Psychedelic Medicine Podcast with Dr. Lynn Marie Morski

In this episode of the Psychedelic Medicine Podcast, Jon Dean, PhD joins to discuss the potential of psilocybin therapies for phantom limb pain. Dr. Dean is an assistant professor at UC San Diego, where he co-founded the Center for Psychedelic Research and his laboratory conducts fMRI-based studies on psychedelics such as psilocybin and DMT for relief of chronic pain and neurological conditions.

In this conversation, Dr. Dean discusses emerging research on psilocybin as a potential treatment for phantom limb pain, a condition that affects many people following an amputation. Preliminary findings from his small pilot study suggest that a single dose of psilocybin may produce clinically meaningful reductions in both phantom limb pain and residual limb pain lasting at least four weeks. Dr. Dean also explores potential neurological mechanisms underlying these effects, including changes in communication between the brain's default mode network and thalamus, and discusses the importance of further research to establish the treatment's safety and efficacy. Looking ahead, he considers how combining psychedelics with targeted interventions such as mirror therapy could improve outcomes for people living with chronic pain.

In this episode, you'll hear:

• What phantom limb pain is, how common it is among amputees, and how it differs from residual limb pain
• How Dr. Dean's colleague Albert Lin's experience with psilocybin and mirror therapy inspired research into psychedelic treatments for phantom limb pain
• The preliminary findings from Dr. Dean's pilot clinical trial investigating the safety and efficacy of psilocybin for chronic pain
• The role of the brain's representation of a missing limb in the experience of phantom limb pain
• Why the subjective effects of psychedelics may be important to their potential therapeutic benefits
• How future research may combine psilocybin with mirror therapy and other targeted interventions

Quotes:

"In the smaller sample size, we did see clinically meaningful - 30% or more - reductions in phantom limb pain and also residual limb pain at the site of the amputation upwards of four weeks after just one dose of psilocybin, which we did not see that in the niacin [control] group—pain either stayed relatively the same or maybe as a mean kind of increased a little bit." [13:41 - 14:04]

"One of the things that we keep seeing—and this has been known with psychedelic research on things like depression, etc. There's this really well studied network in the brain called the default mode network. It kind of incorporates areas across the cortex and into the subcortex too, select medial prefrontal cortex, precuneus… Anyhow, this network is pretty well established to be involved in processing self-referential types of thought—so things like pain catastrophizing and rumination and depression. This network is pretty hyperactive, and you see in the psychedelic work on things like depression, there is some correlation with acute psychedelic administration dampening this network and that correlating with the clinical outcomes such as less depression. And so one of the things that we are very interested in appreciating—because we would be seeing this in our psychedelic work, including this trial and the preliminary data, and in the mindfulness data—that when someone is having the relationship with their pain change (and they're literally telling us this from the studies, especially in the mindfulness stuff) … people will say with their back pain, 'I still feel my back pain, but my relationship to it's quite different.' And we do see this self network being modulated by mindfulness. And we see it in our psychedelic study too. So specifically in phantom pain, in the preliminary data, what we found was a decoupling of the default mode network from the thalamus, which is like the main sensory gate in your brain." [16:56 - 18:45]

Links:

Dr. Dean on Instagram

The Center for Psychedelic Research at UC San Diego website

The Center for Psychedelic Research on Instagram

The Center for Psychedelic Research on X

Albert Lin case report: "Relief from intractable phantom pain by combining psilocybin and mirror visual-feedback (MVF)"

Dr. Dean's randomized trial: "Feasibility and Tolerability of Psilocybin for Phantom Limb Pain"

Previous episode: Can Psychedelics Help Stroke Recovery? With Dr. Steven Zeiler MD, PhD

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Stacey Armstrong, PhD joins to discuss the latest research on psilocybin treatments for PTSD. Dr. Armstrong is Associate Director and Senior Researcher at The Ohio State University's Center for Psychedelic Drug Research and Education, and a clinical psychologist with advanced training in treating PTSD in veterans. She is the first author on a recent pilot study of psilocybin-assisted therapy for veterans with severe, treatment-resistant PTSD.

In this conversation, Dr. Armstrong discusses her team's pilot study of psilocybin-assisted therapy for veterans with severe, treatment-resistant PTSD, explaining why this population urgently needs new treatment options and how trauma, repeated exposure, military culture, and difficulties with reintegration may contribute to the severity and persistence of PTSD among veterans. Dr. Armstrong emphasizes that the potential benefits of psilocybin cannot be separated from the therapeutic context, including extensive preparation, trust-building, supportive care during dosing, and integration focused on psychological flexibility and personal values. The conversation explores how psilocybin may create a window for new ways of thinking and behaving, why preparation itself appeared to contribute to symptom improvement, and what larger, controlled and more diverse studies will need to investigate before psilocybin-assisted therapy can become a more established treatment for PTSD.

In this episode, you'll hear:

• Why veterans with PTSD may experience particularly severe, chronic, and treatment-resistant symptoms
• How trauma, military culture, and difficulties transitioning back to civilian life can complicate PTSD treatment
• The preliminary findings from Dr. Armstrong's pilot study of psilocybin-assisted therapy in 12 veterans
• How the study used four extended preparation sessions and two ascending-dose psilocybin sessions to build trust and gradually introduce participants to the psychedelic experience
• How acceptance and commitment therapy themes, psychological flexibility, and values informed the preparation and integration process
• What future research should investigate, including larger controlled trials, longer-term outcomes, more diverse participants, and the potential therapeutic effects of preparation alone

Quotes:

"[Dr. Morski] What do you think the mechanism of action of why psilocybin might be effective in treating PTSD? [Dr. Armstrong] That's a great question. You know we don't know for sure. That's the straightforward short answer. But there are some hypotheses right. So there seems to be some impacts at the mechanistic biological level, some some changes in brain functioning from what we can tell that perhaps it opens up an opportunity, psilocybin itself, to be able to think in new ways or or perhaps not foreclose on a coping strategy that maybe before I would have been like, no way. I'm absolutely not going to go into that triggering, you know, grocery store at the busiest time on Saturday. So it might create a window of opportunity to basically try out and create new pathways in the brain of ways to think. And, and maybe we feel a little bit different when we're doing things because of these new ways our brain is functioning. But at the same time, you know, there seems to be something important—or at least I feel pretty compelled—that there's something happening psychologically as well. So a lot of the hype and the excitement—of course, and understandably—goes towards the psychedelic itself: like what's happening with the psychedelic and why is it creating better outcomes for some people. But I think there's a really important piece of the story too, which is: it's a therapy and it's a therapy around what we're doing to prepare somebody for a psychedelic experience and how we're showing up for them during a psychedelic dosing session. So, you know, we don't just put them in a room and walk away and we're there. We're with them for the whole day, making sure they don't need anything. If they're feeling anxious, they're having a hard time. You know, we're there to help support them throughout that process, but then also to kind of put the pieces together on the other side, which is this integration piece. And there seems to be something perhaps quite compelling about this complete picture." [12:14 - 14:47]

"Psilocybin when taken at high enough doses can create an experience that can change drastically one's perception of themselves, other people in the world. And so there often are experiences that people are having during a dosing session that can be leveraged in integration, for instance, to help somebody take advantage of that biological window of opportunity. So they're saying like, 'man, I had this really, really significant insight about my trauma,' right? 'I essentially felt a profound sense of forgiveness that I've never felt before. And now I know what that feels like.' And so then we go into the integration session, having had that experience and say, 'what does that sense of forgiveness now allow you to do to get you back into your life in a way that is really important to who you are and your values and who you want to be?' And so it seems, at least for me, that if we're not looking at the whole picture, then we're going to be missing some answers to that question that you've asked, which is why is [psilocybin for PTSD] working?" [14:50 - 16:10]

"If we think about somebody having this profound experience—they're feeling better, they're doing things different, they're living their life in a different way, and now they're engaging in their world different—it's going to take a bit of time for all of those different layers and systems around them to really get used to and understand and start to react to the new way that this person is engaging in their life. And it can take some time to practice those new skills and figure out what works and what doesn't and hone them. And so this idea that it would take a little bit of time before we see full improvement [after psilocybin treatments] does make quite a bit of sense. [25:37 - 26:21]

Links:

Dr. Armstrong on LinkedIn

Center for Psychedelic Drug Research & Education website

Center for Psychedelic Drug Research & Education on LinkedIn

Dr. Armstrong's article: "Safety, feasibility, and preliminary clinical outcomes of psilocybin-assisted therapy for veterans with severe, treatment-resistant PTSD: an open-label pilot clinical trial"

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Christian Jurlando, PhD, joins to unpack the topic of extended difficulties following psychedelic experiences. Dr. Jurlando is a humanities professor at Stevens Institute of Technology in Hoboken, NJ, and a researcher and advocate focused on psychedelic safety and extended post-psychedelic difficulties (EPPD). Drawing in part on his own lived experience of prolonged difficulties following psilocybin use, his work focuses on improving recognition, care, and support for people experiencing adverse psychedelic outcomes.

In this conversation, Dr. Jurlando discusses extended post-psychedelic difficulties, drawing on both research and his own experience of EPPD following a low dose of psilocybin. He explains that these difficulties can take many forms, may occur even after relatively small doses, and can persist long after the acute psychedelic experience has ended. The conversation explores how to distinguish acute crises and shorter-term difficulties from extended post-psychedelic difficulties, as well as the importance of recognizing when someone needs professional support. Dr. Jurlando also discusses the emerging infrastructure for supporting people who experience adverse psychedelic outcomes, including peer support, harm-reduction services, specialized clinics, and the development of clearer pathways for escalation and referral. Throughout, he emphasizes the importance of acknowledging these experiences within the psychedelic field, developing more nuanced approaches to risk and informed consent, and recognizing that recovery can take time and may involve different approaches for different people.

In this episode, you'll hear:

What extended post-psychedelic difficulties can look like and how they may differ from psychosis or other acute psychedelic complications

Four questions for assessing whether someone experiencing post-psychedelic difficulties may need additional support

How peer-support and harm-reduction services can identify when someone may need to be referred for more specialized care

What is currently known about risk factors, set and setting, and the prevalence of extended post-psychedelic difficulties

Why psychedelic risk needs to be considered in relation to the potential benefits and the individual circumstances of each patient

Quotes:

"In my research, I found that back in the late 50s, that was kind of the rule of thumb: that smaller doses were more dangerous because people didn't process what was coming up and could get stuck in a negative state." [5:16]

"The best estimate [of extended post-psychedelic difficulties] that we have right now is from the Global Psychedelic Survey… over 6400 people were surveyed and 8% reported difficulties lasting a month or longer that meaningfully disrupted their daily functioning." [10:43]

"It's very difficult when something presents so fast to realize that the remedy or getting better takes time. It takes, in fact, sometimes a lot of time. And there can be a lot of resistance to that because you think 'hey, if I just took some mushrooms and then suddenly felt this way, surely I can just take something else and suddenly feel better, right?' It doesn't work that way. And so I think that that's sort of an added level of distress, and it's maybe unique." [13:59]

"What we're finding is that what people really need is just acknowledgment that these sorts of things happen. That's the first thing that would have been really helpful for me—because when you're in that state and you think that you've broken your brain or something, then it can just start snowballing." [17:37]

"It does seem like there's a wide variety of treatments [for extended post-psychedelic difficulties] and some work for some [people] and some work for others." [32:05]

Links:

Dr. Jurlando on LinkedIn

Dr. Jurlando's article: "The invention of challenging psychedelic experiences: Meaning, measurement, and foreclosure of extended harm"

Dr. Jurlando's article (pre-print): "Strengthening the Psychedelic Safety Net: A Call for a Coordinated Ecosystem of Post-Psychedelic Care"

Challenging Psychedelic Experiences Project website

Fireside Project website

Previous episode: The Challenging Psychedelic Experiences Project with Jules Evans

Previous episode: Who Is a Good Candidate for Ibogaine? with Fernando Rivas, MD

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Nigel Denning, MA, MPsych, joins to discuss the reasons profound psychedelic experiences don't always lead to lasting change. Nigel is a Counselling Psychologist and Director of Integrative Psychology & Medicine, with nearly 40 years of experience working with psychedelic and non-ordinary states. He has trained with MAPS, and served as co-lead therapist on three psychedelic clinical trials.

In this conversation, Nigel emphasizes the importance of preparation, integration, and creating the conditions for new experiences to become part of everyday life for effective psychedelic therapy. He explains that psychedelic sessions can open a period of neuroplasticity, but that without adequate reinforcement, people may naturally return to familiar patterns and ways of understanding themselves. Nigel discusses his three-phase approach to integration, which begins with simply becoming familiar with the experience, moves into narrating and embodying it, and ultimately arrives at meaning-making. He also highlights the importance of somatic awareness, curiosity, breathwork, and stabilization in helping people integrate experiences without prematurely imposing intellectual interpretations. Throughout the conversation, Nigel cautions against rushing back into ordinary routines or repeatedly pursuing psychedelic states in search of a lasting transformation, instead encouraging people to give new experiences time and space to become woven into their everyday life.

In this episode, you'll hear:

• The importance of preparation and setting realistic expectations before a psychedelic experience
• Why curiosity is more useful than trying to control or rush to interpret what happens during a session
• How somatic awareness and breathwork can help integrate psychedelic experiences
• Why integration requires stabilization and creating space after an experience
• Why it's never too late to begin integrating a psychedelic experience from the past
• The risks of "state change chasing" and repeatedly pursuing psychedelic experiences instead of integrating them

Quotes:

"[Psychedelic therapy] is a very different way of intervening psychologically. You're really preparing someone to be curious about anything that arises so that they're not going in with expectations that this is going to be this incredibly wonderful experience that's just going to change their life—it might be a really awful experience—but that as long as you can make meaning of it as you're coming out of it, that's where the transformation comes." [5:28]

"We can't predict, we can't shape and control what happens in the session. Therefore, let's just get really curious. Let's learn how to breathe and slow down and relax ourselves into meeting anything that emerges." [6:11]

"The real meaning, the real return to subjectivity, is part of the integration process" [7:21]

"[Integration] is all about familiarizing the unfamiliar without racing into a top-down reduction of it into a thing that meant this." [21:45]

"It's amazing how stabilizing the breath can be. If you're in the depths of a psychedelic hell-world and you've got no perspective on anything, what you can still do is breathe. … that quality of centering in the breath creates then that capacity to at least remember you have a body." [27:21]

Links:

Nigel on LinkedIn

Integrative Psychology & Medicine website

Integrative Psychology & Medicine on Instagram

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Fernando Rivas, MD, joins to unpack the safety and screening considerations for ibogaine therapy. Dr. Rivas is an emergency physician with over 15 years of clinical experience. As Chief Medical Officer of Transcend Clinic, he has led the development of innovative treatment protocols in addiction medicine and the clinical application of ibogaine.

In this conversation, Dr. Rivas discusses who may be a good candidate for ibogaine therapy and the clinical considerations involved in determining its safety. He explains that ibogaine has the strongest current support for interrupting substance use disorders and addressing TBI and PTSD, while potential applications in other areas remain emerging and require further research. Throughout the conversation, Dr. Rivas emphasizes the importance of distinguishing absolute from relative contraindications and of carefully screening patients for psychiatric risks, cardiac conditions, and medication interactions. He also discusses medically supported detox protocols, the importance of evaluating treatment through an individualized risk-benefit framework, and how lower-dose or non-psychedelic approaches may eventually broaden access to ibogaine's potential neuroplastic effects.

In this episode, you'll hear:

• What conditions ibogaine has been most studied for and where its potential applications may be expanding
• The psychiatric and physical conditions that may make someone an unsuitable candidate for ibogaine treatment
• How patients with active opioid or alcohol use may be medically supported and stabilized before treatment
• Why relative contraindications should be evaluated through an individualized risk-benefit analysis
• How ibogaine's typical psychedelic experience may be shorter than its reputation suggests
• Why the immediate improvements some patients experience should be understood within the broader context of neuroplasticity and long-term integration

Quotes:

"Ibogaine is the most robust of the [psycho]plastogens in terms of the window of time that it is able to open [for increased neuroplasticity]—at least as per preclinical research. So the potential is tremendous." [3:22]

"Cardiovascular health is the most important [safety consideration for ibogaine therapy]. If you have a big hypertrophic heart and a large dilated heart, the risks are greater. If you have rhythm disturbances, the risks are greater and sometimes unacceptable." [11:08]

"The chances [of an adverse cardiac event] are mitigated by properly screening and vetting patients, as well as by the addition of magnesium to ibogaine treatment. Magnesium is an essential component, as it is cardioprotective. … It simply raises the threshold for an irregular heartbeat or to occur." [17:38]

"A first degree relative with schizophrenia, for example, would be a relative contraindication. However, we must think of this in terms of risk and benefit. If this person is injecting fentanyl every day, they are at risk of overdose and death every single day. … so that relative contraindication should always be ascertained in terms of risk-benefit, particularly risk to life when it is present." [29:31]

"The science currently supports that sufficient exposure over a short enough period of time can yield pretty much the same results in terms of [neuro]plasticity without incurring a psychedelic experience. And we have tailored some specific treatments for patients that did not wish to incur a psychedelic experience, yet wanted to obtain the benefits of the plastic component of ibogaine treatment." [32:15]

Links:

Dr. Rivas on Instagram

Transcend Clinic website

Previous episode: Psychedelics and Psychosis with Alexander Lebedev, MD, PhD

Psychedelic Medicine Association

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This encore episode of the Psychdelic Medicine Podcast features a conversation with Kyle Buller on psychedelics and breathwork. Kyle is co-founder and host of the Psychedelics Today podcast and he has studied breathwork since October 2010 with Lenny and Elizabeth Gibson of Dreamshadow Transpersonal Breathwork. Kyle earned his BA in transpersonal psychology from Burlington College where he focused on the healing potential of non-ordinary states of consciousness, exploring topics such as shamanism, reiki, plant medicine, and holotropic breathwork. He has also earned an MS in clinical mental health counseling with emphasis in somatic psychology and has since worked with at-risk teens in crisis and individuals experiencing an early episode of psychosis.

Kyle opens this discussion by providing a basic definition of breathwork and sharing his own journey with this modality. He discusses how breathwork can refer to a wide variety of practices, but what unites these disparate techniques is utilizing the breath to induce specific physiological states and experiences. The holotropic style of breathwork has roots in transpersonal psychology and the work of Stanislav Grof and it is this modality which is often compared to psychedelic experiences.

Kyle discusses how holotropic breathwork can be an incredibly powerful practice for trauma-healing and inducing visceral experiences—similar to the classical psychedelics. He recounts his own experiences with this practice, describing how he was able to relive the experience of being born in the state conditioned by the method of breathing. Due to the synergy with the psychedelic experience, Kyle mentions that there is a lot of potential for breathwork to help individuals integrate or prepare for psychedelic experiences, as well as being a powerful tool for clinicians involved in psychedelic-psychotherapy to better understand the non-ordinary states of consciousness their patients will be experiencing.

Because of the wide variety of breathwork techniques, Kyle discusses the possibilities of tailoring practices to the specific experiences of a client. Everyone has a unique "window of tolerance" depending on their background and constitution, and some people will benefit more from techniques which downregulate the nervous system and allow for peace and relaxation, while others may find more value in techniques which are highly stimulating and provide deeper, emotionally complex experiences that allow for self-exploration.

In this episode:

• What breathwork is and how it relates to psychedelics
• The origins of holotropic breathwork and Stanislav Grof's transpersonal framework
• Breathwork vs meditation
• How to use breathwork to integrate and prepare for psychedelic experiences
• The effects of different types of breathing on the nervous system

Quotes:

"[Breathwork] offered a really great tool for training, for understanding how to sit with people in non-ordinary states of consciousness." [8:49]

"Some breathing techniques, like these more deeply cathartic techniques, they're bringing up a lot of emotional memory and people are starting to work through a lot of somatic sensations, they are working through trauma." [13:38]

"We really need to look at somebody's whole picture, where they're at, how they could potentially benefit, look at their nervous system, attune to that, and really think about what they could tolerate, what's going on in somebody's psyche." [30:29]

"The breath is this flexible tool, it's a vehicle—we can help to regulate our nervous system with it and explore it." [39:38]

Links:

Psychedelics Today

Psychedelics Today Education Center

SettingSun Wellness

Dreamshadow Transpersonal Breathwork

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Alexander Lebedev, MD, PhD joins to discuss psychedelic medicine and psychosis. Dr. Lebedev is a physician-scientist, medical AI engineer, and entrepreneur working at the frontier of health and technology. His work spans collective societal dynamics, psychedelics, and medical AI; he leads Lebedev Labs and is co-founder of Dreamseer and Once Wellbeing Center.

In this conversation, Dr. Lebedev explores the complex relationship between psychedelics and psychosis, examining what decades of research—and more recent clinical evidence—actually tell us about the risks. He explains why individuals with personal or family histories of psychotic disorders are typically excluded from clinical trials, clarifies the distinction between transient psychotic experiences and chronic psychotic disorders, and discusses why current evidence has not established a causal link between psychedelic use and persistent psychosis in screened populations. Throughout the discussion, Dr. Lebedev emphasizes the importance of careful screening, preparation, integration, and context, arguing that psychedelics should be understood through both scientific and phenomenological lenses rather than simplistic assumptions about safety or danger.

In this episode, you'll hear:

• What inspired Dr. Lebedev to study psychedelics and psychosis
• Why psychedelics became associated with psychosis and how that perception developed historically
• Why case reports of psychotic episodes following psychedelic use are not definitive to establish a causal link between the two
• How the lenses and frameworks we employ can significantly color how we understand psychosis and altered states of consciousness
• The role of set, setting, sleep, substance use, and integration in reducing psychological risks
• How psychedelic experiences overlap with—and differ from—psychotic states from a phenomenological perspective
• The intersection of psychosis and bipolar disorder and the relevance of this overlap to psychedelic medicine
• Why researchers are beginning to reconsider whether certain psychosis-spectrum populations should eventually be studied under carefully controlled conditions

Quotes:

"The first framework within which psychedelics were studied and considered was the psychotomimetic framework, meaning that they were considered as tools that are supposed to mimic psychotic states." [9:22]

"In the pre-prohibition era, psychedelics were tested on very large populations of different patients—including people with psychosis spectrum disorders, including people with schizophrenia spectrum disorders—with some mixed results. But there was already some data indicating that from a populational perspective, from a statistical link, we didn't have clear indication, even back then, that that link [between psychedelics and psychosis] exists." [12:48]

"Interestingly, unlike for cannabis, for tobacco, for some other substances, this link [with psychosis] was not verified in these large studies for psychedelics." [15:54]

"If the only lens that you have is pathology, you can pathologize transformation as well. On the other hand, if the only lens that you have is spirituality, you can spiritualize the compensation that can come with the psychotic experience." [20:21]

"From a phenomenological perspective, there are, of course, clear similarities [between psychedelic experiences and psychosis] . But of course, the background, the emotional content is very different. … If you read sometimes descriptions of people's mystical experiences or bad trips, sometimes they can actually on the surface look remarkably similar. What is different is the affective balance of it. And that's true for psychedelic experiences and also for psychotic experiences." [40:37]

Links:

Dr. Lebedev on LinkedIn

Dr. Lebedev on Instagram

Dr. Lebedev on Threads

Once Wellbeing Center website

Once Wellbeing Center on Instagram

Once Wellbeing Center on LinkedIn

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Arsalan Azam, MD joins to unpack the intersection between psychedelics and GLP-1s. Dr. Azam, founder of Daydream MD, completed his residency in Emergency Medicine at the Metropolitan/Harlem Emergency Medicine Residency program in New York before practicing emergency medicine nationwide. Drawing on that experience, he developed a comprehensive ketamine-assisted therapy practice and now blends functional medicine with personalized GLP-1 services to help patients achieve sustainable, biologically tailored health outcomes.

In this conversation, Dr. Azam explores the emerging intersection of GLP-1 medications and psychedelic therapies, arguing that both create temporary windows for behavioral change that can be leveraged to improve long-term mental and metabolic health. He explains how GLP-1 medications act primarily on the brain's reward and craving circuits, reducing "food noise" while creating opportunities to reshape habits and addictive behaviors. The discussion also covers how GLP-1s may complement psychedelic-assisted therapies for conditions such as addiction and PTSD, potential interactions with ketamine and classic psychedelics, and important clinical considerations, including nausea, delayed gastric emptying, medication dosing, and the importance of individualized treatment strategies.

In this episode, you'll hear:

• How GLP-1 medications influence the brain's reward, craving, and motivation circuits
• Why Dr. Azam views GLP-1s and psychedelics as complementary therapies that each create windows for lasting behavioral change
• The potential role of GLP-1 medications in treating addiction alongside psychedelic-assisted psychotherapy
• What patients and clinicians should know about combining GLP-1 medications with ketamine and classic psychedelics
• How delayed gastric emptying may alter the timing, intensity, and safety of orally administered psychedelic experiences
• Why careful dosing of GLP-1 medications is important to avoid emotional blunting while preserving their therapeutic benefits
• The importance of using both psychedelic and metabolic therapies as opportunities to build healthier long-term habits rather than relying on medication alone

Quotes:

"Not all behavioral health symptoms are driven purely by things going on in the brain and the nervous system and mood and whatnot. Sometimes it's well outside that. And so that's where, naturally, GLP-1s caught our gaze. Here's a medicine that treats probably one of the biggest of the two health crises I think right now facing America: one is—I do think—mental health, but the other is metabolic health." [4:52]

"Just like psychedelics create a window [of transformation], GLP-1s create a window. It's this pharmacologic scaffolding that you can use to start to really reexamine your relationship with food, with craving, how you've been eating, why you've been eating. And you can essentially use GLP-1s to hit the pause button on that noise, and that makes it easier to eat less. But it also makes it easier to start to ask the questions of why? Why was I eating the way I was eating?" [9:59]

"In general, GLP-1s seem to play pretty nicely [with ketamine]. I'd say the bigger thing that I've observed that doesn't get named all that much is that craving and reward are important. They're part of how we see salience in the world and also derive pleasure from it, and if you go too high on a GLP-1, people experience a flattening. They feel kind of blah, and it's not in their head. It's because you've over-damped the salience and reward circuitry. And so it's about finding the sweet spot where there's enough to motivate you in life without being noisy." [20:13]

Links:

Daydream MD website

Daydream MD on Instagram

Daydream MD on Facebook

Dr. Azam on LinkedIn

Psychedelic Medicine Association webinar: GLP-1s and Psychedelics: Clinical Considerations, Interactions, and Emerging Questions

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Dori Lewis, MA, MEd, LPC-S returns to discuss the differences between psilocybin and ketamine. Dori is the Clinical Director of Elemental Psychedelics and Owner/Operator of Reflective Healing in Fort Collins Colorado. As a clinician, she blends transpersonal psychology, depth work, and psychedelic-assisted therapy within a model that centers the therapeutic relationship. To date, she has stewarded over 100 ketamine therapy sessions, more than 200 mushroom sessions, and numerous group ceremonies.

In this conversation, Dori explores how clinicians and facilitators can thoughtfully decide when ketamine or psilocybin may be the more appropriate therapeutic option, emphasizing that the two medicines are complementary rather than competing approaches. She explains how factors such as current medications, trauma history, substance use, prior experience with altered states, therapeutic readiness, and available social support all shape this decision. Throughout the discussion, Dori argues that ketamine often serves as an accessible and effective introduction to psychedelic-assisted therapy, while psilocybin may be especially valuable for addressing grief, attachment and religious trauma, and deeper existential questions when paired with sufficient preparation, integration, and a strong therapeutic relationship.

In this episode, you'll hear:

• Why ketamine is often recommended before psilocybin for people new to psychedelic therapy
• How SSRIs and other medications influence the choice between ketamine and psilocybin
• What personal history, symptoms, and therapeutic readiness clinicians should evaluate before recommending either medicine
• Which conditions and life experiences may be particularly well-suited for psilocybin-assisted therapy, including grief, attachment trauma, and existential distress
• How cannabis use, substance use disorders, and suicidal ideation can affect treatment planning
• Why community support, integration resources, and a trusting relationship with a facilitator are critical for successful psychedelic experiences
• The importance of cultivating self-awareness before engaging in psychedelic-assisted therapy

Quotes:

"How do we help somebody who is on these [SSRI] medications, has been on them for a really long time and is actually doing well with them? The answer is not to get someone to stop taking their meds just to have a psilocybin experience. That's actually really reckless, in my opinion. What I would say is, why don't we start with ketamine and see how that affects you." [7:59]

"There's another important piece here: What [does the patient] want? If this person says, 'Dori, I really don't want to do ketamine. I want to work with a plant medicine. That's what I'm feeling really called to.' I might say, 'okay, then let's explore that.' But if they're open [to either], I might say, 'why don't we start with [ketamine]?'" [15:50]

"There are very few cases that I would say, 'don't start with ketamine' unless somebody says 'I've already done ketamine' … or they say 'I don't want to do ketamine' but in most cases I'm going to recommend just start with ketamine" [23:05]

Links:

Dori on LinkedIn

Elemental Psychedelics website

Elemental Psychedelics on LinkedIn

Reflective Healing website

Reflective Healing on LinkedIn

Reflective Healing on Instagram

Fireside Project website

Previous episode: Common Psilocybin Myths & Misconceptions with Dori Lewis, LPC

Previous episode: How Psychedelics & Pharmaceuticals Can Both Aid Healing with Erica Zelfand, ND

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Katie Fassbinder, MD joins to explore how to choose the right ketamine clinic. Dr. Fassbinder is the Faculty Medical Lead for ketamine-assisted psychotherapy training at Elemental Psychedelics and a practicing psychiatrist based in Wisconsin with over 20 years of experience. She also directs mental health and KAP programming at Promega and has worked extensively in public-sector mental health systems.

In this conversation, Dr. Fassbinder explores how patients can make informed decisions when choosing a ketamine clinic, emphasizing that safety, therapeutic support, and personal fit should guide the process. She discusses the differences between medical ketamine treatment and ketamine-assisted psychotherapy, highlighting how factors such as trauma history, treatment goals, medical complexity, and access to integration support can influence the most appropriate model of care. The conversation also examines the strengths and limitations of various routes of administration, including IV, intramuscular, sublingual, and at-home ketamine programs. Throughout, Dr. Fassbinder stresses the importance of preparation, integration, set and setting, and finding a treatment environment that feels safe and supportive, noting that ketamine's benefits are often maximized when paired with meaningful therapeutic relationships and ongoing psychological support.

In this episode, you'll hear:

• Key factors to consider when evaluating the safety of a ketamine clinic
• How medical and psychological needs influence the type of ketamine treatment that may be most appropriate
• The differences between ketamine-assisted psychotherapy and more medically oriented ketamine treatment models
• How IV, intramuscular, sublingual, and at-home ketamine approaches compare
• Why set, setting, preparation, and integration are critical components of successful treatment
• Who may be a good candidate for at-home ketamine programs and what risks to consider
• The distinction between psycholytic and psychedelic ketamine dosing and how each supports different therapeutic goals
• Resources and community-based options for psychedelic integration when ongoing therapy is not available

Quotes:

"[Ketamine] is one of those medicines that's very much a shape shifting medicine and it can meet people for different types of concerns or goals at different levels and different routes. So it's so good we have such a breadth of options—and very complicated if you're a patient trying to figure out where to begin." [7:55]

"Those challenging psychedelic experiences, when well integrated, typically provide even more benefit for the person than the sort of bliss journeys that we all hope everybody gets to have, you know? So having a challenging journey, if well supported and integrated, is also a gift that's very potent for somebody that's really ready to do that work." [21:52]

"Ego dissolution or that sort of loss of concept of self can be extremely liberating for some people. For others, coming back from that can be very discombobulating and even traumatic. So this really comes down to patient selection and helping people make a safe choice for what they're looking to do in their recovery and also what they're bringing in as risk factors for helping choose that safe dose range." [31:15]

"While we don't have clarity about cognitive impacts of ketamine in the long run, it seems like when done therapeutically in pulses it's pro-cognitive. … But when done daily, what we've seen in recreational ketamine use—or misuse—is that it does have some cognitive impairment that's perhaps difficult to reverse." [42:58]

"The dose of ketamine has so much to do with the preparation of your system more than the number of milligrams. … If you've done the at home course and you're not getting the sustained benefit or you're not journeying, it might be that that's a cue that you need more support for your actual sessions." [45:01]

"Psychedelics and ketamine included, create a nonspecific amplification of everything. Everything feels bigger. And part of meeting with the ketamine provider is for them to really assess: Is this a good time in your life? Do you have the outside support, the inner resourcing to do this work safely?" [47:09]

Links:

Elemental Psychedelics website

Elemental Psychedelics on LinkedIn

Promega website

Healing Maps website

Fireside Project website

ACER Integration website

Journey Clinical website

Usona Institute website

"Psilocybin vs. Ketamine Training: Which is Right For Your Practice?" blog by Shannon Hughes and Dori Lewis

Previous episode: Fireside Project: The World's First Psychedelic Hotline with Joshua White and Hanifa Nayo Washington

Psychedelic Medicine Association

Porangui