065 | Ketamine 101: Ketamine-Assisted Psychotherapy & Making Treatment Accessible with Dr. Kyle Greenway
“There’s this story of antidepressants being numbing and bad, and psychedelics being spiritual and good. Ketamine is a bridge between these paradigms. It’s big Pharma, but often very spiritual.”
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It’s the ketamine episode you’ve been waiting for! Ketamine is not technically a (classic) psychedelic, yet it behaves like one. Many researchers and scientists in the psychedelic space consider it to be a psychedelic, and are applying the psychedelic assisted psychotherapy model to its use.
This episode is a treasure trove of information for those who are considering ketamine for treatment, and those who want to learn more about this “chameleon” drug. Delivering this information is Dr. Kyle Greenway; a highly respected ketamine researcher and psychiatrist. He keeps a low profile, so it was truly special to have him on the show.
Dr. Greenway is a psychiatrist and assistant professor at McGill University. He completed a research fellowship at Imperial's psychedelic research centre and co-led the development of two academic clinics utilizing ketamine in treatment-resistant depression. These clinics are amongst the only services in the world to provide ketamine-assisted therapy in public healthcare systems.
Beyond his academic accolades, Dr. Greenway is very fun to learn from. I promise you that even though this conversation is highly academic, we had a lot of fun talking about serious subject matter.
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Topics Covered:
What is Ketamine? & its history
Why Ketamine is so dose-dependent
Why Ketamine is a “chameleon” drug
How Ketamine started to be used for mental health conditions
Ketamine vs classic psychedelics
The “after glow” / anti-depressive effect
Risks with abusing ketamine, such as “ketamine bladder”
Who and what ketamine is effective for
Why the “inner healing intelligence” might be harmful
What a ketamine treatment protocol looks like
The future of psychedelic assisted therapy and ketamine
“We’re hoping to really understand who people are, both clinicians and patients, and find ways in which that understanding can inform treatment, tailoring the right thing for the right person at the right time.”
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LISTEN
“In psychiatry, if you can find moments when you suffer twice, that is an excellent place to do something different.”
Things Mentioned In This Episode:
Where to find Dr. Kyle Greenway:
Psychiatrist and assistant professor at McGill University, completed a research fellowship at Imperial's psychedelic research centre.
Co-led the development of two academic clinics utilizing ketamine in treatment-resistant depression since 2018, which are amongst the only services in the world to provide ketamine-assisted therapy in public healthcare systems.
Leading multiple research projects on ketamine and psilocybin that seek to answer questions about therapeutic mechanisms, set & setting -- particularly music, and psychedelic treatment tailoring.
Looking for a professional coach to support you on your psychedelic path?
Look no further! Along with being the host of the Modern Psychedelics Podcast, Lana is a 3x certified professional coach who works with people on the psychedelic path.
Podcast Transcipt
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Lana Pribic: Hello and welcome back to the show everyone. I'm here with Dr. Kyle Greenway. Welcome to the show.
Dr. Klye Greenway: Hi. It's it is lovely to be here.
Lana Pribic: Yeah, thank you. And you're calling in from Montreal, which is my favorite city in Canada.
Dr. Klye Greenway: Mine too. That's
why I'm here.
Lana Pribic: the best. The best. Yeah. So exciting. So can you introduce yourself to our audience.
Dr. Klye Greenway: Yeah, sure. So I'm a
psychiatrist at McGill University doing the clinician scientist pathway, which means sometime protected for regular psychiatric work and a lot of time protected for clinical research. And, I'm here, so you could probably guess that most of my clinical research is regarding psychedelics.
Lana Pribic: Can you tell us a little bit about the work that you're doing in Montreal? It's very unique
Dr. Klye Greenway: Yeah. Yeah. I think the
cornerstone of our work, is our Ketamine for Treatment Resistant Depression, clinic. We are operating at the Jewish General Hospital now for a little while, a couple years. And before that we were at the Douglas university Institute. [00:01:00] And I think what's unique about it is that we are
doing ketamine assisted psychotherapy and in a model of our own, we call it the
Montreal model,
actually, we're talking about Montreal which is a bit of a hybrid of a psychedelic, a
model
with some of the most evidence-based interventions of conventional psychiatry.
And it's something that we can offer to real world
patients,
without charge, which is, I think, extremely unique in the world. With the caveat that we have a small capacity and it's mostly at this moment restricted to to patients in our hospital sector.
Lana Pribic: wow, without charge, that's definitely you don't hear of that. Can you tell us a little bit about that and how it's like a public clinic.
Dr. Klye Greenway: Yeah. So there are clinics that are able to offer intravenous ketamine,
or even spravado, intranasal ketamine to patients who are, for whom it's indicated without a direct charge to them, either through private insurance or through public payer systems like we have in Canada.
The hard bit is finding a way to cover things like the psychotherapy, the psychological support during the treatments. And so [00:02:00] our model has been with the generous
support
of funders and and some charitable donations from the Jewish General Hospital Foundation. Our model has been to
essentially, use the public system for the drug costs and then use some research funds to cover the
cost of psychological support and accompaniment because we believe it's at least essential to optimizing the benefits if not for safety of ketamine.
Lana Pribic: Yeah. So is that unique to. Ketamine specifically because of the legal status of it. Is that why you're able to pull this off?
Dr. Klye Greenway: Yeah. There are already, Quebec in
some ways is
leading the world a little bit in terms
of having a government paid access to psychedelics. because some colleagues have treated patients with psilocybin under their Canadians compassionate access pathway and they're able to be, physicians are able to be reimbursed by the public system for their time.
To administer those treatments. It doesn't pay very well at all compared to,
say, conventional medicine. But, it's enough that, that
it, is at least symbolically very important. But
beyond the compassionate access [00:03:00] roots, obviously there's not really any psychedelic that is that is, a Health Canada approved for any indication.
And of course, ES esketamine is approved for depression.
Ketamine is approved
only for anesthetic
or pain indications. Then we use it off label based on really compelling evidence. That's an it's an effective antidepressant.
Lana Pribic: Okay, perfect. I'm really excited to see what happens in the future with the Montreal psychedelic scene. I'll definitely keep posted on that. I wanna get into a little bit of Ketamine 1 0 1. We haven't talked too much about ketamine here on the show, so I'm on a learning journey with my listeners right now.
Can you tell us what is Ketamine?
Dr. Klye Greenway: So I warned you that I would ask you just to
tell me, and just free
associate, what are you, what's, what do you know about ketamine? What are the labels, what is it used for, et cetera.
Lana Pribic: yes. So my, I can draw from my knowledge and experience, which is very limited. I definitely have used this on the [00:04:00] dance floor and that's how I use it in like very small quantities.
But I know that it's a dissociative, it's not a classic psychedelic, but it acts like a psychedelic that it's very dose dependent. You get very different results with different doses and that it's often referred to as like a horse tranquilizer, that it's been used in the medical industry for many years and that there is the possibility of entering a state called the K hole, which I've never gone to, nor do I really want to, but that I know a lot of people have a fear of that. So yeah, that's why I always take it really slow when I'm using this recreationally. So how did I do?
Dr. Klye Greenway: You did. You did well. I'm not gonna comment on any, on recreational stuff today, but I do think, you nailed some of the key elements for me, which are, the plethora, the multitude of words that that we all know to describe this drug. We have dissociative, we have
psychedelic, we have keyhole engender, we have horse tranquilizer.
And [00:05:00] that's what's so interesting about ketamine, is it is
a chameleon of sorts. So I can tell you a little bit about it.
The most basic thing to know about ketamine
that you'll see on every article about it is that it's a N M D A antagonist, which is a glutamate receptor in the brain, which is to say it's a receptor that is largely, or strongly linked to neuroplasticity. But ketamine also has a sort of paradoxical effect.
So on one hand, it seems to increase the excitation
of the brain, which makes information travel more freely, very psychedelic.
And on the other hand, it seems to also put the brakes on that process almost at the same time.
Sometimes some people
call it the stop and go mechanism, and it's this paradoxicality, these
almost competing mechanisms
that I think one could argue is responsible for
the profound dose dependency, how the effects differ dramatically at different doses, which is totally atypical for anything in the broader psychedelic family.
For example, LSD at, a thousand times the normal dose [00:06:00] is gonna look like a really intense experience, but it's not
necessarily gonna look totally differently. Whereas ketamine
at a low dose, it's,
it can be very psychedelic.
At moderate doses. People talk about ketamine dreams or transpersonal experiences, and then anesthetic doses, people are really just switched off to some degree.
Lana Pribic: Okay. And which dosages are you guys working with at your clinic?
Dr. Klye Greenway: It's another interesting thing I,
what you'll see in the literature or in the popular press even, is that the classic sub anesthetic dosing. This is the dose range most often used in biomedical studies. The idea is that it causes mild dissociative symptoms but it's not very psychedelic.
It's not the same thing as, the private clinics that use a psychedelic model. What we found as a surprise, to be honest, is that the sub anesthetic dosing, so re relatively, quite low
really,
0.5 milligrams a kilogram for people who know about about dosing is enough.
If you provide blindfolds, if you provide accompaniment music, it's enough to produce profound [00:07:00] psychedelic effects. And it's the dose range that has the most evidence in the literature for, anti-suicide or antidepressant effects.
Lana Pribic: Got it. So you also referred to it as being a chameleon. I've never actually heard of ketamine referred to in that way. Can you tell us a little bit about that and how that works?
Dr. Klye Greenway: I would love it if
my only legacy in this world is that ketamine is referred to as the ketamine chameleon. I would, I'll go to my grave, happy. It's a little bit in
response to, Edward Domino. Edward Domino is the
chemist, or one of the
scientists who helped develop ketamine back in the sixties.
And he wrote several articles that I highly recommend
hunting down, about how difficult it was to understand this drug and for it to find its niche in medicine. And this is before ketamine went on to become
probably the most common
anesthetic agent in the entire world. It's been on the W H O essential medication lists for decades now.
He wrote these articles and that process of trying
to find a niche for ketamine was called by him as taming [00:08:00] the Ketamine tiger. And I think this is hilarious cuz it
speaks to, the challenge of this drug. And I also think it's not very apt because in the right circumstances, ketamine is not this aggressive, feline
dangerous creature.
It really is
a drug that I think is better described as a chameleon
because it's so context dependent, it's so context dependent, it can look like a dissociative in the sense of mimicking the dissociation of P PTSD or borderline personality disorder, et cetera. When it's framed that way and when you badger patients with questions that are lead them to, to understand their experience in that language and it can look extremely psychedelic when use it in a traditional psychedelic assisted psychotherapy setup.
And then it can be a bunch of other things. And
I don't know how much we want to go down this rabbit hole, ketamine has in some ways found itself at the center of a lot of big forces in our society. For example ketamine is being used mostly inappropriately in big doses to anesthetize or sedate
[00:09:00] people.
Something called,
like delirium sedation or excited delirium, sedation where, you know, paramedics will give massive doses 10 times or a hundred times. What we would use to people. To sedate them if they were agitated. And this has been, central to a lot of criticisms about racism.
Obviously there's a disparity in who gets sedated in this way that has
killed people. Ketamine is deeply involved in the Covid
pandemic
because of the relaxed prescription rules for virtual
care. And that's what led to a proliferation of companies doing at-home psychedelic therapy, or at least at home.
Sublingual ketamine.
it goes on and on. Ketamine was centered in the
Vietnam War where it was called the
buddy drug because it was so easy
to give soldiers this little vial of ketamine to administer to a colleague, a buddy if they were injured, on and on. It's a
very interesting drug.
Lana Pribic: That's so funny I know we're not talking about the recreational containers and that's my only orientation with ketamine. But I always call myself like the ketamine [00:10:00] kitten. And I, the tiger is like my spirit animal. So I'm just, I'm just having like major moments right now. Wow.
But back to the serious stuff. So at what point was it discovered that this medicine actually works for a treating these psycho-spiritual and mental conditions, how did that happen? How did it go from the hospitals to, clinics like yours?
Dr. Klye Greenway: yeah, again, a fascinating
story.
And I'm biased, but I really
do think there's something about this drug that is
compelling. It was synthesized as a derivative of a drug
that was called sarinil. And if you don't know sarinil brand name, you probably know it's generic name, which is pcp.
So sarinil pcp. It didn't last long in the
armamentarium of medicine.
And obviously huge problems with recreational abuse of pcp. And then ketamine [00:11:00] essentially was searching for its role in anesthesia. It found its role in Vietnam War, as I mentioned, but very early on psychiatrists in places like Iran, in South America in Mexico recognized that it could produce, psychedelic experiences.
And that story has largely been written out of the conventional narrative of ketamine. But there are studies, some studies of hundreds of people published in the U S Sr in the eighties and nineties that show Ketamine being used in clinical trials against neurosis. They didn't really use modern language for mental
health conditions,
addictions trauma, you name it.
But the first kind of real foray of ketamine into biomedical psychiatry was a really small trial of seven people in the year 2000 by John Crystal's group. And that trial showed this kind of hallmark that is, that has made ketamine famous since then. Really rapid antidepressant effects that last not a long time, but certainly longer than the [00:12:00] drug is in the system.
So different than something like, if you gave somebody cocaine, you might find their depression improves briefly, but it, they're not feeling great the next day, for example.
And so this rapid but transient antidepressant
signal for ketamine was really convincingly demonstrated for the first time in the year 2000.
And since then, the evidence has just continued
to accumulate for it.
Lana Pribic: that's pretty recent.
Dr. Klye Greenway: Yeah. So it's interesting. And
the drug itself is not that old and in. It's very strong
contrast to most, psychedelics, if you call ketamine is psychedelic. Where obviously there are centuries and millennia traditions in many cases. I guess it's similar age to Ls D but yeah, it's only in the last 20
years or so that ketamine has really been pro really a community.
A lot of clear clinical trial evidence.
Lana Pribic: It really is. I see it as like it's standalone. Like I can't really compare the effects of it to any other substance. I do feel that it really stands out on its own and I. I'm thinking that it's, cuz it's classified as a [00:13:00] dissociative that acts like a psychedelic. So I would actually love for you to touch on, even though this is Yeah.
Classified as a dissociative, why is it that it acts like a psychedelic or even gets, put into the lineup of psychedelic drugs?
Dr. Klye Greenway: Yeah, again, I'll try for brevity, but we could
talk for hours just about this one question. The first thing I'll say is
that the original name proposed for Ketamine by Edward Domino was not a dissociation. It was dreaming. And it's really a sad twist of history that the label dissociation stuck somewhat arbitrarily.
The name basically came from either the
fact that people seem a little bit disconnected from their environment, which is maybe the common sense understanding of the term or from just electroencephalography. Brain electricity signals showing essentially a desynchronization between the frontal and,
and parietal areas.
In other words this somewhat arbitrary [00:14:00] EEG
finding was used to justify the name dissociation, which ended up becoming, the definition or the identity of
ketamine as opposed to dreaming, which again, I think is in many ways a better term. But as early as the seventies and eighties, people were
already pointing out that even though ketamine is a dissociative and
say LSD or psilocybin or psychedelics this was somewhat meaningless, this distinction between them.
But we didn't really, we didn't really,
I think, have good evidence for arguing that
ketamine should or could be considered a psychedelic until the last 20 years or so. And I think some
of the most obvious forms of
evidence are if you give people standardized
questionnaires to try to understand what their drug experiences are like, and you compare ketamine, psilocybin, or LSD and M D M A you'll find a lot of
overlap between ketamine and the classical psychedelics a lot more than there's overlap with M D M A, for example, on things like illusions or hallucinations, a change meanings of precepts, which [00:15:00] is a very nerdy way of something very psychedelic.
very like the altered sense of meaning that we attribute to things. And essentially the one thing that really distinguishes
ketamine from these other two kinds of drugs is that it does produce a
lot of disembodiment. Cause people do feel like their body is
far away or their body is distorted.
Lana Pribic: away body
Dr. Klye Greenway: But
I would argue this is a bad justification for the
word, dissociation because dissociation has so many connotations beyond just your body feels weird. and
then I'll, and
I'll say now very recently, we are accumulating a lot
of neuroimaging evidence that shows that indeed there is a lot more in common between what ketamine and classical psychedelics do to your brain acutely in terms of how the circuits run than you would think despite the having
really different pharmacologies.
They both,
for example,
both classical psychedelics and ketamine decrease the integrity of brain circuits that traditionally in your daily life roll together and increase the [00:16:00] connectivity between disparate brain
circuits. So in other words, information is flowing
less through kind of those hard, trodden paths and more freely in the brain.
And I, I think this is probably a universal
finding. We'll see with everything that could be labeled as psychedelic, eventually
Lana Pribic: Yeah. And what about that antidepressive effect or that afterglow effect with ketamine? Can you tell us a little bit about that?
Dr. Klye Greenway: It's mysterious a little bit, there's a few kind of hand
wavy ways one could understand it. Ketamine in some ways, because it works on
glutamate, is a little bit like the anti alcohol.
So there, despite there being some kind of
overlap between people's ketamine experiences and sometimes being, intoxicated with alcohol chemically they're almost polar opposites.
It's a question of gaba versus glutamate. And so if you know what it feels like to be hungover
and that's produced by essentially your brain being flooded with GABA from the alcohol. And the next day you're in this
kind of hyper glutamate state. Ketamine is almost the process in reverse.
That's [00:17:00] one kind
Lana Pribic: Wow.
Dr. Klye Greenway: hand wavy way to look at it.
Lana Pribic: Way to
Dr. Klye Greenway: And then there's a, there's also the argument of
ketamine increasing neuroplasticity, and we have good ar, we have good evidence in cells, in animals, et cetera. That is the case that you can show that the right dose. Ketamine not too much because that is actually neurotoxic, but the sweet spot improves, dendrite spining.
So it improves essentially your brain's ability to make new connections. That itself might be associated with feeling a little bit better or at least correlated with it. And then obviously for
those of us interested in the psychedelic model of any kind of substance there are good reasons to think that it, that the experiences and the right settings can be beneficial and make people feel better the next day, weeks later, months later.
Lana Pribic: That's fascinating. And are there, obviously higher doses can be toxic to is it the gallbladder
Dr. Klye Greenway: the urinary bladder.
Lana Pribic: The urinary bladder, yeah. Are, so obviously that's something to be mindful of, but is ketamine something that is lethal?[00:18:00] What are the safety implications here
Dr. Klye Greenway: you know, I
Lana Pribic: considering?
Dr. Klye Greenway: probably the best evidence that too much ketamine can be
lethal comes from, as I mentioned this use, which I think is inappropriate of big doses of ketamine for sedation of agitated people because there have been numerous deaths reported from that. Ketamine is also, how should I say it, it chronically, there are definitely real harms as associated with using it on a regular basis at big doses.
That includes the bladder problems you mentioned. There's something called ketamine, bladder or fibrosis of the bladder, which is often permanent and debilitating. There's definitely cognitive issues that have been associated with abusing ketamine and I think all those things are worth keeping in mind, and are good arguments against just taking
ketamine every day or frequently for the rest of your life.
my understanding of the optimal use of this drug, all psychedelics is they're there to facilitate a therapeutic process. They are not there to be just an
escape cuz that you may as
well turn to alcohol or opiates or any [00:19:00] other, pharmacological escape if that's the goal.
Lana Pribic: That's really important. So I wanna, I feel like we've gotten so much information here about Ketamine 1 0 1.
Is there anything else that I haven't asked you that you wanna tell people about ketamine
Dr. Klye Greenway: I think just one,
one other reason I think that there's this kind of chameleon effect, in the psychedelic world, we talk a lot
about the value of experiential learning. And for a lot of people, the idea that you would have
psychedelic therapists who have an experienced psilocybin but are giving psilocybin, a lot of people think that makes no sense.
And there's a debate about the ethicality of
that. There's a debate about
the access questions of that. There's many debates about this idea. Okay. what I would say is that I
think in the classical psychedelics, there's many good evidence of recreational use of these drugs, driving research questions, even driving the creation of questionnaires that are then used in clinical studies, like the emotional breakthrough inventory was created by Imperial based on recreational [00:20:00] surveys.
Ketamine is, in some ways it's, at least up until now, I think it's been almost derailed a little bit by the recreational use,
in the sense that a lot of people who do ketamine in small doses or frequently at parties and stuff like that. I think I've come to somewhat erroneous conclusions about the drug.
They often double down on the dissociative explanatory model. The ketamine just makes people feel woozy and as fun. Whereas, in the right settings with the right preparation it is profoundly psychedelic. It really does produce really meaningful experiences for people.
And I think that's somehow, I don't know, I think
it's a funny case where there's
almost an anti experiential learning,
effect so far with ketamine.
Lana Pribic: experiential anti, can you explain what you mean by that
Dr. Klye Greenway: What I mean is if there's the argument that people,
therapists or researchers
use
of mushrooms, et cetera, have really informed how they understand the drug, how they research the
drug, how they become good clinicians
and administering it, et cetera. I think ketamine, [00:21:00] thus far has been a little bit derailed
by people applying their own recreational experiences to understanding what this drug is about or how it should be used therapeutically.
And I'll just say, we were, we started working with
ketamine because it was available, because it was possible to say, this has excellent evidence as a biomedical treatment of depression. And that gives us the flexibility then to do things like experiment with different aspects of set and setting.
and that's really where our interest came from. But we initially
thought about ketamine as I think Matt Johnson called it hippie heroine, or in other words, a shoddy psychedelic.
Lana Pribic: a shot.
Dr. Klye Greenway: And what we were just really surprised, and I am still frequently surprised by just in the right setting how profoundly psychedelic it is, how it, it meets every criteria.
And in fact would be really hard to
distinguish
from classical psychedelics if you just listen to people talking about their experiences.
Lana Pribic: So interesting. So I need to ask you at this point, how do you define psychedelic? Cause there's so many [00:22:00] definitions floating around.
Dr. Klye Greenway: Oh, you've got me. Yeah.
Lana Pribic: you talking? Yeah.
Dr. Klye Greenway: I have a good friend who said something like it's so funny. We talk about psychedelics and
we
don't talk about the hallucinations. It's so central. When we say mind manifesting, I am of the belief that every drug that alters your consciousness,
whether it's mushrooms or alcohol or Benadryl or whatever it is,
the effects are fundamentally both, combination of the biological effects and the effects of your mind.
who you are, the context who
gave it to you, the dose. All these things are inter,
are
intersecting. And so in some ways, every single drug that has
psychoactive effects could be described as psychedelic
or mind manifesting. And then of course, if you take that definition, then
things just become so blurry that there's no utility in the
term anymore. I tend to think that there is something
valuable about, thinking about the hallucinations that, like vividly experiencing or being immersed in your unconscious or your subconscious. [00:23:00] That I think
really only applies to the things we think about as psychedelics and not things like Prozac or Benadryl, et cetera.
Lana Pribic: Yeah. So what's unraveling for me hearing you talk is I have such a hesitation towards the word hallucination when we're talking about psychedelics because for me it like devalues these visionary states. That's just how I feel. And what I'm kinda thinking here is are these visions or hallucinations pulling us further from reality or closer to reality?
Because I'm thinking that these like. Drugs that we call classic psychedelics in a way, pushes closer to reality. Whereas some of these others, like alcohol and whatever might pull us further away. What do you think? Am I onto something here or is this totally nuts?
Dr. Klye Greenway: Oh, yeah, it's, so that's an interesting instinct and I align with it to some extent. I think somehow [00:24:00] nons, psychedelic psycho tropes get a bad rap a little bit. So if you consider Prozac or something like that, it's in a very, it's a very effective treatment of depression.
We have very good evidence about that. It's been used for a long time, but there's this idea that, antidepressants work by numbing you, whereas psychedelics work by as you say, almost get in touch more with what's there. And I think there's an element of truth,
I think certainly some people report being numbed by antidepressants, but at the same time, there's a really strong argument to be
made that any altered state antidepressants included.
Are inevitably determined by your environment. In some ways they magnify the influence of your environment. And there's these great studies on rats for
example, that if you induce depression in rat models and you put 'em in an enriched environment and you give
them Prozac, they do really well.
And if you put 'em in an impoverished or a challenging environment and you give them Prozac, they do worse than if they weren't given
Prozac. So in other words, you're seeing [00:25:00] the same kind of environmental effect magnification with antidepressants
in some studies. I think really the way I've come to
understand it after I think giving hundreds of ketamine doses is that the, one of the key distinguishing things about psychedelics is their acuity.
That instead of a process happening gradually over weeks or months, it happens in the space of minutes to hours and more dramatic, much more
dramatic.
Okay.
But I would agree with you that, whereas if you take Prozac and you might actually be feeling something that is really reflective of your environment, it's, it might not be obvious.
You might just think, oh, this is the
drug effect,
This drug isn't for me, or I'm sick. Or, it's because I'm, I lost my job last week. It's subtle enough that it just doesn't become apparent. Whereas if you take something like psilocybin, et cetera, what you're experiencing
is in large part coming from within. it's obvious.
Lana Pribic: Yeah. Yeah. Yeah, it's very interesting. Definitely something to [00:26:00] keep chewing on, I
Dr. Klye Greenway: Yeah. Yeah. I think so.
Lana Pribic: What makes Ketamine different from other psychedelics? Or why would someone want to work with this as a medicine as opposed to say psilocybin or ayahuasca or L s d
Dr. Klye Greenway: I think one thing is that ketamine is more forgiving
for both clinicians and for patients. There are these clinics that give ketamine
in sometimes really barren conditions like operating rooms,
et cetera. We've done that actually given ketamine in a place where they used to give lobotomies.
It is not ideal and it is
worse than if you use a proper environment, but compared it to mushrooms or something like that. If somebody took psilocybin and spend one minute in that room,
they would freak out.
You would learn within one hour
that this is never something you should do again. Whereas with ketamine, there are places that have
done it for years with moderate success. So there's something that is more
internal about ketamine or at least more
forgiving. One of the really big differences for me
in the phenomenology, and we just haven't seen good studies on this, but you see it clinically so [00:27:00] obviously.
Is that if you're wearing blindfolds and you take ketamine or you
take psilocybin, often there are vivid hallucinations, vivid visual experience, visions, as you say. If you remove the blindfolds with
psilocybin, oftentimes those sort of phenomena continue. But to a lesser extent, walls breathing is a
classic,
very psychedelic phenomena.
Whereas with ketamine, the world just looks
wonky.
Lana Pribic: the world just,
Dr. Klye Greenway: It just looks odd. There's, if you remove the blindfolds,
it's just suddenly there's a really big difference in the visual phenomenology of ketamine versus,
the classical psychedelics.
Lana Pribic: Yeah.
Dr. Klye Greenway: and I'll just say, and when I say it's easier for
patients,
we've, our team or our broader team has given psilocybin to a bunch of compassionate access patients, psilocybin assisted psychotherapy under Canada's.
A compassion access program. And sometimes in, especially in people who are really unwell, either psychically or physically, four to six hours is a slog.
Like it's a lot of time. And those type of patients who would find it so [00:28:00] difficult, wouldn't
have made it to the clinical trial dosing day because it, that, that preparatory process of getting in a
clinical trial, going through all the screenings, all the neuroimaging, et cetera, is long and, people would've just dropped out by then.
But in real life patients getting clinical access they might not be dropped out. They might take psilocybin with caring therapists and still find after six hours that it's just exhausting. Whereas ketamine is 40, 40 minutes, or actually more, I should say more 60 to 90 minutes. So it's way more forgiving in that way.
Lana Pribic: Yeah, that makes a lot of sense. What conditions or I guess disorders is ketamine useful for in a therapeutic context, especially like people you're working with?
Dr. Klye Greenway: Yeah, the strongest evidence is in this kind of confusing diagnosis called treatment-resistant
depression, which is defined by, failing to respond to at
least two conventional treatments at a adequate dose, et cetera. And that has excellent evidence for ketamine. In the [00:29:00] end of May, there was a study in the New
England Journal of Medicine,
comparing ketamine to electroconvulsive therapy for profoundly resistant cases of depression showing that ketamine was on par with psychiatry's most effective intervention.
So that indication is, has robust evidence, better evidence for it than there is for any other medication really, I would argue. And then that diagnosis,
of treat resistance, depression often entails comorbidity like anxiety disorders post-traumatic stress disorder, medical conditions, personality disorders.
And so almost by definition, ketamine has a good rationale in those conditions as well. And there's some
evidence from smaller trials.
But yeah, I, we couldn't say it has the same robustness of the evidence of treatment system depression itself.
Lana Pribic: so it sounds like you're treating PA patients with a variety of conditions at your clinic.
Dr. Klye Greenway: Yeah. Yeah. Which people with a variety of comorbid conditions, it's really rare that we would get
somebody who has just treatment resistant depression. Okay. And I should add
also that,
there's [00:30:00] unipolar depression and there's bipolar depression. And bipolar depression, as far as we know, is an exclusion for any psychedelic drug except ketamine.
So ketamine has proven evidence of safety in that population with the proper precautions. So yeah, we focused on treatment resistant depression, both unipolar and bipolar.
And that has entailed treating almost the entire DSM of diagnoses. Probably the one thing that we stay
away from are people with psychotic disorders like schizophrenia
Lana Pribic: can you take us through what treatment protocol looks like your clinic from like start to finish?
Dr. Klye Greenway: start to finish. Okay. So I think I'll tell you one of
the big learning, processes for us over the last five years we've been doing this has been
Lana Pribic: learnings
Dr. Klye Greenway: how some elements of the, I
think the psychedelic paradigm are not appropriate or not well suited to people who are really suffering.
For example and let's just give
a couple examples of things that we've
[00:31:00] tried to work with and then moved away from.
We haven't found a lot of utility in the term inner healing intelligence. And it's a term that I kind of love intellectually. I think there's a lot of
warmth and kindness that goes into that term.
But for people who are really profoundly
unwell, it feels a little bit absurd sometimes to present to them that they have an inner healing intelligence. And if there's a challenging moment,
or if they deteriorate at any moment, it is just so easy to say, okay, not only do I feel awful, but now I've proven to myself that I don't have an inner healing intelligence.
Lana Pribic: Oh Yeah.
Dr. Klye Greenway: You can suffer twice in this way. yeah, And
Lana Pribic: it's like additional wounding.
Dr. Klye Greenway: exactly. And I have to say,
one of the things I'm most sure about in all of psychiatry is that if you can find these moments when you suffer twice or you're where you're suffering multiplies, that is an excellent place to do something different. For example, a big part of our process
is to ask,
ask our patients to [00:32:00] set some really clear behavioral goals.
And for example, we know from very good evidence
that exercising regularly is as effective as an antidepressant, as almost any oral antidepressant, any typical medication. And yet very few of us do it.
And it's extremely hard to motivate people to undertake exercise. I don't know how your
routine is, but yes.
So
you know,
Lana Pribic: yes, I feel that.
Dr. Klye Greenway: Yeah, so a lot of our
goals are, to establish, a plan of say we're gonna walk 15 minutes a day.
And what's nice about a goal like that
is even when you feel
like garbage, you can still pursue it. You can feel like crap and go for your 15
minute walk. And there's this whole, I think, Twitter phenomenon about people talking about their terrible walk or their shitty walk or something like
that, but yet how beneficial it is for them.
So those, that in my mind is a definition of a good goal, a really bad goal which a lot of people start with and I don't disagree with on the long
run.
But a bad goal for a treatment process [00:33:00] or the short or
medium term is to feel happy. Because if your goal is
to feel happy, then on a day when you're not feeling happy, not only do you feel unwell,
but you also have failed your goal.
You're also a failure. That's it. One of these kind of suffer twice moments. And I'll just say again I understand depression
to be mostly a phenomena of vicious cycles of these, of positive feedback loops where one problem, one legitimate problem or one legitimate symptom leads to another, and you just end up completely flattened.
And so our model is really based on trying to do the
opposite, trying to build momentum.
And
we're very conscious that ketamine, for most people can have profound benefits, but these benefits typically don't last. There are psychological insights that can persist for the rest of your life.
And, psychotherapy is basically the one thing in psychiatry or the surest thing in psychiatry, that if it works for you, you can be hopeful that the benefits will persist. But otherwise, we understand ketamine to [00:34:00] almost create like a window of opportunity. And so all of our treatment protocol is centered around how do we use this brief, let's say one month where you're feeling better.
How do we use that to make changes in your life that will hopefully keep you well?
Lana Pribic: are you guys using that window of opportunity? Is there additional support outside of the clinic? Are you recommending them to, work with the therapist?
Going on there in that window of time?
Dr. Klye Greenway: So in a nutshell, when we
see people, we think they're a good candidate for ketamine, we feel like we have a good enough alliance that we can build some momentum, set some goals, and work together. We plan for a course of four to six treatments in a month, and we ask our patients to also begin
in parallel psychotherapy or concomitant psychotherapy.
And this is often a little bit hard to find, as you
live in Canada also how it can be challenging to find public psychotherapy for people. So sometimes we have therapists that work
with us that will provide it, and other times, there are government resources, et cetera. So we ask people to have an at least
an hour a week
[00:35:00] with an independent psychotherapist who will liaise with us.
And this is one way in which we were really
quite different, I think from psychedelic models, where it's usually the same clinicians that administer the prep, the treatment and the integration. Whereas we administer the psychedelic
ketamine sessions, semi-independently of the
people that are doing follow up at least weekly in terms of psychotherapy.
And there are pros and cons to this, but it's actually
inspired from the way that normally psychiatrists work by prescribing medications and
connecting people to psychotherapy and liaise hopefully with the therapist, but you don't necessarily expect them to be the same person. So there are pros and cons to this.
I think there's major feasibility
benefits. there are definitely, there's a necessity to
maintain communication and there's also this benefit
that,
Lana Pribic: this
Dr. Klye Greenway: I think it's really good for people not to become too dependent on one clinician or one set of clinicians. And if you listen to the Cover story podcast or you've heard some of the controversy about the M D M A trials, you can hear that [00:36:00] there are negative consequences of
forming way too strong a link with just two therapists that you have a short time with before you leave them.
So in our model, at least, there's a provision of some kind of external therapy. We broaden the circle of care, and if people are benefiting a resources permit, they can continue in psychotherapy. After that one month of ketamine has come and gone.
Lana Pribic: So Four to six rounds in a month. And that be one treatment.
What kind of results are you guys seeing?
Dr. Klye Greenway: So we just wrapped up a study that can, that randomized people, and this is what I mean about ketamine
permitting set and setting research that no other drug would permit safely. We randomized people to either receive, music or matched psychological support, which was generally mindfulness exercises.
So people were randomized for their six treatments of intravenous
ketamine
to either have music at every session or have a therapist in the room asking them to look in words and engage in breathing exercises. And, this is a, it's a goldmine of that we're still working through and analyzing, but we saw some really [00:37:00] cool things.
One of them, for example, is that our hypothesis was that music would blunt the blood pressure increase that comes with ketamine, which is one of the major side effects to be worried about. And we confirmed it. So music made ketamine more tolerable.
Which is cool cuz it at least makes an argument for people in anesthesia, et cetera, who don't really care
at all about the psychedelic paradigm to think about set and setting.
Why not
use music to lower people's blood pressure during a ketamine infusion rather than,
giving them anti-hypertensive other medications? and in our population in our population, you don't expect miraculous gains For most people. You're generally happy with incremental gains and yet we saw profound reductions in depression and anxiety and suicidality.
I'm not gonna get to proportions, but
certainly, the majority of people experience a
significant benefit. And really importantly, at the end of our active treatment,
we only had one month of follow
up. I wish we had longer, but there was some logistic concerns around that. But at one month follow up, all of the be
benefits were [00:38:00] maintained. There wasn't even the slightest signal towards people's benefits fading.
And that is in strong contrast to the biomedical literature on ketamine.
Lana Pribic: Interesting. So if someone is pursuing Ketamine assisted psychotherapy for something like treatment-resistant depression, how many rounds should they expect to go through? Is there maintenance or booster sessions.
Dr. Klye Greenway: Yeah. So we offer those as
well,
to from time to time. Our resources are a little bit limited. This is
one downside in operating in the public system. So we're only able to offer good candidates a boost every four to six months max.
Lana Pribic: That seems like it would be sufficient every four to six months,
Dr. Klye Greenway: Yeah. You know,
Lana Pribic: You wanna be doing like monthly?
Dr. Klye Greenway: I actually, it came outta necessity
because if you look at the, some of the more just biologically oriented clinics, it's every month or every couple months. And some patients have actually voiced to us there that they were upset that we weren't being able to offer them weekly infusions, for the rest of their life or something like that, which is something that I don't think I [00:39:00] would do even if I had the resources for it.
That's one of the big drivers we had in really trying to optimize the psychotherapy side of things was that we just were not resourced to give so frequently. And in the end I do,
I agree with you. I think once every four to six months is enough to have another sort of brief window of opportunity to maybe
break some bad habits or, restart on your goals and to consolidate some of the insights that might have come up from you and the treatments.
And also to, maintain that link with the team. Because a big part of, I think any psychiatric intervention is just feeling understood. Receiving kindness feeling there's somebody you can go to if things get worse, et cetera. And so that serves at least to
maintain the relationship so it's
not just a cold severing.
Which is something that unfortunately is mostly the case in clinical trials,
where that's
almost by necessity part of the design.
Lana Pribic: I wanna put you in the hot seat for a moment. Do you think that ketamine could be a drug that could get [00:40:00] people better? And by that be able to live their life happy where they're at without relying on boosters for the rest of their life. What do you think?
Dr. Klye Greenway: Totally. Yeah. In the right person. And it really depends on so many things. one thing I'll say is that if you're, in terms of betterment
of, people, I am the world's worst at this. Do you know what I mean? I feel
totally incompetent when it comes to people who are mostly doing okay. as Freud would say, neurotic in the good sense who are hoping to, feel better. This is not my wheelhouse. I am, I think,
very confident in my skills with people who are really suffering to get them to a normal level of average suffering. But I don't claim to be an
expert on wellness because,
especially right now in our society, there are so many good reasons not to feel well.
And I think that's okay.
I don't think ketamine is the answer. As just in the same way. I don't think that antidepressants are the answer or psychotherapy alone is the answer. I think all of us are on a continual journey to maintain our [00:41:00] wellness.
And ketamine
can be a catalyst in that process.
Lana Pribic: Yeah. Yeah. At least getting us to the point of being in that betterment of well group
Dr. Klye Greenway: yeah, exactly. I guess that's a good aspiration.
Like, well, I mean, for Freud that was the top of the ladder. once you got to neurotic, you were done. You were like, that is what we have to offer
you. and there's something kind of reassurance.
Lana Pribic: ladder though. Yeah.
Dr. Klye Greenway: I believe it. I
believe it did,
Lana Pribic: I love this conversation because your work and my work is at two opposite ends of the spectrum cuz I'm a professional life coach, so typically people come to me. When they're at that point where they're like, oh, I've done the therapy. I've gone through that journey. I feel good and I want to live and be even better.
So yeah it's
Dr. Klye Greenway: We have opposite skills.
Lana Pribic: modalities and Yeah, which is perfect. That's exactly what the world needs, right?
Dr. Klye Greenway: I think so. I think so. And that's, and this is the place that I feel very comfortable in with my training. And, the government
spends a million dollars or [00:42:00] something like that to train a psychiatrist. And so I,
it's one of the reasons why we
have done things in the public system, even though it's probably a hundred hours of bureaucracy for every hour with a patient.
But I feel like that.
Lana Pribic: Wow.
Dr. Klye Greenway: That's, but it's I think it's our mandate.
That's the way I understand our program is,
there are so many people that are really suffering.
And I do think that some, that's where a lot
of the bang for the buck of the public system is to get people
to a decent level where hopefully they
have the liberty to start working
on the relationships, to start pursuing more meaningful professional jobs or hobbies or whatever it is.
and maybe work with someone like yourself.
Lana Pribic: Yeah. For people who are listening out there and who are really identifying with being in that category of really struggling maybe they are on antidepressants, maybe they have they're struggling with anxiety, which like self proclaiming that I was in that group couple years ago.
Deeply in that. So for people who are listening who are there, first of all, I want you to know that you can get out of that, but I wanna hear from you for[00:43:00] people who are considering ketamine. What do they need to know about. Considering Ketamine as an option? Is there, if they're on antidepressants, do they have to get off of them?
Who's a good candidate for ketamine?
Dr. Klye Greenway: Yeah, it's a great question. One of the nice things about ketamine is that it's compatible with almost every medication except maybe benzodiazepines. So these anti-anxiety medications like Xanax, Ativan, et cetera which in some ways in our hands, we see that a little bit
as a feature, not a bug, because although those drugs are really effective short term treatments of anxiety, or even just the anxious distress of a beginning depression beginning depressive episode I interpret the evidence that in the long run.
Those medications because they're depress genic tend to just reinforce vicious cycles. And we use some evidence that those medications,
anti-anxiety medications
like Xanax, Ativan, actually reduce the benefits of psychotherapy. Because in some ways psychotherapy is driven
by tolerating [00:44:00] distress.
And if you just very effectively drug away the distress, there's not much room for growth to some extent. Whereas I don't, I, I think a lot of the, as I mentioned earlier, I think a lot of
the people in the psychedelic world tend to poo antidepressants or other treatments from mainstream psychiatry.
And that is not my view at all. I really do think these things
are profoundly helpful especially for people in the
more severe category. Good. Okay. Wonderful. Because I, yeah, I don't, there's this story of antidepressants, numbing, big pharma, bad, psychedelics, mushrooms, nature, spiritual
good.
And in some ways it's very interesting that ketamine is a bridge between these paradigms. Big pharma. Yes. Spiritual. Often,
Lana Pribic: often.
Dr. Klye Greenway: anyway, so I think for somebody considering
ketamine for depression, I would say a few big things. one is that
it is a drug that
can be considered a dose of instability in one's life.
And that is in many ways exactly what you need to get out of a depressive episode,[00:45:00] to shake the snow globe, so
to speak.
But it requires, adequate support to go through that process.
And a lot of people with severe depression, also are very lonely and lack in social support.
And, whether or not ketamine is
the answer if you don't have anybody in your life who can at least pick you up from the treatments and debrief with you. I tend to think it's not the right time for this medication. And that was one of the reasons also we
started asking our patients to have at least an hour of psychotherapy a week alongside our process because many people didn't have a single person they could talk to about really, just potentially challenging or intense or
joyful or scary content that came out of the experiences.
So
I would say you need a modicum of social support to go through a difficult process, a potentially challenging process. Then I would say,
Lana Pribic: Say,
Dr. Klye Greenway: I think one of the less obvious truths about all psychoactive drugs is that they are so [00:46:00] fundamentally determined by our narratives. Their experience of them is determined by our expectation.
Consciously, unconsciously, it's determined by whether we feel good with the prescriber. If you take an antidepressant every day
at home and you see the prescriber's name in your bottle, If you think they're a dick, it is not gonna be as effective. If you see that name and
you're like, that's right.
That doctor understood me, that doctor listened to me. And we dismiss these things
as being placebo effects that we should minimize in high quality research. But I think they're just part of human nature and they should be embraced in some extent. And that is to say
that I think one needs to have a clear trajectory, a frame around ketamine treatments, a good alliance with the person who might be administering it, a shared understanding about why it would be useful if one is to really get the maximal benefits out of it.
And
this is something that is a core component of what we do. We don't proceed with scheduling treatments or getting started with somebody until we really feel like there is a [00:47:00] shared understanding of why they're depressed, what would make them feel better, and how we're gonna work to better how we're gonna work together.
Lana Pribic: Yeah.
Dr. Klye Greenway: And I have
heard some bad stories from private ketamine clinics where essentially the requirement for whether you'll be accepted is, you meet basic criteria for depression and the check cashes. And I am strongly uncomfortable with that model. I don't
think,
I don't think it's a, I don't think it's even safe to be honest.
Lana Pribic: Yeah. It'll be interesting to see how hopefully the accessibility changes over the next five or so years, and you guys are really leading the way over there with the model that you've, the Montreal model that you've built there.
Dr. Klye Greenway: Thanks. Yeah. I think in some
ways,
that has been this fortuitous turn of events where we have had the chance to get a preview of what the climbing, psychedelic revolution or renaissance or whatever we
call it, what it will look like in the real world. And, spoiler alert.
Things will look different than clinical trials.
I think we just
need to accept that,[00:48:00]
there
Lana Pribic: Life is not a science experiment,
Dr. Klye Greenway: but even, again, back to
the narrative, if we take these sim the somewhat simplistic idea of I go through a psychedelic trial, I have a mystical experience and I'm cured, or I'm much better, will a mystical
experience have the same impact
on us?
When your hairdresser is talking about their
mystical experiences, your neighbor, your mom is talking about her mystical experiences, not, probably not, probably, it'll feel a little bit more like when you're,
when people blather on a little bit about their dreams,
Lana Pribic: . Yeah. I forget where I've heard. This piece of research that said, the mystical experience isn't actually really the most significant or the most impactful part of treatment,
Dr. Klye Greenway: It's so
interesting, and again, this is where
Ketamine has much to teach the rest of the psychedelic space because ketamine has been, in my mind, a little bit
badly cast with all these different words, with all these different complicated connotations. and that has led to real harms and real,
oversights. [00:49:00] And the same thing I think is happening with,
classical psychedelics where, you're seeing these divergent narratives where, you know, for some people these are drugs that engender mystical experiences. For others,
they are drugs that reset your brain.
For others, they are drugs that allow you to, break through emotional states. And, these things can all be true. And also none of them true, especially for an individual person. Like it gets very complex.
Lana Pribic: Yeah, the chameleon effect,
Dr. Klye Greenway: Yeah, exactly. Maybe ketamine is not the only chameleon in the zoo. But
I would suggest
Lana Pribic: think in its application of
Dr. Klye Greenway: Go
Lana Pribic: how it's been used throughout history, is where that came from. But yeah,
Dr. Klye Greenway: hundred percent. I, I'll just say the other
name, that we, me and my research team have talked about trying to
propose for Ketamine instead of the tiger is this goofy drug
because Edward Domino, again, the creator of
Ketamine, has this
wonderful, he has this wonderful story where after, I think he dosed the first patient ever in the world
with ketamine, [00:50:00] went home to his wife and
said, honey,
Lana Pribic: wife and said,
Dr. Klye Greenway: this, I'm working with this goofy drug.
It's a beautiful anesthetic, but people, like people get high from it.
Lana Pribic: like people get high from it. It is goofy
Dr. Klye Greenway: It is goofy.
Lana Pribic: is the perfect word to describe Ketamine.
Dr. Klye Greenway: Yeah. I.
Lana Pribic: on a slant if you like. Ever try to walk on, it's like walking on a slant.
Dr. Klye Greenway: I you know it.
a hundred percent. And I also think that it's another good example of how
interpretations can totally, or the words we use can totally change what an altered state feels like. For example the walking on a slant, the ketamine walk or feeling discoordinated or a little dizzy after ketamine treatment.
In our clinic, we always suggest the patients that this is the
drug reminding you to take it slow. And I think
this is, a much a lovelier, kind of interpretation for the same drug effect.
Lana Pribic: Like a tiger. Like a tiger takes it slow.
Dr. Klye Greenway: See, I'm not sure a tiger [00:51:00] takes it slow, but I think a chameleon, okay, you're right. Slow and then
Lana Pribic: How a cat like hunt's prey, they take it very slow until they're like ready to attack, right? One foot in front of the other, very slowly. Yeah.
Dr. Klye Greenway: Very true. Methodically.
Lana Pribic: Yes. I wanna start winding this down. So
Dr. Klye Greenway: perfect.
Lana Pribic: looking into the future of ketamine, assisted psychotherapy of psychedelics, what do you think that ketamine in particular Okay. Ketamine or psychedelics can teach us about conventional psychiatric medications and treatments in the future?
Dr. Klye Greenway: So you've heard me make links a little
bit to conventional medications, partly because I'm hoping to salvage the reputation
a bit and partly because I do think there are universal features and one of the big ones is again, how our narratives shape our experience [00:52:00] of
pharmaceuticals. And for example, with ketamine, if you go to a private ketamine clinic and you understand it to be dissociative, there's a very good chance you will understand your
experience to be meaningless
and kind of dissociative in the same way.
If you take a
conventional antidepressant with the idea that it's gonna fix your
brain and that the drug effects themselves are either good or they're side effects to be minimized, et cetera, there's the same sort of black and white
kinda lack of nuance
thinking that it easily comes up from really well-meaning clinicians.
and what I'd advocate bef I'd advocate more for is understanding that, the drug effects
are always a product of both chemistry and ourselves. And that's true for taking
a conventional antidepressant. If you feel suicidal taking Prozac, it might not just be this random, side effect that came from who knows what neurotransmitter it might be because he felt like the person who prescribed
it to you.
Was just totally minimizing
your suffering and that this [00:53:00] was not the right treatment for you. Do you know what I mean? And that's what I'm hoping for psychiatry going forward, is that, we move away from segregating our
brains from
psycho psychotherapy, which is all about experience and psycho-pharmacology, which is all about neurotransmitters and trying to find places, the ways in which these things overlap and intersect in a really rich and interesting way that can always teach us about who
we are.
Lana Pribic: Sounds like you see a more personalized. Treatment option for people
Dr. Klye Greenway: So you've
Lana Pribic: to who we are.
Dr. Klye Greenway: yeah, you put your finger on it. That if there's one niche
that we're hoping to carve out, we will never be this world
leading massive research machine. But
if there's one piece that we're hoping to carve out and pursue and
push for in the psychedelic field and psychiatry at whole.
It's to really understand who people are, both clinicians and patients, and find ways in which that understanding can inform treatment, tailoring, and really finding the right thing for the right person at the right time.[00:54:00]
Lana Pribic: Beautiful. We're on the same team. I love it. That sounds beautiful. Kyle, this has been so lovely. So nice. I get so many Ketamine clinics every week that wanna come on, and I knew you were the one I wanted to come and teach us about this, so th Yeah. Thank you so much for taking the time. I know you're a busy guy.
Dr. Klye Greenway: I I appreciate it. It's been really lovely to speak.
Lana Pribic: Yeah. Any, do you have any last parting words of hope for people who are listening and who are maybe in the, maybe, down depressive, anxious phase right now?
Dr. Klye Greenway: Yeah. I think I'll quote a really close collaborator in friend of mine, Dr. Nicola Garel who always says, where there's life, there's hope. And I truly believe that,
Lana Pribic: Beautiful. Thank you. And how can people learn more about what you're doing? I don't think, I think you're a [00:55:00] chameleon a little bit yourself. You don't seem to have a, you don't seem to have an online presence, but is there any way that people can support your work or get in touch or anything you wanna leave for people?
Dr. Klye Greenway: I guess I'm on research gate. You can see our
publications as they come, and I can be messaged, but you're right, very intentionally, I keep a low profile.
Lana Pribic: Yeah that's okay. That's good. We need you to focus on what you're doing and we
Dr. Klye Greenway: the plan.
Lana Pribic: it. All right. Thank you very much.
Dr. Klye Greenway: Thank you very
Lana Pribic: Thanks for listening, everyone. Very much. Bye.
Dr. Klye Greenway: Thank you. Bye now.
