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Psychologist and pop culture icon of the 1960s, Timothy Leary, famously instructed San Francisco hippies to take psychedelic drugs in order to “turn on, tune in, and drop out.” These days there’s a movement in psychology, also centered in Northern California, advancing the use of psychedelics, as well. But the agenda is less about dropping out than about treating serious mental health challenges. This week on Sea Change Radio, we speak to two people about the intriguing new breakthrough that is ketamine therapy. First, we talk to Oli Mittermeier, the CEO and Co-founder of CIT Clinics to get a glimpse of his company’s innovative approach to ketamine treatment for depression, bipolar, and PTSD. Then, we hear from Reuben Steiger, an entrepreneur who found relief from decades of struggling with depression and bipolar through ketamine therapy.
Narrator 00:01 This is Sea Change Radio, covering the shift to sustainability. I’m Alex Wise.
Reuben Steiger 00:14 My experience is dramatically different than those early journeys which were baffling, but now I know how to operate the machine in a little and it’s different, but back then all I knew was that there was hope.
Narrator 00:32 Psychologist and pop culture icon of the 1960s. Timothy Leary famously instructed San Francisco hippies to take psychedelic drugs in order to turn on tune-in and drop out. These days there’s a movement in psychology, also centered in Northern California, advancing the use of psychedelics as well. But the agenda is less about dropping out than about treating serious mental health challenges. This week on Sea Change Radio, we speak to two people about the intriguing new breakthrough that is ketamine therapy. First, we talked to Oli Mittermeier, the CEO and co-founder of CIT Clinics, to get a glimpse of his company’s innovative approach to ketamine treatment for depression, bipolar and PTSD. Then, we hear from Reuben Steiger, an entrepreneur who found relief from decades of struggling with depression and bipolar through ketamine therapy.
Alex Wise 1:50 I’m joined now on Sea Change Radio by Oli Mittermeier. He is the CEO and Co-founder of CIT Clinics that stands for combination infusion therapy. Oli, welcome to Sea Change Radio.
Oli Mittermeier 2:02 Thank you Alex. Great to be here.
Alex Wise 02:04 You specialize in ketamine therapy treatment and I wanted to learn a little bit more about that. Explain a little bit of the history of it and where it is now and then what you see is the future for this treatment.
Oli Mittermeier 02:18 Yeah, so Ketamine is an old drug. It’s been around since the 60s. Was used extensively by soldiers in Vietnam. It’s an analgesic, meaning it takes away pain. It doesn’t affect core brainstem functions, which is what makes it unique. So you can give someone a ton of ketamine. They will continue. Breathing their blood pressure will change slightly, but it’s super safe. Right so then, in the early 2000s, frankly just by sheer coincidence, some folks started realizing that Ketamine seemed to have a really positive effect on certain patients that were coming to the emergency room and struggling with suicidal ideations you know? So they had probably injured themselves. Had some kind of a you know trauma and they were given ketamine to take away the pain to perform whatever procedures. And then they found that those patients that had received Academy and a huge percentage of them reported a dramatic reduction or even cessation of suicidal ideations for days. You know, after ketamine, so some folks at the Yale School of Medicine said, well, Gee, we there’s clearly something going on here with ketamine. And mental health. Let’s explore this and so they designed some studies and they would give patients a sub anesthetic dose of ketamine. So usually when you go into the OR and you’re getting ketamine you’re given a dose that has you pass through this what we call sort of the psychedelic window really, really quickly. Right, so you feel kind of funny for a little bit, a little loopy, and then you’re out. So we keep patients in that window so they’re conscious. They’re awake, they know what’s happening, but they’re having all of these amazing effects from the Academy, and so their pain is reduced. They feel this sense of wholeness and and you know, connection. So classic psychedelic experiences, and so the folks at Yale. Study, then they realized that even after one single dose of a sub anesthetic, dose or treatment of cat. I mean around 63% of study participants reported feeling dramatically better in terms of their depression. Their anxiety just sort of their general mood, and so that started us. You know? I mean to think about that was those, you know, 20 plus years ago. So here we are now doing this routinely. On a daily basis, giving patients of all ages all walks of life you know our youngest patients are 15. Our oldest are in their late 70s. Many of them come in saying I’ve tried everything, you know I’ve been on antidepressants my entire life. SSRI’s, benzos, anxiolytics, all kinds of meds and nothing is working and then you throw COVID into the mix and you have this massive spike of humans that are just really struggling and they don’t know where to go and so. That’s where we come into the picture with some pretty novel approaches.
Alex Wise 05:22 And why don’t you run through some of the disorders, illnesses, etc. That ketamine has proven to be efficacious.
Oli Mittermeier 05:27 Everyone that comes into our clinic is struggling with both mental pain as well as physical pain. Like when was the last time you met someone who was deeply depressed but felt physically amazing? Doesn’t happen or someone who was struggling with you know chronic physical pain but said oh, other than that, I’m great, I’m you know, I feel mentally. Just on top of my game. And so we realized early on that really what we’re dealing with here is a complex series of, you know, when we talk about depression or anxiety or PTSD, you’re talking about a complex series of struggles that people are having that then manifest behaviorally, right? So you’re feeling really shut down. You feel lethargic, you feel antisocial, and you’re in chronic emotional and physical pain, so enter combination infusion therapy, which is something that we developed where we said, well, let’s treat brain chemistry with ketamine. Let’s treat a body chemistry with high doses of vitamin C and various vitamin B complexes. Compounds like glutathione. And sometimes even add and then let’s wrap that whole in clinic physical treatment with a really hands on compassionate, engaging behavioral program. Meaning you’ve got to help people shift and do things differently so that they begin to acquire. The behaviors that they need to feel well over the long run. And that’s what you do for patients.
Alex Wise 06:59 You’re not a physician, but your background is then the mindfulness space. Why don’t you kind of explain what your role is for a patient? Walk us through what it might be like for a new patient to work with you.
Oli Mittermeier 07:12 Yeah, so my two Co-founders – Adam Tible and Mark Danforth – they started doing this very early on. We’re talking 6 to 8 years ago and back then the focus was very what I would call biomedical, meaning the studies showed that if you give patients a certain amount of ketamine. Patients that are struggling with depression or anxiety, a significant percentage of them begin to feel better, especially if you do a series of ketamine infusions. Now when I entered the picture and started working with them, I actually had just come off of my own experience as a patient struggling with depression and anxiety as well and it was pretty bad for a period of time and I noticed that when I went in for treatments at this clinic again, it was very clinical. You know there’s a lot of fluorescent lights. There were beeping machines there. Or if I almost felt like I was in a dentist office. And so when I conveyed that to Mark and Adam, I said hey you guys, if we’re going to do this the way to do this properly is you have to really honor the fact that this is psychedelic medicine. So this, yes, there’s a certain neurochemical effect that the ketamine activates. But equally important to this whole process is. The environment it’s set in setting. How do you hold patients? How do you guide them through this? Process and in that sense I’ve discovered you know, being a long time mindfulness practitioner and even teacher the dissociative aspects of ketamine are almost like mindfulness in a bottle. And so what I mean with that is you can pretty reliably guide someone who’s a novice. Let’s say in the mindfulness space. You can guide them through an experience while they’re on ketamine, and you can point certain things out to them that help them feel like really get from the inside out that I’m not my thoughts, I’m not my emotions, I’m not my sensations. There’s me that is untouched by all of that. However, I identify myself the voice in my head. My consciousness is much bigger than that, and the reason that’s so profound is when you’re struggling with depression or anxiety really. What’s going on is every time you think something or feel something your mind attaches to it. And then down the rabbit hole you go right, it activates more sad thoughts. Those sad thoughts in turn have a physiological effect on you, you know, sort of a depressive sensory experience, and that in turn just validates what your mind is thinking, which is, oh, this is hopeless. I’m depressed. I’m never going to get out of it. And around the loop. Go soak it. I mean especially the way we do it when we guide patients in the clinic. Through this process, a big part of the guiding has to do with helping them see and notice first-hand the vastness of the space that exists between their consciousness and then these sad thoughts or these. These depressive sensations that they have in their body, and that first-hand experience is magical. That’s the beginning of the healing journey.
(Music Break) 10:25
Alex Wise 11:18 This is Alex Wise on Sea Change Radio and I’m speaking to Oli Mittermeier. He’s the CEO and Co founder of CIT clinics in Northern California. So Oli we were talking about this psychedelic effects of ketamine in general. How does it differ from mushrooms and LSD and peyote besides just being able to control the length a little bit more, are there less hallucinations etc.?
Oli Mittermeier 11:48 Yeah, great question. So there’s this tendency now, especially these days where you know you can barely open up a, you know a newspaper or a blog without someone talking about the miracles of psychedelic medicine. And it’s easy to forget that even within the class of psychedelics, there’s a huge variation in these compounds. So psilocybin, the active ingredient in mushrooms or MDMA, also known as ecstasy, ayahuasca DMT. The list goes on and on, and ketamine is one of these compounds it has. This in a sub anesthetic dose it has this classic effect of the psychedelic effect. Now let’s say the psychedelic effect is you can describe it as this sense of wholeness and oneness. So oftentimes patients will say things like, Oh my gosh, I can, you know, I’m I feel so expansive and I feel so. I feel like I’m everywhere and at the same time I’m nowhere so you get end up with these sort of, you know, typical, you know psychedelic. Some expressions or descriptions that people give now ketamine is is in a class of its own in the sense that it is an analgesic. So it reduces pain. So that in and of itself can give people a real break, especially when they’re struggling with, you know, physical pain or even chronic. You know emotional pain. Just the fact that they’re coming in and getting a cessation of that pain allows them to remember what it’s actually like to be alive without this constant sort of grind of pain that they’re experiencing that’s very unique to ketamine so, Psilocybin, MDMA – it’s not better nor worse. It’s just different, right? So they don’t do that with in the same way that ketamine does. The other thing is that ketamine does that’s very unique is it’s a dissociative. So as you increase the dose of the ketamine, this subjective feeling that there’s more space, there’s more and more of a separation between me or the voice in my head. The experience of myself and things such as thoughts. Memories, beliefs, and so forth there’s this. Tremendous amount of space and separation and like I said earlier, that in and of itself can be incredibly healing as well. And then I’ll say one last thing. The third thing that really differentiates ketamine from other psychedelics is how it works. Neurochemically, so we’re not working on serotonin or dopamine or norepinephrine in the brain we’re working with aneurotransmitter called glutamate. Glutamate is the primary neurotransmitter involved in a process called synaptogenesis. That means the growth or the connective materials between brain cells and gray matter or neurons. In order for us to have thoughts or emotions or experiences, a certain series of those. Neurons communicate with each other and they do so with these through these connections. So as we feed more ketamine into the system, the brain gets tricked into thinking it’s time to actually create more connections between these neurons, and we call that synaptogenesis, and that’s again very unique too. Ketamine, I think, really underappreciated, oftentimes also in the psychedelic community. How amazing that is to have a compound that does that.
Alex Wise 15:04 Listing through some of these other drugs, many of them are narcotics and illegal in many states. There are some states that are now looking at psilocybin differently than they have in the past, but ketamine is legal in all 50 states. It’s a controlled substance, but still one that can be pressed. How long will it be before ketamine treatment is included in people insurance? And maybe you can kind walk through what the reality is right now from a financial standpoint, for potential patients who are interested in undergoing these treatments.
Oli Mittermeier 15:40 If you look at the statistics, the single primary reason you know 40% of patients that are polled as to why did you not get or why are you not receiving mental health care? 40% respond because it’s too expensive, so it’s a real challenge that we have. Many of the treatments that are approved right you can. You can get SSRI’s or SNRI’s. You can go to a psychiatrist. Oftentimes, your health plan covers that. Unfortunately, the treatments that we offer ketamine combined with these other nutrients, is still viewed by most insurances as an off label use. Of the medicine, meaning it’s legal and especially given that my partners and all the staff are licensed anesthesiologists, right? So this is absolutely legal to do, but we’re not doing it in the context of anesthesia, meaning we are not in the OR using Ketamine to put you under. We’re using it in a slightly different manner. The irony, of course, is it’s much safer. What we do. You know, we give tiny amounts of cadmium compared to what’s typically given in the OR. Very rarely are there any you know, physical side effects and yet insurance on the most part still continues to just shrug their shoulders and say sorry we don’t cover that. So we’ve taken it upon ourselves to actually address this financial issue by raising money ourselves so we have a partnership with Maps.org. Maps is the biggest nonprofit that’s driving a lot of the research into psilocybin and ketamine and MDMA and the role that they can play in mental health. So they are a large nonprofit and we’ve partnered with them to say look, we want to raise money. We want to make these tax deductible donations that individuals can give or institutions and the money gets funneled through maps.org and then ends up in an escrow account available for CIT Clinics and we then have a pretty straightforward financial aid application that patients can fill out and it can be anything from just sliding scale income so patients can get as much as 50% of these treatments paid for some get 10% some get 25 depends on their income and it also depends on their status, supporting veterans, first responders, Adam and Mark, and many of our other providers are veterans themselves, and so this this is a whole other area that’s really, really dear to our hearts.
Alex Wise He’s the CEO and Co-founder of CIT clinics, Oli Mittermeier. Oli, thanks so much for being my guest on Sea Change Radio.
Oli Mittermeier 18:19 My pleasure, thanks for being interested in what we do.
(Music Break)
Alex Wise 19:03 I’m joined now on Sea Change Radio by my friend, Reuben Steiger. Reuben is based in Princeton, NJ and he’s an entrepreneur. Reuben, welcome to Sea Change Radio.
Reuben Steiger 19:12 What’s up dude? (laughs)
Alex Wise 19:15 Great to have you on, Reuben (laughs). So we just spoke to Oli Mittermeier. He’s the CEO and Co-founder of CIT clinics. And we were discussing ketamine therapy. Why don’t you first kind of explain your journey with bipolar from when you first recognized it and get us up to when you sought ketamine therapy treatment?
Reuben Steiger 19:38 Well, taking this drug is a very small piece of a much bigger story and I’ll tell it very quickly. I was born March 17th in Montreal, Canada in the hospital to two parents, one American and One South African – both professors. We moved when I was three and a half to a town called Princeton, NJ, and that’s where I grew up, and I grew up and I thought I was totally like everyone else and I kind of was in a really nice vibrant, intellectual and social integrated community. The twist in the plot was when I was… I remember distinctly, I was 13 years old and everything had gone nicely and everything had been easy and fun and socially nice and everything just was normal and in the fall these things are for reasons no one knows. These things are somewhat seasonal as well as genetic. I remember even the moment I was on the soccer field and something hit me and I had never felt it before. I didn’t know what it was, in retrospect, what it what I experienced was I couldn’t sleep anymore and I was terrified I was going to die and I felt like an alien and that was a thing that in the medical field they called depression and the family, I think had been expecting it.
Alex Wise 21:03 So how did you experience on the field that you couldn’t sleep anymore? I think maybe there was another detail there.
Reuben Steiger 21:16 It was, it was like it’s hard to put your put words to it, but when you feel it, you feel it, and it’s it’s fear. What it is is fear.
Alex Wise 21:21 So on this soccer field you felt the type of fear that was palpable, memorable, and one that transformed you moving forward.
Reuben Steiger 21:29 It scared the life out of me and I felt alone and I felt like I was going. And I and I felt like I was the only person in the world and in the history who had ever felt this and everything that was good, went away and fear took over and I felt alone.
Alex Wise And so let’s fast forward to after college when you decided to stop drinking, taking any drugs and kind of moved into the adult phase of your treatment.
Reuben Steiger 22:06 Yeah, I guess I guess you could call that adult phase, I think that’s the right label. I accepted my limitations. I had to be removed from Brown University because I was a real problem and spent a lot of time in hospitals and institutions and eventually in a men’s halfway house for almost two years. So it wasn’t a quick lesson, but eventually I was humbled deeply and accepted my condition and the terms of my existence, which was like I was not someone who could touch drugs or alcohol, and I had to take, listen to doctors and take their advice and take the medications they prescribed. And though it limited me from experiencing the other half of the bipolar condition, which is incredibly enjoyable, highs that other people sometimes don’t have access to unaided, and so I accepted that contract. And as terms of that contract, I was enabled to have a “normal” life. I graduated quickly and well with a degree in English literature, and I moved to New York and got a job.
Alex Wise 23:09 This is Alex Wise on Sea Change Radio and I’m speaking to Reuben Steiger. Rubin is an entrepreneur based in Princeton, NJ. Alright, so you finished college, you’re you’ve managed to be a high functioning member of society for lack of a better term, successful in in many pursuits. Now let’s fast forward to the most recent episode where you decided to seek ketamine therapy. How did you learn about it and maybe explain that first visit to the clinic if you can.
Reuben Steiger 23:44 When I walked in, I was one way which was extremely dead. Is the best word for it. My mind had had receded. I had no emotions and I was hopeless and my body was also felt like that and I hadn’t seen the light of the soul or felt hope in so long. I didn’t even remember it. The first experience. You don’t feel good, it’s not good. That you feel. You are removed from your consciousness. What it does biochemically is it works on a different entire model of how the mind works. So conventional stuff works on meaning. Antidepressants works on the reward pathways of serotonin, norepinephrine, dopamine. This works on something called the GABA system, and it restores the it’s a hard reset. Essentially, that restores the brain to what’s called in the literature. The default mode and what it feels like when you’re. And it is you go somewhere else. You’re conscious. You can see everything, but you don’t. The relationship between you, the body, and the entity that’s part of a massive, larger whole is separated. And something about that is very elucidating, and you can’t put words on it but time. Sort of changes and you see everything connected. That’s my best description of it coming out of it. It’s confusing ’cause you don’t know what happened and all I could do was smile. I couldn’t say anything really because as it’s happening early on you also lose the ability for language I did, which is later in my journey. That doesn’t happen to me at all now. I’m fully lucid and conversant and analytical, and when I do it, which is very infrequently now, just as maintenance, my experience is dramatically different than those early journeys which were baffling, but now I know how to operate the machine a little and it’s different, but back then all I knew was that there was hope.
Alex Wise 25:57 So you did self-guided journeys with ketamine – What did you do to guide yourself? Did you have some music, for example, that you listened to?
Reuben Steiger 26:09 Well, I was flying blind, so to speak. So at the beginning I experimented and what I thought made sense was I’ve recorded myself and I have videos of myself talking to myself. It’s really weird that I would look that after.
It’s with bizarre insights – I took diaries with weird words and none of that was in the end. I think what was recommended or the right approach by the time I was ready to sort of heal, which was January 2022, I had read a book by a guy named Michael Pollan called “How to Change Your Mind” which is in some respects the a bit of the Bible on this, though I don’t even know if he talks about ketamine, but it had influenced me and the people there were like maybe you should listen to music. So I changed my mind and stopped making decisions for myself, because I had not proven to be very good at them (laughs), and so I stopped trying to guide it and I just put on Spotify and tried to pick a single thing that was simple to listen to and I got it wrong at first because I put on Leonard Cohen singing “Hallelujah” and it was Leonard Cohen sing “Hallelujah.” I know it’s just too much and really quickly I just ended up with what I believe to be the right answer and it kind of was everything and the answer from me – it’s not for everyone – was Bob Marley and the song that was obvious was “Three Little Birds.”
Alex Wise 27:42 Can’t beat that. Alright so that’s the correct answer, everybody who is interested in getting ketamine therapy treatments. Bob Marley is the secret sauce (laughs). He’s an entrepreneur and a good friend of mine who I’m very pleased that he was able to share his experiences with this treatment, Reuben Steiger. Reuben, thanks so much for being my guest on Sea Change Radio.
Reuben Steiger 28:04 Thanks, Alex
Narrator – You’ve been listening to Sea Change Radio. Our intro music is by Sanford Lewis and our outro music is by Alex Wise. Additional music by The Beatles, Johnny Cash, Jimi Hendrix and Bob Marley. Check out our website at seachangeradio.com to stream or download the show or subscribe to our podcast. Visit our archives there to hear from Bill McKibben, Van Jones, Paul Hawken and many others and tune into Sea Change Radio next week as we continue making connections for sustainability. For Sea Change Radio, I’m Alex Wise.