In this episode, Erica Zelfand, ND joins to discuss the important topic of pill shaming in psychedelic communities and how psychedelic medicine and traditional pharmaceuticals can both support healing. Dr. Erica Zelfand specializes in integrative mental health, bridging the gaps between conventional and alternative medicine. In addition to seeing patients in private practice, she also teaches facilitation internationally and leads retreats through Right to Heal.

In this conversation, Dr. Zelfand tackles the issue of pill shaming in psychedelic communities, showing why this rhetoric falls short and ultimately harms patients. She discusses complementary roles for psychedelic and traditional pharmaceutical medicines, suggesting that a medicine like ketamine may be particularly effective in contexts of acute intervention, whereas an SSRI antidepressant may be most effective for maintenance. Dr. Zelfand notes, however, that drug-drug interactions can be a significant concern and stresses the need for medical expertise and supervision in the context of concomitant usage of pharmaceuticals and psychedelics. In closing, she emphasizes that what is ultimately important is that patients are able to progress in healing, and any tools that are able to safely and effectively support this goal have an important role to play and should not be denigrated.

In this episode you'll hear:

• The pill shaming rhetoric in psychedelic and cannabis communities
• Pharmaceutical contraindications to psychedelic therapy and the necessity of medical supervision for tapering off such medications
• Why comparing traditional antidepressant pharmaceuticals to psychedelic medicines is often an apples to oranges comparison
• The issues with "no pain, no gain" rhetoric in healing
• Psychiatric support for processing repressed memories uncovered during psychedelic journeys

Quotes:

"When I went into medicine, I actually specifically went into integrative medicine, functional medicine, because I didn't like that patients were being in this position of having to choose: the conventional route or the alternative medicine route. Both routes have their merits and both routes have their shortcomings and I felt like we all deserve to be able to access both and have it be an integrated model." [3:06]

"The only form of ketamine that is FDA approved for depression—which is Spravato—is only approved in the context in which the person is also taking an oral antidepressant." [20:48]

"We have data showing that if you feel really really freaked out and anxious during your [psychedelic] trip, your outcomes aren't necessarily as good. And the biggest predictor of having a positive experience is actually feeling awe. You don't have to do the ego death thing, but if you can feel awe, if you can feel inspiration during a trip, your outcomes are better. And there's even data showing that individuals who are on an SSRI and then trip—they may actually have better outcomes than people who don't take medication." [24:12]

"I think part of this trepidation is we don't want to harm anybody through a dangerous, or potentially lethal, drug-drug interaction. That's one thing. It's another thing to be like 'yeah but if you're using these [pharmaceutical] drugs you're doing it wrong and you're not healing right.' And I think the one often is used as a camouflage for the other—and they're two separate things." [38:59]

Links:

Dr. Zelfan's website

Dr. Zelfand on Instagram

Dr. Zelfand on Twitter

Dr. Zelfan on LinkedIn

Right to Heal website

Psychedelic pill-shaming article by Jules Evans and Shayam Suseelan

Previous episode: Integrating Challenging Psychedelic Experiences with Keith Kurlander, MA

Previous episode: Warning Signs When Selecting a Psychedelic Facilitator with Juliana Mulligan

Previous episode: How to Choose a Psychedelic Facilitator or Retreat Center with Joël Brierre

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