part. yeah. lead to send out to genesis. so i have to say, i, you know, robert of coming from a doctor that was the most absurd layman explanation in a beautiful way. i was still able to follow you. so just for the audience, maybe people who may be struggling with some of that jargon. i want to share derek story that says someone who has some experience with kennedy and therapy. echoing a lot of what you say, but just with different words, take a listen. my 1st experience with all of

your emotional trauma experiences. you go separating yourself or is it allowed me to come back with you back to a place where it says or when you hear that? i mean how does that compare to your personal experience with ketamine therapy? i think it's really interesting because it seems that it had to be in therapy. there are kind of 2 things that are happening. there's the neurological changes which the doctor just explained. and then there's also these kind of like mental realization that you're coming to and that secondary, but it's very powerful and that's how it was for me. i definitely felt

very forgiving when i was doing academy and, and i felt not only for giving towards other people, but towards myself and my own maybe mistakes that i had made. and it was a sense of peace that was really comforting. and i appreciate you using those terms . i know that other people have used them also from the pre interview. i loved robert that you talked about ketamine being a great catalyze or for humility and hearing for tis i say. and i'm curious, dr. hannah, you know, what is this about? is it about generating empathy? people have describe the experience as giving you new perspective. maybe an objective perspective on some subjective traumas? what can it be used to treat and, and who should be using it? yes, so i think that's a great question. and again, thanks for having me. it's amazing to be here and thanks for the interest in the

subject. as robert said, you know, i think it's important i so i went through neurology, occupational medicine, psychoanalytic training and. and now i teach therapist and facilitators how to facilitate how to become facilitators and ketamine, assistant psychotherapy, as well as working with mbm and phyllis. i've been and when i teach them, i always say here's the brain explanation. and here's the other explanation, which is how i want you to think about it. so the brain is really important and it's important to think about how these like synopsis and the neuro plasticity occurs. but it's also just as important, if not more important in my mind that these substances, whether it's ketamine, phyllis, simon, m, d, m a 5 m d m t. we have so many things coming down the pike. what they do is they help us get into our difficult, difficult experiences, get into the difficult memories and really process things that we couldn't process . and it's like, it seems so simple and yet it's like, you know,

when they say it's like a 100 therapy sessions in one session. yes. isn't it, isn't it, is it so? and i can talk about my own experience as well that i was i, as i was training to be a psychoanalyst. they did 4 times a week for 4 years. psychoanalysis. like so that's, that's how you get trained as you receive and you also have patients. and for me, i had this idea of what my trauma was. i could tell it from like a 3rd party perspective. and i have one of the best, like analysts in philadelphia, he's actually 94 years old and he's trained a lot of the therapist and analysts here. and it's like we can get to it, but we couldn't get into it. and i think and maybe or access it or process later. yeah. right. there was like, i couldn't put and i wanted to and i was ready and it wasn't like, wasn't ready to get it. and i could through ketamine, assisted psychotherapy and other psychedelic assisted therapy as the legal ones. because you can go to other countries and do legal versions of these things. i was able to actually get into it and feel it and cry and process and it's like and then

and then and then your, your trauma lifts or your difficulty and i'm like, you know, there's lots of different types of different i'm and i want, i want to unpack all that i see for to so it seems like you wanna jump in as she was speaking there some things maybe echoed with you resonated? yeah. well, so my 1st 2 sessions as academy, and i actually went with my mom and she came and sat with me because i was very nervous. i was anxious about how i would feel on the drug. and so she came with me and we have a great relationship, but it really felt like just in those couple hours, we felt like we had gone through therapy for like 4 years together or like it just things that i didn't even realize that i wanted to tell her or be able to express where suddenly just like there and it was really cool. and, and i'm wondering, i mean, we didn't really get to the heart of this question,

but who should be considering this therapy? robert? so there are a number of different people who can benefit and there are some folks who were not quite sure if there is an evidence base or that there shortly will be an evidence base for them to benefit. right now the most robust evidence is for folks who struck who suffer from treatment resistant, major depressive disorder and possibly major depressive disorder. and there is also quite a bit of evidence for patients who are specifically suffering from suicidal ideation in the context of treatment resistant, major depressive disorder. and i really want to emphasize that one of the reasons why, and by the way, i think of cat mean as the 1st of of my, of much to con, really kind of a gate keeper to 2 things that are coming down the road. and the reason there's so much interest in this medication and part is because we're in a public health crisis. if you look at the 1st 2 decades of this century,

suicide rates globally, or excuse me, in the united states have gone up in the past, approximate to decades by 35 percent. 035 percent. right. and we know that the world health organization has reiterated depression is the leading cause of is the leading cause of ah, let's call it disability morbidity in the world, global. so we're in a public health crisis and we have drugs that tend not to work very quickly and tend to be permutations of each other to have something new that's opening up a gate wave for other drugs as well as cat m e n. a psychedelic pipeline. is exciting and robert, when you talk about it being a cadillac or for humility, i had a personal experience taking another psychedelic, i'll just be transparent. i was in a legal environment, it was a, it was, i was guy actually. and it was very hard for me after that experience. i know

they're very different, but it's these same difficulties and trying to find words to encapsulate this feeling of connecting clue trauma as being able to process things feeling, you know, feeling very sort of humble about your own struggles if you will. i mean, that's a very general way of putting it, but i'm curious before we get into some of the risks and challenges. robert, why is this humility catalyze? are so important for 2 reasons. not a day goes by where my team and i, i think are not instilled with a sense of respect and humility for this are merging mechanism that, that can mean seems to leverage. and that is to say we're, we're often surprised about what's coming out and what's evolving as we better understand it. and it tells us just how much we don't know about this very exciting thing. i think from a subjective perspective on the a sense of humility,

one might feel can be due to any number of things, but in some cases probably has something to do with what we heard a little bit earlier before about the combined effects of synaptic janice says in an environment where a patient is allowed to explore new cognitive or psychologic stances and starting point and see things with a new lamp. well i, i really appreciate you a framing and that way because we have a video that we want to share where someone does just that, see people echoing what you say throughout this. so dr. before we get to that video, i just want to share with you. yeah. what, what people are saying in youtube, for example, big read saying, or sorry, past as saying my wife wants to try it for her migraines. nothing else has helped and i'm hoping ketamine treatment will be a miracle. maybe nothing is a miracle a but there have also asking about the side effect. so we'll get to all that. but before we do this is dr. michael very bora,

from toronto explaining sort of some of the rapid dis association that can happen. take a listen when people are under the influence of ketamine, they get this rapid association of your, you know, constant thoughts that they normally have. and over the period of an hour, they get a chance to kind of have an opportunity to say fresh, new perspectives on, you know, a lot of their personal beliefs or routines or whatever it may be. and for people suffering with mental illness that can be very therapeutic to have a fresh perspective on, on their life there. so many people suffering from depression or anxiety who want to try ketamine therapy or just psychedelic therapy. and they, and they want help, right? they don't want to go do this in their back yard or underground, where they don't have a medical team in the therapy to help them. so hannah, about fresh perspective that we have heard from time and time again when talking

about me and therapy. i mean, you've said that the results you've seen have been astounding. and even people who were previously suicidal have felt like, you know, their entire traumas or depression has been lifted. could you just talk us through? what's astounding, you yeah, i like. i like to tell people that i did 15 years of training and in western medicine, and i didn't feel like i had any tools to actually heal people, which is it seems ridiculous and crazy, but the, the, the healing that we're that i'm seeing and that my team is seeing in the clinic and, and i think it's really important to note that we're doing ketamine assisted psychotherapy. it's not like if it's sent to your home, or if it's done as an infusion and not together a psychotherapy, it essentially works as a long acting antidepressant. well, we're doing is we're really doing therapy we do for our sessions. so this, you're seeing one of our patients who as a marine who had severe trauma, saw his best friend die in front of him when they switched places and he was

leading the squad was able to go back and cry and miss and apologize and really feel the feelings of missing his best friend, he lost, but then he also underneath that was able to uncover all these other traumas and difficult feelings. and what we're working on now in therapy is his grief over his loss of his mother. and just like that, he never got degree for, he was in the military, he went home and then had to go back into the field to rock rock like 2 days later . so it's like all these things to get bottled up and you never feel them. and you think you're pushing away and you think you're fine, but actually you don't realize what you could, the life you could be living if you weren't squeezing all the memories back and not processing them. and i think it really, really amazing example as someone who came in to us and had treatment resistant, depression and treatment resistance, suicidal ideation for her whole life had been adopted. and her 1st cut in session. she actually had a memory of being taken away from her mom, son and build record and had this her 1st 3 years of life. or actually she didn't

remember them, but she was remembering, being in the orphanage, not really knowing who to turn to right. and just cried and cried and had no idea was even part of she'd been in therapy or her life had no idea that it was even part of something she should process. and then the suicidal ideation lifted. so i think it's all really important when in the last clip we watched someone talk about dissociation, and we've heard that word and i think it's really important to know that it's technically categorized as a dissociative. but most people actually report that they, you know, they'll travel into different realms during their journey, but they actually end up feeling more connected with their body, which it no one can really explain why that right through. but it may be part of like you travel and you come back, you know, like, well, i have a body. well my body needs rest, you know? so it really isn't like, i think we need to, to really just think about that term and not just categorize it as just this one thing, but it actually does many things for people therapeutically, most certainly, and i, i see robert nodding there, robert, i want to come to you, but before i do,

i kinda want to share with our audience. of course, there's a, another aspect to all of this. there's the startup culture aspect, if you will, a lot of online prescriptions. and there's concerns, as we said at the top, about safety, oversight and accountability. i mean, robert, if you look at my screen here, this is, i think one of the wellness center is that are popping up online, you know, discover the power of psychedelic therapy. here's another one, talking about how their programs centered in science and it helps you see transformative results yet another one here, encouraging you to unlock your ability to heal and, and, you know, i think this is great. it encourages people to ask questions to reach out. but, but what are the maybe concerns about the different ways in which this could be abused and the ease with which there is access? now? yes, it's a, it's an extremely important question. so for all the optimal, the cautious optimism and enthusiasm that, at that basic science clinical science and translational clinical research and

research levels that there is many of us are quite concerned that there is apt, an absence of adequate oversight, a, i, as ketamine and other molecules and medicines circulate, so my phone rings, you know, several times a month with a disaster story about a situation that evolves somewhere in the country or the world. and a patient suffers catastrophic consequences or may possibly death as a result of either inappropriate procedures, lack of oversight, lack of monitoring, inappropriate dosing or giving the medicine to someone who has contraindications and it's critical to realize that and translational pharmacotherapies, this field of translational science and clinical signs, it's very hard without a strong group of collaborators, nationally and internationally, establish

a precise standard of care. so one of our goals is to always say, what's the evidence base asked, what's the evidence base? show me the data. and then let's create together a reasonable statement of standard of care that is reflective of the evidence and the data, and let's not be fooled or coerced into using it outside of those bounds because that's when dangerous. that's when the danger and on mountain that's when bad things happen. well, i appreciate that. i also want to share that there are other people in our youtube chat chime in real time saying for example, line junior academy in a great solution for physical and mental issues. but really dangerous when it becomes in the dixon, my co, reagan. yes, i think ketamine is an in listing concept alongside various other psychedelic substances. all very good in theory, but in practice faces resistance from the medical establishment. i'm curious. i see,

or you're nodding, robert, a doctor, hannah, you talked about sort of the disconnect between western medicine and how that inability you felt to actually treat people. but what do you make of this comment? this resistance that we see? it's are robert 1st and then we'll come to you, dr. ana, but i'm curious specifically, you know, we saw this, you know, or again, i think in the u. s. context is now able legally to treat silo psy been, of course, which is magic mushrooms, but with all the psychedelic, we've seen this pushback. what can you share with us, robert, about that pushback, and is it good? i mean, is that gonna help us maybe control potential abuse? yes, the pushback is actually, it's not just important. it's critical. the pushback and my experience, it 1st doesn't follow in east west binary. i would suggest we really deconstruct using that language because it just doesn't follow along those lines anymore. fair enough. the pushback really, i think is about ensuring that there is an evidence base for the

protocols that are being used in the community to make sure that patients are 6 that's pushed back that you want to exist, right? we want data driven evidence based care, and that data driven evidence based care is it can occur and the research that's needed is happening. what we don't want to have happen is for the unregulated, broader community in which market incentives are extraordinarily powerful, right? to dictate care program and unfortunate money driving care. no, i appreciate you saying that i do wanna just take us to another topic because we have this woman who posted about her experience with ketamine therapy on tick tock for tastes. i'm going to come to you after this have a look at this. of course, she's using all those hashtags like ketamine therapy and mental health, but take a look at this. okay, let's talk about i v. ketamine therapy. this treatment as ideal for people with severe anxiety, depression, p, t s d,

a dickson. i have treatment resistant anxiety and depression, which means that i've tried literally every single medication and not have worked. so my doctor recommended t. m as in ice economy, but benefits are supposed to be long term or permanent. so i'm really excited to see how they'll stick around long term. but i have noticed amazing changes since i've started these infusions. i highly recommend this treatment to anyone who has been struggling. it is a game changer and it literally saved my life. your reaction to them for teresa? yeah, i just wanted to comment really quickly on what you were saying about the companies that are sending it out and kind of making it easier to get. and i do think there's a conversation to be had about the accessibility of mental health treatment, especially in the united states. but as someone who did ketamine in a clinical setting. and i could not imagine doing it outside of a clinical setting and not having a doctor there and not having a technician,

just the red blood pressure. i mean, seriously, like we talk, i will said, i would say the doctor is how heavily there nodding right now, they're both like yes. well, i mean, sometimes i think, you know, maybe it's an cool of me to say, but sometimes it like hits me really hard and i get very, very anxious. and i literally feel like i am not and a good place i need that professional there. and so sorry, i just wanted to say really quickly that i think it's really important that the accessibility is wider than but i would never tell someone, even though i mean has done great things for my mental health. i would say if you can't do it in a clinical setting, it might not be the right time to do it. i don't agree with these companies and, and how they're doing. and i'm wondering the video, the video that we shared with you. i mean, it also addresses sort of breaking some of the stigma around not just mental health but, but this whole issue. i mean how important is that in dr. hannah, in terms of moving forward? i know, for example, and i don't want to just mix too many things here, but, but

a lot of moving pieces here, for example, a proposal by biden in the new york times here that would been online prescribing of certain drugs. i would imagine including the academy and how important is it that we break the stigma, but also keep access available? yeah, i think it's more about like how do we keep safety and keep keep accessibility in mind, but not throw safety out the window. i don't think sending cutting me home to people is safe in most circumstances. once in a while we'll do it. 95 percent of our patients are all in office. we do like extended in person treatments, but i think it's really important for for ketamine. there's 4 categories, really i say they're saying there's home laws, hinges, there is in office i, v and fusions that are usually not with therapy, and then there's therapy. and then you can have like at home, you can have someone sitting with you so there can be alone. someone sitting with you and fusion and therapy. yeah. and i think it's really important that we're keeping the separate right. and i also think it's really important to keep in mind

that i think the facilitators and well trained facilitators are really what's going to make or break this ecosystem. our, our program is actually one in 7 in the whole country. ok, that is well that using that license to train and oregon and i think we really just need to keep an eye on who is sitting with who and how safety is. and we also need to keep an eye on people like you and other developments of this very fascinating topic, which we will do. i want to thank you. in the meantime, robert. and then for, for being with us. they tuned the next time. ah ah. a hollywood,

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