The Future Of Mental Health: Psychedelic Medicine For Depression, Addiction, Trauma, And More - Transcript

Introduction:
Coming up on this episode of the Doctor's Farmacy,

Dr. Pamela Kryskow:
There's parts of our brains that just don't talk most of the time. And under the influence of these psychedelics is that those parts of the brain then connect, and that gives us a possibility of having new ways of knowing, new ways of interpreting.

Dr. Mark Hyman:
Welcome to Doctor's Farmacy. I'm Dr. Mark Hyman, that's farmacy with an f, a place for conversations that matter. If you've been listening the news or watching TV shows online, you probably have heard about the psychedelic revolution, which is taking the scientific world by storm and medicine and psychiatry by storm, by transforming our way of thinking about mental illness. It really is a very different paradigm, and I think it's a renaissance that we haven't seen in psychiatry since the advent of Zigmund Freud for that matter. And today we're going to have a chance to talk to someone who's deep in the work of this, not just in the theory of it, but in the practice of it. And this is Dr. Pamela Crisco, who's a medical doctor and the medical lead of a nonprofit called Roots to Thrive Psychedelic Assisted Therapy program, which treats PTSD, depression, anxiety, substance abuse, and end of life distress.

She's a founding board member of the Psychedelic Association of Canada and the medical chair of the Vancouver Island University postgraduate certificate in psychedelic medicine assisted therapy. Her ongoing research includes psilocybin, MDMA, ketamine, microdosing of psilocybin, and helping frontline healthcare workers and first responders mental wellness. She was also a firefighter for eight years in Canada and worked in provincial forestry firefighter for Four Seasons, which is pretty amazing. And she's also a good friend and a brilliant physician and works with a team of researchers in Canada doing extraordinary research around how to bring psychedelic medicine into practice. And in America, we haven't quite gotten there, but there are some more free provisions in Canadian law that allow for this type of work to be done under medical supervision. And so she has a lot of experience and a lot of practical experience as well as the research experience to help us understand and navigate this often very confusing and often complicated field of psychiatric medicine. So welcome, Pam.

Dr. Pamela Kryskow:
Hi, mark. Great to be here. Thanks for having me.

Dr. Mark Hyman:
So I want to just first start off by saying that so much of traditional psychiatry has been such a failure. When you look at the treatment of depression, addiction, anxiety, PTSD, the increasing rates of suicide, the increasing rates of opioid addiction, the incredible existential distress that many of us are feeling, even if we don't have a mental illness. And traditional psychiatry has been focused on talk therapy originally and then increasingly in the last 40, 50 years on psychiatric medication, which is a third leading category of drugs sold after I think statins and acid blocking drugs, which are lifestyle diseases. And they've been found to be somewhat effective for some patients in extreme situations, but they're generally not that effective. And what we're seeing here with psychiatric medicine is kind of a rethinking of how we approach the root causes. Rather than trying to cover over symptoms, there may be a way to deal with some of the root causes of the trauma.

And a colleague of yours, and I'm sure some of you know well, Gabor Mate lives in Vancouver near, we also live in British Columbia, and he talks about the trauma we all experience as we grow up and that we all, whether we're subject to big traumas, he calls it the big trauma with a big T, which is sexual abuse, violence, things like that, or little traumas, which is just being neglected by your parents or being bullied at school or not fitting in or dealing with the stresses of just being a human being in the 21st century all impacts us and is driving so much of what's underlying mental illness. And it seems to me that for the first time we have a model for helping people understand and deal with their traumas in ways that gets them free rather than just having to manage their psychiatric diseases.
So I think can you kind of talk to us about the sort of revolution in psychedelic medicine that's happened over the last even five years and how it's being now recognized and being implemented through programs like yours, like Roots to Thrive and others and research are doing to treat these really treatment resistant problems? It makes me laugh in the emergency room when someone comes in with a heart attack after everything fails, we give them intravenous magnesium to calm their heart down. Why don't we do that at the beginning? Why don't we deal with the root causes at the beginning rather than as the last resort therapy. So can you talk about the different types of psychedelics that are being out there used and how they kind of work to deal with some of these really recalcitrant mental health problems, psilocybin, ketamine, MDMA, and your experience with them?

Dr. Pamela Kryskow:
Well, thank you for mentioning Dr. Gabor Mate as a colleague, and he really opened up a lot of doors here for us, the whole medical field. And even he hit the population before the medical field really even really caught up to what he was saying. He was saying, these are symptoms. The addiction is just the symptom of trying to soothe normal self-soothing behaviors. We're all trying to feel better. And he really opened the doors on how we look at addiction, not as we were looking at addiction as an illness, when really it's a symptom of soothing the trauma. So, so much thanks and gratitude to Dr. Mate for all the doors he opened for us and really having us start to think differently on well approaching these problems and especially approaching him with psychedelics. He was certainly a leader working with ayahuasca in Canada and trying to get that Telehealth Canada stopped them.
But there's so many of these medicines you alluded or you talked about are coming back. And how exciting, because again, as you said, we've been in this area of psychiatry that's been biological, oh, you have a problem, here's a pill, as opposed to, like you said, getting to that root cause. And I think we in medicine are like, no, we are ready. We haven't liked that system and we really do want to get to the fundamentals of health. And so we have these psychedelic medicines that are coming back. And the history of it too is really important that people know, especially in Canada, LSD and psilocybin were used. They were used in Saskatchewan and Wayburn Mental Hospital. They were used very successfully for alcoholism, for substance use, for treatment, resistant depression. And then we had the war on drugs that kind of shut it all down.

Dr. Mark Hyman:
Was that in the sixties? This was going on

Dr. Pamela Kryskow:
In the fifties and the sixties. And shout out to Dr. Erica Dick, who is a brilliant Canadian historian and is really chronicled going back into these patient archives and meeting the patient's description of what they had before and how they felt after with these medicines. And you asked, how are these medicines coming back? And over the last five years, definitely, this is, again, shout out. We always need to really acknowledge whose shoulders we're standing on. And Roland Griffiths really and his team at John Hopkins, they really opened the door. They were persistent and they got the first trials through to use psilocybin for end of life to show us that this was possible. And I think that opened a lot of our eyes up in medicine that, whoa, maybe these are going to come back. Maybe this is going to be a possibility again. And as many of your listeners will know, and of course we're seeing lots of emerging evidence for psilocybin, for treatment resistant depression for distress at end of life. So depression and anxiety at end of life. We've had a couple clinical trials now for substance use disorders such as alcohol use, two or three sessions with psilocybin having durable effects going out 12 and 24 months, tobacco cessation going out with two or three sessions going out. And when you think of the billions of dollars we spend on pharmaceuticals to help these exact problems and the durability of those effects are really hovering at 30 to 40% success rate and sharing,

Dr. Mark Hyman:
How does that compare to traditional success rates?

Dr. Pamela Kryskow:
Well, that's what I mean you, that you would prescribe as a physician for let's say tobacco cessation, a 12 week course of the medicine that in my patient case that they're doing it every two, three years or even more regularly and still not quitting their tobacco, whereas the psilocybin we're looking at two or three sessions and still a success rate close to 70% two years later. These kind of numbers we don't see in addiction therapy.

Dr. Mark Hyman:
No,

Dr. Pamela Kryskow:
We don't see that in

Dr. Mark Hyman:
Addiction. I mean, yeah, recidivism is people, it's very high and success rates are in the low double digits, like 10, 20% if that. And the same thing with food addiction, with depression, treatment resistant depression with so much of the psychiatric problems people have and yet PTSD, these are things that debilitate society that cost enormous amounts of money. And I did a review of the economic impact of chronic disease, and it was estimated that it was going to cost society 95 trillion over the next 35 years. It's enormous amount of money. I was almost three and a half trillion a year. And a lot of that was the indirect costs of mental illness on society. In fact, the number one category or problem wasn't diabetes or heart disease or obesity. It was actually mental illness and depression particularly that was debilitating to people in such a way that made them not able to live their lives. And so if there's this new treatment out there that has success rates that are double, triple or even more the conventional therapies, it's big news. It's like, wow, we discovered the cure for cancer or something. And I don't want to overstate it, but I do see these results and I see it in clients who have used it. I've been reading the literature. Can you highlight some of the important studies that have sort of documented this and their comparative value to, for example, traditional psychiatric treatments?

Dr. Pamela Kryskow:
Yeah. Well, you sort

Dr. Mark Hyman:
Briefly mentioned the one, but I wanted,

Dr. Pamela Kryskow:
Yeah, you talked about the question already and what we know with our medications or SSRIs, they're hovering, depending if you bring in all the negative studies that weren't published and they're hovering right around, they're hovering right around placebo, and we're not seeing that. I mean, there's certainly

Dr. Mark Hyman:
Hovering around placebo. I like that that means not affected.

Dr. Pamela Kryskow:
Well, it's really the doctors, it's that therapeutic, that therapeutic relationship that's doing it. But I mean, the big picture is stepping back versus a caveat is these are not cure alls. But for the SSRIs, there are certainly a portion of the population that respond well to them. And I think that's what we really need to acknowledge. Some of these medicines are lifesaving for people, and I don't want to throw them out at all for the people that respond to SSRIs or SNRIs or other medications. They're fantastic, but there's so many people that don't respond to them. And so for those people, when we start at a psilocybin session or a ketamine session done really well in a therapeutic container or MDMA, we're seeing the reason that, like you said, the fundamental, the foundation that is causing those other symptoms. And it's very rarely just depression.
It's often depression. It's often depression and anxiety. It's often substance use. There's other self-soothing behaviors, sex eating, smoking. There's other self-soothing behaviors that are completely logical for people trying to feel better. And the psilocybin studies, and the caveat here is, remember the psilocybin studies are on the synthetic psilocybin. The majority of the clinical trials have been done with the synthetic. So we actually haven't even seen the clinical trials of how good it will be with the whole mushrooms. So we have this really interesting situation, mark, in that all the clinical trials, other than a few now are all using synthetic psilocybin. And all the people out there that are having a psilocybin mushroom session in the real world are using psilocybin mushrooms. So we have a bit of a disconnect. So we don't even have the clinical trials that are actually looking at the psilocybin mushroom, which have many more constituents in them than just the synthetic. You have Bain, nor Bain, nor Silas and Silas and many other constituents. So I think that's an exciting place there is what kind of results are we going to get around depression when we can actually really do good studies with the whole mushroom and what we're seeing, for instance, in our program, we have an end of life, so we have an end of life cohort, and that's what we work with that go through. And there are depression scores at the beginning to the end are clinically six or seven points better, which is a lot. Huge difference

Dr. Mark Hyman:
Is this the Hamilton Depression Scale.

Dr. Pamela Kryskow:
We mostly use the PHQ nine. We try to use something that's shorter and smaller because we are working with people that have end of life distress and we don't want them to be doing a ton of long questionnaires. But,

Dr. Mark Hyman:
And these are standardized research validated questionnaires, all

Dr. Pamela Kryskow:
Validated

Dr. Mark Hyman:
Researchers use to actually measure the effectiveness of interventions for depression. So I think when you see a big, doesn't sound like six or seven points a lot, but it is actually a big delta on the improvement in depression.

Dr. Pamela Kryskow:
Yeah, that's a huge, I mean, a lot of the medications are just looking for two to three points,

Dr. Mark Hyman:
And

Dr. Pamela Kryskow:
That's considered a success. And we're seeing six to seven double that in these studies. So we're seeing quite a bit. But it goes really back again to what you said earlier, it's like we're hitting the foundations, we're hitting the root trauma, we're hitting that thing that they've been carrying their whole life that has really influenced their mood that so often these human conditions that so many people have, I'm not good enough, I don't belong, my parents didn't love me. All these things that just sit at the base of our wellness. And when you extrapolate it out, it's the reason, again, back tobar mate, why we see addiction or why we see other self-soothing behaviors or anxiety or depression, et cetera.

Dr. Mark Hyman:
It's sort of a soul crisis in a sense in our society where we're all sort of living in worlds where we're disconnected from our original ways of living as human beings close to the earth in concert with nature, eating real food and deep community and tribal networks. We're isolated, we're disconnected, we're disjointed. We have social media, but it's anything but social, sorry, antisocial media,

Dr. Pamela Kryskow:
Very destructive,

Dr. Mark Hyman:
More disconnected, more isolated. And I remember as a young man, I had the chance to take psilocybin mushrooms, magic mushrooms in college. And I think we had some big doses because now they talk about heroes doses. And I've tried it not anything close to what we did in college. And I remember this feeling of really having a profound sense of connection with nature and with the friends that I was with in those moments. And sort of a dissolving of the sense of separateness, which is sort of at the root of depression, it it's this sense of disconnection, isolation, meaninglessness, hopelessness, and these compounds somehow change our brains in the short term to actually dissolve some of this sense of separateness and isolation and disconnection, which gives us so much of our existential suffering. So can you explain the science behind how that might work and what the theories are behind it? I know there's been a lot of talk about, for example, the default node network and the dissolution of the ego and ego death and all these sort of terms, which I don't know if people understand what they mean, but can you talk about from a scientific perspective, what actually may be happening and how this works to change people's sense of relationship themselves to others, to the earth, the nature to humanity after they take one of these compounds?

Dr. Pamela Kryskow:
Yeah. Well, and that's such a big question mark, so not question mark, but question mark. So first off, we have tons of theories. We have tons of theories on the mechanism of action, of all these medicines, which receptors do they bind with and what is the downstream response to that, which neurotransmitters are released? So we're looking at a lot of things. So we've got the classic psychedelics like LS, D and psilocybin. We've got psychedelic, but I would argue is very psychedelic like ketamine and then MDMA, which isn't pathogenic and how they all work. And so there's some common threads that you see. So I'm just going to try to weave them a little bit together, but not perfectly. So there's this one part where we do know that for people that are in A-P-T-S-D response, they're amygdalas kind of running the show. And so we see that with stuff like MDMA, we see the amygdala gets this calm down and then more active like prefrontal cortex. So you get into this parasympathetic, Dr. Julia Holland is excellent really talking about getting into the parasympathetic and where you can really just be calm and thoughtful and not having the alarm bells running your life. And so there's that one element there that it gets us calmed down so we can then think and be, there's other theories that work around getting,

Dr. Mark Hyman:
So just to recap that for people, basically there's a part of your brain that's the old reptile brain, the lizard brain that's fight or flight or freeze. And that's the sort of limbic brain or where the amygdala is, which is the sort of fear center in the brain. And the frontal lobe is more the adult in the room, the grownup, the person who has perspective and in charge of executive function and can kind of sense the world in a more accurate way. And often they're disconnected in our modern life and the amygdala is activated. The frontal lobes decrease in function. And there's an interesting actually theory about this that people who are inflamed, which by the way is most of the people today in the western world who are eating a processed American diet, that the inflammation, the brain disconnects the frontal lobe and the amygdala. So it activates this increased sense of disconnection, isolation, fear, otherness, divisiveness that we see today in society. So I think healing our brains is an interesting perspective to think about how do we use these compounds to potentially not just mask or treat or cover symptoms, but how do we heal our brains using these medicines and the therapies associated with them

Dr. Pamela Kryskow:
And knowing that we do need our amygdala, right? If we're under attack, you need your amygdala. We need to be in that dinosaur brain for sure. But you can't run around every day in that space and be healthy. So certainly. And then there's this other part of the psychedelics that, and this is where you see the connect agram that Beckley Institute funded where you see that connecta gram like this is your brain not on psilocybin, and this is your brain on psilocybin. And people will have seen that is that there's this part that there's parts of our brains that just don't talk most of the time. And under the influence of these psychedelics is that those parts of the brains then connect. And that gives us a possibility of having new ways of knowing, new ways of interpreting. And that's part of the theory of ketamine too, is that part of the influence of ketamine on the brain is that you get these repetitive pathways, these super highways, and the brain always wants to go to the easiest way.
That's why the first time you drive, it's impossible. But now when you drive, you're not even thinking the brain has found all these superhighways of driving that you don't even have to think about. So it does allow now that, so you have the super highway of anxiety or depression, and that's where you go to, and then suddenly you now have this new way of going, oh, and I don't have to do that. And you open up a new pathway and with practice, that pathway can stay and you can continue with that neuroplasticity. And so that is another one of the theories. And then there's also track B is come on, and a lot of people say, oh, now it's a receptor of the day, but it also makes sense, are we getting new neurons? Where is that neuroplasticity coming from? Where is the BDNF coming from and why are we getting it with different ones?
And there's the serotonin receptors that are bin with, then we're talking about the neurotransmitters. So we're getting with MDNA, we're talking about more oxytocin, possibly more dopamine, possibly more norepinephrine. And so I think your question is why are they working? And my thing is we have a lot of theories and these theories are going to continue to proceed, but they all make sense to me with ketamine, there's the theory of that we have a glutaminergic surge, and maybe that's why we get such an rapid antidepressant effect. Think about it, the SSRIs, we tell our patients, oh, maybe in six weeks you'll start to feel better.

Dr. Mark Hyman:
But

Dr. Pamela Kryskow:
On ketamine, literally an hour later people are like, I feel great.
So I'm not answering your question as well as I think you want it to be answered. But I think it's good. There's a part of this that is like we have a lot of theories, they make a lot of sense. And I don't think we're smart enough yet to have really hit the pinnacle of why these work, because then you also have this other part of the brain that you've experienced, that we've experienced, we've everyone that has done psychedelics and had that big universal consciousness, universal oneness. And then what is that on top of all these other things? And I sometimes just feel like we're just not quite smart enough to fully appreciate all those mechanisms.

Dr. Mark Hyman:
Yeah, I think that's right. And I think you're right. And I think what I was most excited talking to you about was their clinical experience. Because I've had a bunch of people on the podcast talking about psychedelic therapy from a research perspective or from a more cultural perspective like Michael Pollan and Tony Bosses and others talking about psychedelic therapy, about Iboga, Debra Mash, they're researchers, you're a doctor and you treat patients. And I'd love to hear some of the work you've done, both end of life work, but also around depression and what you're seeing on a clinical basis from the stories of your patients. What are some of the cases, obviously not using names, but what are the stories that you see and how does this work? And tell us about the process. If someone, let's say this gets legalized in a year or two or whatever, what are we looking forward to as sort of the standard of care? And I know you're very rigorous about how you do this. There's a lot of pre-work. There's the therapy, there's the post-work. It's only just go in room and take the drug and put a blindfold on and put some nice music on. We'll see you later. It's, it's a very structured process for working people through their experience of mental challenges and their traumas and end of life experiences. So I'd love you to share some of your actually real experiences both around psilocybin and other compounds you've used in different conditions.

Dr. Pamela Kryskow:
Well, roots to Thrive is a nonprofit that we've, a bunch of healthcare providers came together and created a program and said, we need to do this. We need to make this happen. So we built it on the scaffolding of Ketamine assisted therapy. And what we did is we knew we needed to create a really strong container. And what we didn't want to just do is we didn't want to just be in the biomedical Western way. We could see the work that was coming out of the clinical trials, but we all have the privilege of working in a part of Canada that has a really strong indigenous heritage and way of knowing. And we have indigenous elders on our team who right from the beginning brought us through the process of creating a very ceremonial container, something more this what's called two eyed scenes. So taking the best of indigenous ways of knowing and taking the best of western ways of knowing and weaving them together to make an even better synergistic container.
And so our process is very rigorous. Our programs run over eight to 12 weeks. We do an incredibly detailed intake to make sure people are psychologically safe, that they're medically safe to work with the medicine. So whether psilocybin MDMA or Ketamine, and because we're in Canada, we we're in this position where we can actually get exemptions from Health Canada to work with psilocybin and MDMA. So that's why those are part of our program. And then Ketamine, of course, is a legal medicine that we've always had access to. And so we have a very rigorous intake. We really make sure that the people we're working with understand what they're in for and really solid consent. And everything we do is in group. And we know that people, like we've already talked about crave community. They need community. We need connection. We need love. We need unconditional positive regard.
We need to be witnessed and heard, and that's the container. We're making a whole human container where people can show up as participants as their full self and can the medical team, so the medical team and the therapy team get to show up fully. And the team is very interdisciplinary. So we have medical doctors working side by side with nurses, with therapists, with indigenous elders, with somatic therapists, with energy workers, clinical counselors, social workers, all of us working together in a non-hierarchical way to serve the patients. And so there's a really detailed preparation and starting the integration right away. And so good. In fact, mark, that we start to see people's anxiety scores already drop before they even get to the psychedelic session.

Dr. Mark Hyman:
Wow.

Dr. Pamela Kryskow:
We see their depression scores dropping before we see their substance use dropping before they get to their first psychedelic session, and then they come on site together. So all this is done virtual, which is really interesting. We didn't think that would happen that we didn't think people would bond so well virtually. But they do. They bond really well. And then they all come together on site. And when the participants are coming together and meeting for the first time, it's like family and friends reconnecting. It's like they've known each other forever and they've really only known each other for four weeks. The ceremony on the day of their psychedelic session, it's very ceremonial. That set and setting is set, the safety consent, it's a beautiful room. We make sure people can share their intentions and their pillars of strength and the kind of support they need.
And then the whole team holds the ceremony. So the medicine is everybody has their medicine together. In the case of psilocybin, they're ingesting it. MDMA, they're ingesting it, and ketamine, it's an injection, but all the participants get the medicine together. They wear eye masks, they have a specially curated song list that's just for the group. And then they journey together. And then as they emerge out of the medicine, they start their integration and their sharing in community. And that is such a healing way. So our whole team used to work in the dyad model, and now we all work in this team model, in this group model. And no one would go back. They were just like, this is amazing to watch these participants. They hear each other, they share the stories, they hold each other accountable. And the healing, I think is just doubles, triples in what it would in our old model of doing the diad. And then they continue to integrate, and we see success rates of PTSD resolution of like 92% in 12 weeks.

Dr. Mark Hyman:
Wow. So what is the typical PTSD resolution in traditional psychiatric care?

Dr. Pamela Kryskow:
30, 40% over many, many years.

Dr. Mark Hyman:
So treating people for years or decades, you see maybe a 30% resolution. And you're talking about 98% resolution.

Dr. Pamela Kryskow:
92% in about 12 weeks. In 12 weeks, yeah.

Dr. Mark Hyman:
Wow.

Dr. Pamela Kryskow:
The results that we're getting with our 12 week program are very similar to what we're seeing with the MDMA. So there's something that's very similar on this whole process of bringing people together, preparing three sessions, good integration and that time. So it's not just the medicine that does that, it's this therapeutic alliance as well. In our program, again, it's like we need connection, we need to connect with people. And so much of mental health issues is about we're siloing. We're like, I'm the only one with depression. I'm the only one with a eating disorder. I'm the only one with this. And then you have these groups coming together, and I think this is part of the success you see in stuff like AA and na, it's people coming together, they're community with this shared experience, but here you have people having the shared psychedelic experience. But even in

Dr. Mark Hyman:
Aa, the success rates are in the 10%, maybe 20% rate. It's not very effective. It's better than anything else, but it's still terrible. And what you're saying here is just orders of magnitude different. And then I think gives me a lot of hope for where we're headed with this. And I mean, tell us a little bit more about some of the personal experiences that you've seen people go through and stories of transformation from traumas and depression and things that you've seen around the work you've done.

Dr. Pamela Kryskow:
Well, there's kind of two sets here that I'd like to share with you, mark. So one is we have our psilocybin end of life group. So have, right now we have 13 people going through a program that have just started the program. Again, we've just gotten more exemptions for that from Health Canada. But what's so remarkable is people are, to qualify, they have to have an end of life diagnosis. And most of the people that have come through our program, actually all of them probably at this point, really based on their prognosis, should have passed by now. And only a few have, only three out of the 40 some that have gone through have actually passed on. And what we're seeing is this remarkable removal of this thinking about death or thinking about taking care of the family and how this is going to affect their family.
And now they're living, they're out there living, they're going surfing, they're going camping, they're going on these vacations. One of our participants walked in with two canes, just barely being able to walk, and at the end jumped up off cane underarm, walked out and was thinking, I think I might go back to work. I really miss work. I think I might go back. There's these layers that just get lifted and are gone. And so we are seeing that in the end of life. So they get to come together under this shared issue that they've been given a palliative care diagnosis, and they get to talk about it openly and honestly in a group. That's the community part. And then they get to journey and have this shared experience, even though they're having their individual experience, they're also having a shared experience. And then they have this community to talk about it that truly, truly understand it. So we're seeing that this longevity and also this whole removal of layers of depression and anxiety related to that diagnosis. So it's absolutely a delight to be able to see these people get their ability to be connected back to their families and their friends and their life, even though they do have this palliative

Dr. Mark Hyman:
Diagnosis. They're living more even while they're dying.

Dr. Pamela Kryskow:
Exactly.

Dr. Mark Hyman:
And are you seeing any differences in the survival rates of these patients?

Dr. Pamela Kryskow:
Well, the thing is, they're all still alive other than, like I said, three and one chose made and decided wanted to go out on their own terms, and that was totally fine. And then two,

Dr. Mark Hyman:
That's euthanasia, which is legal in Canada,

Dr. Pamela Kryskow:
Right? Yeah, yeah. Medical assistance and dying, right? Correct. Yeah. And so just people being able to go out on their own terms, while the rest are still, they still have the challenges of the palliative care diagnosis. They still have bad days, but they still have more of the ability to have just those layers of depression and anxiety just lifted and not as common. Why

Dr. Mark Hyman:
Haven't they died? Is it just because the study duration is not long enough for them to have reached the end of their life? Or is this psychedelic medicine somehow helping them survive longer? I mean, there's been evidence that different kinds of therapeutic mushrooms are effective in cancer, but I'm curious about any data you have about that.

Dr. Pamela Kryskow:
Well, I wonder if, you know, think about the neuroinflammation related to anxiety and depression and not waking up with dread or waking up with just that heaviness of knowing. And then that's lifted. That's where I would go. I would go, all this other stuff is lifted and now the body can move forward in these other biological processes. If you're not depressed, you don't have that inflammation of being depressed. That inflammation of being in anxiety, I don't know. It's a bit of awe and wonder for us as well as the team to get to watch people get this and what are the biomarkers that we'll find in these people that are doing well, and we continue to follow them. And in fact, some of them have come back and we have an alumni program. And I think that's a really important element. You asked what

Dr. Mark Hyman:
Is I, I had this patient once who was in hospice, but he was in hospice for five years. He just didn't die. He had stage four lung cancer. And I was like, what? Just don't follow the typical norms. And I just wonder, obviously the biggest is the one between your ears. And so who knows what is being released when you relieve that existential stress and fear and connect to love and interesting,

Dr. Pamela Kryskow:
Fascinating. And what is happening? We don't know. And we follow them. We follow them mountain and see, and we'll find out hopefully over time and maybe, but that's what I was going to say about the program. What is really important is that once people are in the program, we're like, you're in the program as long as you want. So even though the 12 weeks is the end of the official program, if people want to come back and do, so, we have people coming that are psilocybin alumni, palliative care people that are coming back for their third psilocybin session because they're doing well, but they're taking it to the next level. They're going, now, I want to be a better dad. Now I really want to work on this other stuff because I'm not worried about my cancer anymore. What I'm worried about is preparing relationships in my family.
And so that's what we see on the psilocybin side. And then on the other side, we have this very ceremonial ketamine assisted therapy program. And so that really caters a lot more to healthcare, like frontline healthcare workers and first responders. And you ask, what are some of the success stories? I remember one of our MD colleagues who came through the program, I mean, he was having recurrent nightmares over an episode in the er, recurrent every single day, nightmares, same nightmare. First psychedelic assisted ketamine session in his small group of eight people. Next day the nightmares are gone.

Dr. Mark Hyman:
Wow.

Dr. Pamela Kryskow:
Just

Dr. Mark Hyman:
Like that.

Dr. Pamela Kryskow:
Just like that. And we see that with our firefighters. We have a lot of firefighters that come through our program, police officers, paramedics, doctors, nurses in similar things. I was always on high alert. I always had to sit in the restaurant in the chair where I could see all the exits and all the doors. I went out for dinner last week, didn't have to do that. Letters from the spouses, I've got my partner back, letters from the kids, my dad is back. There's all these layers. And especially in these caring professions and these first line professions, I think everybody that gets accepted to these professions and medical school should have to psychedelics first

Dr. Mark Hyman:
Because

Dr. Pamela Kryskow:
There's something about us that we drive. There's something, why are we so driven to do these things? And I think it's ubiquitous. It's I'm not good enough. If only I accomplish then this, then I'll be important. Or I can earn my parents' love or there's lots of things that are so common, imposter syndrome, all these things. And especially in the first responders, this white knight syndrome, I'm going to save people. I couldn't save my mom from being beaten up. So I'll go out in the world and I'll save other people from house fires or stuff like that. And if we could really help people cure that when they get hired or accepted into these, first and foremost, I just imagine how much more resilient and healthy they would be in these programs. But you take that trauma, then you layer on seeing people hurt, injured, not being able to save someone, and you layer on all these traumas and then you take those off, they're able to get to the seat of that trauma in their psychedelic journey where they can go, yeah, that happened. I did my best. And it's not happening now.

Dr. Mark Hyman:
Powerful. Powerful. So this is, you're talking about right now, is using full dose psychedelics as part of structured therapy, but there's also this whole movement of microdosing, which you're involved with. And actually you're one of the co-investigators of a really remarkable study that's a community-based study as opposed to sort of a clinical study in academic center with over 25,000 people, which is a huge study. And you're able to use an app to help track the behaviors, habits, responses, outcomes of people who are using microdosing. Now it's all over the place in terms of what they're using, where they get it from, how much the dose is. But I'm just sort of curious about what you're seeing from this data. Because one thing is to take a psychedelic journey where you have really clear changes in your perception, your feeling, how your body feels. The microdosing is sub perceptual. You don't necessarily know you're doing it. So can you talk about some of the data? It seems really quite fascinating, this we're having different effects on the body and it's also working in similar ways, but it actually might be a strategy for helping people as a kind of long-term therapy, not continuous therapy. We talk about why, but intermittent therapy to actually help with some of the same issues.

Dr. Pamela Kryskow:
And the driving force behind this study mark, was that we knew we had hundreds and really closer to thousands of case reports of people microdosing. And how do you even begin to look at that? So it's a prospective observational study. So it is a registered clinical trials. And what we wanted to do is figure out where are the signals. So amongst all the reasons that people were microdosing, are they getting the results that they think they are? And so we had, as people come into the study, we get their demographics, they get all the reasons why they're microdosing or why they hope to microdose. We have all the validated scores, so all the mental health scores that we can put in an app. We have validated tests for reaction time and memory, and then all the different permutations of what people are microdosing. So are they microdosing, psilocybin, LS, D, ayahuasca, Chuma, everything and what they're stacking it with and what they're putting in there.
And some of the remarkable, we've already published a couple twice in Nature Scientific reports and what we found in those publications, and we're still crunching. We still have eight teams crunching data on this that's continually coming in. But we found positive moods go up, low moods go down, depression goes down, anxiety goes down. Reaction time gets faster in 55 year olds that are stacking psilocybin with niacin and lions, Maine. And then there's a lot of other things. So when we first launched this study, we kind of had a sort of an idea of why people were microdosing. And then as it launched, we started having all these other groups come to us and say, Hey, what about us? We're also microdosing. There's this group of 30,000 women moms who microdose out there that are part of this complete support group that are microdosing for multiple reasons, like premenstrual dysphoria, menstrual challenges that maybe don't qualify for something as severe as PMDD, cramps migraines related to menstrual stuff around depression, postpartum depression.
And so there's a whole bunch of stuff there. There's a whole bunch of neurological challenges. So people that have these progressive neurological conditions like cerebellar ataxia are out there and we're seeing improvements in that. And all of these of course have to be, we have to take these to clinical trials to confirm, but when you have 25,000 people, you get to start to see where the signals are. You get to see in which group patterns doing which type of microdosing on what kind of schedule is getting a result. It's kind of this thing that people are microdosing for. So many things is over the top. Some people are microdosing to have more energy, some people are microdosing to have less energy. And definitely every single mental health condition is being microdosed for out there. We have elite athletes that are microdosing to improve their reaction time, to improve their focus, and on all sorts of regimes.
So what it's going to pan out to be in the end, I think what we're going to see is we're going to see a whole bunch. And based on what we're already seeing, we're going to see certain people are going to microdose maybe three or four times a month just when they need to. Some people are going to microdose on a very rigorous schedule. We see that already. We see a whole group of people that are using microdosing to slowly wean themselves off of other medications that they don't want to be on anymore, and kind of doing a cross wean. And then we see this neurological data, which is, I find the most impressive because we have so many progressive neurological degenerative conditions. And if we can find a way where we can challenge ourselves while we're taking these medicines that can help with neuroplasticity or stimulating new neural pathways, then we might be finding something that's really going to help. I mean, we're all progressing that way, and I would love to keep my brain unwind as long as possible.

Dr. Mark Hyman:
Is this potentially a preventive treatment for Alzheimer's or for Parkinson's? You're seeing signals that show that it may be improving some of the symptoms of it, or reversing some of them, which is fascinating.

Dr. Pamela Kryskow:
And working on so many different parts of the brain. You think about proprioception and people are getting better in their proprioception, so their ability to balance and move their body in space and time and tene people being able to say, ever since I started this, my surfing has gone through the roof. Or maybe it has nothing to do with it, but it's really, I mean, if you're an observational scientist and you're really curious, you have to be going, why in so many different areas are we seeing people? And maybe it is partially expectancy, but maybe there's something more to it because I think there's some things that you just can't have expectancy effect for. I don't think in something like cerebellar ataxia, you can expect that a microdose will help with that. It's degenerative condition.

Dr. Mark Hyman:
Yeah, that's a condition where you kind of don't have balance in the part of your brain that is in charge of balance and walking and normal movements is all messed up. And so yeah, you wouldn't expect something like that if someone has a stroke or some physical deficit to see an improvement. But it seems like we're seeing changes. So I think it's a whole area, additional research. I know your partner has been, Paul Staus is actually working with you on this and the Staid stack as a way of actually researching this. And there's, I think it's called Myco Medica, which is a company that you've informed to actually help deliver this therapy at scale and do the research behind it. And I think it's very impressive. Are you seeing people get the relief from depression with microdosing and anxiety in the same way that you see,

Dr. Pamela Kryskow:
That's what caught my attention first Mark. Over 10 years ago, I had three patients literally in a very short timeframe that were depressed and suicidal. And that's what they came in and said, this has changed my life. I need to tell you about it.

Dr. Mark Hyman:
Just microdosing, not actually full dose.

Dr. Pamela Kryskow:
Nope, just microdosing. Just started taking little bits, taking little bite of a mushroom every day and saying, it's changed me. And that's really what piqued my interest. That's where I started collecting the case reports and really diving into what Jim Fatman had been doing, because he had really been collecting case reports for much longer. And this just started looking at that nuts. Yeah. And tons of case reports now, and of course this will bear out, is with people that have written up their protocol on how they are slowly weaning themselves off their SSRIs. So very highly educated people. This is not so often in medicine. We say, oh, well, people are susceptible to all this. These are people that are super smart that take control of their health. And they're sitting there going, okay, here's my regime. I'm microdosing a little bit. And as I get that stability, then I wean down on my S-S-R-I-A tiny bit and I keep my microdosing and they're doing it very thoughtfully.
And we're seeing a big difference here. And the nice thing is that it gives 'em the ability to dose themselves as they need to. So when their mood is solid, they're not microdosing. And then when they start to feel the mood dip, they'll start to microdose again. So there's those kind of, and we don't do that with medicines, right? We're just like, no, take the pill every day. And so we may have to think a little bit differently because maybe people don't need something every single day. But definitely seeing improvement in depression, definitely seeing improvement in anxiety.

Dr. Mark Hyman:
Are you seeing more advanced thinking in Canada around this in terms of legalization pathways for therapy? I mean, with Roots to thrive, you're able to now legally do this with people who are at end of life as legitimate reimbursed medical therapy, right?

Dr. Pamela Kryskow:
Well, we hope so. We're working a lot with Health Canada. We meet with them regularly and really just like the FDA Health Canada wants, they want clinical trials. They want lots and lots of clinical trials, and we're trying to bridge it both. And this is where Roots to Thrive really does it well, is that we are studying real people in real programs and getting real outcomes. Most of our patients wouldn't get into clinical trials. So are we seeing more openness in Canada? I think we're seeing researchers at every single university are leaning in to doing this research. We have the program at Vancouver Island University with outstanding amount of applications of medical professionals who want to be trained in these therapies. So you kind of see that the practitioners a little bit ahead of the regulation. We've had two national polls in Canada and psilocybin with 80% of Canadians supporting the use of psilocybin, especially at end of life. So that's a higher rate mark than we had support for cannabis when we legalized cannabis federally in Canada. So more people right now support psilocybin than supported cannabis at the time. So that's pretty high. And we see the colleges, the medical colleges and the provinces that administer healthcare trying to figure out how to do this. And so we're in this weird situation in that these medicines are available everywhere. You can go into Vancouver right now into 10 different stores and buy psilocybin.

Dr. Mark Hyman:
You mean it's legal to buy?

Dr. Pamela Kryskow:
It's decriminalized in Vancouver. It's decriminalized in two other cities in Canada, so people can just walk into the court.

Dr. Mark Hyman:
There's dispensaries like a cannabis dispensary in Canada. Wow. So that's different. One thing being decriminalized, another thing being legal to sell it.

Dr. Pamela Kryskow:
Well, and decriminalize, it just means it's the lowest police priorities. So they have to have solved every other crime before they can go after the dispensary, basically. So it's defacto legalized. And so what we're seeing is a huge underground happening with psilocybin in Canada. And MDMA has been decriminalized in British Columbia as well. And so people have access to it. But the issue is that medical professionals are limited

Dr. Mark Hyman:
In what they can do or how they can do it. We

Dr. Pamela Kryskow:
Have to get special access. We have to apply for each and every patient individually to Health Canada to get a yes to do that. So you can imagine,

Dr. Mark Hyman:
I mean, these medications certainly have very low toxicity and very low sort of adverse effects, not without adverse effects, because I think in an unsupervised way or in the wrong setting, it can be very destabilizing for people. I mean, the whole conversation on set and setting is important, which is where do you take it? What is the setting and how is it the overall experience if you're in a times square versus a quiet meditative tempo somewhere as a very different experience being on a substance that alters your perception and your sense of safety. So are you feeling like that this is premature to allow it to be available in dispensaries around Canada? Do you think that's something that actually could be helpful in bringing about its better use within therapeutic settings, or do you think it's kind of a problem?

Dr. Pamela Kryskow:
Well, I'm torn Mark, because every one of us that have had a psychedelic experience have had it in the underground for the most part in our teens, our young adulthood, our last week, whoever. So I'm torn because I want safety for my patients. I want them to have the best set I want them to have, make sure that this is not a medication that will destabilize 'em, or this is an experience that will destabilize. I want a strong team around them of support. And they also want the freedom for patients to have that in multiple settings. So if they want to have it in something that's completely hospitalized and completely medicalized, I want people to have that choice. And if they want to have it in a completely beautiful outdoor setting in a beautiful retreat center, I want them to have that choice too. And if they want to have something in between, I want them to have that choice.

Dr. Mark Hyman:
And

Dr. Pamela Kryskow:
I think the only way we're going to get there is if we legalize and then put parameters around that in some way. So to make sure that that psilocybin that's being provided or people are getting is really in fact the highest quality without bacterial contamination. And if they're doing MDMA that it's been CGMP created meaning good manufacturing practices, it's about if people are going to take the time to work with these medicines, I want them to have the best possible outcome. And if it's a contraindication that they shouldn't be having it, then there needs to be a process of them going through that. And that's our concern, is we often are rescuing people out of the emergencies that have worked with people that don't have any kind of medical clearance background in the underground. And that's not disparaging people that work in the underground. It's just saying that we need this high quality intake to make sure people are psychologically appropriate to work with it, that they're medically appropriate to work with it. And then the best setting for that. So five star all the way. And right now what we kind of have is we have this two-tiered system. If you have a lot of money, you can go off to a beautiful retreat center somewhere where it's legal and have a beautiful session. And if you don't have those resources, then you may be working in a place where you're going and buying something that you don't know if it's what the quality is of it.
And so I'm torn. So the legalization hopefully pushes it so that we can have high quality therapy. And I think it's necessary. I think people have the right to their own consciousness. I think people have the right to these substances. And the fact that a mushroom is illegal right now just is mind boggling. It's mind boggling to me. Yeah.

Dr. Mark Hyman:
I mean, it's considering when alcohol is legal and tobacco is legal, which are really highly addictive, destructive substances, and these aren't.

Dr. Pamela Kryskow:
Yeah. Yeah. And we need to move past this. I mean, this is propaganda. We're in this place because of propaganda, because of stigma. And I think we should be, as physicians, we should be really angry that these medicines were taken away from our patients. We're 40, 50 years behind where we could be. We could be in such a better situation right now. And we have such a crisis here of mental health, a crisis here of substance use. And it all comes back to trauma and connection and love,

Dr. Mark Hyman:
Trauma and connection and love healing, trauma building connection and kind of leading with love. I think that's powerfully beautiful. Where do you see us in a year, three, five years in healthcare with this in Canada and maybe in the States? You have some insights. You spent a lot of time here. Where do you see this going? I mean, do you think this is going to completely change psychiatric medicine? Do you think it's going to be still marginalized with big pharma pushing pharmaceuticals?

Dr. Pamela Kryskow:
I think we're going to see everything. I think we're going to see some provinces in Canada and some states in the US say really lead the way. They're going to make mistakes. We're all going to make mistakes. That's a given. We're humans, but we're hopefully each state, as each state comes on board in the us, we're going to see it done a little bit better, a little bit more thoughtfully learning from the others. Oregon sticking. It's not going and leading the way here, and they're not doing it perfectly, but at least they've started. And I give them a lot of grace and compassion that way and go way to go. That's great. Washington. Many other places are following, many other cities are legalizing. And that's what I see is one after the other. I think this is a nonpartisan issue. I think people need healing. We want to feel better. We want to feel more connected. We want to be happier. We want to have more joy, we want more safety. And this is a way that way. I see. And what I see, there's no doubt there's going to be equalization of this. No doubt that is going to happen. Pharma

Dr. Mark Hyman:
Is going to take it over. You think? Is that what you're

Dr. Pamela Kryskow:
Saying? No, I don't think they're going to take it over. I think what, this is my hope, this is my hope for the world, is that what we see is this whole circle, a circle of availability. That certainly there is this level that is pure pharmaceutical. You're going to need that. There's going to be people that want the pill, that want, I want to know exactly what the dose is. I want you to tell me exactly when to take it, how often to take it. And I don't see a problem with that. And I also love the other side of it, like the circle of it, that can you do it in a ceremonial setting? Can you do it in a more spiritual nourishing setting, a more culturally appropriate setting, and everything in between. I don't think it's an either or. I think it's an and I think that whole possibility is there.
And I think we have the right to choose where on that circle. Do you want to access these medicines if you want to. And that's really my hope. I hope that we have enough foresight to see that these are, we as humans seek non-ordinary states. We seek homeostasis. We seek to heal. We seek to feel better, we seek to be connected, and we have the right to do that. And however we do that, I don't think there's any monopoly on it. And I think we should push very hard on any kind of monopoly and just say an and it's this and this and this and this, right?

Dr. Mark Hyman:
Yeah. I mean, when we see the ailment, not just of individuals, but of society today with the increasing divisions and hatred and tribalism and nationalism, other is it seems like this may be a tool to help heal that divide and repair our humanity, which is now fractured in ways that I don't remember seeing in my lifetime. And we were recently together at a dead show in Washington, and it was just an amazing experience of about 30,000 people, probably from all walks of life, from all different political persuasions, from all different beliefs, from all different religions, from all different cultural backgrounds. And yet we're all there sharing this one common experience of enjoying the music, being in nature, dancing and having a great time, and people were kind to each other, polite to each other and nice to each other, help each other. It is part of the dead culture in a way, but it's like, wow, it just kind of occurred to me, wow, we need things to bring us together rather than take us apart. And music certainly does that, but these medicines seem to be such a unique thing. From my perspective in the history of medicine, there really isn't anything akin to it from a pharmacological perspective or a therapeutic perspective.

Dr. Pamela Kryskow:
And when people have these shared experiences, exactly like you're saying, we become together, we appreciate our commonalities, and we let go of the things that are different. We agree to agree and not worry about where we don't. And you asked earlier about some of the things that really stand out in the therapies, and one of the ones that really stands out is we had a First Nation woman who came through the program and she said

Dr. Mark Hyman:
That's what they called Native Americans in Canada, first Nation,

Dr. Pamela Kryskow:
Nation.

Dr. Mark Hyman:
People listen, say, what is that?

Dr. Pamela Kryskow:
Yeah, first Nations, that's okay. That's okay. Or Indigenous, my friends prefer First Nations. And she said, I was in this group, this small group in Roots to Thrive, and I looked around and I was, everybody else was white, and I thought, how the hell am I going to heal with all these white people? And then she goes, and then this was 16 weeks after the program had ended, she goes, then I realized that's the only way we're all going to heal is together. And this woman is now on our team. She's joined the team, and she's phenomenal. And it's true. We have to heal together. We are more alike than we are different. We want similar things, and our disagreements are petty. We just have to put them aside, and these medicines truly bring us together. Anybody that's ever had the privilege of sharing a psychedelic journey with other people, you become family. You're family. And

Dr. Mark Hyman:
It's, yeah, it's true. It's true. It's true. There are places where you can get this therapy right now. It's very inaccessible for most people. It's not something you can go to your doctor and get. There are ketamine assisted clinic therapy assisted clinics. Some of them are variable in their integrity of how they deliver the care, the medicine with or without therapy. But those things are available. I think MDMA, this looks like it's slated for approval maybe early 2024 in the United States for treatment with therapy, not just MDMA, but with therapy. SY may not be too far behind, but there are people who are going to Costa Rica or to Mexico or to Europe or other places where they're able to be doing these therapies legally or doing them underground in America. And I think we're seeing more and more people having these experiences. I was at a conference with you and Paul, which was a traditional straight up medical conference, and Paul asked, who here has not taken psychedelic or suicide? Which kind of a great way to ask people not to share something illegal, right? If you say, I've taken it, it means you've done something illegal. And literally half the audience about raised their hand, which means the other half had done it. And this was not a Grateful Dead concert. This was a very conventional, straight up, business oriented healthcare conference. And I was like, wow, that's really remarkable.
Things have really shifted, and I think we're in this really incredible moment in history where we have the potential to do healing at a level we haven't before that's been known by ancient cultures that used in traditional ceremonial rituals, whether it's the South American Amazonian folks using Ayahuasca or the Native Americans using peyote or in Mexico, which all is using mescalin or there's just all sorts of cultures where this has just been embedded in there. We were in Egypt together and we saw psychedelic mushrooms engraved in hieroglyphics on the wall of these 5,000 year old older Egyptian temples. I'm like,

Dr. Pamela Kryskow:
What? Yeah, it's just returning to it, right? These lineages have been unbroken for many, many, many First nations on this planet and indigenous cultures on this planet. It's just us westerners that are just finally returning back to ourselves. I dunno about you, but I don't know a doctor anymore, and I don't know any nurses that have not had a psychedelic experience.

Dr. Mark Hyman:
You probably hang out in different circles. I can tell you.

Dr. Pamela Kryskow:
It's actually, it's very surprising. It's very surprising. Some of the meetings you go to and people will say things that they're saying because they've had a session.

Dr. Mark Hyman:
Well, I know it profoundly affected me for sure, and my worldview when I was very young. So, well, Pam, thank you so much for your work, for being an advocate, for moving the research along, for being in the trenches, working with real people, doing this work, and seeing the profound changes and can't wait to see what comes next out of your work and research and how we all make this not just sort of a marginal thing, but really standard of care for people with some of the most intractable problems that humanity suffers from. So thank you so much.

Dr. Pamela Kryskow:
Yeah. Well, it's a team effort. I just need to say that it's

Dr. Mark Hyman:
A team effort. Yes.

Dr. Pamela Kryskow:
Nothing we do at Roots to Thrive is based on any individual. It's a fully a team effort, and without everybody holding that blanket together, we wouldn't have done nearly as much. And we'll keep doing it.

Dr. Mark Hyman:
Well, thank you so much. Everybody wants to know more about the work that Pam is doing. You can go to Roots to thrive.com. You can look at Michael Medica, which is some of the microdosing research around how this works for various kinds of problems and the commercialization of it. Microdosing me.com is the website for the research study, which I think anybody can join by downloading the app. And I look forward to continue to follow your work and track what you're doing and hope people listening to this have found something useful. If you have been inspired by, please share with your friends and family on social media. I think many people can benefit from hearing what Pam has to say. Leave a comment how psychedelic use or treatment helped you, and we'd love to hear how it's changed your life and the things that you might've benefited from it. And we'll see you next time on The Doctor's Pharmacy.

Closing:
Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.