Plant Medicine Podcast

This episode of the Plant Medicine Podcast is the second conversation in a three-part series with Dr. Julie Holland. Dr. Holland is a psychiatrist specializing in psychopharmacology, and she is also the author of many books, including her most recent work Good Chemistry: The Science of Connection, from Soul to Psychedelics which discusses the neurochemistry behind human connection. She is also a medical monitor for several MAPS PTSD studies using MDMA-assisted psychotherapy and has worked for decades on US drug policy reform based on harm reduction principles. In addition to this work, Dr. Holland has nine years experience running a psychiatric emergency room as an attending physician on the faculty of NYU school of medicine and she continues her psychiatric work in her private practice in New York City. 

In this episode, Dr. Holland talks specifically about the nuances of antidepressants and psychedelic medicine. As is commonly known, many prescription antidepressants have contraindications with various psychedelic compounds, meaning there are concerns regarding how people taking such medications will be able to also access psychedelic-assisted therapies. 

Dr. Holland discusses the specific contraindications for individual psychedelic medicines and suggests some strategies for safely and effectively tapering off antidepressants in consultation with a medical professional. She suggests various wellness practices, such as regular exercise, as particularly helpful during the course of tapering, and even mentions situations where an additional antidepressant is prescribed to support the tapering process, stressing the complexity and delicacy of this process.

To give context to this discussion of psychedelics and antidepressants, Dr. Holland provides an overview of the history of psychiatry over the past forty years, showing how antidepressants came to prominence as a therapeutic tool. She also explores additional considerations, such as how things like hormonal birth control interacts with SSRI antidepressants on a psychopharmacological level. The common thread Dr. Holland weaves through this conversation is the importance of connection, both as support for the tapering process and as the end goal of effective therapeutic practice.

In this episode:

• Health and wellness practices which can act as support while tapering off an antidepressant in consult with a medical professional

• Contraindications between various psychedelics and antidepressants

• The difference between microdosing and macrodosing psychedelics while taking antidepressants

• Why falling in love can present a good opportunity to taper off antidepressants under supervision

• Why Dr. Holland sees the divide between recreational and therapeutic use as a false dichotomy in some cases

Quotes:

“There was a lot of hand-holding and de-stigmatizing back in the 90s, educating people around antidepressants. But twenty years later most of my work was really around people [who] had been medicated for ten, fifteen, twenty years and wanted to be off meds.” [6:15]

“The people who really responded from MDMA-assisted psychotherapy who had PTSD were the people who’d never been on SSRIs. The people who had a muted response who didn’t get as much better as the other group were the ones who had been on SSRIs.” [9:47]

“Coming off of psych meds is no easy feat. You really have to do a gradual taper, there has to be somebody who is supervising you, and you’ve got to have other things in place.” [10:42]

“You have to have somebody helping you… It’s not the kind of thing you can really go alone. Getting off antidepressants requires somebody who knows what they are doing to help you.” [14:16]

“Your brain learns to be sad, your brain learns to be anxious, your brain can learn to be at ease and learn to have joy.” [21:31]

Links:

• Dr. Holland’s website

• Good Chemistry: The Science of Connection, from Soul to Psychedelics

• Psychedelic Medicine Association

• Porangui

This episode of the Plant Medicine Podcast is the first installment of a three-part conversation with Dr. Julie Holland. Dr. Holland is a psychiatrist specializing in psychopharmacology, and she is also the author of many books, including her most recent work Good Chemistry: The Science of Connection, from Soul to Psychedelics which discusses the neurochemistry behind human connection. She is also a medical monitor for several MAPS PTSD studies using MDMA-assisted psychotherapy and has worked for decades on US drug policy reform based on harm reduction principles. In addition to this work, Dr. Holland has nine years experience running a psychiatric emergency room as an attending physician on the faculty of NYU school of medicine and she continues her psychiatric work in her private practice in New York City. 

In this first installment with Dr. Holland, the conversation focuses on the idea of connection she explored in Good Chemistry. Dr. Holland begins by discussing the importance of feeling a connection with oneself and details how many things in modern life can get in the way of this connection. Self-connection is important, she stresses, because if we are not grounded in ourselves, it can be difficult to establish healthy connections with others. Dr. Holland explains how various neurotransmitters such as oxytocin and dopamine are involved in connecting with self and others and how pharmaceuticals such as opiates act on some of these same systems to simulate comfort.

In addition to discussing human connection from a pharmacological perspective, Dr. Holland also explores the topic through a psychological lens, looking at the role trauma can play in muddying opportunities for connection. This is an area where psychedelics can be particularly impactful, as these substances can disrupt the constant ruminations and patterns of behavior which keep people from pursuing or deepening connections. 

Dr. Holland then brings some insights from the science of connection to bear on the practice of psychedelic therapy, discussing how group facilitation of psilocybin therapy could be more impactful by allowing the experiences and integration work to happen in community. The conversation closes with a discussion of how psychedelics can impact the connections one feels, especially to the natural world, and some speculations regarding how the feelings of interconnection elicited by psychedelic experiences could impact political convictions. 

In this episode:

• How distractions and addictions get in the way of our ability to connect with ourselves

• How the epidemic of loneliness and the epidemic of overdoses intersect 

• The pharmacological pathways of oxytocin and the function of the dopaminergic system

• How psychedelic experiences “shake up” one’s sense of self and the therapeutic effect of this process

• The double-edged sword of the feelings of group cohesion produced by oxytocin

• The impact of psychedelics on one’s worldview 

Quotes:

“If you’re not in your body, and embodied, and feeling your feelings, you’re not gonna be much use to anybody else in a relationship.” [5:59]

“One of the reasons why opiates are so soothing is they really quell that unease, that anxiety, and they really mimic the chemistry and physiology of what we feel when we are taken care of, held, attended to.” [10:40]

“We are not healthy when we are disconnected. It is a proinflammatory state when we are disconnected, and it is anti-inflammatory when we feel cared for.” [13:35]

“There’s always trauma and everybody carries it around in their bodies to some extent and it really needs to be unearthed and investigated for us to be healthier and happier. So everyone can avail themselves of MDMA-assisted psychotherapy or psilocybin-assisted psychotherapy.” [24:30]

“Oxytocin facilitates neuroplasticity, it facilitates learning. And we learn better in group than we do individually. When we are isolated we do not learn as well.” [29:13]

“There is actual research to show that people who take psilocybin mushrooms and have psychedelic mystical experiences do feel more connected to the planet and do feel more of a sense of obligation to take care of the planet.” [37:23]

Links:

Dr. Holland’s website

Good Chemistry: The Science of Connection, from Soul to Psychedelics

Psychedelic Medicine Association

Porangui

In this episode of the Plant Medicine Podcast, Dr. Mark Braunstein returns to discuss potential concerns surrounding the use of ketamine, especially use which is not overseen by a knowledgeable medical professional. Dr. Braunstein is a whole-health psychiatrist with 22 years of clinical experience. He is the medical director for multiple mental health and psychedelic psychotherapy clinics in Colorado, New Mexico, and Utah and he also runs in-patient and out-patient programs for addiction. Additionally, Dr. Braunstein is involved in multiple projects focused on expanding access, awareness, research, and safety in the field of psychedelics.

To begin this conversation, Dr. Braunstein shares how his original exposure to ketamine wasn’t in a medicinal context, but rather as a recreational drug of abuse. However, since then he has seen the transformative effects this substance can have on patients when used in a physician-directed context and for therapeutic purposes. Nonetheless, Dr. Braunstein stresses that this does not mean ketamine use does not come with certain risks.

Ketamine can be addictive and even carries a risk of overdose, particularly when used recreationally in a context where the purity of the substance is unknown. Dr. Braunstein distinguishes recreational and therapeutic uses of ketamine, explaining that recreational doses are often lower and dosing is more frequent, whereas ketamine is used in high doses in a therapeutic context, with extended periods between sessions.

Dr. Braunstein stresses both the responsibility of physicians and of patients to ensure ketamine is prescribed responsibly and used as directed. Despite the dangers posed by recreational ketamine use Dr. Braunstein describes in this conversation, it is still a medicine he believes can have significant positive impacts for patients. This requires, however, that it not be treated merely as yet another quick fix pill. Instead, Dr. Braunstein emphasizes that ketamine treatment ought to coincide with psychotherapeutic work. This combination, he says, will maximize the therapeutic potential of ketamine while also helping to ensure that the medicine is used responsibly, under the close direction of a medical professional.

In this episode:

• The addiction and overdose potential with recreational ketamine use

• How dosage can dramatically change the effects of ketamine

• Responsible prescribing practices for physicians working with ketamine

• The psychological and physiological harms of ketamine abuse

• How Dr. Braunstein talks to his patients about responsible use before prescribing ketamine

• The importance of combining psychedelic medicines with psychotherapeutic work

Quotes:

“Part of why ketamine works is because it lights up your brain in all these different ways and when done occasionally, intentionally, it moves you. But if you’re always doing that, it ends up having the reverse effect, causing damage.” [12:56]

“This is a heavy-duty medication that, if you cross the line, can cause you to stop breathing and then die. So there is an actual, real danger to ketamine.” [16:25]

“I think the organ that is most prone to damage from overuse of ketamine is the same organ we are touting it fixing: the mind.” [18:39]

“When we think about these medications, we should think about combining them with therapy and not just taking these medications as medications… So that’s why with ketamine I’m really recommending it with therapy.” [25:04]

Links:

• Reconscious Medical

• Psychedelic Medicine Association

• Porangui

This episode of the Plant Medicine Podcast features a conversation with Shannon Carlin, MA, LMFT, to discuss how to become an MDMA-assisted therapist, including a discussion of the MAPS training program. Shannon is the Director and Head of Training and Supervision at the MAPS Public Benefit Corporation (MAPS PBC), a wholly owned subsidiary of the Multidisciplinary Association for Psychedelic Studies (MAPS), a 501(c)(3) non-profit where she oversees the development and implementation of clinical training programs that prepare mental health and medical professionals to deliver MDMA-assisted psychotherapy in approved clinical settings. Shannon started working with MAPS in 2011 before joining MAPS PBC in 2016.

In this conversation, Shannon discusses her personal background and some of the nuances of psychedelic-assisted therapy. Shannon shares her experiences being trained as an MDMA facilitator in 2014 when this therapy was much less mainstream and mentions how much the program has grown and evolved since then. In discussing her own background with various forms of therapeutic work, Shannon emphasizes the unique client relationship obtained in the longer sessions of MDMA therapy, saying that this therapy is very well-suited to meeting people in their time of need.

Shannon also discusses the details of the 100-hour MDMA-assisted therapy training program she leads and supervises at MAPS. The program consists of an online course, a training retreat with senior MDMA-assisted psychotherapy researchers, and opportunities for experiential and didactic learning. 

Shannon additionally touches on the topic of MDMA therapists-in-training undergoing this treatment themselves as a learning experience, stating that this is an opportunity MAPS tries to make available and that many of those who have had this opportunity found it beneficial to their future work with MDMA in a therapeutic context. In closing, Shannon discusses MAPS’ commitment to equity and mentions that some scholarships will be available for the training program.

The MAPS MDMA Therapy Training Program is now accepting applications from trained mental health and medical practitioners. To learn more, visit https://mapspublicbenefit.com/training

In this episode:

• How MDMA therapy differs from traditional talk therapy

• The importance of nurses and other paraprofessionals in MDMA-assisted psychotherapy 

• The history of the use of MDMA in therapeutic contexts prior to prohibition 

• Current training programs in psychedelic-assisted psychotherapy 

• The future of legal MDMA use in therapy

• What skills translate from MDMA psychotherapy to other forms of psychedelic psychotherapy 

• How to enroll in the next round of MAPS MDMA training

Quotes:

“Our training program really focuses a lot on the therapeutic relationship in MDMA therapy and the ways that that relationship changes, deepens, becomes more complex.” [13:20]

“As we do our training program we have a really multidisciplinary group. We have physicians and psychiatrists and we have nurses, we have psychiatric nurses, social workers, therapists, psychologists, clergy people.” [15:56]

“We work in a cotherapy model so every session has two providers in the room, so we always have one person who is licensed to practice psychotherapy and then we have flexibility about exactly what the role of the second person is.” [26:09]

“We’re looking at possibly MDMA-assisted therapy becoming a legal treatment medicine, not only in the US, but in multiple countries, even as soon as in the next two years.” [28:21]

“It’s really difficult to do healthy volunteer therapist studies because the FDA thinks about clinical trials in terms of treating a disease.” [35:21]

Links:

• MAPS MDMA Therapy Training

• MAPS Public Benefit Corporation

• Psychedelic Medicine Association

• Porangui