This is an edited excerpt from the transcript from a podcast Dr. Ko did on The F*ck Saving Face Podcast. This podcast is designed to empower mental & emotional health for Asian Americans by breaking through taboo topics and redefining what it means to be Asian in America today. In this interview with Judy Tsuei, we talk about what ketamine is, how it works, the default mode network, near death experiences, and psychedelics, plus a bit about my background growing up as an Asian American.

If you want to check out the rest of this episode, head over to Judy’s website for show notes or listen to her podcast on Buzzsprout or your favorite podcast platform.

Judy Tsuei 5:27

I've listened to some of your other interviews and you talk a bit about consciousness, just how it relates to ketamine. But before we dive into that, one of the things that I think is interesting is when you talk about using it as an anesthetic; it is because it has this dissociative property between the mind and the body. Can you explain that a little bit more?

Dr. Samuel Ko 5:46

Yeah, that's a great question. So ketamine is an NMDA receptor antagonist, N-methyl-D-aspartate, which is one of the receptors in our brain, stimulated by a neurotransmitter called glutamate. That's one of the ways that ketamine works on the biochemical level.

Additionally, the experience for the person receiving the ketamine, which is also known as a dissociative anesthetic, dissociates their mind from the body. This is great because when someone is having a lot of pain, then we're able to disconnect the mind from the body.

And so we're able to do these various things to the body in a procedural sedation type of setting: put a bone back together or to stitch up a face. And I think this dissociative effect is also beneficial for patients who may have some PTSD or depression because it's like getting a new perspective on that depression or getting a new perspective on that PTSD experience.

So, just stepping away and taking a break from your mind, also known as the default mode network, can be really beneficial because it just gives you a new paradigm and a new perspective.

Judy Tsuei 6:56

I think in your other interviews, you kind of talked about some similarities between that and mindfulness practices.

Dr. Samuel Ko 7:02

Yeah, so there was a really interesting research project where patients were receiving ketamine and they placed them on EEG's or electroencephalograms. And they'll put these electrodes all over the skull, and then they measure the brainwave activity. They then compared that group of patients receiving ketamine and their EEG pattern compared with these long-term meditators; people who have been practicing for 10 to 20 years. And what they found was that both of those groups started entering a similar brainwave state. It's interesting because I'll get patients who are meditators and they'll say, “yeah, it felt like I was just in a really deep state of meditation.”

Some patients talk about being in the eternal now; just being really present in the moment because with ketamine, there's a bit of a time distortion. So it's like, “hey, has it been 10 minutes? Has it been one hour?” And there's this sense of eternal analysis that patients describe related to their ketamine experience.

Judy Tsuei 8:05

That's incredible. And one of the things that you told me before too, is that because there are certain conditions that seem treatment-resistant, ketamine has this ability, even in one session to potentially have substantial effects. Can you speak to some of that?

And then the next question I'm going to ask is the four stages that you were talking about? Because I think most people are "Wait, what is happening? What's going on when you have one of these treatment sessions?"

So whichever one you want to speak to first.

Dr. Samuel Ko 8:31

Yeah, so let's talk about the four stages or the four mechanisms of action then I'll break it down into the biological mechanism of action, which is going back to the NMDA receptor, the glutamate neurotransmitter, and how ketamine can block the activity of glutamate. So there's that component happening, which in turn, causes neurogenesis. So literally neurons being formed brain cells as well as increased connections between neurons so those are known as Neuron synapses. And because of that, that increases neuroplasticity inside of the brain.

A lot of the time we think, “Oh, yeah, the brain doesn't change, it's permanent.” But there's actually neuroplastic changes that occur, and ketamine seems to facilitate that, through releasing a hormone in the brain called brain derived neurotrophic factor (BDNF), which again, increases neurogenesis and neuroplasticity. And that's the biological mechanism.

Then you have the psychological mechanism. We know about the subconscious mind and then the conscious mind, and ketamine seems to allow patients to kind of go into that unconscious mind.

And they'll have, for example, repressed emotions or memories. Things that have just been held down for such a long time which they weren't even aware of. Then during the ketamine experience, it'll just kind of come up to the surface.

So from that portion, it seems like it's allowing a person to kind of mentor that unconscious subconscious mind and deal with things that they haven't necessarily dealt with. ‘

And then the third mechanism would be the functional mechanism. So we have a portion of the brain that's called the default mode network (DMN). This default mode network works when we're not doing anything, resting, daydreaming, or just not focused on any activity. When this happens, you can see certain portions of the brain light up. And this is where we believe these old chronic thought patterns may live. So someone may have a self-defeating thought pattern like," Hey, I'm ugly", or "Hey, I'm not good enough", or, "Hey, I'm not worthy." The default mode network seems to be where these thought patterns live.

What's cool about ketamine is that it actually disrupts the default mode network during that experience. So, it's kind of taking a break from the mind and in turn, when you're able to take a break from those chronic self-defeating thoughts, patterns, and beliefs, then you can go in and insert new patterns and beliefs, which is related to the intention that someone has during the ketamine infusion.

The last stage or the mechanism would be the spiritual component. And this is something that's not explained by modern medical science. We can't physically measure the spirit but I feel like a lot of our patients will have these feelings or experiences where they'll feel a sense of connection to God, or they'll feel a sense of connection to humanity. It's interesting, because once they have that experience, "Hey, I am more than me and I am connected to these other people,” it gives them this kind of a transcendental space.

In turn, that leads to healing because when we're just so focused on ourselves, and our own issues, it's nice to take a break and be "Hey, there's more than just me." There are other people, there is society, there's Earth, so all four of these mechanisms seem to play a role for therapy and ketamine.

If you’ve enjoyed this excerpt and want to read or listen to the rest of this interview, Episode 62: Ketamine Therapy For Mental Health With Dr. Sam Ko, then we invite you to go to the The F*ck Saving Face Podcast website!