The Ketamine StartUp Podcast

This week we are reaching back to our very first season to resurface a conversation that has stayed with us. And there is a reason we keep coming back to it.

There are a lot of conversations about the mechanics of opening a ketamine clinic. This one is about the why behind it.

Dr. Glareh Imani is a board-certified emergency physician who opened Nameen Infusion and Wellness in Goodyear, Arizona after more than eight years in emergency medicine. Her background in neuroscience, her personal experience with ketamine, and a deep sense of gratitude shaped the kind of clinic she built and the way she shows up for her patients every day.

What makes this conversation stand out is how honest and human it is. Dr. Imani talks about the unexpected challenges of opening a clinic, the patient transformations that confirmed she had made the right choice, and the personal evolution that came with doing this work.

She also reflects on autonomy, on what it means to finally be the one making the decisions, from clinical protocols to the waterfall in her reception area.

Recorded at the ASKP3 conference in Austin, Texas during our first season, this episode holds up beautifully. 

If you are considering the pivot from your current position, or if you are early in building your practice and need a reminder of why you started, this one is for you.

What You'll Gain:

· Dr. Imani's honest account of what it took to go from the idea of opening a ketamine clinic to actually delivering on it, including what surprised her most along the way

· How her background in neuroscience and her personal experience with ketamine shaped both her decision to open a clinic and her approach to patient care

· What set and setting actually means in the outpatient clinic context, and how Dr. Imani thinks about the environment she has created for her patients

· Two patient stories that capture what ketamine therapy can do when it is delivered with intention and individualized care

· What the transition from corporate emergency medicine to clinic ownership actually feels like, including the autonomy, the trade-offs, and the parts you cannot put a price on

· How Dr. Imani balances running a clinic, working emergency medicine shifts, and family life, including what she says makes it all possible

Episode 66 show notes:

00:00:00 Teaser: "I'm Happier Now Because I Know I Can Help in a Different Way"

00:00:18 Episode Introduction

00:02:03 Background: From Neuroscience to Emergency Medicine to Ketamine Therapy

00:06:13 Her Personal Ketamine Experience and the Decision to Open a Clinic

00:08:19 Unexpected Challenges and the Backup for Everything Rule

00:09:00 Ketamine in the Hospital vs. the Outpatient Clinic: Set and Setting

00:10:33 Safety Standards and Why EM Training Is an Advantage

00:13:00 Patient-Centered Care, Setting Expectations, and the Tools She Relies On

00:15:08 Advice to Her Past Self: Start Sooner and Do Not Do It for the Money

00:18:02 The Power of Autonomy and What Clinic Ownership Actually Feels Like

00:19:40 Personal Evolution: Mindfulness, Journaling, and Resetting Yourself First

00:23:21 Patient Stories: Transformation That Confirms the Decision

00:26:24 Balancing a Clinic, ER Shifts, Family Life, and Why Community Matters

00:28:40 Rapid-Fire Questions Begin

00:37:00 Time Travel: Being a Teenager in Vienna as a Refugee

00:38:22 Gratitude, Resilience, and the Gift of Helping Others

00:40:10 Final Thoughts and Where to Find Dr. Imani

00:40:54 Episode Ending

Connect with Dr. Imani at:

Nameen Infusion & Wellness website

Nameen Infusion & Wellness Instagram

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast

This Soundbite from the Vault packs three genuinely useful sections into one digestible clip, and each one stands on its own.

It opens with something most emergency medicine physicians quietly wonder about before making the pivot: what does it actually feel like to work in a ketamine clinic after years of shift work? 

Dr. Nico Grundmann, founder of Ember Health in New York and an emergency physician with an MBA from Stanford, gives a refreshingly honest answer. The schedule changes. The mental model changes. The relationships you build with patients are unlike anything the ER allows. And for the right person, all of that is exactly the point.

The middle section pulls back the curtain on what patient care can actually look like. From the first call to the four-visit induction series to long-term maintenance care, Dr. Grundmann walks through the full patient journey at Ember, including their 84 percent real-world treatment response rate and why they believe the care coordination model is what drives it.

It closes with the three things Dr. Grundmann would tell anyone opening their own ketamine practice. Not generic advice. Specific, hard-won pillars that have shaped how Ember operates across five New York City locations and more than 2,200 patients treated.

What You'll Gain:

· An honest account of what actually changes when you move from emergency medicine to a ketamine clinic, including the parts most people do not talk about before making the leap

· Why care coordination takes up 30 to 40 percent of the day at Ember and what that means for EM physicians who are used to handing off at the end of a shift

 · A clear picture of what the patient journey looks like inside a well-run ketamine practice, from first consultation through long-term maintenance care

 · Why Ember's real-world treatment response rate of 84 percent outperforms the published academic data of 75 percent and what Dr. Grundmann believes is driving that difference

 · The three pillars Dr. Grundmann would share with any provider opening their own ketamine clinic, built from years of operational experience across multiple sites

Episode 65 show notes:

00:00:00 Teaser: "This isn't a role where you clock out and you're done."

00:00:13 Episode Introduction 

00:01:25 What Is It Actually Like to Work in a Ketamine Clinic After Years of Shift Work?

00:03:20 Who Is a Good Fit: Longitudinal Care, Fixed Schedule, and Panel Management

00:05:00 For the Right Person It Checks Every Box: What the Fulfilling Version of This Work Looks Like

00:07:58 What Does the Patient Journey Actually Look Like from First Call to Treatment?

00:10:30 Real-World Treatment Response Data: 84 Percent at Ember vs. 75 Percent in Published Literature

00:12:33 Three Pieces of Advice for Anyone Opening Their Own Ketamine Clinic

00:14:36 Episode Ending 

Thanks for listening

Selected Links From the Episode:

Want to go deeper? This soundbite comes from Episode 040 – Episode 40 - Scaling Ketamine Clinics: From Pilot to Five Locations with Dr. Nico Grundmann, where we cover the full conversation including how Nico built Ember from a one-room pilot site to five locations in New York City and the systems thinking behind all of it.

Follow us on

Linkedin

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

Clinical Disclaimer: This episode is for educational purposes for licensed healthcare professionals and is not individual medical advice. Ketamine and esketamine are not FDA‑approved for preventing or treating postpartum depression; any use in this population is off‑label and should be considered investigational and undertaken only with appropriate training, collaboration, and adherence to current standards of care.

Postpartum depression affects roughly 10 to 20 percent of mothers and remains one of the most undertreated conditions in medicine. As public awareness of maternal mental health grows, providers in the ketamine and psychedelic therapy space are increasingly asking: is there a role for ketamine or esketamine here?

This episode is our evidence-based answer to that question.

We walk through the current clinical literature on ketamine and esketamine for perinatal depression, drawing on randomized controlled trials, meta-analyses, and expert commentary from institutions including the Center for Women's Mental Health at Massachusetts General Hospital.

The research landscape is more nuanced than most providers realize, and understanding it clearly matters both for patient conversations and for how you think about your practice's scope.

One distinction shapes everything that follows in this episode, and it's an important one: virtually all of the existing trial data involves perioperative prevention in cesarean delivery populations, not outpatient treatment of established postpartum depression.

Knowing what the evidence actually supports and where the gaps remain is essential context for any provider working in this space.

What You’ll Gain

· A clear breakdown of what current ketamine and esketamine trials actually show for postpartum depression prevention, and what limited data exist for treatment.

· An understanding of why racemic ketamine and esketamine tell different stories in the peripartum literature.

· The key ethical and practical considerations for any provider thinking about this population.

· An honest framework for how to talk with patients who ask about ketamine for postpartum depression.

· Context on what the research gaps mean for where this field is heading.

Review the research behind this episode, including full citations for every study discussed, in the Clinical References and Further Reading.

📖 Prefer to read? We turned this episode into a full blog post with structured tables comparing the racemic ketamine and esketamine evidence side by side, plus a research gaps summary you can reference and share with your team: Read the Blog Post

Episode 64 show notes:

00:00:06 Episode Introduction

00:02:02 Clinical Context: Defining PPD, Postpartum Psychosis, and Perinatal Depression

00:03:34 Prevalence, Public Health Burden, and Why Cesarean Delivery Matters Here

00:04:40 Why Ketamine and Esketamine Are Conceptually Interesting in This Population

00:05:38 Prevention vs. Treatment: A Critical Framing Point Before the Research

00:06:32 Racemic Ketamine in the Peripartum Setting: Mixed and Conflicting Signals

00:09:22 What the Meta-Analyses Tell Us: Darwish et al. 2025 and Li et al. 2024

00:11:18 Bottom Line on Racemic Ketamine in the Peripartum Setting

00:12:05 Esketamine: Why It May Outperform Racemic and Why This Is Not About Spravato

00:13:32 The Esketamine Trials: From Early Signals to the 2024 BMJ Landmark Study

00:18:51 Treatment vs. Prevention: What About Established PPD?

00:21:29 Ethical and Practical Considerations

00:21:40 Lactation and Infant Exposure

00:22:14 Neurodevelopment Data: The Long-Term Unknown

00:22:35 Informed Consent in the Peripartum Period

00:23:04 The Tension Between Rapid Relief and Premature Clinical Adoption

00:24:10 Clinical Takeaways, Research Gaps, and What Cautious Optimism Looks Like in Practice

00:24:27 What the Evidence Supports: Esketamine Summary

00:25:23 What the Evidence Does Not Yet Support: Outpatient PPD Use

00:25:41 Bottom Line on Racemic Ketamine: Summary

00:26:07 Five Research Gaps the Field Needs to Address

00:27:56 What This Data Means for Ketamine Therapy Providers Right Now

00:30:03 Closing Remarks 

Thanks for Listening

📝 For Complete show notes along with the the research behind this episode, including full citations for every study discussed, please visit http://www.ketaminestartup.com/podcast/episode-064

In this episode from the vault, we’re going back to when Sam gave a presentation at the American College of Emergency Physicians (ACEP) Scientific Assembly, making the case for why emergency physicians and clinicians are uniquely positioned to successfully practice in the ketamine therapy space.

This is not a generic overview of ketamine. It is a frank, evidence-based conversation directed at clinicians who are feeling the weight of burnout, decreased autonomy, and a healthcare system that is asking more while giving less in return. 

Sam walks through the science, the mechanism, the financial realities, and the deeper question of purpose that every provider should sit with before taking the leap.

If you have ever wondered whether your emergency medicine training could translate into something more fulfilling, this episode makes a compelling and well-researched argument that it can.

What You'll Gain:

• A clear picture of the mental health and chronic pain crisis driving demand for ketamine therapy, and why the current standard of care is falling short for so many patients

• A walk through the key clinical studies supporting IV ketamine for depression, anxiety, PTSD, and chronic pain, including the landmark 2023 New England Journal of Medicine trial comparing ketamine to ECT

• An honest look at the mechanism of action behind ketamine therapy, from NMDA receptor antagonism to neuroplasticity and BDNF, explained in language that makes clinical sense

• Why emergency physicians bring a uniquely transferable skill set to the ketamine therapy space, and how that advantage plays out in practice

• The financial and emotional realities of running a ketamine clinic, including what Sam wishes more providers understood before they opened their doors

• Why knowing your why is the single most important thing you can do before starting a ketamine practice, and how it will carry you through the inevitable hard moments

Episode 63 show notes:

00:00:00 Teaser: "This is the why, the purpose, the motivation."

00:00:34 Episode Introduction and Overview

00:01:45 The Mental Health Crisis: Why This Work Matters Now

00:03:48 Burnout and the Changing Landscape of Emergency Medicine

00:04:43 Why EM Physicians Are Uniquely Positioned for Ketamine Therapy

00:05:02 The Clinical Evidence for Depression: From the Berman 2000 Study to the 2023 NEJM Trial

00:07:25 The Clinical Evidence for Anxiety: Dr. Paul Glue's Escalating Dose Study

00:08:20 The Clinical Evidence for PTSD: Single and Multiple Infusion Data

00:09:41 The Clinical Evidence for Chronic Pain: What Works and What Doesn't

00:10:55 Mid-Episode Ad: Free Ketamine Startup Checklist

00:11:44 How Ketamine Works: NMDA Receptor Antagonism and Glutamate

00:12:19 Multi-Receptor Action, Neuroplasticity, and BDNF

00:13:30 Beyond the Mechanism: The Experiential Dimension of Ketamine

00:14:40 The EM Skill Set Advantage: Clinical Experience, Procedures, and Scheduling Flexibility

00:15:24 Emergency Medicine Is a Mindset, Not a Location

00:15:53 Before the How, There Is the Why

00:16:39 The Toxic Waste Pool: A Story About Purpose and Motivation

00:17:23 The Financial Reality: Don't Open a Clinic for the Money

00:18:14 Why You Should Open a Ketamine Clinic: Purpose, Autonomy, and Saving Lives

00:18:55 Patient Testimonials: In Their Own Words

00:20:17 Outro

Thanks for listening

🎥 Prefer to watch? This episode was originally a live conference presentation with slides covering the clinical studies, mechanisms of action, and other helpful visuals. The YouTube version brings all of that to life: Watch Episode 063 on YouTube

📖 More of a reader? We turned this presentation into a full blog post covering the clinical evidence, why your EM training is an unfair advantage, the financial reality nobody talks about enough, and what patients say when the treatment works: Read the Blog Post

📝 Complete show notes with resources and  links, please visit https://www.ketaminestartup.com/podcast/episode-063

Follow us on

Linkedin

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

Dr. Lowan Stewart is not just someone who opened a ketamine clinic. He is someone who built the infrastructure for an entire country to access it.

In this conversation, Sam sits down with Dr. Stewart, an emergency physician who co-founded the first ketamine clinic in New Mexico in 2016, brought ketamine therapy to Norway two years later, established the first public ketamine treatment unit in Scandinavia, and played a central role in Norway becoming the first country in the world to approve national public reimbursement for off-label ketamine in treatment-resistant depression.

What makes Dr. Stewart's story particularly resonant for our audience is how familiar the starting point will feel. An EM physician who loved his work but felt the limits of what emergency medicine could do for the river of suffering flowing through the department. A side project that became a calling. An uphill battle against institutional skepticism that most providers in this space will recognize immediately.

He also brings a perspective on the future of psychedelic medicine that is worth hearing. His argument is straightforward: ketamine is not just a treatment. It is the infrastructure that will make everything else, psilocybin, MDMA, and what comes after, possible in clinical and public health settings. Getting ketamine right now is how the field prepares for what is coming next.

This is a wide-ranging conversation covering career pivots, pioneering in resistant systems, the mechanics of moving a national healthcare system, and the daily reality of doing work that genuinely transforms lives.

What you’ll gain:

• The full arc of Dr. Stewart's career pivot from emergency medicine to ketamine therapy, including what pushed him toward something with more systemic and sustainable impact than the ER could offer

• A firsthand account of what it actually looks like to be the first mover in a resistant healthcare system, from opening the first ketamine clinic in New Mexico to fighting a formal complaint from the Norwegian Psychiatric Association

• How Dr. Stewart built the first public ketamine treatment unit in Scandinavia and the strategy behind getting ten major Norwegian hospitals to implement ketamine therapy simultaneously through a multi-site clinical trial

• What Norway's landmark decision to become the first country in the world to approve national public reimbursement for off-label ketamine in treatment-resistant depression means for the global field and what other countries can learn from it

• Why Dr. Stewart believes ketamine is not just a treatment but the infrastructure that will determine how ready clinical and public health systems are when psilocybin, MDMA, and other psychedelic medicines arrive

• His honest reflection on why this work is worth it, including what it feels like to shift from focusing on the quantity of life in the ER to focusing on the quality of life in ketamine therapy

Episode 62 show notes:

00:00:00 Teaser: "Once somebody says, 'I'm alive today because of this treatment,' you can't not do it."

00:00:24 Episode Introduction

00:02:19 Sam Welcomes Dr. Lowan Stewart

00:02:53 Background Overview: Emergency Medicine, Norway, and the Journey to Ketamine

00:08:56 Why Neuroscience: Starting an MD-PhD and the Rat Brains Advice

00:10:09 From Space Medicine Dreams to Emergency Medicine Reality

00:12:14 The Decision Point: Going Away from EM or Toward Something New?

00:15:37 Opening the First Ketamine Clinic in New Mexico: What the Ketamine World Looked Like in 2016

00:17:55 Bringing Ketamine to Norway: Opening Axon Clinic in 2018

00:20:06 Approaching the Norwegian Psychiatric Association and Health Department with the Data

00:26:40 Psychiatrist Skepticism: "I Don't Know What to Do with These Patients If They're Fine"

00:28:29 The Formal Complaint from the Norwegian Psychiatric Association

00:31:23 Establishing the First Public Ketamine Treatment Unit in Scandinavia

00:34:34 Axon Clinic's Acquisition by Awaken Life Sciences and the Ukraine War Impact

00:40:18 Norway's Landmark Approval: National Public Reimbursement for Off-Label Ketamine

00:44:20 The Multi-Site RCT Strategy: Implementing Ketamine Across Ten Major Norwegian Hospitals

00:50:17 Why Ketamine Gets Overlooked at Psychedelic Conferences and Why That Needs to Change

00:55:14 One Piece of Advice for Any EM Physician or Clinician Considering This Pivot

00:58:34 Rapid-Fire Questions

00:59:07 How Dr. Stewart De-Stresses: Cold Ocean Swims and Sauna in Norway

01:02:17 How to Connect with Dr. Lowan Stewart

01:04:03 Episode Ending

Thanks for listening

Connect with Dr. Stewart at:

Clinic Website - Axonklinikken http://axon.no/ 

Email: [email protected]

Linkedin: https://www.linkedin.com/in/lowan-stewart-27349616/

📝 Complete show notes with resources and  links, please visit https://www.ketaminestartup.com/podcast/episode-062

In this Soundbite from the Vault, we're revisiting a carefully selected segment from a live conference presentation we gave to a room full of ketamine therapy specialists, walking through the exact marketing framework we've built and refined over the years.

Not familiar with our Soundbites from the Vault? These are shorter, standalone segments from earlier episodes that we think are worth revisiting: easy to digest and immediately relevant to your practice.

This one is a little different from our typical guest interviews. It's practical, visual, and built for providers who are doing their own marketing, outsourcing it, or using AI tools to help, and who want to understand the thinking behind it all. Because the framework matters regardless of who's doing the work.

We cover the full ACC model: awareness, consideration, and conversion, breaking down exactly where every marketing effort you're making fits inside it. Then we get into organic content, what it actually is, how to create it sustainably without burning out, and our Venn diagram approach to figuring out what to talk about in the first place. And if you stay to the end, you'll hear why your clinic's online presence may be one of its most important vital signs.

If your marketing has ever felt scattered, reactive, or disconnected from any real goal, this framework gives you the language and the structure to change that.

What You'll Gain:

· A clear understanding of the medical marketing funnel and how every marketing effort you make maps to one of its three layers: awareness, consideration, or conversion

· The ACC framework explained through a relatable analogy that makes the patient journey easy to visualize and remember

· A practical Venn diagram approach for figuring out what content to actually create, where what your patients want to know meets what is authentic to you

· A simple content creation system that turns one video into a blog, social media posts, and micro content across platforms

· Why your clinic's online presence is one of its most telling vital signs, and what asystole, bradycardia, and atrial fibrillation have to do with your Instagram account

Episode 61 show notes:

00:00:00 Teaser: "What you want to be is in normal sinus rhythm…"

00:00:19 Episode Introduction

00:01:43 What Is the Medical Marketing Funnel and Why Should You Care?

00:02:08 The ACC Framework: Awareness, Consideration, and Conversion Explained

00:02:35 Awareness: How Patients First Discover You and What Content Helps Them Find You

00:03:45 Consideration: Why Patients Compare Their Options and How to Stand Out

00:04:24 Conversion: Making It Easy and Frictionless for Patients to Say Yes

00:05:13 Want More Patients? Start by Growing the Top of the Funnel

00:06:34 What Is Organic Content and How Is It Different from Paid Advertising?

00:07:58 The Venn Diagram: Finding the Sweet Spot Between What Patients Want and What's Authentic to You

00:08:14 What Your Patients Actually Want to Know

00:08:29 Why Authenticity Is What Turns Generic Content Into Content That Connects

00:10:00 From One Video to a Blog, Social Posts, and Micro Content: The Content Creation System

00:12:02 Is Your Clinic Asystolic? Why Organic Content Is One of Your Most Important Vital Signs

00:13:41 Episode Ending and Resources

Thanks for listening

Selected Links From the Episode:

Want to go deeper? This soundbite comes from Episode 035 – The Medical Marketing Funnel for Ketamine Clinics, where we cover the full conversation including a deep dive into the newsletter as a standalone marketing tool for your practice.

🎥 The marketing funnel, the Venn diagram, and the organic content framework are all significantly easier to follow when you can see the slides. Check out the full Episode 035 on YouTube to watch the original presentation with all the visuals included: Watch Episode 035 on YouTube

📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-061

Follow us on

Linkedin

Ketamine StartUp Website

YouTube

🚀 Want to fast track launching your ketamine clinic? If so, download our free checklist.

We're taking it a little easy in July, and in the spirit of that, we're launching something new: Soundbites from the Vault. These are shorter, standalone segments from earlier episodes that we think are worth revisiting, easy to digest, and immediately relevant to your practice.

For our first soundbite, we're revisiting one of our favorite conversations from Episode 32 with Steve Gelberg, author of Tuning In: Experiencing Music in Psychedelic States. 

Steve spent years researching the intersection of music and psychedelic-assisted therapy, and what he shares here has direct practical implications for how you're running your ketamine sessions.

This segment gets into something most providers haven't thought deeply about: music isn't just filling the silence. It's doing active therapeutic work, from calming a patient's first fear response as ketamine comes on, to opening access to the subconscious material that makes treatment meaningful. 

Steve also covers the practical side, including what types of music to use, why lyrics are generally a problem, and how to think about the classical versus ambient debate without getting dogmatic about it.

If you've been using the same playlist since you opened, this one is worth 15 minutes of your time.

What You'll Gain:

· Why music and psychedelics share a unique therapeutic synergy rooted in how both interact with emotional and subconscious experience

· How the right music can calm the ego's fear response during the onset of a ketamine session and support deeper therapeutic outcomes

· Why lyrics are generally avoided during psychedelic-assisted therapy and what instrumental genres tend to work best

· The case for neoclassical music as a middle ground between classical and ambient for ketamine sessions

· How to think about patient-chosen music versus therapist-curated playlists, and why avoiding dogma matters more than finding the perfect answer

Episode 60 show notes:

00:00:00 Teaser: "The right kind of music…”

00:00:33 Episode Introduction and Soundbites from the Vault Launch

00:01:32 The Shared Ontology of Music and Psychedelics

00:03:37 How Psychedelics Open the Emotional Sphere of Consciousness

00:04:41 The Unique Therapeutic Synergy Between Music and Ketamine

00:05:08 What Music Is Actually Doing at the Onset of a Ketamine Session

00:05:55 How Music Helps Surface the Root of Depression, Phobias, and Trauma

00:07:01 Music as an Ancient and Primal Human Tool: Lullabies and Soothing

00:08:25 The Case for Healing Female Voices in Psychedelic-Assisted Therapy

00:09:41 How to Choose Music for Ketamine Sessions: A Provider's Guide

00:10:23 The Classical vs. Ambient Debate: Origins and Context

00:11:36 Why Lyrics Are Generally Avoided During Ketamine Therapy

00:12:39 Neoclassical Music: The Best of Both Classical and Ambient

00:13:39 Avoiding Agitating or Overly Dramatic Music in Sessions

00:14:11 Patient-Chosen vs. Therapist-Curated Playlists

00:15:12 Why There Should Be No Dogma Around Music Selection

00:15:48 Episode Ending and Resources

Thanks for listening

📝 Want Steve's exact playlists and a link to his book? Everything is in the show notes at https://www.ketaminestartup.com/podcast/episode-060#links

This week, host Sam Ko goes upstream from our usual clinical and business topics to sit down with Dr. Roberto Malinow, emeritus professor at UC San Diego, member of both the National Academy of Sciences and the National Academy of Medicine, and one of the world's leading researchers on synaptic plasticity and NMDA receptor biology. His work has been cited more than 30,000 times, and his recent perspective piece takes a very different view of what's actually happening during a ketamine infusion.

The core of this conversation is his hypothesis that ketamine works by selectively weakening hyperactive brain circuits, but only the ones actively firing while the drug is on board. 

It's a finding that raises some genuinely uncomfortable questions about the standard set and setting approach, and points to chronic pain treatment as a practical place to start testing these ideas clinically.

You'll also hear about the brain's "disappointment center," the lateral habenula, and why it may be hyperactive in depression, the Stanford anesthesia study and what it suggests about brain activity during treatment, and a wide ranging look at consciousness, optogenetics, the gut-brain connection, and what basic science still doesn't fully understand about how psychiatric drugs work.

What You'll Learn in This Episode

· Revolutionary ketamine mechanism - How Dr. Malinow's hypothesis suggests ketamine works by weakening hyperactive brain circuits, but only when those specific circuits are actively firing during treatment

· The disappointment center concept - Understanding the lateral habenula as the brain's disappointment center that inhibits dopamine and may be hyperactive in depression, serving an evolutionary purpose in reinforcement learning

· Challenge to set and setting orthodoxy - How activating negative thoughts or painful experiences could possibly enhance therapeutic outcomes

· Neuroplasticity fundamentals - How synapses can be rapidly modified and why NMDA receptors are crucial for both strengthening and weakening neural pathways, forming the basis for learning and memory

· Rapid vs. delayed therapeutic effects - Why ketamine can work almost immediately while traditional antidepressants take weeks, and what this reveals about different mechanisms of action

· Chronic pain treatment implications - How activating pain circuits during ketamine infusions might be more effective than current protocols, and why chronic pain could be the ideal testing ground for this hypothesis

· Basic science translation - How laboratory findings about synaptic plasticity and NMDA receptors connect to real-world therapeutic applications in depression, PTSD, and pain management

· Optogenetics technology - How scientists can now deliver light-sensitive proteins to specific neurons, allowing precise activation or inactivation of brain circuits to study behavior and memory

· Memory manipulation research - Fascinating studies showing how specific memories can be turned on and off using targeted brain stimulation, with implications for trauma and addiction treatment

· Consciousness and synaptic function - Exploring the complex relationship between individual neurons and higher-order brain functions, and why bridging these levels remains challenging

Episode 59 show notes:

00:00:00 Teaser: Those hyperactive circuits…

00:00:24 Episode Introduction and Guest Overview

00:01:12 Sam Introduces and Welcomes Dr. Roberto Malinow

00:02:41 Background: From Reed College to The MD/PhD Path

00:05:17 Why Basic Science Won Out Over Clinical Medicine

00:06:06 The Lecture That Started It All: Professor Rodolfo Llinás and Synapses

00:06:51 How Ketamine Interacts with the NMDA Receptor

00:07:47 The "Disappointment Center": What the Lateral Habenula Does and Why It Matters in Depression

00:09:16 The Standard Set and Setting Approach in Outpatient Ketamine Clinics

00:10:12 The Three-Part Hypothesis: Neuroplasticity, Hyperactive Circuits, and Negative Thoughts

00:11:49 Written Exposure Therapy and PTSD: Priming Circuits Before the Infusion

00:12:53 Chronic Pain as the Easier Testing Ground for the Hypothesis

00:14:20 Activating the Pain Pathways During a Ketamine Infusion

00:17:23 The Anesthesia Study (Heifets/Stanford): Why the Brain Needs to Be Active

00:18:48 What Would a Human Study Design Actually Look Like?

00:20:41 Animal Study Evidence Supporting the Active-Stimulus Hypothesis

00:21:33 Zooming Out: Synapses, Consciousness, and the Shakespeare Analogy

00:23:18 Optogenetics Explained: Using Light to Control Specific Neurons

00:27:31 What Don't We Understand About Depression?

00:28:29 Lateral Habenula in Animal Depression Models and Dr. Malinow's Own Experiments

00:29:13 The Dystopian Scenario: Using Ketamine-Like Drugs to Wipe Out Ideas

00:31:31 Common Misconceptions Clinicians Have About Synapses

00:32:47 What Surprised Dr. Malinow Most About Studying Synapses

00:35:15 Why Ketamine Works Rapidly While SSRIs Take Weeks

00:37:30 The "Party Trick": Learning Is Neuroplasticity in Real Time

00:39:13 NMDA Receptors and Their Role in Learning and Memory

00:39:47 Optogenetics Research: Turning Fear Memories On and Off in Animals

00:42:08 Glutamate: 90% of Synaptic Transmission Explained

00:43:55 Synapses in the Gut: The Enteric Nervous System

00:45:58 The Gut-Brain Connection and Future Research

00:46:23 Papers Worth Reading in the Ketamine Space

00:47:50 The Psychedelic Renaissance: Psilocybin, the Disappointment Center, and What's Next

00:50:20 Could the Activation Hypothesis Apply to Psilocybin and MDMA as Well?

00:52:57 Rapid-Fire Questions Begin

00:53:19 Time Travel

00:54:19 Hidden Talent

00:54:48 Alternate Career

00:55:42 Advice to 18-Year-Old Roberto

00:56:29 Final Thoughts and Call to Action for Clinicians

00:57:00 Where to Find Dr. Malinow's Research (UCSD Website)

00:57:40 Sam's Closing Remarks

00:58:32 Episode Ending

Thanks for listening

Connect with Dr. Malinow:

Website: https://biology.ucsd.edu/research/faculty/rmalinow

Email: [email protected]

📝 Complete show notes with resources and  links, please visit https://www.ketaminestartup.com/podcast/episode-059

Follow us on

Linkedin

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this conversation, Dr. Marc Smith shares his journey from hedge fund trading in New York's financial district to building an integrated ketamine psychiatry practice in California. 

After three years in finance doing trading and sales, Dr. Smith made the bold decision to completely pivot his career toward medicine, driven by a desire for purpose and meaning that his financial career couldn't provide.

Dr. Smith's path took him through Columbia University for medical school, followed by psychiatry residency at USC, where he discovered his passion for interventional treatments like TMS and ketamine therapy. 

His unique perspective, having worked in both profit-maximizing finance and purpose-driven healthcare, provides valuable insights into the challenges of maintaining ethical medical practice in an increasingly commercialized healthcare environment.

Dr. Smith's practice, Clear Ketamine + Psychiatry, represents an integrated model where he personally handles psychiatric evaluation, preparation therapy, ketamine treatment administration, and post-treatment integration sessions.

What You'll Learn in This Episode

· Career transition insights - How Dr. Smith navigated the complete pivot from finance to medicine, including the challenges and rewards of choosing purpose over profit in healthcare

· Mental health crisis analysis - Dr. Smith's perspective on factors contributing to rising depression, anxiety, and suicide rates, including social isolation, technology impacts, and healthcare access barriers

· Treatment-resistant depression understanding - Why 30% of patients don't respond to traditional antidepressants and how ketamine offers a different mechanism through NMDA receptor antagonism and neuroplasticity induction

· Integrated practice model - Dr. Smith's unique approach combining psychiatric evaluation, preparation therapy, ketamine administration, and integration sessions all under one provider rather than outsourcing components

· Intentions versus goals framework - How to help patients set internal emotional states they're striving for (intentions) alongside specific, measurable functional outcomes (SMART goals) for comprehensive treatment planning

· Ketamine as catalyst concept - Understanding how ketamine works like "jumpstarting a car" to improve mood and motivation, while ongoing therapy and lifestyle changes provide the maintenance needed for sustained improvement

· Ethical practice building - Dr. Smith's mission to combat ketamine stigma through evidence-based protocols while addressing concerns about recreational associations and inappropriate use in the field

· Private practice autonomy benefits - How owning your own practice allows values-driven decisions that may conflict with profit maximization, contrasting with private equity-driven healthcare models

· Business building practical advice - The importance of talking to other practice owners, understanding it's a marathon not a sprint, and knowing your limitations to outsource effectively

· Biopsychosocial treatment approach - Addressing biological, psychological, and social elements of mental health through medications, therapy, exercise, sleep, nutrition, social connection, and nature exposure

Episode 58 show notes:

00:00:00 - Teaser: Profit vs. Purpose in Healthcare 

00:00:35 - Episode Introduction

00:02:03 - Dr. Smith's Background: From East Coast to Medicine 

00:02:30 - Career Transition: Three Years in Financial Industry 

00:04:12 - Discovering Psychiatry Through Clinical Rotations 

00:05:32 - Why Psychiatry: Deep Relationships and Human Connection

00:08:50 - Tools in the Toolbox: TMS, Ketamine, and Treatment Options 

00:09:30 - The Leap: Stepping Away from Finance Success 

00:11:17 - The Marble Metaphor: Chiseling Away What We Aren't 

00:12:46 - Self-Actualization and Gratitude in Medicine 

00:14:01 - USC Residency and Academic Reception of Ketamine 

00:16:54 - Evidence-Based Medicine and the Slow Pace of Change 

00:19:17 - Mental Health Crisis: Social Isolation and Technology 

00:22:50 - The Invisible Nature of Mental Health Challenges 

00:25:28 - Private Equity vs. Patient Care: The Business Tension 

00:30:18 - Private Practice Autonomy and Values-Based Decisions 

00:32:15 - Clear Ketamine + Psychiatry: The Integrated Model 

00:36:11 - Treatment Protocol: Six Sessions with Therapy Integration 

00:37:56 - Ketamine as Jumpstart: The Car Analogy 

00:42:00 - Intentions vs. Goals: Internal States and SMART Outcomes 

00:46:30 - Ethical Standards and Combating Ketamine Stigma 

00:50:15 - Practice Building Advice: Talk to Other Providers 

00:52:55 - Rapid Fire Questions: Book Recommendation 

00:54:52 - Last Meal 

00:55:52 - Pickleball Obsession and the Philosophy of the Game 

00:56:50 - Time Travel

00:58:46 - Alternative Career

01:00:04 - Advice to 20-Year-Old Self

01:01:53 - Contact Information and Practice Details 

01:03:03 - Final Thoughts: Gratitude and Evidence-Based Care 

01:04:20 - Ending and Resources

Thanks for listening

Connect with Dr. Marc Smith at:

Website: https://www.clearketapsych.com

Instagram: @clearketapsych, @marcsmithmd

LinkedIn: www.linkedin.com/in/marcsmithmd

Google Maps: https://maps.app.goo.gl/GCHVy8q183c7WvfLA

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-058

Follow us on

Linkedin

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this conversation, Dr. Michelle Weiner shares her evolution from chief resident in interventional pain medicine to pioneering integrative practitioner who treats chronic pain through a biopsychosocial-spiritual lens. Double board-certified in Interventional Pain Medicine, Physical Medicine, and Rehabilitation, Dr. Weiner reveals why traditional procedure-focused approaches often fail chronic pain patients and how she discovered more effective ways to create lasting healing.

Dr. Weiner's journey started with her background in nutritional science and athletics, leading her through physical medicine and rehabilitation before specializing in interventional pain. But day after day of performing procedures without truly connecting with patients left her frustrated and seeking deeper solutions. Her introduction to medical cannabis as chair of Florida's advisory committee opened her mind to personalized medicine and treating the whole person rather than just diagnosis codes.

You'll hear about her unique approach to fibromyalgia, which she reframes as "central sensitization" to empower rather than limit patients. Dr. Weiner explains how trauma and adverse childhood experiences prime the nervous system for hyperreactivity, leading to chronic pain that becomes centrally mediated rather than structurally based. Her practice now integrates cannabis protocols, ketamine therapy, and comprehensive team-based care to address the root causes of both physical and emotional pain.

Dr. Weiner also shares her personal ketamine experience during training, including a profound vision that later manifested in real life, demonstrating the spiritual dimension she now incorporates into treatment. You'll also hear practical insights about building an integrative practice, the importance of set and setting, and why true healing requires addressing the person with the diagnosis, not just the diagnosis itself.

What You'll Learn in This Episode

· Career transition insights - How Dr. Weiner evolved from high-volume interventional procedures to relationship-based integrative medicine and why she felt traditional approaches were "stringing patients along"

· Central sensitization framework - Why she avoids the term "fibromyalgia" and instead explains central sensitization to empower patients and create hope rather than diagnostic limitations

· Biopsychosocial-spiritual model - How incorporating the spiritual dimension creates awe-like effects and connections that traditional medicine misses, supported by neuroscience research

· Medical cannabis integration - Her role on Florida's Medical Cannabis Advisory Committee and how cannabis opened conversations about personalized medicine and treating individual endocannabinoid systems

· Trauma's role in chronic pain - How adverse childhood experiences and physical trauma prime the nervous system for hyperreactivity and chronic pain development

· Practice building strategies - Practical advice about insurance credentialing, marketing to other providers, creating therapeutic environments, and building multidisciplinary teams

· Set and setting importance - Why the physical environment, staff training, and patient preparation are crucial for maximizing ketamine therapy outcomes

· Patient education approaches - How she explains that healing happens during the neuroplastic window after ketamine, not during the infusion itself, and why "more is not better"

· Team-based care model - Working with coaches, therapists, and specialists trained in pain reprocessing therapy and somatic approaches to support comprehensive healing

Episode 57 show notes:

00:00:00 - Teaser: Heart-Forward Medicine and True Passion 

00:00:19 - Introduction and Dr. Weiner's Background Overview

00:02:00 - Educational Journey: From Nutrition Science to Pain Medicine 

00:05:13 - Colleague Reactions to Non-Traditional Approach

00:08:37 - The Pivotal Moment: From Procedures to Purpose 

00:11:04 - Cannabis Integration and Personalized Medicine Discovery 

00:13:43 - Biopsychosocial Model and Pain Neuroscience Education 

00:17:09 - Trauma Patterns and Chronic Pain Development 

00:19:54 - Reframing Fibromyalgia as Central Sensitization 

00:23:54 - Adding the Spiritual Dimension: Biopsychosocial-Spiritual Model 

00:29:07 - Personal Ketamine Experience and Training Story 

00:34:22 - Practice Building: From Employee to Business Owner 

00:38:18 - Set and Setting: Creating Therapeutic Environments 

00:41:48 - Patient Misconceptions and Education Strategies

00:47:08 - Rapid Fire Questions: 

00:53:55 - Advice to 18-Year-Old Self

00:55:34 - Final Thoughts: Pain Complexity and Nervous System Healing 

00:56:32 - Contact Information and Practice Locations 

00:57:29 - Ending and Show Resources

Connect with Dr. Weiner at:

Website: www.drmichelleweiner.com

LinkedIn: https://www.linkedin.com/in/michelle-weiner-do-mph-276b34b9

Facebook: https://www.facebook.com/drmichelleweiner/

👉 Disclosure: Some of the links in these show notes are affiliate links. If you choose to make a purchase through them, we may earn a small commission at no additional cost to you. Thanks for supporting the podcast!

Selected Links From the Episode:

📕The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

by Bessel van der Kolk M.D. 

📘The Awakened Brain: The New Science of Spirituality and Our Quest for an Inspired Life

by Lisa Miller.

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-057

Follow us on

LinkedIn

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.