Episode 46
Depression, Neuroplasticity, and Medication Progression

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Description

In this episode we are joined by Dr. Ashley Johnson, DO to discuss depression and the progression of modern treatment.

Talking Points

1. Explaining current terms related to modern science such as neuroplasticity and neuromodulation. 
   
2. Discussing what has changed in modern treatment for depression and the exciting effects of newer methods.
   
3. A mini neuroscience lesson explaining how depression damages neurons and how to help them heal with treatment for depression.
   

Quotes

“If you take a thick rope and rub something rough back and forth on it, you’ll see that the fibers start fraying. Those frayed fibers on this rope really represent what your neurons can look like when you have suffered from an untreated mental health condition for quite some time. When they [mental health disorders] go untreated, they actually are assaulting the brain in different areas.”

-Dr. Ashley Johnson, DO

Episode Transcripts

Episode 46 Transcripts

empathy is knowing your own darkness

without that connection you don’t have

anything what’s the opposite of

addiction just freedom

well hello everyone uh welcome back to

another

episode of finding peaks my name is

brandon burns chief executive officer

for peaks recovery centers joined today

by our chief medical officer

dr ashley johnson and our chief

operating officer mr clinton nicholson

everybody uh

welcome back everybody who’s joining us

today as we spoke about on the last time

i hosted we were going to invite dr

ashley johnson in to

talk about a variety of issues

surrounding patient care in the

direction of depressive major depressive

disorders

we’re going to do what we can to stick

true to depression as the topic today

but if you know how this show works if

you catch us going out in different

directions

you already know how it works and for

those who are new this is how it works

so

um so here we are today uh on top of

this uh not just our chief medical

officer and i think i just want to

highlight you know really what that

means for you know peaks recovery

centers you

came into peaks and showed us a variety

of different ways about how to improve

patient care not only did you introduce

um and and bring onboard detox services

for us so that we could do a continuum

of care through peaks recovery centers

but you were really

the anchor and the flagship for us

developing integrated care whatsoever

making mental health primary

a significant feature of programming and

creating that inclusion as well as us

having to kind of punch through the door

of medication-assisted treatment and

move through those kind of attitudes at

the time so

she’s done an incredible amount of work

on behalf of peaks recovery centers that

we are super grateful for

at the same time as well too

she’s branched out and created uh

colorado recovery solutions uh for which

she’s the ceo and founder of as well too

and we’ll get into more of what those

services um include uh in that regard

but a lot of fantastic things happening

um that you’re a part of and i think uh

for the viewers out there as well too um

you all know me my job here is wanting

to disrupt an industry and i think uh dr

ashley johnson here i’m just gonna go to

dr j because that’s what we call her at

the office dr j here um is a big part of

this disruption and i think in a really

beautiful and vibrant way and so we’re

going to tackle

uh these topics today and get right into

it so

um through your vision at colorado

recovery recovery

recovery solutions um what do you see as

needing to be disrupted from an industry

perspective and i’m sure that’s a loaded

question and maybe there’s a lot to

dive into there but i think maybe at

just a high level in a general sense

what are you seeing

through the lens of psychiatry

that is not working for which you

wish to change moving

forward i think what i what i see most

and what drives me the most is what a

lot of other

psychiatrists are seeing too

is it’s just this exciting kind of

emerging field

of

neuroplasticity

and neuromodulation

and so that is what really drives uh

this kind of

changing the path of our approach um

so for for decades it was just

medication we had to wait for the next

new medic

new

mechanism really to come out

especially with depression

which is one of the most debilitating

mental health conditions and

so we’ve just gone through probably

every decade since the

we had a new mechanism of action come

out and then it wasn’t until the

ssris

hit the market that

in probably around 1990 or so

was prozac it came out first and then

zoloft was soon to follow

and they are amazingly still the

standard

first line medication

however

what we have also found out over the

last three decades

is that you can’t expect full remission

of symptoms especially with depression

and ssris are

first line medication for many different

psychiatric disorders

ptsd

ocd

generalized anxiety so all of those are

really kind of top of the list

that we see

especially when you come into peaks and

you know because we have

now this primary mental health

i guess kind of track

it’s not only treating

someone who has a primary substance use

disorder but

we have to think differently about it

and so because depression is probably

the most common

mental health condition

we are going to see a vast majority of

primary mental health patients who come

to peaks for stabilization

have major depressive disorder

and so

it just makes sense that we look at the

next

the next best treatment past medications

and

that has now emerged as tms

or transcranial magnetic stimulation and

i’m glad you said it because i was like

how do i say tms

don’t mess it up brandon but you have

the language so that’s perfect

it took a lot of practice

to get that one down

and then i just went back to calling it

tms

so

it’s a safe place for me too

so

i look at the this

emerging field of

uh really neuromodulation as kind of

really two different emerging categories

and one is tms

and one is ketamine and

there’s a couple different forms of

ketamine now available

first it was just your basic

generic ketamine that was first used um

for anesthesia

and it’s a it’s a very short acting

anesthetic dissociative anesthetic and

um and so for again decades we were

using it and then just incidentally

found that it had an extremely potent

antidepressant effect and so

then

practitioners started noticing this and

and said well why why not just go ahead

and let’s refine this

medication

and

and give access to the psychiatric

disorders really people who are

suffering where we haven’t made a whole

lot of

improvement again since the ssris came

out and then

that was primarily for depression where

we saw people really just coming back

into their own

after a ketamine

i guess dosing and then over time we

also found that through

understanding the bioavailability of

ketamine

is that infusion

is the best way for people to get

the best effect and the most exposure

throughout their body

from ketamine

and so that’s why

for the most part

if you want a an extremely effective

version of ketamine therapy you want to

do infusion and so infusion

uh i guess if you said

infusion versus spravato which is the

nasal spray that’s still that just came

out a couple years ago

and is still on patent of course

is much more difficult to

access that medication

um

but the bioavailability of sprovato as a

nasal spray

is it’s it’s actually s ketamine

um which is just a slight change in the

chemical makeup

of it and

different from

your just

basic ketamine

ketamine is 100 bioavailable

through infusion

whereas s ketamine or sprovato

is 50

bioavailable through nasal spray

and so that you can kind of

associate the differences in its effect

based on that bioavailability

so because

when you deliver that drug through

the nasal passages

it has to go through many different

stages of processing through the body

where

it actually degrades it

whereas infusion can bypass many of

those kind of filters in your body

to where you get much more effect from

it so

um

you brought up if you don’t interrupt if

you brought up two really interesting

concepts that i think are worth kind of

mentioning again which uh the idea of

neuromodulation and neuroplasticity and

i’m wondering if you could speak to that

a little bit just for the audience so

that they recognize because that those

concepts like you’ve mentioned really

have sort of changed our approach and

kind of our understanding of what

uh the ability or capacity for

long-lasting change and recovery

actually really looks like in somebody’s

day-to-day life um so i’m wondering if

you could speak to that from the

psychiatric standpoint what the

importance of that concept of

neuroplasticity and neuro modulation

really is

yeah absolutely

so

really

it’s not so much that that concept is

new from medications however it seems

new because

these treatments that i’ve mentioned and

as well as even better understanding

about

psychotherapy or talk therapy

as well as

your traditional oral medications

like we mentioned the ssris

all of those actually have

an effect on your neuroplasticity if

done

correctly

right uh it’s just some are more

effective at it than others so that’s

where tms

and ketamine come in

is that they really kind of showed up on

the stage here

as

having a neuromodulatory effect on the

brain

that could cause a faster healing

process basically we were seeing the

effects faster

than if you did long-term psychotherapy

even cbt

that’s time limited if you did you know

by the book 12 sessions

in 12 weeks and then you did occasional

follow-ups for cbt

you could see the effects

similar effects

if you did six infusions of ketamine

uh

in two weeks

and so

if now what we’re finding is that the

the neuromodulatory effect is so much

more improved if you have a ketamine

infusion

or even spravato

or even oral ketamine while you’re doing

therapy right so now we’ve combined it

all and

while there are lots of therapists out

there doing that i don’t think we quite

know yet um the impact of this and how

positive it’s going to be

and just so much more effective that’s

what’s so exciting to me about it

especially

absolutely for treatment resistant

depression

but especially for ptsd

in that regard

yeah i think that you know brandon spoke

to you um really sort of creating this

interdisciplinary culture at peaks and

establishing that through a really

robust medical program but the it’s the

integration and sort of the

collaboration of the clinical world and

the medical world that where we really

start to see that where we can have the

most efficacy as far as change in and

sort of taking advantage of that the

sort of neuromodulatory effects of

treatment and it’s

what makes this very exciting these

types of collaborations and the fact

that there’s this is new

to a degree you know at least the

concepts may have been around a while

but our understanding of them has

improved our ability to approach them in

a more in a fresh more um innovative

fashion is also really improved and then

when you bring the two worlds together

you get this sort of um

exponential impact which we’re just now

starting to really to kind of explore

and see what how that works and how that

engages and really does improve the

treatment of clients and just quality of

care in general so it’s pretty um it’s

it’s an interesting and fun time to be a

neuro nerd basically it is it is yeah it

really is absolutely and for me i mean i

think the brain is the is the new

frontier it’s the final frontier as far

as our understanding of of everything

about us as individuals and how we work

and how we function and so bringing in

these kind of new um and uh or or kind

of more innovative approaches to

treatment is really exciting

it is yeah absolutely and and you gave

um and i’m curious for because i’m

hearing neuromodulation and

neuroplasticity and you know at the end

of the day how how we might be able to

simplify it through you know a metaphor

and what that healing mechanism actually

looks like and you gave uh

a beautiful presentation and training

opportunity for staff a few weeks ago as

well too around the subject and you um

in describing the neuropathway and what

was happening i think you brought up the

metaphor of a rope and it being frayed

and

if that still is applicable here and has

context i would certainly love for you

to re-review that metaphor on behalf of

the viewers um so that we can bring

these con these

big encyclopedia style terms into you

know something that’s a little bit more

palatable yes try to get it down to less

than five syllables

in the word uh

but

so i love the that metaphor of uh

if you were to kind of take your

you know a piece of the brain and kind

of smush it and you would see all the

different nerves or even throughout your

body um

and in neurons which are kind of long

and like a rope and so

what we had talked about was that

if you take a big rope um like you might

see it at some

port somewhere around ships and things

um and and you just kind of take

something rough like a brick or or

whatnot and you just rub it on the rope

really hard like a hemp rope and

you’ll start to see the fibers start

fraying right and so those frayed fibers

on this rope really represent what your

neurons

can look like if you have suffered from

an untreated mental health condition for

quite some time like years

so

absolutely major depression generalized

anxiety

and ptsd and ocd all fit into that

category they can all really when

they’re untreated and they go on for

years

they actually are assaulting the brain

in different areas of the brain

through the different hormone cycles

that are being released the

neurotransmitters are

dysregulated and that kind of thing so

like all the chemicals and such that are

swirling around the brain

they are so disregulated that they’re

actually assaulting the brain and so

they will

those conditions can over time kind of

almost shrink parts of your brain

uh again if it’s untreated and so that’s

why it is so important to

intervene early in these processes if we

can you know

assign the diagnosis figure it out

through someone’s history

and then we can come back to what we

described as this rope

and by applying even the medications we

talked about the ssris

or

the psychotherapy

tms

and ketamine

when all of those are applied

appropriately

those frayed fibers from the rope

are kind of like smoothed out it’s

almost like you are

pouring

a substance that kind of clears that

rope off of the yes like a like a wax is

a good

good uh analogy as well so then once you

go and you pour the wax on the rope you

can’t feel those fibers anymore and

that’s really what your nerves

will then look like as they are healing

if you were to look at them under the

microscope

once you have undergone some of these

treatments right and especially if you

achieve full remission meaning all of

your symptoms go away

and you kind of return to full

functioning in your life

i mean the english major me just loves

the metaphor so yeah yeah yeah

absolutely

and

and as a philosophy major was always

told not to use metaphors i think i

think it’s a great metaphor

in that in that regard as well too um so

there’s oh there’s so many different

branches we could fire off from here uh

on but i think flat out speaking

somebody comes in with a major

depressive disorder before we were um as

a medicalized system or through the lens

of psychiatris a psychiatry really

looking at uh these opportunities it was

just medication right and when it was

just medication or assuming medication

moving forward

um you know there’s a reason in which we

kind of want to move away from it and

that reason to me seems to be that there

isn’t a great uh deal there isn’t a

significant probability that all

individuals will get well under

medication that at some point it feels

like we’re throwing darts in the dark in

that regard so

before diving more into these you know

unique value propositions that you’ve

created and brought into colorado

springs and certainly supported peaks

patients through

colorado recovery solutions what is the

efficacy of medications in the direction

of

major depressive disorders at this time

what we can expect is about 30 percent

of

individuals that try

any one of these first-line medications

so

ssris which again is prozac zoloft

lexapro those are the common ones that

people are prescribed

maybe 30 of those people who are

prescribed those meds will get 30

improvement in their symptoms of

depression

and then it continues down the line

if if

prozac zoloft lex pro if it doesn’t work

standard of care is that you would then

either try a different ssri or you would

switch classes of medications and that

typically in our

traditional psychiatric

prescribing world would mean that you

would go to an snri usually

is most common and so that would be your

effexor which is venlafaxin or cymbalta

which is duloxetine um

you might somewhere in there try

wilbutrin which is its own unique

mechanism it’s a stimulating

antidepressant and so

if you have anxiety you don’t typically

want to use wellbutrin

but it can be a potent antidepressant in

and of itself

and so

generally speaking you would go down

that

kind of algorithm of decision making if

someone doesn’t respond at any one level

of that or any treatment there and so

every time you fail a medication

generally means that you have less of a

chance of getting better with a new

medication

it’s still worth a try generally

speaking because medications

oral medications meaning by mouth

are

the side effect profile with ssris and

snris

again are all those i just mentioned uh

they

the side effect profile is very low

generally speaking

um

at least in regards to if you are

weighing the risks and benefits of do i

go on continuing to suffer from

depression

or do i try a new medication

the benefit does outweigh the risk

of the side effects or even

the fact that it may not work

so then um

so that’s that’s really the cycle we’ve

been on for

we didn’t talk about this prior to

coming on here so uh feel free to just

say we didn’t talk about this we’re not

talking about it but it reminds me of

like when i i think this is how tylenol

works right let’s say i have a headache

right because of dehydration i’m not

aware that i need to drink water but i

have a headache so

in american culture one of those quick

external strategies isn’t to explore hey

am i did i drink enough water today it’s

like no i have a headache advil you know

or thailand all night prescribe that for

myself over the counter in the moment i

give it to myself um it’s not clear to

me that when i take it that i’ve

actually resolved the core issue that

the medication is in fact

at least in the way that i’m perceiving

it right now is just distracting me from

the fact that i still have this ongoing

headache because i have not drank enough

water

and if that’s true about how those work

at least in those moments as a

distracting feature how much

do those medications when they’re

working are

are they working in a similar way of

where they’re not actually smoothing out

the rope in the way that you know

ketamine infusion and tms is actually

doing um is it more of a distracting

feature and it’s still frayed or in time

is it actually smoothing out that rope

if all that

yes that’s a that’s a great question so

the way i would look at it is

and what i tell my patients is

when we’re starting an ssri or an

antidepressant in general is that this

is a

is not just a patch

it is a neuro regenerative

medication

and it if you take it consistently which

is every day for the most part with all

of these medications you have to take it

every day you have to allow your

body to to reach a steady state of the

level of the drug

and then allow it to remain at a steady

state level for weeks before you will

get the optimal effect

on your depression or anxiety and

during that process

it is actually stopping the assaultive

process on your brain’s nerve so it’s

like taking that brick

or whatever it was this razor blade that

that whatever was scraping across this

rope and fraying it it’s like it’s

removing that from the process it’s

putting it’s stopping it but it may it

may not be

at least not in the immediate sense it’s

not

pouring the wax over the rope to smooth

it out that takes probably at least a

year or more

of you taking the medication

consistently

really doing consistent psychotherapy

so there’s no modulation neuromodulation

taking place it’s just

giving it’s taking the brick away and

then allowing the rope to stay there the

distracting feature of the medication is

that i no longer experience the fraying

the major depression and that sort of

thing but in time

uh because we have these natural uh

cellular you know remodulation that’ll

take place independent of all these

things in the background it’s slowly

healing itself now whereas

uh

under the new lens of like ketamine

infusion for example it’s an immediate

remodul remodulating of the the the

neuron there right

yes uh it still requires uh repetition

of the infusion

but

uh

and then it still may require boosters

of the infusion

uh over

you know the

the following year or so

um

but it’s quicker and so like with the

medications the oral medications

it’s like taking

if you’re gonna pour wax over the rope

right it’s like taking a candle a tiny

little candle that’s burning

and you do like one drop

yeah and it

i mean if you had a rope like as big as

this room

that would probably you know could

easily take a long time yeah a couple

years easily

inconsistent therapy and medication to

achieve the healing that you might

achieve

uh through tms or ketamine and so with

ket well tms actually

is right now we think that

you can

[Music]

probably achieve

double the effectiveness of medication

with a six week actually about more like

eight week trial

of treatment with tms

so speaking of the time frame that it

takes you know because it

we have a 45-day residential program in

which medications are first line of

defense we usually start those

immediately however

seeing the efficacy of those take effect

is going to take weeks sometimes um and

we only have six of them right so we

start the medication right away the

clinical interventions start right away

the psychotherapy the sort of

traditional

intervention strategy happens right off

the bat but we know that’s going to take

time and that really that is the healing

mechanism at that point it’s

so

we have a shortened model we have a

shortened amount of time and now we have

these

new interventions or more

interventions that have become more

accessible

is it appropriate then to start

ketamine or start tms right off the bat

in order to kind of almost as a jump

start to that process does that make

sense from a medical perspective

it does and uh i i don’t think of it as

well if if you look at

our our detox

model of care right where it fits in the

continuum of care for substance use

disorder treatment

it’s the first week of treatment about

right so it’s it’s removing the

substance

helping keep someone comfortable

until they can kind of get back

to somewhat of their baseline right

they’re still going to need to go

through a few weeks of stabilization in

the residential program

but having removed

this the substance that was also

assaulting the brain

is stopping that process

and then we’re kind of in the clear is

how we look at it medically cleared

basically to then apply these other

treatments that are more rapid in their

effect

while someone is

you know participating in the group

therapy the individual therapy

especially at peaks and the the model of

care that we have there

it’s

we also can start the the oral

medication at that time too because

ketamine

s ketamine or sprovato tms they all work

as augmenters of the oral medication as

well as the psychotherapy

right and so

instead of let’s say we have someone who

comes to us with treatment resistant

depression and suicidal ideations which

is pretty common

in order for them to really

be able to bypass going to the hospital

for that to stabilize

these new treatments especially ketamine

can help stabilize someone like that so

that they can continue in the program

and then with repeated administrations

of the infusion or sprovato

it actually is helping propel them into

healing

and so it does work

really seamlessly together and should at

least now our systems may not our

financial systems and such i was going

to might not help us with that a little

disruptive for a second because knowing

what we know about the efficacy of these

treatment interventions and strategies

the access to them is is does not

necessarily align with what our

treatment trajectory would look like

specifically within this timeline the

sort of chronological timeline we want

people in right away and insurance

companies are not necessarily allowing

that and i’m just curious want to be

curious with everybody

why that is and what we can do within

our industry and as disruptors of this

industry to try to change that

through um

sort of collaboration with

organizations like yours and companies

like yours like crs so as a psychiatrist

what do you think is our best strategy

to make

to make these changes and make them

known

so

i’m uh

i’m i’m someone who

my first approach is to just comply

with whatever they tell me to do

in order to get my hands on the

treatment or be able to give access to

my patients as i just do what they tell

me to do and

so

that’s what i’m doing right now and kind

of have and just now

have fulfilled many of these

requirements

from insurance companies from the fda

which you know a lot of those kind of

things from the fda and what

what’s bravado is controlled by is

called a rims program so that stands for

risk evaluation and mitigation strategy

and so that’s overseen by the fda the

dea

um

and jansen who created spravato and so

uh

we

in order to

provide spervato to any given person

with major treatment resistant major

depression

and or acute suicidal ideations we have

to comply with their program

in order for the drug to be safely

administered and not diverted basically

into the community

and

so

that’s one approach

[Laughter]

[Music]

we encourage that approach yeah sure

right yes uh safety first absolutely

absolutely

truly believe that yeah

and so uh

but then come the insurance companies uh

is so how do you comply with everything

they want you to because they all have

different standards

despite what different interpretations

of the studies the literature about

these different treatments and so they

impose on us

all their different criteria or i look

at it as

what’s that agenda

yes the almighty dollar

is always looming in there somewhere so

so in my approach i learned their game i

i learn

basically how do you give access to

these treatments in their most effective

manner

according to

the evidence that we have for them

and then how do you advocate to the

insurance companies

on the behalf of your patients so that

when when they’re denied which all of

these ketamine infusion aside

it is not covered by any insurance

because

many different reasons it’s generic it’s

been around forever

there’s no patent for a company to

really take it and advertise it to

all these different companies and such

but

that is really if you think about it

while ketamine infusion is invasive in

that it’s an iv

um

effect probably

potentially

versus bravado

should suggest in our culture that you

know we should be

supporting this treatment really and

trying to get

this one

out because it’s affordable more

affordable at least

than spervato so

but

insurance has embraced sprivado

they they cover that

but we have to

of course go through this prior

authorization

form for everything that i’ve mentioned

tms bravado even med management

at its basic level we have to go through

these um

at least

you know

figuring out the benefits and such and

the millions of different plans and such

and

but it’s it’s in the times when you you

spend a lot of time with the patient

filling out the prior authorization you

submit it

um you think it’s a

slam dunk of a case this person has just

been suffering for years

from treatment resistant depression

you’ve justified all that through all

the med trials that they’ve gone through

through the duration of their major

depressive episode and then um

it’s possible through some technicality

that’s written in the insurance um

policy about tms or academy or spravato

that they’ll say oh wait no we don’t

agree with

that you know

the overlap of when you tried lexapro

was one month outside of what you

documented as the current episode of

depression and so

so we don’t count that as a medication

trial

and

you know i think you have to really get

up

up to speed on

all of the literature so that you can

really you have to kind of go into a

debate

with the other physician on the other

line who is saying no this doesn’t

qualify i’m going to go ahead and deny

this and you can just barely keep them

from hanging the phone up on you

and then

if if you do

get your point across with them

they still say without any kind of basis

for it sorry

we’re just not going to approve this

today you need to either go to an appeal

or resubmit it or sorry you’re just out

of luck so it’s

that takes hours out of your day

and the whole time that the patient is

still suffering absolutely and the risk

is mounting absolutely for how

debilitated they may be from their

depression

if they’re suicidal yeah you know what

may happen and these are people who are

not in the hospital that we’re trying to

help keep them out of the hospital um

which ultimately saves insurance

companies money so there’s this element

of irony to it all and the thing is

yeah and i i think i just i i’d like to

talk about it because this is the world

in which we live right this is the

access to care

that is um

we we have these new and amazing uh

intervention strategies at our disposal

but not necessarily always accessible

and that is um and that’s frustrating

and i think it’s valuable to talk about

it yeah oh a hundred percent and it and

from uh you know you know my

frustrations of course and all the

episodes i’ve done around treatment

centers websites hope and save and all

these words have behind it a great deal

of complexity to actually

bring the individual forward to which

now they start feeling hopeful and um

this is such a wonderful discussion but

for the sake of time for sure because

the kids on the social media only have

so much attention span i think they’ve

all walked away now

with the rope analogy so i think we got

that much across in this moment i just

wanted to uh before i before i uh take

us home and uh out of this room uh at

least for this time until you come back

with uh jason friesma uh in the

following week um

what is

how long does it take is it neuro uptake

i forget the language of when you

take an ssri say you know it’s zoloft or

lexapro whatever the case might be how

long does that actually take before the

individual for the 30 that it may work

for how long does it take for them to

actually start experiencing that is it

immediate is it weeks what can what does

that look like

we generally just

tell people to

expect

you know at least four to six weeks

before you get the max effect of the

dose that you are currently taking

you might feel some effect in the first

week or two

it’s

very possible but

it’s not going to be the full effect

and then at four to six weeks

you

if you don’t have full remission of your

depression at that time you always want

to look at what a net would the next

higher dose be

uh

indicated here and usually it is usually

you just go on up if you haven’t had

side effects to the to the drug

and if you have had side effects and

they’re still going on

the standard of care is that you have to

wait that out so you can’t go up on the

dose

unless you’re just willing to accept

that those side effects may get worse

and then you have to wait it out again

it can be

become a very

strenuous laborious process for any one

person who’s suffering from depression

or extreme anxiety even to

have to wait that out and then

if it doesn’t work on the first

go-around to have to do it again

and then give up if that that one

doesn’t

work

um do have augmenting strategies we can

try sometimes that does help it kind of

take control a little bit better

or take effect

not all levels of medicine and at least

practitioners are comfortable doing the

augmentation strategies with different

medications but

so again access to care

then becomes another risk

with medications

and so uh and then access to care

in regards to tms and and spravato

is so much more difficult

to achieve

then then your risks just continue to

mount and the suffering continues to

mount really

um

and the vast majority of people

don’t have

you know money flowing out of them to

just kind of yeah pay out of pocket for

any one of these treatments

and and for instance bravado

if you paid out of pocket for that could

be

fifteen hundred dollars in

administration

and so you could have

you know it

easily

i’m calculating in my head what may be

the average of someone how many

administrations someone might have

uh to actually stabilize on sprovato

you know at least eight in the first

few weeks and so

who can afford that yeah

absolutely

they’re already paying for their health

insurance right so they can barely

afford that and then it doesn’t um

oftentimes cover it so yeah it’s a it’s

a dilemma yeah

yeah well it i i think that uh so one of

the things that i just want to challenge

viewers on especially in relationship to

addiction treatment centers you know

even mental health primary centers when

you get to all of our brilliant websites

we are stating we treat things like dual

diagnosis and dual diagnosis as a

category could be i have a major

depressive episode taking place right

now and yeah i was smoking pot six

months ago or you know maybe engaged in

some other you know abuse around drugs

and alcohol but this is the primary

issue of concern and

our admissions lines are always so

passionate to bring people in to be the

opportunity to be the treatment episode

that provides these services

but i think for me and the caution to

the wind here is is that if our only

shot at this is to you know dole out

medications ssris or otherwise that we

have a fairly limited opportunity to

actually treat what we say we can treat

at the end of the day and that really

resonates with me and calls upon

treatment providers

watching this aware of this information

all around the country

to proactively

move in the direction of the creation of

these advanced services and on top of

that

or these services through colorado

recovery solutions that dr aj has

brought to

the community here in colorado springs

and certainly been supportive of our

patient demographic coming through

finding peaks

uh that

uh there needs to be these alternatives

and that

uh what we can also hear out of this

discussion is like there is a whole

insurance side of thing in payment

platform and a fragmentation that is uh

right for disruption in this regard in a

really big way because it is in the way

of okay now we know meds aren’t going to

work or it’s going to take four to six

weeks but the person’s suffering right

now and how do we get ahead of that in

this moment so i think it calls upon all

of us to do a better job to lean into

these types of

resources and where we’re going so kind

of to you know recapitulate what’s going

on it seems like the problem within

psychiatry at least in the past has been

kind of just waiting for the

pharmaceutical industry to create

something for us and then to get behind

it and then hopefully there’s enough

money behind it for the insurers to come

in and say okay we’ll provide this

and that um

we can’t wait anymore mental health and

depression and anxiety especially over

the last two years are just skyrocketing

exponentially among

american citizens and certainly around

the world and so we’re in the need of

new solutions and through platforms

such as colorado recovery solutions that

dr

jay here has created on behalf of this

community and is working with peaks

recovery centers to

defragment our situation seems like the

new opportunities and where this is

headed for which we should all be

excited about

but slightly discouraged by um

the

amount of time it may take to actually

get all of this to come together so

at the end of the day

thank you so much for coming on and

talking about this with us it’s a really

important topic especially around

depression ptsd

generalized anxiety there are solutions

that are out there and available to the

community and through treatment centers

like

peaks but at the end of the day

the situation is extraordinary and it

calls upon all of us to do better and to

have these discussions and to

represent what the limitations are so

that people can appreciate why these

solutions exist and where we’re headed

as an industry so

on that note

as always signing off here at peaks find

us on finding peaks at peaksrecovery.com

dr uh johnson here is going to be on uh

next week’s finding peaks episode as

well so if there’s more questions

thoughts ideas that you want to ask in

her direction uh please let us know

about that so we can address that at

that time certainly won’t be the only

episode i think there’s a we could go on

for weeks about this uh these topics in

general uh as you all know chris burns

is doing awesome fun videos on the tick

tock follow the peaks recovery tick tock

page so you can hear loud screams of

recovery and energy here

a little bit different than the

discussions that i’m generally having uh

again the facebooks the twitters

you kids all know what’s going on out

there thanks for being with us and being

patient as we describe

these uh technical and detailed uh

issues that are going on especially

around depression and until next time