Jeff: We’re certainly the only public company, because it’s easy to find that information. We’re the only company that has a grass approved extract of this mushroom that is legal for human consumption. The mushroom, again, was never scheduled as a drug. The mushroom is legal, but it’s not legal to sell products for consumption. So you’re not legally allowed to take this mushroom and turn it into a product and sell it, except for us. So we did that. We, again, we did two years of all those preclinical studies, toxicology, neurobehavioral, everything to, to ensure that we have a safe extract.

Further to that, we work with the CGMP manufacturing facility. We have all the standardization procedures in place, even when we pick the mushroom the foragers that we work with, they have very strict protocols in which we ask them to pick them pick them in a sustainable fashion so that the spores will drop as they’re going through, and then package them , the day that they’re picked, rather than waiting and taking them back, so that it has the best result for the composition of the mushroom.

Bruce: Welcome to the future of psychiatry podcast, where we explore novel technology and new innovations in mental health. I’m your host, Dr. Bassi, an addiction physician and biomedical engineer. Today we’re going to be focused on an alternative treatment option commonly called magic mushrooms or amanita muscaria.

Today we have Jeff Stevens. He’s a CEO and co-founder of Psyched Wellness. Psyched Wellness is a Canadian company that is dedicated to researching and producing products made from the medicinal properties of the amanita muscaria mushroom. On the website, it says that it could soothe the body, provide a restoring feeling of calm wellness, and also can reduce anxiety, diminish depression, and help reduce insomnia, and make you feel more energized. And we’re going to get to a lot of that, what a patient will experience when consuming the Amanita muscaria mushroom. And today we have Jeff Stevens. 

Welcome Jeff.

Jeff: Thanks very much, Bruce. It’s a pleasure to be here.

Bruce: So before we get to the mushroom itself, I’m sure a lot of people are curious about that. Tell us a little bit about yourself and how you got here.

Jeff: Sure. My journey started actually on the capital raising side of things. I’ve worked institutional sales and trading at Boutique Investment Banks in Toronto for many years, working with micro cap small cap companies helping them raise money, helping them go public introducing them to portfolio managers.

And about… Eight, nine years ago, I took the leap to the dark side as it’s commonly called on Bay Street where I left the desk and started working with issuers directly, initially working with them in roles where I would assist them with interest capital and helping them to go public.

And about three years ago, myself and a group of people that I’ve worked with previously started Psyched Wellness with the goal of, bringing to market. alternative options to regulated psychedelics. And that was what we were focused on.

Amanita muscaria is the mushroom that you mentioned, that we identified. My colleague and co founder, David Schiesel, identified it. And it was never scheduled as a drug. So we were able to work with it as a food supplement, which is quite unique in this sector, where our peers are generally working with these regulated substances and yeah, we started it three years ago. We did a ton of work, scientific, preclinical studies all the scientific studies that you would be required to do to bring a product to market safely. And then we took that and we received what’s called the self grass. We’re an independent review of scientists, reviewed all of that data and approved it.

It’s an FDA path to market for food supplements. So if you think of Red Bull, for example, when they bring a new market, a new product to market, they’ll go that route as well.

Bruce: Do you have any guesses or assumptions as to why it’s considered a supplement and not a medication or a more regulated substance like psilocybin

Jeff: Yeah, for sure. It’s a mushroom, very interesting. , has been mislabeled for years. People recognize it because it’s that red and white mushroom cap, Alice in Wonderland, Super Mario Brothers, the emoji on your phone. So everyone recognizes it and it’s often used as the image for psychedelics.

So magic mushrooms, for example, with psilocybin, they’ll use that. However, the main compound is muscimol. Very different from psilocybin., the effect is very different as well. , But if you were just to pick it and eat it, you’d get quite sick. And I think that’s the reason it was never scheduled as a drug, because it took an extra step.

You had to boil, you had to do a decarb, and in order to do that, you know, it took time and effort and, realistically on the recreational side, to just go pick something and eat it, I think people would go that route. It just never made the radar screen because there weren’t enough people using it in a recreational form.

Bruce: Gotcha. Do you think that could change in the future or likely not at this point?

Jeff: Personally, I don’t think so. I think the trend is moving towards, decriminalizing and legalizing these various substances because this was never scheduled. I don’t think so. We’re certainly doing everything we can as a public company and the pioneer with this mushroom to bring up to market in a safe standardized fashion, so that people are, you know, consuming a product that is known and safe and, less risk of that happening as a result of it.

Bruce: Gotcha. So you mentioned boiling it and doing a decarboxylation, I think, of the compound that we were mentioning. And then how close does that make it in terms of its effects to psilocybin? Can you compare the two?

Jeff: Yeah, again, very different. To put it into terms, you know, if you’re psilocybin, you’re having that sensory experience, the visuals and going through that with muscimol, which is the main compound that we isolate through our extraction. Although it’s a full spectrum muscimol is the predominant compound in the end, and that gives a sense of, you know, in smaller doses, a calming effect. Hence the name “Calm” of our flagship product. In larger doses, it’s going to feel like being inebriated. So much like alcohol. The reason for that, Bruce, is it works on your, it’s a GABA A agonist. So it hits that receptor similar to alcohol. And that’s the effect that you’ll have with it.

Bruce: gotcha. Interesting. So can people have any withdrawal effects? Like alcohol? I’m sure a lot of clinicians are probably first thinking of that when, you know, they think of the effects of alcohol.

Jeff: Well, Maybe this is well put in the, sort of, the general statement warning, we haven’t done any clinical trials. We’ve done preclinical studies on that and all the safety, toxicology, We have done interaction studies, to be at the position that we’re at now.

 But we Don’t make any claims. We don’t make any claims to this based on han trials because we just the opportunity to do them I can tell you I can provide you a lot of anecdotal experience that , myself as a co founder and probably the longest user of our extract , also what we receive from our consumers, when they share with us that, how they’ve been using it and and the benefits that they’ve had.

Bruce: Thank you for giving us that background information that we’re not talking about any patients here, but consumers of the substance and So if somebody were to be using it, say, for a month straight  and they stopped , what could they expect

 Jeff: I’ll use myself as an example for this. When we first started, I was using our raw extract and now our more refined final version that we’re selling. And I used to take it every day initially, and then I would take it every other day. I’m now at a point where I’m taking it once or twice a month, really, when I notice that I’m not falling asleep as easily as I would if I had another sort of, not dose, but if I took calm again. So the reason for that, I think, is my body has gotten into a rhythm, where I’m sort of back in a sleep rhythm where I, when I lie down and my intention is to fall asleep, it’s easy to do so. And then when I notice that I’m not falling asleep as easily, I’ll take some calm. , and that’s over the course of about a year. When that sort of took that time for my body to get into a rhythm and feel it. I think if you really listen to your body, you’ll know, and when we talk to people, you give a range and you say two milliliters is, is what we recommend for the dose. Take it 30 minutes before you sleep and it’ll provide that calming effect. And if your intention is to fall asleep, it makes it easy to fall asleep. So it’s not a sleeping pill. It doesn’t knock you out. But if your intention is to do so. . you’ll, you’ll feel it. And I did like, I just noticed that, geez, I’m falling asleep easily, I don’t need it. and then I just sort of decrease it and then use it when I feel that I need a little bit to help me.

Bruce: Interesting. So a good reminder that we’re not making any sort of medical advice. We’re not giving advice to any patients, but , imagine a lot of clinicians aren’t really familiar with how to recommend dosing. To individuals do you guys have a directory of providers or practitioners, clinicians who those individuals, those consumers can go to who might be a little bit more educated on how to make recommendations about dosage?

Jeff: Listen, Hey Bruce I would love to, if any of your listeners are interested in learning more and working with us, we would love to do so.

It’s just really been the scientific review panel that provided us with the dossier for our grass approval.

You know, we are at the very low range of what our dosage range would be. So, again, with our flagship product, we didn’t want it to be too strong that people felt an effect that they were uncomfortable with. And so we dialed it back to a point where it’s like, okay, this will work for the largest group of population, you know. The people that have used Amanita previously, that are purchasing it online in the gray market, , this is probably not the product for them. They’ll have a higher tolerance to it, they’ll, they have been using it and they’ll be wanting something different. People who have never tried it before and who are looking for an alternative to say melatonin or CBD, you know, this should be right in range where it’s going to be beneficial to them. , and that’s certainly sort of the feedback we’ve had.

Bruce: Maybe We could talk about the safety of the product. I’m sure a lot of people want to know about that. I know you’re one of the only companies I wanna say that distributes this to consumers. Is that correct?

Jeff: We’re certainly the only public company, because it’s easy to find that information. We’re the only company that has a grass approved extract of this mushroom that is legal for human consumption. The mushroom, again, was never scheduled as a drug, but in all states, Louisiana’s the only state that you can’t sell the product. Outside of that the mushroom is legal, but it’s not legal to sell products for consumption. So you’re not legally allowed to take this mushroom and turn it into a product and sell it, except for us. So we did that. We, again, we did two years of all those preclinical studies, toxicology, neurobehavioral, everything to, to ensure that we have a safe extract.

Further to that, we work with the CGMP manufacturing facility. We have all the standardization procedures in place, even when we pick the mushroom the foragers that we work with, they have very strict protocols in which we ask them to pick them pick them in a sustainable fashion so that the spores will drop as they’re going through, and then package them as they’re, the day that they’re picked, waiting it has the best best result for the composition of the mushroom.

Bruce: And what kind of regulation is done on the consistency of the substance or compound from batch to batch or how to standardize that? Or is it too complicated to explain?

Jeff: Yeah, so that’s all self regulated ourselves, and again, as a public company, we hold ourselves to standard on that, so we do batch testing. When the raw material arrives, we do batch testing when the extract is done. And what we’re looking for in that response, Bruce, is Amanita muscaria is part of the Amanita genus of mushrooms. And there are, you know, some of the most poisonous mushrooms in the world in that family. So it’s very important to make sure that you’re working with foragers that they understand what they’re picking and know the difference, but also that you’ve got procedures in place to test batch testing of the raw material, batch testing of the extract, and testing for those other toxic mushrooms, testing for heavy metals, and making sure that you’ve got that. So, Those are all procedures that are in place. We work with a third party lab. We don’t do that testing in house. We want to have arm’s length on that, so know, , if people can trust that it’s done properly. And that is done with each batch.

Bruce: Very interesting. Just Out of curiosity, where do you actually source these from?

Jeff: Currently, we are working with a group of foragers, mostly in Poland. We have been working in Russia, Ukraine, and we have enough raw material right now that we haven’t had to source in a while. So, we hope to work with those foragers in the other countries as well.

But for the time being, it’s mostly, in Poland that we’re, Poland, I think Latvia as well. So we’ve been testing them. We’re the largest importer of this mushroom into the United States ever. Again, it just wasn’t a commercial reason for it previously. In the last year, we’ve started to see a lot happen in the gray market, where people are trying to chase the legal, use this as a Trojan horse for a legal psychedelic product, and you know, you’ll see in health shops and stuff, these gummies, Amanita muscaria gummies.

We’ve actually purchased 10, 15 of these various gummies and had them tested at our third party lab. And they don’t have amanita in them. If they do, they have more ibotenic acid than they have muscimol. Oftentimes it’s going to be psilocybin or ketamine that’s inside them. And they’re just trying to, use amanita to, to circumvent and get it out. So, you know, We’re really focused on just bringing a wellness product to market for people. We think that opportunity is far greater than any recreational opportunity that exists. If you can demonstrate to people that you can help them with sleep anxiousness.

Personally, I can tell you again, anecdotally, the anti-inflammatory quality of this mushroom is incredible. Last year, waking up in the morning and walking down my stairs, I’d have to hold on to the railing because my knees are so stiff. This year, I take them two at a time. And the only thing that’s changed in my routine has been the introduction of Calm and our extract AME-1, which predominantly is muscimol. So, you know, scientifically, we know that it’s good for inflammation. We know the GABA receptors are good for pain. , and we’d love to be at a point where we can make those claims and do those studies, but it’s just a factor of time and money and getting there. But certainly, that’s something we’d like to do down the road because…

We think with being able to make claims, we can then offer this product a little more legitimately to consumers working with groups, like yourselves where you feel more comfortable with it, recommending it and, and having a dosage that you can recommend. , so it’s just steps. It’s, you know, it’s not a, it’s not a hundred meter dash. This is a marathon and we’re just in that first round in that first corner.

Bruce: What would be some benefits that you would describe to a friend or family member of why they should consider this over any other option, really for conditions of chronic pain, pro inflammatory condition, or, insomnia, anxiety?

Jeff: A lot of people when they’re using, I’ll use melatonin again, or CBD for example, when they’re using those products, or products using those compounds, they find that they wake up the next morning feeling groggy. So they’ll sleep, but they’re feeling, you know, you often feel like you’ve got a little bit of a… Melatonin hangover and what we find with our product is that most of our consumers wake up refreshed I certainly do we have some of our consumers that have been wearing the aura ring and sharing that data with us and we think that they’re likely in it in that  REM sleep longer and that could be attributed to it again We can’t make those claims. It’s just information that we’re gathering and you know putting it together which sort of gives us direction on okay, when when capital is available and we want to do some studies, we’ve got this field data that we’ve collected. So, from that perspective, I would definitely say if you’re, if you’re looking for something to help you, , you know, fall asleep, stay asleep, , it’s certainly the, the feedback’s been phenomenal. But again, I think because you have those other benefits that are with it. Inflammation is the root cause of disease, and everybody with their western diet probably has inflammation, if you’re trying to help yourself fall asleep, and a side benefit could be a reduction in some inflammation, perhaps, you may as well go for the two for one if you can.

Bruce: Gotcha. Interesting. Are there any common side effects? Stomach upset, or other than drowsiness, imbalance maybe, that people should be on the lookout for?

Jeff: Not if you take it in the range that we suggest on the box. If you were to triple the, double, triple the dose, you might feel that sort of inebriated effect, like you would feel, one glass of wine versus three. So, you know, the intention is to help  you calm down, relax and set a stage where it’s easy to fall asleep, as prescribed, or not prescribed, but as suggested in the dosage. If your intention is to try it for something different, and we certainly have, as the founder, we’ve sort of gone to extremes with it and, there’s an enjoyable experience with that. If you go too far, that could be not so enjoyable like anything. So, but as we suggest the usage, we haven’t, there have been, you know, safe from say a thousand units sold. the number of people that have come back to us, , that, that have had a negative experience with it, I would say it would be five to seven people and, and that is from what we infer from the way that they’re writing to us, and it’s usually by email, there’s some underlying conditions, , that in, our return policy is we don’t have one, but in situations like that, if someone takes the time, they come to us, they explain to us, this hasn’t worked or this, experience was awful. We asked them to stop taking it, consult your physician and we will refund you for that bottle. Because they took the time and they talked to us and it helps us as well with that to try and understand it. We have had a number of consumers that use it to wean themselves off of benzo alcohol. Some people have said it helps them with smoking. I think because it hits the GABA receptor, it sort of makes it easier to wean off those, but we don’t have any clinical data to support that. It’s just been what people have been telling us and they, there are some on the benzo community side where they have been actively using this from vendors in the gray market for that purpose.

 I guess there’s a desperation where they’re looking for anything that can help. And so they come to us oftentimes, I don’t know if our dosage is strong enough for them to have that effect. Those are sometimes the people that have said, Hey, I go through a bottle in five days as opposed to 15 and it’s too expensive. And what can you do for us? And sadly, we just can’t be the solution for everyone. Right.

Bruce: Interesting. Very interesting. So there’s some people who just don’t quite see any effect to it. And it sounds like you have a really high satisfaction rate among your customers. But every once in a while, maybe they metabolize it more quickly? Do you have any hypotheses for how that happen?

Jeff: You know, I just the only thing I can think of is similar to say alcohol. You and I could have a drink, and you know, I’m 5’10 230 pounds. You and I have a glass of scotch, you might feel a buzz, and I’ll just think I had a glass of scotch. So, I think it comes down to how every individual body interacts with it. And then also what the expectations are. You know, some people might have an expectation that they take this and it’s going to change their life. And one, one time is going to be this incredible, you know, staples easy button, red pill that changes everything. So I think, continued use, give it some time, let it into your system, you’ll feel that difference and some people, you know, don’t, don’t have that, ability to, to give something a week or, you know, let, let alone three weeks to, to feel, a regular use and feel that benefit. But you take it, Bruce, we’ll send a bottle to you. I’m sure that most people, when they take it, feel it within 30 minutes. And that’s been our best sales tool.  when people have the opportunity to try the product and they go, Wow, I, I felt that and I slept really well. You know, that’s, that, that says it all. And then it’s about word of mouth and sharing that. We just like to be transparent. You know, it doesn’t work for everyone.

Like there is a small portion of our consumers that have taken the time to come back to us and tell them, Hey, you know, this did not work for me. And we say, okay, you know,  sorry.

Bruce: And it comes as a liquid in a kind of an eyedropper type of bottle solution. Do you just put it under your tongue, and swallow it directly? Does it, or do you need to add it to something to mask any taste to it?

Jeff: So, it has a slight corn flavoring to it, because mushrooms are, you know, not everybody’s palate.  so we did that for ease of consumption. Especially because you ideally are taking this in the evening, before you intend to fall asleep. So yeah, it’s two milliliters, so two full droppers. And sometimes that gets confused too, because they think two drops as opposed to two full droppers. So it’s at two milliliters, and you take it about a half hour before you intend to fall asleep. I take it directly, and just swallow it. My wife will put it in a glass of water, and drink it before she goes to bed. It’s entirely up to you.

Bruce: I know the topic of addiction, I’m sure we could spend a lot of time talking about that and the nuances of it, and the spectrum of addiction. Anything that really works well for people is going to have some habit forming properties to it. But, is that something that’s of concern or should be of concern to clinicians who might be recommending it to consumers or patients?

Jeff: Yeah, so, to the best of our knowledge. Professor David Nutt sits on our board. He’s a professor at Imperial College. he’s done quite a bit of work. He was Robin Carhart Harris professor that led him towards studying psilocybin. So he’s one of the sought after experts in the field of psychedelics and pharmacology. And when we talked about it, he said, Listen, these are not compounds that are going to make people addicted. , you know, psychedelics are not addictive habits. So people could get into a habit where they do that. But, we have not done clinical trials to support that. So I wouldn’t, you know, plant my flagpole on it. I’d just say that from the conversations that we’ve had.

And again, certainly, I’ve been using it the longest, I think, out of anyone. Maybe my co-founder as well, going from daily to a couple days to only when I feel the need for it versus feeling a need for it. So, you know, I think from our experience, yes, it’s not an issue.

Bruce: Anything really that has a benefit to people obviously can lead to continued usage and habit forming properties because you’re depending on something that is helpful. You know when it’s an addiction, I think it’s causing some sort of untoward issue and problem and uncontrolled use, compulsive use that they can’t cut back, but it sounds , for most people they’re able to control their intake of this, but I’m sure a lot of clinicians out there listening to this conversation, they say, Oh, kind of similar to alcohol. The effects are similar to alcohol. I wonder if some of my patients who have alcohol history are kind of contraindicated. or should not be advised to use it.

Jeff: For sure. And, you know, again, there’s a lot that we would like to do with this, with our extract AME-1, which is our proprietary extract of this mushroom. The three main compounds are ibotenic acid, muscimol, and muscarine. And we convert ibotenic acid into muscimol, and then we reduce the muscarine to a point that both of those compounds have a vanilla effect on hans in consumption based on our extract. And so everything we do is based on our extract. It’s full spectrum because it doesn’t remove them entirely. But it, you know, you’re left with a predominantly muscimol effect, so we, you know, it’s, I think it’s important to distinguish that because, muscimol itself is an isolate. There’s synthetic muscimol that people are making and stuff. It has a very different effect than ours because you’re removing those other compounds. Doing a decarb, and just boiling it. You’ll convert some ibotenic acid but you’ll be left with a larger percentage than what we would be comfortable with. It’s interesting as we move forward with it and have more entrance into the market because one Amanita product will be different than the other as a result of how they do that.

And I think that the extraction process is key to this and key to having safe products in the market for people. Let’s talk about the company in terms of challenges that you see. I can see various domains. Here individual awareness and Wanting to reduce the black market consumption, public education, awareness of this, and then there’s the quality control side of things and business marketing what’s kind of on your plate these days? What kind of challenges do you see moving forward in the near term?

Jeff: that’s a loaded question because, because all of them, the CBD market as an example to explain this, so say 10 years ago, 12 years ago now, maybe when, when that push for cannabis and CBD products as an alternative to health and wellness alternative for people, you had, you know, three, 500 companies. talking about it, coming to market with products, doing studies, lobbying,  you know, for the last three years, we’ve been the pioneers of doing that. And for the first two years, we were probably the only ones talking about Amanita Muscaria and the benefits of it and how this can be a product to help people in their health and wellness pursuits.

So, you know, there was one voice trying to educate and get a message out, which, which is a lot. And, it’s expensive and it’s cumbersome. it’s also harder to remove a stigma when it’s just one voice. And so what we’ve done as a company, what we’ve decided to do is offer, you know, we will sell our extract in bulk to some other companies that we feel are aligned with us, with how they want to bring a responsible product to market because that helps us if there’s more voices amplifying the message and they’re doing so with what we know to be a safe product because it’s our extract.

That gives us comfort to do so. So those are challenges, the various social media platforms have been challenging because our image of the mushroom has been used in the psychedelic space. So when they see that image, they think it’s a recreational drug. Even though we have our dossier that has our grass approval and we show them all that information.

So those have just been challenges that we’ve had. We’ve been able to overcome them. We, you know, it takes time. Sometimes  you lose your instagram account. You have to start from scratch, which is frustrating because it costs time and money and effort to build that up. And it’s also where people go to determine if they think a product is legitimate or not.

You know, the number of followers is a real issue when it comes both for brick and mortar and for D to C when people are going online and looking at your product. So those have been challenges that we’ve had to work through. But nothing no red flags, nothing that you can’t, you know, roll up your sleeves and keep going.

It’s just, doing it yourselves. So we’re happy to see others come into the market. We think more people talking about it, , in a responsible fashion will be beneficial for consumers everywhere. And, for us, we’re, we were the lead, but we don’t need to hog the puck. We’re happy to be part of the voice and part of the growth of this.

Bruce: Sounds like the lack of competition, relatively speaking, compared to cannabis, is somewhat of a double edged sword for you. I mean, it could be good to not have that much competition, but it also doesn’t help in terms of public awareness, it sounds like, from what you’re saying. Why do you think it’s not just a booming industry similar to cannabis?

Jeff: I think we are just… at the beginning stages of that happening. I think you are always in these sectors, the black market, gray market leads, right? So the cannabis sector, that was happening. The shops were opening up and Getting shut down and opening up and getting shut down. We’re starting to see that now with psychedelic shops, mushroom shops.

And that’s part of removing stigma, where people say, Okay, I’m open to this now. I’m starting to see it in mainstream media. I’m starting to see people like Psyched Wellness on a podcast like yours. These are all those steps that go towards legitimizing, removing the stigma, where people, consumers feel more comfortable giving it a shot.

I think we’ll see that continue to happen. Right now we’re seeing a lot in the gray market, black market, which scares me because, you know, if something bad happens. And then it’s on the front page of the paper that that is very negative for all of us. So, again, that’s why we made that decision.

We want to offer our bulk extract to companies that we feel are aligned and wanting to bring a safe and responsible product to market. because that just helps reduce the risk of bad actors effectively bringing just crushed powdered caps from the Ukraine that they have no testing done and they just turn them into gummies.

And you hope. Because the guy told you that’s what they are, that’s what they are. you know, versus ours, we’re batch testing, heavy metal testing, all  just being sure. So, it, it will happen. Again, we’re, we’re not looking at this as a hundred meter dash. We’re not just trying to make some money quickly.

We, we think that this is our first product and this is our first,  studies that we’ve done, but as we grow, when we bring more products to market and we are able to, you know, allocate more capital to do more clinical studies to be in a place where we can make some claims, I think that opens up the market for us considerably as well.

Bruce: I haven’t heard of the phrase gray market before, but I’m imagining it’s a public facing company that sells something that just isn’t what it’s supposed to be or isn’t it truly is.

Jeff: Well, Using that in the sense that the mushroom’s legal, but product consumption aren’t, so some people will sell the product, for religious purposes or for scientific purposes. a lot of online vendors will say not for hand consumption. Then they’ll directly message me for information on how to use it. So those are where I say sort of gray market where they’re up front talking about the fashion, and again, when the market is being decriminalized, it’s kind of gray as well, right? So if the police aren’t going to enforce something because the general indication is that we are decriminalizing this, it’s not a priority.

We’re focused on opioids and fentanyl, and 100 percent I think they should, right? Those are the ones that are killing people. Then you create this environment where, you know, the pseudo legal vendors can exist without fear of being shut down or being prosecuted. And I think we see that in cannabis right now in the United States where, you know, the legal… Cannabis companies have been doing everything, following the letter of the law, bringing it to market, but they just can’t compete on price because the government didn’t shut down the illegal cannabis retailers and as a result, you know, you have this challenging environment where they’re trying, they’re waiting for safe banking, they’re waiting for these at the regulatory but if you don’t get rid of the black market, the gray market, then, you know, from a price perspective, it’s hard to compete.

Bruce: Interesting. Do you have any advice for clinicians who are interested in learning more? Where can they go to, educate themselves from some reputable source, any sort of call to action for clinicians who are interested in seeing how these types of supplements can help patients?

Jeff: Sure. We would love to speak with them for sure. If you’re interested in this and you think that this is tool that you’d like to introduce and offer to your clients, your patients, we would love to talk to you more about that. We’d be happy to arrange a call with Professor David Nutt. If there was, Something on the scientific side that goes above my head, which happens very often. I don’t claim to be an expert, we work with the groups and hire the professionals. But we, yeah, we’d love to, we’d love to chat their third way, for example, is a group that does a lot of psychedelics and talks about it. We’ve, We’ve been on many interviews with them and highlighting sort of our product and the benefits there that we see from it.

So there’s a lot of it’s starting to happen more to actually see more scientific studies with the mushroom as well and not just ourselves. So we’re excited to see that when we see third party studies coming out it just helps validate it . But yeah, we would love to speak with them. We have an Affiliate program set where if they introduce people there’s a way that benefits from that. about the legalities of your sector and how that works. And we’d also like to talk about providing some samples. If there’s an interest there and you’d like to try it, we’d love to get some samples for you and share it with your groups.

Bruce: And in terms of the word psychedelic, do you correct people and say that Amanita muscaria is not a psychedelic or like, what is there an advantage to kind of drawing that distinction apart from a psychedelic in terms of its effectiveness or effect on people?

Jeff: So it’s actually, yeah, it’s a great question. It’s not a psychedelic mushroom. We purposefully took advantage of the attention and moment that psychedelics were getting. , you know, When we went public to raise money, to raise awareness. And then about a year and a half ago, we really started pivoting as we recognized all the challenges that we were having.

The social media platforms, etc. even retailers. And the reality is our product is a wellness product. It’s not. It’s not something using in a recreational fashion for that. we’ve Really made a pivot, corporately, where we’ve sort of said, Okay, our identity, It was psychedelics and it was that because we needed the awareness, we needed eyeballs, we needed to raise capital and do that.

But once we completed our R&D and we moved towards having a product and bringing it to market, it didn’t serve us to piggyback on that. And so yeah, we really just sort of focus on the wellness side and how Amanita muscaria, and we talk about our AME-1 which is our proprietary extract. We actually talk about the Amanita mushroom.

So that people. Aren’t put off or, you know, because if you were to Google right now, still, you go into Google, Amanita muscaria mushroom, you know, that first page is going to talk about poisonous mushroom and, you know, all those reasons that people say, Oh, I’m not touching this. And as I did too, when my co-founder brought it to us, I said, are you crazy? We’re a public company. There’s no way we’re going to work with this poisonous mushroom. He said, Jeff, it’s been used for 5.000 years, there’s a safe way to use this. This is our opportunity. Let’s roll up our sleeves. Let’s do the work. Let’s make this happen. And so to his credit, he pushed us to do that work and allowed us to be that first mover and pioneer with it.

Bruce:  I guess a lot of compounds just get put on the back burner and then get a second wind based on some new data out there and publicity.

Jeff: Translate this into Russian and have it broadcast and there’d be a bunch of people saying, What is This guy talking about? This isn’t new. Like were picking it and, you know, making topical ointments and, Oh, for sure, you know, Siberian shamans used it. There’s a, lot of suggestion that the, the mushroom and the Siberian shamans are actually where the story of Santa Claus came from cause he would wear a red robe, generally speaking he was an elder in the community with a beard. And they, they would collect, it’s actually not the most, this story is a little weird because they would actually collect reindeer urine. So the reindeers, they would pick the mushrooms, hang them in pine trees.

And then the reindeer would chew them cause they liked the intoxicating effect that it gave them. But their liver would process the ibotenic acid. And then… The shaman would collect the reindeer urine, and then they would go around to the various villagers, and this would be part of their celebration.

Oftentimes in Siberia in the winter, when that would happen, they were snowed in, so they would come through a chimney. So, You start looking at a lot of these similarities, people go, oh, perhaps the story of Santa Claus with the reindeer and the man in the red robe. Joe Rogan did a really interesting podcast where he talked about that, and many similarities there are.

For our purposes, you know, we think it’s great. It’d be incredible if there was some tie into that, but it’s the fact that this has been used for, you know, 5, 000 plus years through ceremonial purposes. My grandparents used it and they would make a balm that they would put on it for a cut or, you know, if they had sore muscles, they would make this cream and put it on. We would make tea and drink tea. And so there’s, there’s a lot of historical use of the mushroom, which, yeah. Today, we talk about a novel. This has come to America, and we’re the first to bring it here.but there’s a long history of use of it, for sure.

Bruce: Well, I’m thinking this is probably some sort of marketing strategy for a stocking stuffer coming up soon for people. You could tie in some sort of interesting videos.

Jeff: we’re also, you know, we’re at a point right now, Bruce, where, from a marketing and a sampling perspective, , if there are any, any of your listeners who, who work with underprivileged, marginalized communities, you know, we, we do have a sampling program where we would donate, , units for that purpose. You know, Although it’s not, in our opinion, by comparison to the peer group in the psychedelic sector, it’s relatively inexpensive at 49. 95 a bottle,but we do recognize that that is still a prohibited number for some. And, so if there’s an opportunity where there’s some of your listeners perhaps that have clinics in those areas and they’d like to offer it and that they’d like to see, we’d be happy to have a discussion and see about donating some bottles, to that for that purpose.

Bruce: Interesting. It’s about the same price point as SAMe or L methylfolate and other, , well validated naturopathic supplements for mental health space.

Jeff: Yeah, we, we did our homework to make sure we were sort of in line, with other similar products in the space. , but again, you know, it is in, in times of inflation and, and such, , you know, we do recognize that there are some that is prohibited for, you know, we, we think everybody should have a sense of calm and a good night’s sleep. So we’d, yeah, we’d be happy to have a conversation about that.

Bruce: Any sort of new novel treatments that are out there that excite you, that you think are particularly interesting, that you’ve come across, even if you’re not an expert on it, something that you feel particularly interesting

Jeff: I’m really excited, you know, Obviously We’re We’re not exactly a psychedelic company, but we’re in the space and, you know, one of my board members, Nick Kadysh, runs a company called PharmAla Biotech, which is, they do clinical grade MDMA production and they use that, that’s sold and used in clinical trials.

And as we’re starting to see more and more countries open up for the use of MDMA, for example, you know, I’m very excited about that. I think that a lot of these compounds have been Treated as recreational drugs as opposed to medication. I think we’re going to see some very exciting things come through from the results of their studies.

And I think, we’re going to see a tremendous amount of benefit to, to patients who need that PTSD related mental health issues, traumatic brain injury. certainly you see, , a lot happening on the veteran side where, , there’s advocacy groups. pushing for it, where anecdotally they’ve used these compounds and they’ve had success and now they want to make it open for a broader audience.

So that to me is exciting because I think plant medicine. You know, it’s been around forever. We just commercially haven’t, you know, Big Pharma hasn’t been able to patent it per se and so it’s not been something that they’ve been focused on. But there seems to be a push and a change in the trends where, you know, concerns are looking for natural remedies to their health and wellness and, and even on the medication side when you want to go that far. So, I think it’s going to be exciting and, and that to me, I’m excited to be in the sector to watch it. Although we’re not directly in that lane, but,  you know, we see it and I think we’re going to see a lot of exciting things and people are going to benefit from it.

Bruce: You know, that’s absolutely true. There’s definitely a shift over the past five, 10 years of people who are interested in more naturopathic wellness options. Everything I do is really with the focus of trying to help patients and I started a, I had to keep track of all of these recommendations in a spreadsheet and I learned the most from my patients.

And, you know, I asked them how they benefited from that or how a medication or supplement had benefited them and put it into that spreadsheet. And it’s just grown over the last five years. There’s a lot of stuff out there that I never knew but, you know, patients are very good researchers when they want to be, when they’re looking for something that could be a, solution to their problem. And It’s like even though that, even though there’s not very many studies on something, you can always learn from a patient these alternative treatment options

Jeff: 100%. Yeah. Well, listen, I, I hope you put us on your list.

Bruce: Definitely. Yeah, it definitely will. Jeff, it was really nice talking to you. I really appreciate you being on today and telling us more about Amanita muscaria and how it could benefit people, the common side effects, how you process it, how you keep it safe. All of this background regarding the company challenges that lie ahead. And yeah, I really appreciate it.

Jeff: Yeah, well, listen, It was my pleasure. Thank you for giving me the opportunity to speak to your audience. I think it’s the first time that we’ve had an opportunity to sort of go the clinician side. So, you know, fantastic. Again, any of your listeners, if they’d like to get in touch with us, I’m sure there’ll be a link on your page, but we’d love to talk to you, and see if there’s a way that we can assist, , you learning about our product and, and also feeling comfortable with, , this as an option that you recommend because we, We know from our own anecdotal experience and what our concerns are sharing with us that has been beneficial. And we just like to spread the word and get it out to more people.

Bruce: Very nice. I appreciate that. Thank you so much for being on and, take care.

I’d appreciate it if you please like and share the podcast with your colleagues. It would be especially helpful for us. And if you’d like, please leave us a rating on your favorite podcatcher. If you’re a clinician, I developed a course on how to start a private practice. And for patients, I’ve also developed a course on ACT and CBT based lessons for treating and helping anxiety.

And you can find those all on our website as well. Thank you so much. And I’ll see you in the next episode.

 

Arnie: I always joke that I know what your diagnosis is after seeing somebody for a minute or so, and then they’ll say wow, what’s my diagnosis?

And I’ll just, say their name and say, yeah, John Brown, that’s your diagnosis. And they go Well, I said well, I thought I, you’re not bipolar disorder, you’re not alcohol dependence, these are things that are going on right now at this scene in the movie, but you know, you’re moving along, and that journey should be characterized by better understanding and returning a locus of control back to a person, rather than just ceding all this to other people around the professionals, and then I’m just a consumer.

Bruce: welcome to the Future of Psychiatry podcast, where we explore novel technology and new innovations in mental health. I’m your host, Dr. Bassi, an addiction physician and biomedical engineer. Today we’re going to be talking about those with chronic and complex illnesses in psychiatry.

Now I’m with Dr. Arnie Mech. He’s a psychiatrist in Texas. He provides neuropsychiatric care with a unique and holistic approach. He acknowledges the crucial interplay between mind and body, leading to a comprehensive and patient centered treatment plan. Dr. Mech’s practice thoroughly investigates the potential factors that influence symptoms, including vitamin and neurotransmitter cofactors, hormone levels, sleep patterns, ambulatory EEGs, and genetic testing.

This all comprehensive approach enables Dr. Mech to offer personalized treatments that support brain health and overall wellness. With a particular focus on addiction and attention deficit disorders, Dr. Mech is a specialist in dealing with complex mental health issues. His approach invites patients on a journey of wellness that spans their lifetime, grounded in understanding of their individuality.

Welcome Dr. Mech.

Arnie: Thank you. Great to be here.

Bruce: Tell us a little bit about Dr. Arnie Mech and how he got here today with this approach to treating patients.

Arnie: Thank you. Yes. I was very interested in medicine as a child. And I was interested in neurosurgery. You know, There was a program on television that focused all the medical drama, and it was all this excitement about being able to help people. When I got to medical school, I did a rotation in neurosurgery and it wasn’t very inspiring.

I did a rotation then in neurology, kind of shift over to something else, and it’s yes, the brain, excited about the brain but they didn’t seem to have a lot of great solutions. Like there are progressive, chronic illnesses that will, sprinkle a little steroids and maybe we’ll see what happens.

Then I got a chance to do psychiatry as a student and I thought this is great. And this is an opportunity to really treat the whole person. And a lot of times that person that you have in front of you is of course a member of a family. And they have family members that have similar issues.

And so it got to be really like a family. Kind of family approach and then a holistic psychosocial, biopsychosocial approach. And the idea of focusing on wellness, I remember riding my bicycle back and forth to the health food store when I was a kid, to get the latest healthy foods.

And looking at that in medical school, there was not a lot of focus on wellness and nutrition. So I’ve always had that as a strong interest. And it turns out that’s really very helpful. Other than just selecting, medication. 

Arnie: Medication is very important. Somebody comes with very difficult symptoms.

Getting that right medication. I’ve done clinical trial research for decades. That’s a great benefit for people. But then, that’s the beginning. What do you do for the next part and the next part? What’s your exit strategy? So when I was in training, we would say how long do you keep somebody on an antidepressant? They go well, you know, a year or so. And so then what happens? Then you taper them off and see if they, get better, stay better. And if they get worse you put them back on. Then what?

Well, Leave them on for maybe two years and then stop. I go this doesn’t seem like a very hopeful, scientific approach. Doing clinical trial research using outcome measures I thought was very helpful, getting information, listening to a patient, and then taking that and systematizing that into an inquiry that can be looked at with a pre interventional kind of state, and then in follow up to see are the things that we’re doing together helping or not? How are they helping? How much are they helping? And there are a lot of co occurring things, right? A lot of moving parts. I always joke that I know what your diagnosis is after seeing somebody for a minute or so, and then they’ll say wow, what’s my diagnosis?

And I’ll just, say their name and say, yeah, John Brown, that’s your diagnosis. And they go I said I thought I, you’re not bipolar disorder, you’re not alcohol dependence, these are things that are going on right now at this scene in the movie, but you’re moving along, and that journey should be characterized by better understanding and returning a locus of control back to a person, rather than just ceding all this to other people around the professionals, and then I’m just a consumer.

So that’s always been my interest and I set up the eating disorders program at the Menninger Clinic when I was there. And there was a lot of interest about nutrition again and so forth. At the same time, developed a program to help patients look at their nutrition. So we completely revamped the dining room at the Menninger Clinic.

We looked at fitness kinds of things that can be done. We had a prominent spa owner from California come and set up that part of the program. So this health opportunities program was then a clinical trial. That was the experimental condition. The control was another unit that was exact same range of patients.

At the end of the year, the incidence of difficulty critical incidents and so forth completely disappeared. It was low to begin with anyway, but the the difference being that looking what a person ate the kind of activity that they had made a huge difference about their wellness.

They felt better. They really embraced then some of the things that, that we were otherwise trying to do. So rather than doing something to somebody, we were working with somebody in partnership and then being able to say, yes, of course, who wouldn’t want to raise your level of wellness? So that isn’t necessarily always The approach in psychiatry, it’s a lot more about, here’s the medication and in addiction medicine, I’ve been boarded in addiction medicine, addiction psychiatry there’s a lot of opportunities to help the whole person, but again, it can be some programs, and training about more therapy and some are lean towards more psychopharmacology.

You want all of those tools in your tool chest And including TMS which I think I was one of the first psychiatrists in Texas to embrace that when it became available in the mid 2000s. So that’s all helpful, and but being able to try to identify what are the factors that are predisposing and perpetuating in a person, and then trying to get at those functional aspects not just, all right, we’ve got a kind of a standoff between the depression and the antidepressant.

We’re done. No. We’re just beginning, and so the idea of what was going on before? I always tell people, look, you weren’t always taking five medications. What’s going on with this? And and try to understand. So, The whole nutritional aspect and getting the pharmacogenetic testing has been very helpful.

The pharmacokinetic testing when that became available outside of research, we used that in research to see, Non responders characterize them and see perhaps they were rapid metabolizers of a pathway for a medication. And that’s all helpful when that became available outside of clinical trial research.

That’s what was genetic testing. So that’s fine. That’s helpful. But what’s what’s more interesting to me is the Pharmaco dynamic testing, in other words, looking at things such as MTHFR. So whether a person is able to prepare to methylate B vitamins and to have them be brain ready, that’s a huge thing.

I’ve done a lot of clinical trial research over the decades, but we, a lot of this has been investigator initiated. We did a study with people who had MTHFR polymorphism, so they had difficulty with utilizing B vitamins. and had major depressive disorders. So they got randomized to a placebo or to a methylated B vitamin.

At the end of eight weeks breaking the blinding, those people that were on the placebo, no change people that were on the methylated B vitamin had their mood improve. In fact, the effect size was better than a lot of clinical trials with antidepressants. And all they were getting was a methylated B vitamin.

Okay, that’s important. Otherwise, that was used methylated B vitamins one or two that first came out were used as an adjunct treatment. Well, If you tried, six or ten different medications and a person doesn’t respond, maybe add this to them. I looked at that the other way around to say why did they develop this in the first place?

Perhaps they’re elevated homocysteine because homocysteine can’t be converted to SAMe to all the neurotransmitters. Perhaps that was a predisposing factor. This elevated homocysteine… got to show up on the radar for cardiologists to say, okay if the inflammation is there for the heart, we want to get that lower.

So getting it to less than 11 was great, but we found that really for the brain, getting it to 4, 5, or 6 by using the methylated B vitamins and by looking at some other measures, that was a huge contributing factor to them improving and being able to discontinue sometimes some of the medication.

So, you know, The medication and tow truck pulling you out of the ditch, that’s great, you don’t necessarily want to stop with that. What’s wrong with my vehicle? What’s wrong with my driving? Where am I? And those are all important questions really when a person is looking at this. And so we can have that perspective, again, be something that is understandable and able to be utilized by each person.

So again, raising that level of wellness instead of pin holding and then somebody, okay, there they are, you’ve got this disorder and this now becomes your identity. And you have all the direct consumer pharma ads on TV. Ask your doctor if our drug might be right for you. Maybe you fit into our categories.

Oh, yeah, I fit in. Okay, now I’ve got four or five pharma. Maybe I’ll get another one. 150 vaccines, what do I do? It’s okay, so there’s a different focus, and that’s one of wellness. And that’s true, whether it’s, the physical, psychological, spiritual aspects. All these things are… better than, to me, just treating somebody as, you meet this criteria, inclusion criteria, you have this disorder, and now I’m going to treat that disorder, and now it’s better, and that’s all we have to do with each other.

To me, that’s pretty one dimensional, right? The person’s really wanting to say, how can I… I just talked with someone earlier in the week and they said, before looking at at some of these things, I had a tendency to get really upset at family members and just really just spoil the evening and just rage and so forth.

How much sleep are you getting? I sleep pretty good. What time do you go to sleep? Four in the morning. What time do you get up? About seven. Okay, so you’re getting three hours of sleep. It’s that’s not a lot of sleep. And no, I’m fine. I can get up. I just push myself. I get some coffee and…

Okay well, how’s that working for you? is there a different approach that could be done? We talked about some of that. He made some changes and I initially got him some medication that helped him with some of that short fuse, getting his fuse longer. But then doing the testing, the pharmacodynamic testing and seeing, yes, he did have MTHFR issues.

Getting methylated B vitamin was something that allowed that homocysteine level to go down. Homocysteine is a pro inflammatory amino acid and… In the brain, inflammation is really excitation. Too much excitation, all of this going on is overwhelming. And sometimes the other things that we see co occurring with that, might be somebody who really responds poorly to having a deficiency in omega 3 fatty acids.

Maybe they’re not sleeping well. Maybe they tend to look for some way to calm their brain down. And so that could be seeking all kinds of Self medication, other things that may be going on, but having the opportunity to say what could I be doing differently that might really be able to help me prepare my brain for the next day.

Arnie: So looking at sleep architecture is something else that I became very interested in. A lot of medications affect the ability for the brain to get into REM sleep or get into Delta slow wave sleep, N3 sleep in the beginning of the night. And those all have crucial functions. And so when somebody has symptoms. Why wouldn’t it be important to look at that, just like we would somebody coming in for a general physical exam. You’d want to check their blood pressure, their pulse, look at some general laboratory studies. Looking at somebody’s sleep architecture would be great. We even looked at fitness bands to see, okay could we find something that would closely correspond to the data we’d get in a polysomnogram.

So. Going to sleep, getting the full data collection in a sleep study. And then looking at how did that show up on the fitness band? Better than nothing, but difficult to distinguish between REM sleep and slow wave sleep. And they’re different things. People that abuse alcohol increase slow wave sleep.

That’s great. But then you inhibit REM sleep, and it fragments sleep all the way through the night, so you’re not getting that fortified periods of REM sleep with increasing length which is preparing you for the next day. Also increasing serotonin and crashing it then, along with that, so you’ve got multiple pathways that are going in the wrong direction.

Being able to know a person’s sleep architecture is important. So this fellow I was talking about said, I had no idea that this affected, how I was doing. I’ve been doing this for a long time. I’m cheating because I’ve seen thousands and thousands of patients tell me this, but it was really important information for him.

Just as it was for a family that came in. With a seven year old and said he’s just having trouble. He’s all over the place. He’s easily upset He just has no ability to tolerate anything. And so going through some different things Information and what about sleep? What time is it good asleep? He goes to sleep about 2 in the morning He goes to sleep at 2 in the morning?

Yeah, his dad doesn’t get home until 1 o’clock. So he likes to play with him . Do you have dogs or something else that you couldn’t stand in maybe? But being able to have enough sleep, not something I thought about. I said, okay, here’s what you’re going to do. Please, if you want this to look better, then why not do something, arrange a schedule differently so he gets his sleep.

So we did it, I came back in two weeks and said, he’s like a different kid. iN fact, we just realized that before his dad had that change in his work schedule, that’s what was going on. Okay, you have to ask about sleep, and it would be very easy to give him some medication and just to do that only.

Not that medication is wrong, but that if you look at more of a functional medicine perspective, why did that happen? And that involves circumstances family relationships stressors on the job at school, other things that may be going on. But then also that underlying biology if there’s some… genetic aspects that need to be supported. We’d like to know that. Okay, somebody who has extra excitation in the prefrontal cortex and has trouble managing stress, that increased anxiety is often converted to anger, secondary emotion, and then they have all this anger trouble. Well, they must have bipolar disorder. Well, maybe. But if you look at then those people who have that those kinds of symptoms and when you see that they have some of these genetic factors and you support that genetic biodiversity, then now that reduces the tendency to have symptoms develop, and now you have a better way of now working to integrate some other aspects.

Kind of hardware and software analogy with a computer, that’s great to have different programs, but if there’s a hardware issue, you want to be able to address that, maybe first. That’s the idea of looking at the wellness aspects of sleep, nutrition, and trying to incorporate that into a plan that involves more than just what medication should I stay on for the rest of my life, or how many medications should I stay on for the rest of my life.

Oh, by the way, the medication’s 1400 dollars per month, and that’s with insurance. Probably not a good plan. 

Bruce: We have an interesting backstory about how you got interested in psychiatry. Something similar happened to me with my background. And I started off in emergency medicine and when I would present a patient, I would, for example, say this patient ran out of their medications. They can’t get to the bus station because of their caregiver is no longer there. They’re like, Hold on. Hold on. Is are they breathing? What are the A. B. C’s it’s like they didn’t care about the actual reason. They just wanted to know all of the most important life threatening issues at hand. And if we had labs done, if we had a chest X ray if we ruled out aortic dissection and like the things that are going to kill the patient and I’m like yeah, those are normal, but this patient can’t get their medications and that’s why they came in.

And it just seemed like there was definitely a disconnect there between treating the patient and their social psychosocial issues as well as the medical issues. And I had pretty similar experience as you. For a clinician who is interested in maybe incorporating more integrative medicine into their practice, what would you suggest to them? Are there any sort of new, novel, exciting approaches there that they can incorporate that you’ve heard of recently? Or is it just the bread and butter? History and physical exam type of approach.

Arnie: Fortunately, there’s more than that, and I share that perspective there’s so many complex things that go on with people, and we, in medicine, tend to simplify things for the sake of trying to understand, but we can oversimplify very easily and lose focus on , the entire patient.

If there are, somebody is coming in, and if you don’t know anything about how they’re metabolizing medicine, you don’t know anything about nutritional factors, and you’re going to intervene without doing that would be like someone in the emergency department saying, We don’t need chest x rays. We don’t need CBCs.

They’re H and H. I don’t, care about that. We’re just, we’re interested in something else. Obviously, these things are very important to know. To me, the sequence of if you can do the little buccal swab and get back data within a week or so you can temporize in the meantime with medication to be able to help, reduced suffering, reduced symptoms, and so forth. But then, the next step ought to be to look at that, present that information, discuss that, and develop a plan to address anything that seems like an obvious opportunity for improvement. And that would then also be accompanied by then looking at sleep aspects that could improve sleep.

Arnie: For example, I have people I just saw somebody yesterday who incorporated Omega 3 fatty acids into their supplement plan. Before that, they took a multiple vitamin. I’ll get to multiple vitamins in a second. But they just had no idea that they needed Omega 3s. We 35 percent dry weight of the brain is docosahexaenoic acid Omega 3s, and but the other Omega 3 subgroup, the EPA, the eicosapentaenoic acid is a very calming effect in the brain, so when people can, if they can get a supplement that is a 4 to 1 ratio of EPA to DHA, take that, and do that in a therapeutic intervention that can a lot of times reduce some of the difficulty with sleep onset latency sleep discontinuity, and then that can help them have a better opportunity to respond to whatever else we’re going to think about. And then looking at some of that, I said, okay perhaps we need to get some blood studies. And so I looked at for one trial we did, we had people that had the MTH of our polymorphism. And so we treated that, but they also had difficulty with sleep.

So on the fatigue assessment scale inventory development mid 2000 , out of 6 different inventories only those things they had to do with … mental fatigue make the cut so in this people would have 2 or 3 times as many symptoms of fatigue also we look at being able to measure the RBC membrane component made up by omega 3. If somebody’s low in their the amount of Omega 3s in the RBC membrane. That probably corresponds to other organ systems.

Like, what about the neurons? We’re not, doing any brain biopsies, but I’m being able to look at, okay if they’re low in that, let’s supplement them with the EPA to DHA high ratio Omega 3s. And sure enough, then, that led to an increase in the RBC Omega 3 membrane component and led to a dramatic decrease in their fatigue.

On the fatigue assessment scale, they look normal. What did they have? They had methylated B vitamin, and then they had the omega 3 EPA DHA high ratio. That’s great. Okay, then, so we want to look after those things. What if somebody’s low in magnesium, they have trouble, calming down, going to sleep?

Okay, then supplementing magnesium can be a benefit. You can’t do the same thing for everybody, You can’t take uh, one approach, well this is good for this symptom. Two people could have the exact same symptom set, but have arrived at those symptoms in very different ways.

Even though they look the same they have other things that are underpinning that we need to understand individually. And that’s really the importance of functional medicine and individualizing that approach. We don’t treat people as diagnosis, we treat people as people seeking a higher level of wellness.

Bruce: Yeah, you mentioned a number of concerns there for people to investigate and check out. What would you tell a patient who has seen numerous doctors and they can’t come to A diagnosis, I know there’s more to a person than a diagnosis, but they don’t know what’s causing any of their symptoms, they’ve been bounced around, they have maybe a variety of different issues that are all contributing to their fatigue and malaise and body aches, maybe chronic pain issues.

What do you think our healthcare system needs to do better at treating these types of individuals who have these issues?

Arnie: That’s a great question because a lot of times the easy things don’t come to us as specialists. Obviously, we see complex situations where people haven’t been able to get a diagnostic understanding. And there’s nothing wrong with the diagnosis. You just don’t want to use that diagnosis and replace the understanding opportunity to understand the patient with that diagnosis.

But not being able to ask the right questions leads to maybe a smaller chance of being able to understand that etiology, that evolution of the symptoms. Being able to, in the emergency department, okay, you’d get some blood work, you get a chest x ray, maybe some other things, depending on what’s going on.

If we never look at genetic biomarkers. If we never look at or ask questions about or measure the quality of a person’s sleep if we just miss those things, then we’re going to miss opportunities for improvement and probably aspects that have been contributing to developing those symptoms right along.

To me, The diagnosis we’re trying to reach was preceded by several steps of things that were going off. So you get off kind of the, the GPS kind of coordinates. You’re going off the wrong direction, wrong direction. You don’t necessarily end up way off right away, but over time there are things that maybe if they could have been known it would lead to something other than just the gradual development of a full blown… Illness that has to be diagnosed. So of course we want to diagnose it. But we need to ask the right questions, sleep quality, look at genetic biomarkers look at blood work. So in psychiatry, most psychiatrists don’t get blood work. They might get a level, I mean I remember having discussions with the managed care review person I remember with they didn’t want to approve sertraline at a level of 300 milligrams a day because we’ll be… on label dosing that was done in 1990 or so was up to 200 milligrams and shown it was safe and effective and that was it. And for six year olds, up to 200 milligrams. I said, this person was a rapid cytochrome P450 2C19 metabolizer and their level was low, their sertraline level was low, and we looked for that because, of course, they weren’t responding.

We had this genetic, consideration we could look at and then we measured their sertraline level and it was like… Crickets and the farm D working for the insurance company said, you can do that. I said, yes, we can do that. And that’s not always done, but yes, we can measure blood levels of medications because everybody’s different.

Of course, there’s a difference between what’s on label. And if you’re, a pharma company, you can only talk about. What you’ve demonstrated in clinical trial research to be safe and effective and have FDA approval for same and that’s great and it should be the way it is.

But if you are treating somebody, if they’re not responding, you don’t want to give up too early. Perhaps there’s a reason why that medication is not working. Are they getting an adequate level? If we just… Throw out all the people that aren’t responding without asking any questions. Then maybe we miss the opportunity to use something.

It would be very helpful. But we have to ask more questions. Asking the right questions leads to a better understanding diagnostically. And then say, all right, now what do we do for an intervention and treatment approach? We can do that better by knowing who that person is. And, all right, they ended up getting out of that 200 milligrams.

When they’re metabolizing it five times more rapidly as an ultra rapid metabolizer they’re getting one fifth the blood level, right? 40 milligrams is not usually the effective dose for so often. That’s that’s a an approach. And in primary care clinicians will, of course, start with a medication that they’re familiar with.

For, I’m talking about for psychiatric say depression or anxiety. And then they’ll start with a starting dose, and maybe they’ll go a little bit more, but they’re, That’s not their area. They’ve got to do all kinds of other things at the same time. They then typically refer, right? So refer to a specialist and the specialist is typically used to seeing people that don’t respond to the starting dose.

I rarely see people who are slow metabolizers who responded great at just the starting baby dose, if you will. And that’s great. You want to individualize treatment. That’s perfect. That’s why you would start at a low dose because you’re going to find some of those people. But there’s a lot of people who have these kinds of contributing factors that MTHFR difficulty. Activating B vitamins is something that 80 percent of people we see have, 80%. That’s higher than the general population. But the kind of homocysteine theory of contributing to depression not that everything is all one approach, but if there are 80 percent of people that have trouble methylating B vitamins, and they end up having high homocysteine levels, And you don’t even look at that and don’t ask the question, but you just do one serial trial after another of antidepressant medicine.

Maybe then there are people that don’t respond, and maybe those people have something else going on, a question that needs to be asked that hadn’t been asked. And that’s the idea of trying to… Characterize somebody better, but doing that earlier, I always joke that when parents leave the hospital with their newborn, they should, here’s your owner’s manual, right?

You should have all these things. We’ve done this by this genetic characterization. You want to, and these are not the things that people are afraid of. There’s a lot of fear about genetic testing. I don’t want to find out I’m going to die three days after, the full moon or something. No, no, no, no.

These are things that have to do with knowing that if you have someone who has, and this is a family issue MTHFR. You look at a family that has somebody who’s depressed. Okay you get the testing, that they have the say C677T, the Allele that problem with being able to utilize B vitamins, you only get not 100 percent of, say, a perfect, we used to get B12 and folic acid levels, of course, that’s great, but what if they can’t utilize what’s there?

They may only be able to utilize 70%, or 50%, or 35%, or 5 percent if they’re heterozygous for those two alleles. That is something that should be asked, because it’s so prevalent, right? Once you know something, it’s hard to go back to not doing it, right? Once you know that you need to have clean drinking water, you don’t go back and say, Oh, I want to care about the sewage.

No, you want to be able to make sure that you utilize all those things. Then you build on that and you get better. What’s the best practice you build on the information that you’ve gleaned from others. And I’ve learned most of what I’ve learned from listening to patients. Patients will tell you.

This is what my story is. And then my job is to think with them. So from a medical perspective, what are some things that we could understand? Or questions that we could ask maybe. to be able to then have a better approach at getting some answers that’ll make a difference for them. Again, give them more of an internal locus of control about their wellness.

Bruce: Let’s talk about the concept of a diagnosis for a second. We know that a diagnosis has a purpose depending on who’s considering it. An insurance company, they need it for billing issues. The clinician, they might need it for making sure that we’re treating the patient appropriately for that diagnosis.

And the patient themselves might find it useful for validation, for clarity. for understanding more about themselves. But, a nosological category for a particular set of symptoms, obviously, has some drawbacks to it. There are people who we all know that bipolar exists on a spectrum, as does numerous other psychiatric disorders.

We also know that certain medications for the treatment of one disorder can also help treat another disorder. Even though they’re not FDA approved and so we can use them off label. What is your perspective on the dilemma of a diagnosis and what do you tell patients about the purpose of a diagnosis for your patients?

Arnie: that’s a great question. To understand what’s happening, we certainly want to utilize our medical experience, expertise, training to come up with a diagnosis and that’s, it’s just not the end. That’s important, that’s the beginning looking at that and so in clinical trial work we use outcome measures and we’re looking at the, does a person have symptoms of depression?

As measured on a Hamilton Depression Inventory or a PHQ 9 or whatever you may look at however complex that may be, but That helps them to be able to say when we see new people, we use about a dozen inventories. So we’re having these inventories and we’ll go over that with people and say, okay, so you have this, tell me more about that, tell me more about that.

So you get, it’s like having a a structured interview before you ever see the person. So they’re being able to wax lyrical on all of the things that are going on that they’ve experienced and then My job is to integrate all that information and say you’ve got elevated scores here and here, so it looks like you have co occurring episodes of major depressive disorder based on the history and here are these inventories supporting that but you also have co occurring anxiety, you have an elevated anxiety and by the way, then you have an elevated fatigue score.

So what about your sleep? Ah, I sleep okay. What is that like? do you feel rested? Do you feel like you have restorative benefit when you wake up in the morning? No, I never have that. Okay a lot of times people have given up for, the quest to try to say, I would like to jump out of bed in the morning like I’m eight years old and go, Yay, it’s great, what a great day.

Maybe there’s some things standing in the way that we can understand so that we could get people, closer to to something that is, is attainable, but we have to ask the right questions. I like clinical inventories to help then guide my… Inquiry, when I’m talking with people, listening to their story, but then at the same time I’m formulating, an understanding in terms of So that, they have this theory that’s related to this, I wonder about this, I wonder about that.

Then I’m going to pursue some investigation by looking at the genetic testing, looking at some blood levels of things, perhaps. And and then be able to ask the right question, and then have more information. And then be able to say whatever levels there are of those things to be able to over time.

I like using a a graphic so that you can see somebody’s mood is down here and is depressed. Every time, the first visit, and the next visit, next visit, next visit. Now they’re, you know, in a normal range based on what they were doing. So they get some kind of sense of how am I doing?

That’s how you’re doing because it’s hard to say, Hey, how you doing? I’m fine. That’s, there’s so many complex things going on, you have to really have a chance to understand that more and break that down. And that’s what inventories can do. And most psychiatrists don’t use inventories. I’ve traveled all around the country talking with physicians about the use of inventories. It can be helpful not just in clinical trial research, it can be helpful just in clinical medicine. And having that kind of partnership between the patient and the clinician to ask those questions, to understand more, gives a better way to to get that complexity, that more finer grid understanding.

Other than, oh, you’re depressed, you have anti, you have major depress disorder, here’s an antidepressant. We’re just going to throw things against the wall and see what sticks. Okay, that’s so 1970s, right? We want to be able to have something that’s a little more nuanced, something that’s 2023. So being able to have those ways to characterize people, with getting their history, getting those symptoms, coming up with a diagnosis based on evidence and inclusion criteria.

So whether it’s DSM 5 or ICD 10, being able to look at those things that characterize, okay, this is a diagnosis. The question is, why do they have that diagnosis? We never know, it’s just family history. It’s a genetic, it’s genetic. There’s genetic predisposition, but there’s also epigenetic interventions, things that can be done to help mitigate that risk or help improve the opportunity for somebody to really have a fully developed capacity that’s something positive.

That’s, that comes from me asking the right questions. And I, sitting down with a legal pad saying, tell me about your mother is a, that’s one way, but it’s not a very efficient way. It’s just a it doesn’t really help the person be able to give the right information that could then be used to say it looks like we’re ruling this and this up, but they do have this and this area, so let’s look at that more.

And then perhaps look at an EEG, an ambulatory EEG, somebody that has. Periods of time where they have mood changes and sometimes they have maybe history of absence seizures, petit mal seizures or something as a child in school. And then looking in at a EEG can give us some, a clue that there’s something else going on there.

Bruce: tell us more about an ambulatory EEG. I would say vast majority of psychiatrists don’t order that. If they suspect a neurologic issue, they’ll refer to neurologist who would order, an in-lab, EEG. Tell us more about an ambulatory EG. How do you order that kind of referral? Would you give, and what kind of data does that give back and who would you order it on?

Arnie: Yes, great question. well, You’re right. If somebody has a neurologic problem, it makes sense to send them to a neurologist. The trouble is this is the integrative medicine aspects. So this is the, the American Board of Psychiatry and Neurology for a reason, right? So these are very related specialties.

If it’s a neurology problem, okay, they’re maybe they have had a stroke or something. Okay clearly that’s a neurology issue. If somebody’s having depression, okay that’s clearly a psychiatric issue. What if somebody’s having, irritability or having outbursts? and so forth. If you send them to a neurologist, they’re going to do a neurologic exam and say, okay, it’s normal and may, order some, a few biomarkers to see if they have any elevated issues and say, no they’re okay. But they still have the symptoms. So that didn’t get them anywhere in terms of any, gaining any understanding.

So integrated medicine would have to do with, in this situation, what is an EEG going to show? It can have 8 on the Richter scale and having a, an ictal event and that’s an obvious thing, that’s a neurology opportunity for improvement and understanding why they have the seizure of course but what if they have more subtle findings?

If they have 8 seconds here and there between say N3 sleep and then getting into stage 2 sleep or so, and you see this left frontal temporal sharp wave activity going along and a couple of sharp deflections. That doesn’t show up as any kind of generalized seizure or motor seizure or something.

That’s just interesting finding. Oh, a lot of people have that. Yes, but do those people also have these other symptoms that we’re looking at more? Because again, neurology is looking at a different frame of reference. So it’s like, how do you understand something? You want multiple frames of reference.

You want to be able to characterize that as best you can from a lot of different perspectives of understanding. All valuable, potentially. But in this instance, I use that when people have… They have mood swings. What are the mood swings? They just get really frustrated and they just, just lose it.

Okay. When does it happen? Did they have a history of head injury? Yeah, they had a couple concussions. In fact, they had eight concussions in high school playing football. Okay, that’s a clue. Did they do any studies at the time? Yeah, they did a CT scan to see if there was any bleeding and there wasn’t a cortical bleed, so they just was the end of it

Okay, but then the person since then maybe has had difficulty regulating their emotional response to frustration. Doing the ambulatory EEG looks at 72 hours. 20 leads. It looked at 200 times a second. And if there’s all normal, there’s nothing there, that’s a very fine… grid fine tooth comb to look for something, but oftentimes we see with those histories something that’s there, those little, that sharp wave activity.

Then treating somebody, of course, with an antigen bolts, and there’s nothing else there. The neurologist says, I don’t, they don’t have a seizure disorder. Oh, those are just epileptiform discharges. There’s nothing there. Okay. There’s nothing there for you as a neurologist, but there’s something there for me as a neuropsychiatrist.

So that’s the kind of way in which we would use that and refer that to a neurologist maybe to get that done or we’ve done that ourselves in the in the practice. And then the key is reading it so that you see everything. You don’t just look for the, the 10 out of 10 kind of events.

You want to look at the entire thing and make sure that each. Those opportunities to consider if they’re there and then treating somebody and now they’re better and you look at the EEG and now it’s normal, I think that’s helpful information.

Bruce: So, for the individual who has irritability after a concussion, what do you do with that information next? What kind of treatment might you suggest for them?

Arnie: It’s a great question and that happens a lot of times. People can have concussions and have, again, same thing, have identical sets of symptoms but got there in a different way. Before the and I’m thinking of an adolescent that had a concussion and before that. Everything was fine. That was the initial history, but everything wasn’t really fine. There was some other trouble there with short fuse, trouble with frustration tolerance. After the concussion, that magnified. So then that became that this is what’s gone on after the… But there was something else there to begin with.

So then looking at the MTHFR, okay, the person is heterozygous for the C677T and the A1298C. mutations together, dropping the most severe genotype, dropping the availability of B vitamins, and homocysteine way, way, way elevated. So that was there before the concussion. So then now the concussion’s here, and so what do you do?

Treat them with the methylated B vitamins, and then utilizing the EPA, DHA high ratio omega 3s, that’s helpful. And then looking at their sleep. Do they have enough delta slow wave sleep where the body is sending out stem cells to do reparative work. I’ve seen people who’ve had, one patient who’s had a persistent coma for weeks and weeks, and after a motor vehicle accident, she actually fell out of a vehicle.

And so then after that, she was not herself, was irritable angry, family members just, ugh, that’s just the way she is. Looking at those symptoms, doing an EEG, seeing that she had that sharp wave activity, And then treating her with Omega 3 fatty acids and also with an antidepressant.

Serotonin, dopamine, and reuptake inhibitor, which is… Sertraline is the only one that does that. You have to get the right level though, the right blood level to get the secondary binding affinity for dopamine to come in. And her symptoms dramatically resolved. In fact, they said we have her back. She’s the old, Mary.

And so that’s that’s great. It’s wow, okay. What do you think about that? I think we should do more of that, right? We should look for opportunities. When people give up and say there’s nothing you can do. Now, I, I think we need to look for something, other things that we could do, and then that’s the idea

Bruce: You mentioned when we were first talking about the importance of coming off of a medication. I don’t think that’s something that’s emphasized very much in training and mentorship and it’s probably one of the key. Important factors on a patient’s mind when they’re starting a medication, and I think it could lead to polypharmacy, it could lead to med, drug interactions, they can also build tolerance to that medication, and before you know it, they are on 10 medications and they don’t really know what the purpose of any of them is for the individual who has found benefit to a medication, they’re not having any issue with it necessarily, no side effects. What would you suggest for patients and clinicians about when they should think about coming off of medication? Let’s take SSRIs, for example, since they’re so commonly utilized by our audience.

Arnie: Sure, and so SSRIs, are helpful. Before SSRIs, people were getting tricyclic antidepressants, and if you take the entire bottle, then you have a widening QRS complex, have an arrhythmia and die. That’s bad, and so now you could take a whole bottle of fluoxetine and be okay. That was a safety thing, people got, all right, we do SSRIs. The trouble though is that when you have the unopposed increase in serotonin, the raffinucleus has input into the ventral tegmental area that’s inhibitory. A lot of times what you’ll get is this is great, okay, now they have improvement, but then what you’re noticing over time is maybe they start to have some other things that are developing.

Lack of initiative, motivation, drive libido task initiation, task completion. So you’re almost inducing some of the… Executive function deficits that people would have with adult attention deficit symptoms. And that’s because you’re causing this kind of this depletion. The other thing is, again, it’s not just somebody who’s depressed and getting an SSRI.

Who are they? I mean, What’s the best treatment for me? People will ask me, they’ll go, wait, dude, who are you? We want to be able to know what is there that we can characterize about that person. And if we if we just give the the medication only and we don’t really look for these other kinds of symptoms, we might miss the opportunity to to do something else.

So I like the idea of balancing. And this was called when this increases and decreasing Doping was Prozac poop out. Okay, Prozac poop out was described as, people do great on Prozac, then after a while, they’re not doing so well. Yeah, because you just, you suppress their dopamine activity into the basement.

It’s really not not just what goes on initially, but, and it may be fine initially. Yeah, it’s okay. initial intervention, perhaps, for some people, but what if they break down dopamine more rapidly? So their COMT genotype is really important. If you look at people who 50 percent of the population are looking at alleles characterized by methionine and valine, they’re Valmet, so they have that pairing, and that, let’s say, is 100% dopamine level.

People that end up being Valmet end up being a Val Val, they break down dopamine more rapidly they end up having only 60 percent of the amount of dopamine potentially. And let’s say they get depressed, and they get put on an SSRI, and that works for a while, but they’re already potentially set up to have a deficiency in dopamine activity.

Not always, but they could be. That’s something you’d want to think about, and not necessarily just let that go too long without… looking for what’s the next thing that can be done. So that’s the idea of looking at a more integrative health functional medicine approach, what are some things we can do to increase wellness that perhaps would now allow a person to be able to get off of some of those pharma interventions.

And then the flip side, there’s 25 percent of people who are at MedMeds. So they have… Increased levels of dopamine, so you don’t necessarily want those people to drink a lot of coffee. So the methylxanthines caffeine, theophylline, thebromine will cause them to be more tremor or have migraines or other kinds of things.

So they’re vulnerable differently because they have a different genotype for regulating catecholamines. So it’s important to know that. Once you know that, then that can be something that can be utilized. We also have done some studies with vitamin D. And looking at vitamin D is a cofactor for the synthesis of dopamine, for tyrosine hydroxylase and the rate limiting step of dopamine synthesis.

So if a person is low in vitamin D, really low in vitamin D, stays there, okay, you get rickets. 1920, you figure out, okay, let’s put vitamin D in the milk, vitamin D milk, and let’s get it up above a 20 nanograms per milliliter 25 hydroxy vitamin D level. The brain is a kind of high maintenance organ.

It needs a lot more. Being able to supplement that when we had people low, they did better with their depression. In fact, we measured depression scores, keeping everything else constant, and then giving them 10, 000 IUs of vitamin D. 10, 000? Yeah, that’s what you get if you’re in the sun for half an hour, lightly pigmented skin.

Or, darker and darker pigmented skin, it may take as long as six times longer, three hours. It just depends on who you are, the kind of treatment you get. Looking at the incidence of colon cancer in people at higher risk, African Americans, other high risk groups. If you got the level above a, not just a 20, but a 30 or 40 and higher dramatically reduces the risk of colon cancer in those people in that population.

So that’s good but what about the brain? The brain is more high maintenance and you need to get that up higher. So being able to get that up to 60 makes a huge difference. So a lot of times people can at that point get off of their initial SSRI intervention because That was a contributing factor for them.

Not necessarily everyone, but it’s for a lot of people. So same thing with the, winter blues and, seasonal affective disorder symptoms, people in Anchorage or Minneapolis or what have you, a vitamin D. So that’s a huge thing. And then we did, swallowing, the old vitamin D2, 50, 000 units orally once a week to then D3.

And then how, okay, using 10, 000 as a swallowing, as a PO. Oral form of the medicine, or of the supplement rather and then comparing that to an oral dissolving tablet. The tablet actually did better for people in terms of their depression. So we looked at that and go to that. And then we looked at vitamin D liquid versus the oral dissolving tablet and stay in the mouth longer, make full access to the oral mucosa and not have to go through first pass metabolism through the liver. Those people did even better. We presented that in European Congress on Neurosurgical Pharmacology. And in Europe there’s a lot of interest in these kinds of things, right? Looking at things that are perhaps not just pharma interventions but things that could be dietary supplements and other things that would be helping certain people.

It’s all about who, you can’t give something to everybody vitamin E you might, but you can give targeted interventions really a very better, A much better approach if you know who you’re treating, and that’s the idea. So SSRIs are great maybe to start with but you need to make sure that you’re getting enough of it. And then make sure they’re not starting to develop symptoms of dopamine deficiency.

Bruce: On the topic of SSRIs, let’s talk a little bit about PSSD or post SSRI sexual dysfunction. What are your thoughts on that? Do you have any integrative suggestions for an individual who continues to have sexual dysfunction after stopping the SSRI? Most typically anorgasmia, low libido difficulty having any sensation during intercourse.

Um, What are your thoughts on PSSD?

Arnie: Yeah, I think it’s a, it’s an interesting symptom that is, fairly common. And then getting, having the intervention of the serotonin enhancing drug. Okay, that’s what’s going on, so let’s get off of that. But it doesn’t necessarily, these are systems in the brain that are changed by whatever you’re doing.

So it doesn’t, it’s, the intended effect isn’t the last effect, so there are other things that go on, so taking that out of the way can still leave residual effects, and so looking at that and doing things that would enhance dopamine so for example, getting a 25 hydroxyvitamin D level, and if that person is low push the dose up higher.

What will that do? That will tend to increase some of the opportunities for improvement in people that have post SSRI sexual dysfunction and then having that be now something that’s maybe in their daily regimen for what they can can do. So that’s an example. And then getting enough sleep, again, repleting sleep.

Some medications will inhibit REM sleep and afterwards they’ll still have REM sleep inhibition and SSRIs will do that. So being able to have enough time for REM sleep to restore, doing things that can improve On that for example, alcohol, people drinking alcohol, say, okay it’s fine, I’ve always been drinking some.

But you’re always inhibiting REM sleep, and now you’ve got these symptoms, that had to do in the aftermath of the SSRI treatment. Lose the alcohol certainly lose the alcohol later in the evening, so that, if you’re doing that at lunchtime, it’s probably not affecting the sleep architecture as much as if you’re doing it at 11 o’clock at night, and then, going off to the bedroom.

So that’s those are things that, it can make a difference trying to characterize the individual predisposing factors. Again, thinking what happened before the symptom

Bruce: you mentioned the importance of genetic testing and you drew the distinction between pharmacokinetic testing versus pharmacodynamic testing. And I think a lot of patients think that when they do genetic testing, generally speaking, they’re going to know which medication they should be on in terms of effectiveness.

And from my understanding, other than the MTHFR. Genetic tests. I don’t know if there’s many other pharmacodynamic tests that get done. Unless maybe you can educate us if there’s any others that are tested for that help draw a conclusion about efficacy.

Arnie: Great question. So yes, there are and So the MTHFR we talked about that’s obvious and that’s a huge effect So again 80 percent of people we see in our setting I have MTHFR polymorphism. So Okay, that’s one thing. What about what other than that? Exercise affects the brain a lot.

People have known this for a long time. Looking at the effect of of exercise on mood. And that’s great. But exercise also has effects on on sleep. And it also has effects with certain people differently. Differentially, it’s good for everybody. However, there’s a certain slice of people BDF, Brain Derived Neurotrophic Factor the gene that has to do with this question.

If you have somebody that shows they’re either hetero or homo for this this defect or variation, if you will, then if they don’t exercise and they do everything else right, they’ll have some benefit. But if you’re heterozygous or homozygous for that variation for the brain derived neurotrophic factor gene.

Doing exercise, doing cardiovascular exercise and strength training exercise can make a huge difference. There was a study, back a few decades ago with women looking at strength training increasing bone density. Okay, so that was shown to be helpful. But a secondary outcome with that was that women who were depressed got better.

It’s oh, okay so exercise makes a difference for those, and this was strength training exercise doing cardiovascular exercise and doing strength training exercise for people with that BDNF, either heterozygous or homozygous variation makes a huge difference. And so sometimes they can get off of some of their medicine because this is now what they’re doing.

Ah, I feel great with this. And they get that excitement that comes from recognizing they can do something and have control over something that can restore. The way things used to be when they were, before developing the symptoms. So that’s another psycho dynamic gene to look at. So brain derived neurotrophic factor, BDNF.

Another one is uh, CACNA1C. So this has to do with prefrontal cortex calcium channel activation. So there are people who have a higher level of stimulation, activation, excitatory activity in the prefrontal cortex. Those people, if they’re deficient in omega 3s, are really predisposed towards anxiety, difficulty sleeping, and maybe irritability, poor frustration tolerance, and pulse control.

Giving those people omega 3 fatty acids that are high in that icosapentaenoic acid so that 4 to 1 ratio, that makes a huge difference in being able to do well. We did a study in with kids that had ADHD and looked at fatigue. Kids don’t have trouble sleeping. Kids do have trouble sleeping.

Some of them have trouble getting restorative sleep. And looking at those kids with ADHD and giving them omega 3 fatty acids with that high EPA to DHA made a difference over just regular fatty acid, just a kind of one to one ratio. And that was something that I presented that at the adolescent psychiatric scientific meaning.

So that’s something that looks at There’s always maybe more complexity than we can appreciate, right? We only know a little bit. It’s the tip of the iceberg that we have as understanding, but so that’s another gene that has to do a lot with predisposing people to Anxiety, trouble sleeping, depression, irritability.

So if they have that increased excitation and they have MTHFR polymorphism Now they have two things going on. Now they have more homocysteine. Now they have a lot of excitation going on And then they’re not sleeping, and so they’re not getting that restorative benefit of sleep. So now they have a lot more difficulty during the day. 

SLC6A4 is another serotonin receptor gene that if you have a certain genotype like that, someone will likely do well with SSRIs. If you don’t, then maybe not so much. If you know that to begin with, you can then choose a medicine that’s more likely to work. But also at the same time again, somebody’s not just one gene, just like they’re not one diagnosis.

So we have to look at all this together. And so it can be very interesting if they, or a met genotype, and they have all this dopamine going on, and yet they’re not sleeping, they’re going to be short fused, irritable, because you have all the stimulations, like having your accelerator stuck, and you’re trying to navigate down a side street, and almost side swiping the cars as you’re going by, that has to be offset with, again, the omega 3 fatty acids. Huge difference from met, COMT genotypes if you are able to use that omega 3, the EPA omega 3. And there are many more like that, but there’s, so that’s the benefit of looking at that and starting to study that, because we have begun that process.

There’s so much more to do. But there are a lot of those kinds of things. These are like the keys to wellness. What are some things this person maybe can do? Let’s… help them in that way. Let’s address that one factor and see if that improves things. Great. Now, what else can we find? There’s a, it’s, you’re never wanting to rest on one gene.

Are there this genotype there for where you got the answer? No, there’s no gene for depression. There’s no gene for This, that, or the other thing, there’s a combination interplay, a complex interplay between genetic predisposition and epigenetic factors which either make some of those genes more likely to be expressed or some not to be expressed.

And that could be either for positive outcome or for negative outcome. That phenotypic event is underscored by that what, what got there? How did they get there? Understanding that the predisposition and then having the epigenetic interventions. And that’s what we do as physicians, really.

We’re doing epigenetic interventions all the time. We just don’t think about it that way. We look for people that respond to increasing serotonin. We look for people who respond to something else. People who have obstructive sleep apnea. A small percentage of the population. It’s a great benefit to… Treat that, to do that with CPAP or whether it’s elevated or oral appliance or stimulating the hypoglossal nerve with a stimulator. But there’s 63% of people that have disturbed sleep architecture every night, and that’s not because of obstructive sleep apnea. So what about 63% of people that need improved sleep? We need to be looking for these kind of factors, and that’s what I’m thinking would help reduce the incidents ultimately of some of the psychiatric disorders.

Bruce: Let’s talk about diet for a little bit because you mentioned the importance of supplements. I think if we go upstream, it’s probably important to talk about what is a good healthy diet to, to have. And we grew up with thinking about the food pyramid and since then, there’s been just so many studies about what your diet should be and what is the best diet to lose weight and the Atkins diet, the Mediterranean diet, the paleo diet, there’s just a million of them.

I think it leads to a bit of confusion and frustration and also patients are probably like, well, they don’t really know what they’re talking about, because there’s just so many diets that are all competing for the public’s attention. But what do you recommend to patients? Is there any new data there that we can help use to guide them? About proper diet.

Arnie: Yes. And I’m going to sound the same alarm that by not knowing a person’s genetic makeup, it makes it difficult to make recommendations. For example, if someone needs Omega threes, it’s not just getting Nordic natural Omega threes and swallowing the supplements as good as they are. But those people really need to have more Omega threes. What should they do? They should be able to consider that if somebody has an overbalance of pro inflammatory omega 6 and under representation of anti inflammatory omega 3s, perhaps getting it back into balance would be An important intervention that that could be done, so it really has to be more complexly thought of in that way so there are there’s just a lot of of interplay, I think, that that can be helpful, and we have to ask the right questions, and to me, it’s, , we can’t stop, but, We have to always look at, is there something else, I wonder about these other people that there was nothing else to be done for.

So for example, when people have been diagnosed with bipolar disorder, okay, they have bipolar disorder. And there’s a family history, so they’re going to always have bipolar disorder. And the thing that characterizes them is bipolar disorder. What do you call when people have mood instability and then you identify some of the genetic factors and treat that and Eventually tapered to a lower and lower and lower doses of medicine, which were very helpful to begin with But now they no longer have those symptoms.

A spontaneous remission? Not bipolar disorder?. So people develop syndromes and disorders But they do that gradually so again thinking of that long process There are things that could be thought of that are dietary interventions that might be better. So the standard American diet, for example with all carbohydrates, that’s not a good thing.

We’re made to be flexibly metabolic. The brain uses glucose, yes, but the brain also uses beta hydroxybutyrate. So BHB is very helpful, but you never get any because why? We don’t break down fat, we store fat because we always, like a hybrid vehicle, we always have carbohydrates available, right? So we never switch over to that other circuit of of utilizing beta hydroxybutyrate, but that’s something that causes a change with people that that diet helps, so having, the whole, now this is, I think, in vogue somewhat, intermittent fasting there’s always some kind of new thing that’s as you’re saying, that’s, eat this way, eat that way, but for thousands of years, cultures have used fasting, intermittent fasting.

Having certain days of the week that they would fast, right? Why did they do that? It’s just some kind of genetic, or… No, wait, they would never say that. They’d say some kind of religious something. And what if it’s both? But yeah, so that’s that’s another factor is being able to think about food. As supporting certain genotypes, why do people do certain things? It may be a cultural aspect to it, but there may be some biologic underpinnings, right?

And so certain things that certain people do, maybe that’s good for a certain group of people, but maybe something else is needed over here, or this factor isn’t important for these people. And it is over here. So for example the genus Allium some people have trouble with that.

Some people have trouble with FODMAP, high FODMAP foods. And so being able to identify that, and being able to eat in a way that support one’s genotype is important. But you can’t do that if you don’t know, right? I’ve had patients who have had abdominal pain depression, and other things going on, but…

We can put somebody on antidepressant, but what about these other, oh, let me just send them to a gastroenterologist. We can do that, but what if you also, make a person aware of certain foods maybe they should control for, to eat a low FODMAP diet, and then reintroduce some foods, and different foods for different people maybe can be tolerated and not be so much of an issue.

But that’s, that requires asking something about myself. How do I respond to different things versus I’m supposed to do this, or this is what everybody should do. Cholesterol is bad. There’s some data that pursuing low cholesterol may increase risk of certain cancers. Then you want to maybe do something different, right?

In the back probably in the fifties or so, you know, I started having margarine. Margarine’s healthy. Butter’s bad. Now we know, of course, it’s the other way around, right? But if you’re just hearing this again and again, that may be excuse me, hard to sort out. So that’s a a way that you have to ask those questions and then individualize the approach, but be open to making a change.

Somebody who eats high glycemic carbohydrates the lots of reliance on carbohydrates and never has a chance to get away from carbohydrates because they’re not eating any for 16 hours, doesn’t have an experience of using the beta hydroxybutyrate. In that situation, it really makes a huge difference to be able to experience that, and that can, for a lot of patients, make a difference.

I’ve had patients come back and go, Why didn’t anyone tell me this? I said I’ve been eating this way for my whole life. Welcome to America. You’ve been eating whatever all the rest of us have been doing. You can do something different and uh, have a different outcome. 

Bruce: Are there any novel treatments within psychiatry that excite you? That are particularly interesting that have come out recently? What are your thoughts?

Arnie: I would say TMS is what that is for me. Transcranial mandibular stimulation has to do with Doing a reset really in the brain and having that somebody’s on medication, they have a little bit of response but not all the way. Try another medicine, try another medicine, and then they have the opportunity to get TMS.

That does a reset and often times people can then start to get off of some of the medicines that they were on. That’s pretty exciting. No medicine, no medicine side effects, and something that is really of significant benefit in terms of reducing the risk of relapse. And then doing that along with the genetic characterization I was saying, then improves their outcome.

In other words, if you did a reset, and now you’re not experiencing those symptoms, if you could also do some of the genetic informed interventions with supplements, maybe then you reduce the same contributing factors of developing that depression. So they stay on and a year later ninety percent of our patients are doing very well and haven’t had to get back on medicine or haven’t had some other kind of treatment for depression.

So that’s a real benefit. It’s exciting to me and it was looked at as just another treatment for depression but you want to treat the whole person. If they need to be following a low FODMAP diet, if they need to be having Methylated vitamins. These are all things you want to do after the reset, otherwise you’re likely to fall off track again.

So TMS is really exciting. That’s something that I think is is more than just a treatment for depression. It’s an opportunity to change the direction of things moving forward in a person’s life who’s had depression because it can really make for the opportunity of incorporating these other changes and not having to have that weight of symptom burden. Be hanging over them. Maybe they’re not there now, but it’s gonna come back. It did with all of my medicines it’s different with TMS. So I think that’s a very exciting.

Bruce: Thank you, Dr. Arnie Mech, and I appreciate you joining me today and talking more about integrative psychiatry. We talked about a lot of different, really important topics, patients issues with chronic illness, complex patients, struggle with the diagnosis, when to stop medications, the importance of diet and genetic testing, TMS. Polypharmacy, there’s just so much here and I really appreciate you giving us your insight into these topics on the future of psychiatry.

Arnie: My pleasure. I’m excited about what we have now for patients And I thank you for the opportunity of discussing it

Bruce: Thank you so much. Appreciate it.

I’d appreciate it if you please like and share the podcast with your colleagues. It would be especially helpful for us. And if you’d like, please leave us a rating on your favorite podcatcher. If you’re a clinician, I developed a course on how to start a private practice. And for patients, I’ve also developed a course on ACT and CBT based lessons for treating and helping anxiety.

And you can find those all on our website as well. Thank you so much. And I’ll see you in the next episode.

 

Ross: final takeaway for me really is we need to change the mental health spectrum that we use in this country. for most people, the mental health spectrum that we use is, on one side you have people who are sane, in the middle you have people who have like mild mental health disorders, and then the far end you have people with severe mental health disorders, and this spectrum is broken.

 

I was diagnosed with bipolar disorder, I’m also sane at the same time. I can’t be on polar opposite ends of the same spectrum the same time. If you think about physical health, we tend to think about an issue we are experiencing, and what we need to use to function. So, if we have a cold, we think like, I might take some cold medicine, but I can go to work. we have the flu, we know that like, that’s it. If we tear an ACL, we know that we’re gonna need surgery and rehab and then our own work and then it’s gonna be difficult before we can fully use our knee again. It’s really time to start thinking about mental health in the same way. What’s the issue we’re experiencing? What’s the support we need along the way? And framing it from that perspective instead of you’re sane or you’re insane.

 

Bruce: Welcome to the Future of Psychiatry podcast, where we explore novel technology and new innovations in mental health. I’m your host, Dr. Bassi, an addiction physician and biomedical engineer.

 

Today I’m with Ross Szabo, who has created a mental health curriculum that is used by over 200, 000 students and teachers.

 

His curriculum, although simple, is quite unique. He wants mental health to be taught in schools much in the same way that physical health is taught. He advocates for conversations that should be happening daily about how we feel, signs and symptoms, treatments, diagnoses and more. He was just on the Dr. Phil show and the Dr. Phil podcast speaking about this new innovative curriculum welcome Ross. Let’s start off by telling us a little bit about yourself. How did you get involved in helping improve mental health literacy? 

 

Ross: I always joke with people that you don’t choose to become a mental health advocate. Uh, Mental health advocacy kind of finds you. It’s not like you have this perfect life and then you’re like, let me tell people about it. Uh, So I come from a lot of lived experience. I grew up in a family with a history of severe mental health disorders and addiction.

 

Went through my own trauma between 11 and 12, was diagnosed with bipolar disorder when I was 16. When I was 17, I attempted to take my own life. Eventually graduated from high school on time. Went to college, relapsed with bipolar disorder, and really struggled for the next four years in and out of treatment centers battling extreme alcohol abuse.

 

And then around 22 was really the first time that I started that I had these issues and and doing something more proactive to work on it. And, you know, since then, it’s obviously been a journey. Uh, we, We all find our own ways of dealing with mental health. And, And I think through each decade of my life, I found different ways to address it.

 

The advocacy piece actually started when I was a senior in high school. I had some really unfortunate misunderstandings from people. And so I actually started sharing my personal story when I was 17 and then had the opportunity to be the Director of Outreach for the National Mental Health Awareness Campaign, which was started at the White House in 1999.

 

And it was the country’s first public health approach to mental health. So from 2002 to 2010, we actually created the first large scale mental health assemblies that were ever happened in this country. And, uh, I had the opportunity to train over 50 speakers and write a book and speak to over a million people.

 

Uh, I burned out. I did what anyone does when they’re exhausted. I joined the Peace Corps. Um, Came back from the Peace Corps and saw that mental health awareness had really taken off. When I started sharing my story nationally in 2002, there were only two other young mental health advocates in the whole country.

 

When I came back from the Peace Corps at the end of 2012, so just 10 years later, there were millions of young mental health advocates. And awareness had really taken off, but what I saw was now there was a gap between awareness and actually teaching skills. So I started my own company to create mental health curriculum in 2013.

 

And then in 2017, I became a founding faculty member of Geffen Academy at UCLA, which is a school for students in grades 6 through 12. Where students have a class where they learn about mental health once a week, every single week of their education. And then in the summer, we actually host a mental health education institute where we teach teachers from around the world how to implement mental health literacy and how to use their personal stories effectively.

 

Bruce: So you recognize there was an exquisite lack of education in the field of mental health? Growing up and also as a patient, what is the benefit of educating somebody? Why do you think it’s helpful to do that proactively rather than retroactively

 

The Comparison that I always use is physical health. With 60 years of physical health literacy research, we know that when someone can name the body part, they can identify when they’re sick. They can seek help sooner, but more importantly, physical health literacy about physical health. The issue with where we are right now is, when I say the words physical health, you all know what that means. You know it’s naming your body parts, it’s exercise, it’s knowing your family history, it’s eating healthfully, it’s taking care of your body. The place we’re in right now, because mental health awareness expanded so rapidly is, when you say the words mental health, there is not the same equivalent of understanding.

 

Some people still think mental health is just for people who have severe mental health disorders. Some people think mental health is going to a spa and getting massages and facials. Some mental health is, any emotion, right? So, like, Now you have people who, when they experience any kind of nervousness, are labeling it anxiety.

 

Any kind of sadness, labeling it clinical depression. And so, we need to really be specific. And we can do that with a public health approach. It doesn’t need to be therapeutic. It’s a way that we can follow the public health approach for physical health and really have some success with it.

 

Let’s getting back to those misconceptions that you were talking about earlier. 

 

What do you feel are the biggest misconceptions about educating the public about mental health approaches? Is it that tendency to over diagnose normal feelings and put them into a pathological bucket?

 

Ross: Think that there’s a couple of things. One, we have categories for physical health. So, You know the difference between a sprained ankle and a broken leg. You know the difference between having a cold and having the flu, you know the difference between diabetes and cancer because we’ve been taught that from a really young age.

 

There are different categories for mental health need to start teaching that. So, you know, Everyday influences are things that affect us every day. They could be positive or negative depending on the experience. Stress could be good or bad. Sleep could be good or bad. Body image could be good or bad.

 

Self compassion could be good or bad. But these are things that occur every single day that affect everyone. The next category for that would be your environment. The home you grew up in, the school you go to, your workplace, the way you’re raised. Like, That’s a very different category of how it affects you.

 

The next category after that would be significant events. So experiences, big life experiences that don’t happen as frequently. Experiences with loss, change, or rejection that affect us. Um, And they also can be positive or negative. And then there’s a category for mental health disorders and a category for developmental disabilities.

 

We need that separation because to your point, What’s happening right now is people are having everyday experiences and saying it’s a mental health disorder. And when that happens, it’s it’s really difficult for two reasons, and I’m sure you know them. One, you’re pathologizing a typical emotion. So you’re someone who’s nervous, who, you know, could do some work to just get calm, and get the butterflies out of their stomach, do whatever it is they’re doing, and you’re making it more severe than it is.

 

But the more damaging thing, really, Is you’re dismissing the experiences of people with severe anxiety disorders or just anxiety disorders in general Because you’re looking at them and saying like, oh, why don’t you just calm down? I’ve been been there. I know what it’s like so can really teach that separation To to help people just understand it a little bit more.

 

And people always ask me like well doesn’t teaching about it Have more people self diagnosed And it just really doesn’t like I can stand in a room of 6th and 7th and 8th graders and have this conversation and none of them leave there being like, I have an anxiety disorder.

 

They actually leave there with the opposite. 

 

Bruce: What 

 

society thinks is that if you talk about mental health disorders, more people are going to have them. Um, and so, you know, it’s been interesting to see that just explaining these differences really helps.

 

What do you feel like is the main drawback or consequence to poor literacy? 

 

Drawback is you do dismiss the experiences of people with severe mental health disorders. You do conflate the experiences of typical emotions, but more importantly, you just leave people in a space where they don’t have words to describe what they’re going through. And so then they’re going to rely on more unreliable sources because they don’t actually have those words.

 

They’re going to rely on social media. They’re going to rely on all these other places. Because no one’s giving them a structure and a framework to operate from. And, as a society, we then don’t normalize conversations about actual mental health. We confuse people with that conversation and we make it harder for them to get help.

 

That’s a good point. 

 

You bring up a really good point. I think by educating people, they do tend to talk about it more and share more about it on social media, and in order for influencers to develop more catchy types of videos, I think they they tend to gravitate towards topics that may be controversial, Or a little bit dramatic and I think there could be a one consequence could be a spread of misinformation as well, through our original purpose, which was to spread understanding and conversation about it.

 

I do feel like it, it almost can backfire on the social media piece. I think people also need to be educated about where are they consuming their information from. Yeah, this individual might have had a bad experience with x, y, and z, but that’s not to say all individuals would have that same experience that person had.

 

So it can lead to a little bit of a biased perspective depending on who they get the information from.

 

It is and if about the approach to physical health, we’ve been clear and successful with it for so long. But they did start from a place of, what do we teach? How do we teach it? What’s that? What are the steps here? 

 

And, I think even going beyond just the language piece, there are other parts of mental health literacy that are important to one is brain development and understanding how brains work.

 

There are so many times where when I’m teaching, my students are going somewhere else and explaining that, the digital age keeps us trapped in our limbic systems. And when we’re in our limbic systems, we can only use our sympathetic nervous system. And when we’re only using our sympathetic nervous system, we don’t feel like we need to eat. We don’t feel like we need to drink water. We don’t feel like we need all these other things. And even just giving people those basic, the basic understanding of brain development, obviously there’s ways to go deeper into neuroscience, but that just basic understanding is so important.

 

And then, another big piece of mental health literacy for us is peer support. Every school in this country. Every night has one kid begging another kid to stay alive. And it’s something that puts kids on the front lines of mental health even more than mental health professionals. And there’s a lot of dangerous ways that goes.

 

One, most kids are successful in talking another kid out of taking their own life. That gives them a false empowerment that now they can do it all the time. And then two, it traumatizes that kid. Because the next time they get a text from that friend or a phone call from that friend, they now live in a state of panic of, am I going to have to talk them out of suicide again? Is this going to be another night where I don’t sleep because I’m so worried about this person? 

 

And so at our school, we don’t do suicide prevention trainings because I don’t want to put teenagers in a place where now they think they can prevent suicide. We give them the basic things of what they can do.

 

They can help their friends feel comfortable, they can ask questions, sometimes just letting someone know that you’re there to listen and you don’t actually know what to do is enough, and that they should tell someone that they can’t hold on this on their own, because more often than not, it actually either ends badly, where someone does die, or they just live in that state of trauma and they don’t know how to get out of it.

 

Yeah, it’s a huge burden that kid probably feels to be given that really deep, serious information about somebody not wanting to be alive. I’m glad that you teach them the tools that they need to recognize when they need to basically outsource or refer their friend to professional help rather than take on that responsibility themselves.

 

You know, I mean, All of you watching this know the way that it is for you as professionals. But, But you all went through years, years of training, years of experience, years of studying hours of, getting your licenses, everything else. And these kids are put in those situations on at least a monthly, yearly basis. Like it’s hard.

 

What kind of feedback have you gotten from individuals? I’m sure there’s probably really powerful and moving feedback of lives that you’ve affected in countless ways. 

 

The feedback varies. So when the, when students are in my school, they don’t know that no one else is getting this education. So a lot of times uh, they’re kind of like, well, why, why do we need to know this? Or why can’t I have a work period? What’s going on in, obviously that’s not all of them.

 

There are a lot of them who go through it and really have these wrecking. Like, Just kind of realizations and things that, that help them and that would be a majority of kids. 

 

The biggest time it sets in is when our students graduate. When our students graduate and go to college, that is when they often reach out immediately and are like, Hey I didn’t know that other people aren’t getting this information.

 

And they’re so stressed out and they have so many issues and they don’t know how to talk about it. They have no framework for it at all. And so I’m I now see why we did this. I now see why all this happened. But obviously it also changes their interactions with their parents. A lot of times our students are the ones going home and leading these conversations with their parents, where they’re the ones who are able to have a framework and explain things and talk about things, which is really powerful.

 

And then from our mental health Education Institute in the summer, You know that the stories from that are really amazing. You have so many teachers who go back to their school and say they’re now more prepared for mental health than they ever were before because one, they have a framework to use in the classroom, but they also have a framework for themselves.

 

I think the most powerful feedback we get is that our mental health Education Institute actually improves the mental health of the teachers who go through it. And then, the second part of the Mental Health Teacher Education Institute is giving teachers guidelines on how to normalize conversations about mental health.

 

And there are so many teachers who care in this country, but they’ve never been given guidelines on how you interact, how you share a story, what you do, how you take care of yourself. And so they’re oftentimes so grateful for that information.

 

That’s so interesting. Yeah, I’m sure that these tools you’re giving them empowers them for the rest of their life, especially in a huge transition like going off to college. They’re going to look back and think about how valuable that was. 

 

In talking about the curriculum, you mentioned in one of your other videos that you described it as evidence based, which I’m sure our audience love.

 

And also using humor to to teach a point, can we talk a little bit more about that? Because I think that’s something that there’s a thirst for among clinicians because they recognize it’s valuable to use humor in a mental health setting. But I think they also find it very challenging to use it tastefully and appropriately in the right context.

 

What’s your approach like for that for using humor and teaching mental health?

 

Humor is a good release. When you’re talking about serious issues, when you’re talking about a lot of things that people have gone through. There is that nervous energy that builds up where people do need a moment to laugh or do need a moment to just exhale. And so when I’m working with teenagers, you know, you’re not, uh, balancing it, if you’re not including some humor, if you’re not, lightly joking around with them, doing things like that, it’s just not going to resonate. And so in the classrooms, I spend a lot of time joking with students, uh, having them roast me back, things like that, because it just humanizes it more. I think what’s tough for mental health professionals a lot of times is feeling that pressure of being the expert and feeling that pressure of having to have the solutions.

 

And once you do get all those degrees and everything else happening in your life, it’s hard to not relax, but… feel like you can walk that line between professionalism and more like a, an unorthodox approach. So I think it’s important one to have moments where you’re talking about like how absurd something is or how funny something is.

 

Self deprecating humor tends to work the best, especially with teens. And then also letting them have moments of lightness, even in classes where we talk about some more difficult stuff. We’ll always end it with what are you grateful for or what’s something you’re proud of or what’s something you wish you could do more things like that so that the weight isn’t just always on the heavy parts of it because when it’s when it is that we’re not activating parts of our brain that are going to help that last anyway.

 

Yeah, I always noticed that there’s a little bit of a dissonance there between what we’re taught in training Versus what actually resonates with a patient in person. I think a patient wants a human connection. They want to know that you’re real. Especially when it’s virtual and you’re, there’s a setback there because you’re not in person, but they want to know that you’re relatable, essentially.

 

And then what we’re taught is To maintain professionalism and not give anything that could alter the expression of their own emotions from a psychoanalytic type of approach, you want to not disclose anything and be careful of your reactions and your facial expressions and how your posture is.

 

And that almost teaches trainees to be a little bit too concrete and robotic, I think. Which maybe makes it a little bit more challenging to have a therapeutic alliance. So it is a really difficult thing. I think people need some time to find their stride and what’s comfortable and suitable for them, in their setting.

 

But I think that’s really cool and interesting that you have tried to incorporate this into your approach with the kids. I think that’s right. You’ve hit the nail on the head that it also depends on your audience and the age group and the generation that they’re in that you’re using their lingo.

 

They are in difficult places too because of the liability aspect, even at some schools I go to when students go to school counselors and the school counselors have to stick to the script that they have been trained on because if they don’t stick to the script that they’ve been trained on, somebody could sue them or something could happen.

 

The students will often say, like every time I go to this counselor, it’s just the same question. It’s it’s robotic. It’s not engaging. It’s not interaction. It’s not a conversation. And so You know, I think it’s tough. I think there are a lot of people who are afraid of the litigation and things like that, so they’re going to stick to what they know because that’s what they know, but when you’re treating someone, any kind of human aspect you can add is important.

 

And I do think in some ways the lack of humanization that people are taught as they go through med school and everything else, it’s not applicable as much as it was in the past.

 

So you saw this need, you had this desire, you had this motivation. And you also felt it needed to be evidence based. How did you go about developing the curriculum and have you refined it and changed it at all over time based on feedback?

 

So I had the opportunity to go out and speak to millions of people. And so I think a lot of times when we develop curriculum, it’s often done in a lab or it’s done based on research where somebody comes up with an idea and they’re like, Well, we need to teach about this.

 

And so then they try to figure out how they can get My curriculum design was actually opposite. It was, I went out and had a focus group of literally millions of people and saw, Oh, here are the biggest gaps. So the interesting thing about that when we started piloting the curriculum it was resonating already because it was already filling the gaps that so many people had said they were missing, or so many people had said they didn’t, have right?

 

And that that piece didn’t change much. The original curriculum was really, here’s a definition of mental health. Here is the categories of mental health challenges. Here’s how you can change the spectrum of mental health to be more like physical health. These are what coping mechanisms are and how your brain works. Here’s how to support a friend. 

 

And that curriculum from my company was available, you know, 2013 to 2016. When I started the school and became a founding faculty member of the school, Well, then we needed a lesson about mental health once a week, every week from grade six through grade 12. And so my core curriculum now had to shift to how do we follow the adolescent development milestones of all these people grade six through 12, and give them different variations of it so that they’re not completely bored. in that regard, what we started looking at was, okay, well what are kids in middle school most concerned about and what, what can we give them to deal with it? How can we teach them? How can we focus on that? And then it was, what are kids in high school most concerned about? How can we adapt to that?

 

How can we have enough repetition where they’re building skills, but enough variety where they’re not bored. so that that was a much bigger transition from going from, you know, roughly Probably like 15 lessons to around 220 lessons.

 

That’s interesting. Interesting dilemma, too. And challenge for you to keep it. Helpful and applicable for what their interests are at the time also, not make it too boring or too repetitive or they can actually get new information about, uh, you know, the next lesson .

 

And that’s the hardest thing because I have honest with you. You know, A lot of social emotional learning programs will use the same measure every day, right? And so they’ll start and from a very smart place, they start teaching that in first grade. But literally by the time a kid is in third grade, they’re like, I learned this in first grade.

 

I don’t want to do it again. That’s for babies. And so you do have to really be creative in how you teach these things because obviously mental health has a lot of the same principles, but how you engage and how you talk to people about it is really important.

 

What is a typical student’s… Feedback like from year two versus year one do you see like the stigma just melting away from people or that’s what I’m imagining in an ideal world, but are people still pretty reserved about opening up about mental health issues, even though we’re trying to, you know, you’re, you’re trying to do a better job a normalizing it

 

That’s really great question. So I do think there’s a big difference between a public health approach and a therapeutic approach. So we never unpack emotions or really discuss a lot of therapeutic things in the classroom because… It’s not, that’s not replicable. We wanted to create a program that other schools could do.

 

What we hear from our students is that they’re more open and have less stigma talking about it in their personal lives, and that’s what you would want. That’s what you want to see. And that’s what the hope is. We walk that line of, here are all the skills you can build for mental health, here’s the vocabulary you can have, here’s how your brain works, here’s how all this other stuff can occur.

 

And in class we talk about it from a skill based perspective, but then when they are in their own personal lives, that’s when they might be having less stigma. 

 

So we hear from parents a lot that it has changed their households and that it’s a little bit easier for them to talk about, but it is not a perfect thing. It’s just, you think about our public health approach to obesity. We’ve done more in this country to try and approach obesity than ever before. But now we have more obesity than we’ve ever had, right? And if you look at something like obesity well, socioeconomic status affects that, biology affects that, and then there are factors in our society that affects that, right?

 

We live in a country that says don’t be obese, but we don’t rein in fast food, we don’t rein in the chemicals in food, we don’t rein in the ingredients that people are allowed to use, and then we are like, why are people obese? It’s a similar thing for mental health in this country. 

 

We tell people they should have mental health. And then, I don’t know, you could argue that a lot of what we do in the environment in this country wouldn’t even allow someone to have mental health, especially someone in a lower socioeconomic status. So when we talk about the changes, we also have to factor in what else is affecting people.

 

That’s so interesting. Yeah. So I’m imagining. You’re approaching it from a preventative stance as early as possible. I feel like that’s at least better than trying to do it later on after issues and symptoms have developed, though. You’re doing the most you can do to try to mitigate those causal factors that you were referring to 

 

with that, you know, like, look, to be honest with you, the public schools in some of the biggest cities where they’re underfunded, a lot of these public schools are literally just providing the first tier of Maslow’s Hierarchy. They’re providing food, they’re providing shelter, they’re providing safety, they’re providing water, and we we can’t overlook the fact that for a lot of these large cities, that’s really all they can do.

 

The education piece they get on top of it is, is, is helpful, and I’m not saying it’s not, but If you’re a kid who’s relying on your school for your meals, what is your home environment going to do to support mental health? And then there are public schools, obviously, even in the same city, that have more funding, that are doing more, that are able to have more in effect. Um, And then obviously there’s independent schools, private schools throughout this country that can do more and have probably better access to a more comfortable and safe environment. But we can’t have this conversation about mental health without talking about the factors that influence it.

 

You mentioned One thing I think people would be interested in hearing about is how they can go about changing or helping change, incite change in their child’s school to talk more about mental health. Say they’re listening to this podcast, they think you have really great ideas and their child’s curriculum really doesn’t include a whole lot.

 

And they want to maybe advocate on behalf of the students to, to create some change in their school’s curriculum. How would they go about doing that? What is your business model like? Is this an open source type of curriculum that they can take and hand deliver to the school for them to look at and maybe incorporate in their school? Or tell us a little bit more about that.

 

We run a mental health education institute at Geffen Academy at UCLA every summer. So the the easiest thing people can do is connect their school with our mental health education institute. We offer an in person training and an online training and that is, you know, one of the easiest things that can happen.

 

We have the benefit of being a school at a public university, so we can host these trainings and offer CEUs and do all these other things. And a lot of people come because, again, we’re at a public university. The second thing people can do is if they’re not able to do that, my website is humanpowerproject. com And that’s really where the curriculum lives outside of this So there are people who find me privately through that company, through that website. And that’s a easier kind of just hey, here’s this curriculum, let’s implement it. Those would be the best options. Either going to the Mental Health Education Institute at Gaffin Academy at UCLA, or contacting me at humanpowerproject. Com

 

do you have any tips or suggestions for how they might go about approaching a school board or educator to incorporate something like this in terms of maybe describing some of the benefits or the reception that it’s gotten?

 

If you’re in a public school setting, or in a charter school, or in a setting where there’s bureaucracy, you’re gonna have to go… Through the bureaucracy, the thing that I think works there is mentioning again that the surgeon general put out this advisory for the youth mental health crisis and asking the school, Hey, what are we doing to teach about this to normalize it?

 

What are we doing to go upstream to start this conversation in a preventative way? And here’s this approach that is public health approach that does have effectiveness that Does help students develop a framework and a vocabulary and understand what they can and can’t do in a lot of situations.

 

If you’re in a private school or independent school situation, then, the bureaucracy is much less. You can actually just go to the counselors or to a wellness department and say, I found this curriculum, I’d really love to teach it. I’d love to know more about what’s happening at the school.

 

How can we implement this more? Or go and say, have you considered going to this mental health education institute? Because I think it could really benefit our school. Those would be the kind of things to do. I think the one thing if you’re approaching independent school or a private school is what we hear, what our college admissions department hears at our school is colleges are now realizing that this program exists and they’re more willing to accept kids who have an understanding of mental health because colleges are so overwhelmed in this crisis.

 

UCLA has 57 counselors and they can’t keep up with The amount of students seeking help. But when you dig deep into what students are seeking help for, it is not severe mental health disorders. That’s not the number one thing. Obviously they are doing that. I’m not saying that’s not happening, but the more common thing is just, communicating with a roommate, dealing with dating, dealing with basic life skills that we’ve been able to teach from sixth through 12th grade.

 

That’s so interesting, and that’s a really good point. You mentioned communicating, and I think we do have literature and English classes. And you also mentioned in one of your videos, the importance of being able to tell your story from a mental health perspective and from a non mental health perspective, and I think that was a really great important point for Children to understand because I do feel like you’re just thrown into the world and you’re just almost surviving day to day or hour to hour.

 

You don’t really understand quite who you are. You don’t have any sort of life experience to draw from. No previous job. You don’t really have a sense of identity that’s paired to that job. What is the importance that you’ve seen in helping guide students in describing their story?

 

one thing that works best is modeling how to do it. So. When I share my story, or at the Mental Health Education Institute, when we teach other people how to share their stories, the biggest part of it is, don’t share anything you haven’t processed. When you’re an educator in a classroom, make sure you’re sharing things, only sharing things that you’ve processed, because you don’t want to be in a situation where you’re processing with your students, or processing in some learning capacity.

 

The second piece of it is, making sure that what you’re going to share has a relevant point for a lesson you’re teaching. When I talk about addiction, I can share that three of my grandparents were alcoholics. And the number one factor for addiction is biological predisposition. 

 

Or I can share that age of first use is the second biggest determining factor. And I started alcohol when I was 12.

 

And kind of just going through making sure that I’m sharing a story that has a point and I’m not just sharing a story for my own emotional validation because Unfortunately, All of us need emotional validation, everybody. And you’re getting validation from your students on what learning, really healthy, really positive.

 

If you’re getting validation from your students for your own emotional needs, really slippery slope, definitely not healthy. And then there are other steps for adults to understand how to share their personal stories. 

 

One, again, it should have that learning objective. Two, the learning objective should be universal. It shouldn’t be a personal thing, where somebody is like, Yeah, so then I did this extreme rock climbing adventure and that is the only thing that works and everyone should do it. You know, You can do whatever extreme thing you do, but then it should be exercise benefits the brain or getting outside benefits the brain or you know what I mean?

 

and so when we do use personal stories in the classroom, it’s got to be something you process, it’s got to have a learning objective. The learning of the learning lesson has to be universal. And you’re basically using your story to get other people to think about their lives. We don’t really encourage students to share their own stories in a classroom, uh, unless it is something that they are confident about or something that they want to mention.

 

That’s so good to know. I feel like I’m learning a lot just by talking to you. I feel like maybe there’s a lot of benefit for clinicians and counselors in the training that you were describing earlier. You mentioned that doing this also helps work on your own mental health. And I understand, you don’t want to do that in session with students.

 

You shouldn’t be getting any sort of validation from the students. But how does… being a teacher make you a better student, a lifelong learner?

 

Well, one, I learn so much from my students. Opening the door to these conversations, Get you a chance to hear their perspective, their experiences and what they’re going through. And it’s really important to hold space for that because they do have a lot happening. I think sometimes we always try to, not always, but there are a lot of people who dismiss the experiences of young, people and they say, well, you’re just young, you’ll figure it out.

 

Or, you know, you’re just young and you just got to get through this, but that’s all they know. All they know is their, whatever, how many ever years of their life that they’ve lived. And validating that for them gives them more confidence to say, okay, this is real. And let’s be honest, like, you know, when people get cheated on in high school, that cheating lasts with them for the rest of their relationships.

 

They go into college not trusting people. They go into young adulthood, uh, yeah, early 20s, kind of being like, well, I got cheated on that one time. The second largest period of brain growth being 12 to 25, we know that what happens in that Can often last a lifetime. I joke with people a lot of times that being an adult is really just trying to either undo adolescence or relive adolescence, depending on your level of self awareness and so the, the listening and the validating piece for the the young people, the students is really important. 

 

You mentioned that people tend to dismiss or diminish a young person’s experience, but I almost feel like it should be the opposite. I feel like being a teenager is one of the difficult, most difficult times of your life where you’re, you’re really just going through motions of things that were told to you that you have to do.

 

So there’s huge sense of obligation and lack of independence. You don’t have any sort of financial authority to make any choices on your own unless you’re, doing crypto trading on the side or something like that. And you’re living in somebody else’s house. You don’t have any say in anything you do.

 

You have no sort of tools to draw from to deal with stressors at the time. I mean, I, I think that it’s, it’s the opposite. People should be supporting teenagers as much as 

 

they could uh, but that’s not always happening. Also, I think should recognize that, you know, that period of brain growth between 12 and 25 is so powerful. That most people with severe dementia or most people with Alzheimer’s, That’s the period of their life they can recall in a second.

 

And a lot of times it does go by in a blur, a lot of times it does go by with all these other influences. Even my students, and we are an independent school and our students, do come from environments that are safe and protected. I can’t say healthy because, everyone’s home environment is different.

 

But when they share what they’ve gone through, the, sexual assaults, the sexual harassment, the suicides in their families, the divorce, the dysfunction, the abuse, like, all kinds of stuff that they’ve navigated by 14, 15. It’s just a reminder that a lot of this is gonna affect everyone for the rest of their lives. 

 

And all we can hope to do from a school perspective is give them some tools and some normalcy that yeah, you didn’t choose to go through this and you didn’t choose to have to grow up this quickly, but you can try and work on coping mechanisms and work on ways out of it because the reality is, it doesn’t matter what community you’re in.

 

It doesn’t matter the socioeconomic status. People are going through a lot right now. They’re going through a lot. Yeah. And we can have conversations about what they can do for themselves.

 

Yeah, that’s a good point. In the moment, everybody’s own issues feel like the most important, disastrous time that they’re going through. 

 

Let’s shift and talk about the, your growth the growth of your mission. You’ve come a long way over the last 10 years, I’m sure. What types of challenges lie ahead for you?

 

What kinds of things are on your plate these days? And where do you like to see the, the model going from here?

 

Bruce: 

 

The biggest challenge is how do you scale up I have just had a meeting yesterday in Sacramento, uh, with, you know, people at, at the state level of education. And on the one hand, the model does exist. 

 

So what I was sharing yesterday was we already have a model for physical health education. It’s a funded bill in the California State Legislature. There are already teachers in schools. There is now a curriculum that they follow and all these other steps that every school district, no matter who they are, what they are, can do to take care of this. We need to find a way to do the same thing for mental health. The funny thing is, a lot of states have already mandated mental health curriculum.

 

They just don’t have a curriculum, and they don’t have a way for people to come rally around one kind of unified way of mental health literacy and implementing it. So the biggest challenge for the next 10 years is going to be, how do we scale up? And if you think about scaling up, there has to be different tiers The approach for a public school in a large city is going to be different than a well funded public school, is going to be different than an independent school or a charter school. So in our scaling up, we’re really going to have to be specific about how we do it, what the lessons look like, where it goes and what is managed from that.

 

That’s interesting. Yeah, you’re right. It’s not a one size fits all approach to every school. What kinds of ideas can you brainstorm? 

 

If somebody out there who’s listening is interested in going into this and innovating and moving the needle forward in terms of what you’re doing where would their effort best spent?

 

I think the other thing that often impedes mental health education is people come up with different ideas, different perspectives, so they start different organizations. A lot of those organizations and a lot of those things end up doing the same work, but in that fight for funding, the Hunger Games fight for survival, everybody seeks out their own money, things like that. So I think collaboration and partnership one of the most important things we can do. 

 

Don’t think you have to put pressure on yourself to come up with something different. We have satellites of this in a lot you know, cities and states because people are saying, this is what works. How do we bring it here versus this is what works.

 

So I’m going to create it. Um, I’m going to try and navigate this. When we find things that work, let’s collaborate, and let’s, let’s bring stuff together.

 

That’s a good point. And do you have any sort of recommendations for anybody who’s interested in innovating in mental health? Just generally speaking, maybe not in the curriculum space?

 

Ross: The best innovations that I see are identifying a gap that exists and trying to fill that gap. I’ve been able to have the opportunity to do that in a lot of ways. Originally, there were no large scale presentations or assemblies about mental health, and so I really asked how can we fill that gap?

 

Then there was no curriculum, how can we fill that gap? Then it was mental health education doesn’t exist in schools, how can we fill that gap, right? And so I think some of the best innovative ideas come from asking the question what’s missing and how can we fill it? I think that’s part of the reason you saw online therapy grow to the place where it is now, there I know people who don’t even have an in person practice Everything they do is online and that has come from the innovation of Okay, what if this was more accessible?

 

What if people could have more access to it when they do it? And so I think anytime you’re trying to innovate It’s asking what the gap is and what you can do to fill it.

 

Yeah. Totally. Are there any new novel treatments or innovations within psychiatry that excite you?

 

I’m not saying this personally, what’s going to be interesting is to see the continued rollout of psychedelics and their use for some of these severe mental health disorders, uh, that that early data on the therapeutic use of ketamine and, um, psilocybin MDMA has been fascinating to me from, from my layman’s perspective, it makes a lot of sense.

 

If you’re in a situation where you can’t activate these parts of your brain, and psychedelics give you a chance to do that, but it is guided and protected and safe with someone guiding you through it, uh, that’s a really interesting phenomenon to me, but I think the challenge is going to be how do you roll it out?

 

For all the existing psychiatrists, what course or class are they going to take to get accredited for understanding psychedelic use? And then how are they going to be responsible for leading people through these very vulnerable, intense journeys? Uh, and so, you know, what’s what’s interesting about calling that an innovation is a lot of these psychedelics have been used by traditional communities for thousands of years.

 

So I don’t know that it’s an innovation as much as it is an innovation to the medical system to understand how to use something that is showing effects, but how do you get the entire system to do it? Are they going to start teaching psychedelic, um, accreditation in, in med schools? You know, what, What’s what’s going to happen?

 

And so it’s interesting. I’m, I’m interested 

 

It’s a very new and exciting time, especially when we have the opportunity to maybe revisit something that’s had some proven history there among other cultures, to be clear, I’m talking about the therapeutic use of use there. There is a difference, living in Los Angeles right now. The recreational use of psilocybin and ketamine is shocking to me, um, and people are doing that from a place of of all different kinds of emotions and connections and wanting certain things, but the actual therapeutic uses that I’ve seen, and then I know people who have gone through it, have massive benefits, and so I’m more interested in the therapeutic use, the recreational use I’m not excited about, and you know, there are students Who I talk to all the time, who have friends who are microdosing every day microdosing, psilocybin at age 16. 

 

I think that maybe should be part of the curriculum to not conflate any data there regarding the treatment use of medication or herbal or supplement for the treatment does not necessarily equate to broad and universal approval of that medication or supplement for any usage whatsoever.

 

I would say, final takeaway for me really is we, need to we we change the mental health spectrum that we use in this country. for most people, the mental health spectrum that we on one side you have people who are sane, in the middle you have people who have like mild mental health disorders, and then the far end you have people with severe mental health disorders, and this spectrum is broken.

 

I was diagnosed with bipolar disorder, I’m also sane at the same time. I can’t be on polar opposite ends of the same spectrum the same time. If you think about physical health, we tend to think about an issue we are experiencing, and what we need to use to function. So, if we have a cold, we think like, I might take some cold medicine, but I can go to work. we have the flu, we know that like, that’s it. If we tear an ACL, we know that we’re gonna need surgery and rehab and then our own work and then it’s gonna be difficult before we can fully use our knee again.

 

It’s really time to start thinking about mental health in the same way. What’s the issue we’re experiencing? What’s the support we need along the way? And framing it from that perspective instead of you’re sane or you’re insane. And on this new spectrum, thinking about mental health, the same way you would think about physical health, using resources is in the middle because that’s where it is for physical health.

 

When we see people exercising or walking or running, none of us think what a weirdo, why are they doing that? We often think like good for them. I should exercise. We but we think about it and that’s important. Uh, So we need to get to a place where we are framing mental health that same level of functionality as we do our physical health.

 

Yeah, there probably was a time back in the 1890s where people looked absurd to, to lift up arbitrary weights, but now we accept that as working on their physical health, and to your point about overgeneralizing individuals with mental health issues, I think that directly ties into the whole gun control debate in regard to gun violence because how many times do you hear a legislator Saying it was because that individual had mental health issues.

 

We don’t say, oh, they had physical issues, therefore they caused it. It’s a total misrepresentation and a misunderstanding of mental health issues that if you have a mental health issue, it somehow leads you to becoming violent and want to, kill individuals. It just sounds silly to, to think of it like that.

 

But people do for better or for worse, just try to. to say something like Maybe it catches attention more. 

 

Bruce: Well, 

 

Ross, it was really fun having you on the show. I learned a lot, and I think this is really applicable to our audience and their children as well, and any nieces and nephews who are probably going through elementary school and finding difficulties in understanding their own mental health.

 

I think it’s really important and helpful for our entire country that This is on the table, just as the same way we have P. E. teachers, we need to have M. E. teachers as well. Thank you so much. 

 

Do you have any, 

 

Do you wanna have the last word? 

 

Anything we can do to normalize mental health, to have, uh, conversations and a framework for mental health literacy and to really implement this can make huge changes. And one thing that we know about human beings is when we do rally around something, we can make 

 

Ross: massive change 

 

and we can do it quickly.

 

So, Never underestimate what you are doing as a person and what that impact has on so many other people. Because it really can give them a language and a framework to work from that has changes and ripples through every aspect of their life.

 

Awesome. Thank you for coming on the show. I really appreciate it and explaining all your points so well. And if anybody is interested in reaching out to you, we’ll have links and resources in the episode page on our website. And and you can go there, telepsychhealth. com and navigate to that to connect with Ross.

 

Thank you.

 

I’d appreciate it if you please like and share the podcast with your colleagues. It would be especially helpful for us. And if you’d like, please leave us a rating on your favorite podcatcher. If you’re a clinician, I developed a course on how to start a private practice. And for patients, I’ve also developed a course on ACT and CBT based lessons for treating and helping anxiety.

 

And you can find those all on our website as well. Thank you so much. And I’ll see you in the next episode.

Chelsie: the main issue is that sleep disorders are super common in the general public. Most people are not getting diagnosed or treated. Most people don’t even know they have a sleep disorder. It’s more prevalent than we think it is. And every year that percentage of people who have things like sleep apnea and insomnia is rising.

So it went from 10%. Now it’s closer to 20%. It’s creeping up to 26%. So. THe fact that we have so many undiagnosed, untreated people means that these chronic health conditions are going to continue to increase in the population

So welcome to the Future of podcast, where we explore novel technology and new innovations in mental health.

Bruce: I’m your host, Dr. Bassi, an addiction physician and biomedical engineer. Today we’re going to be focused on sleep, which is super important. I’m with Dr. Chelsie Rohrscheib, who is a sleep expert, neuroscientist, and sleep consultant with over 10 years of experience in the field of sleep. She holds a PhD in neuroscience with a specialty in sleep genetics.

She’s also worked in clinical trials where she oversaw sleep apnea research. She’s the founding member of Wesper, which is a startup that has a FDA cleared device to diagnose sleep issues. And to help monitor treatment efficacy over time, it measures position, airflow, blood oxygen levels, and respiratory effort to try to diagnose a whole host of sleep issues and then help monitor the treatment thereafter.

Welcome doctor.

Chelsie: Thank you so much for having me.

Bruce: Tell us a little bit about yourself and how you got involved in this discipline.

Chelsie: Sure. My background is in biomedical science. That’s where I got my start. Which is looking at medicine more broadly, but looking at the scientific aspects of medicine. through that, I started to get into research, where I specialized in neuroscience for my PhD. During my PhD, These studies, I was specifically examining brain infections and how they affected our patients.

And one of the aspects I was looking at with sleep specifically, and that’s really how I got into sleep medicine. After that, I started getting more into the genetics of sleep. So how Specific genes control sleep and affect sleep when you alter those genes. More recently, I’ve been involved in the clinical side of sleep, so more of the medical side, working with patients for a variety of sleep disorders.

The sleep disorder I primarily focus on is sleep apnea, which is the second most common sleep disorder behind insomnia. It affects 20 to 26 percent of adults in America, so it is a major health condition. Now I’m the head of sleep expert for Wesper. We are a sleep disorder testing technology. We are considered a home sleep test, so we do all the testing at home in the patient’s bed.

But we’re a little bit more than that. So we do diagnostics and we can also continuously test our patients night after night so we can follow them.

Bruce: I do often find that individuals come to us for another reason, and we uncover an underlying sleep issue that they had no idea that they had, or they’re not getting enough sleep, and that’s contributing to their inattention, lack of focus, lack of motivation.

Their low mood, their impulsivity, perhaps their cardiovascular disease, the weight gain. So sleep has so many downstream effects and actually can also predispose people to drinking alcohol and using substances. I think sleep is so critically important to talk about and make sure that people are following adequate sleep hygiene and also make sure that there’s not any underlying sleep issues as well. Tell us a little bit about Wesper’s mission and how it accomplishes that.

Chelsie: Like you said, sleep affects absolutely every system in the body the brain and body. So if there is, an organ or Any process in the body’s sleep can disrupt that process. If you’re not sleeping properly, Wesper’s first primary mission is to make sleep testing for sleep disorders more accessible to people across the globe.

Traditionally, people have had to go into a hospital for an overnight sleep study. It’s very expensive. It can take forever to get an appointment especially in America. If you don’t have the right insurance coverage, you may not be able to get a sleep study at all. So there’s a lot of factors that inhibit people from getting tested for sleep disorders, even though sleep disorders are so incredibly common in the general public.

So Wesper is very comfortable. It’s very affordable. It’s very easy to use and set up. And again, like I said earlier, you can retest over and over as many times as you want. And because we allow longitudinal testing the data we collect is more accurate. So we have a very precise picture of what your sleep looks like typically, as opposed to a single night.

In hospital sleep study where you’re not in your bed, you’re in a foreign environment. wiTh all those factors combined we’re making the sleep testing process

Bruce: So I know that there’s basically two electrodes that’s involved with Wesper and they pair to a phone, a smartphone. One electrode sits right underneath your right breast and the other one, and correct me if I’m wrong, the other one sits right above your belly button, and it monitors your position, your blood oxygen level, and it uses those metrics to diagnose a sleep issue.

Tell me a little bit more about why an individual would choose to use Wesper versus I know the field of sleep diagnosis is very competitive space to break into. What does Wesper do differently? Why is it at the forefront of the future of psychiatry?

Chelsie: Sure. The nature of Wesper’s technology is that the biosensors we use are two tiny little passes that, like you said, go on the abdomen and thorax. They’re flexible. So when you put them on, they flex with the body and they’re very comfortable. Once they’re on, you don’t even know they’re there.

Very easy to fall asleep. This is important for people who have a lot of sleep anxiety or people who are highly arousable. And what I mean by highly arousable is somebody who’s very sensitive to environmental factors and things like that, waking them up at night. They’re just a lot easier to use than most.

They collect a wide variety of data. Like you said, respiratory metrics, heart rate, sleep metrics, body temperature, position metrics, we collect sound, so we can tell if you’re snoring or if there’s a disturbance in your bathroom. And the possibility to use this technology for other things.

So it’s very adaptable. What makes us very different is we’re very accurate. Compared to an in lab. Yes. We’re just as accurate as an in lab studies that we have 95 percent correlation. The other thing that makes Wesper for super unique is our longitudinal data collection capabilities. Most sleep tests are limited in the number of tasks you can actually perform.

Wesper can perform unlimited tax reasonable easy to charge. If you want your patient to collect data for a week, you can do that a month. You can do that even a year. We’ve had patients who have collected over 350 tests at this point without any issues at all. So not only does that allow you to test and diagnose your patient, but it also allows you to monitor your patient.

In the long term, which is very unique. Finally, we are very focused on the patient journey. So we actually involve your patient in the health care process. Doctors and providers get their own clinical reports, their typical medical report they would get with any sleep test, but our patients. In the app, also get a easy to understand a patient report, which is similar to something you would see in like a consumer wearable like Fitbit.

It’s very interesting, interactive, and this uses a lot of psychology to keep the patient motivated.

Bruce: You mentioned that the data can be used for a whole host of other things. What were you referring to with that?

Chelsie: Sure, so we have providers that use for insomnia tracking. We have providers and help our mental health care that use our device to track their patient sleep because sleep and mental health. I always say they’re married right? Almost every single mental health disorder has a sleep component to it.

That means we see sleep disruption and dysfunction with nearly every mental health disorder. We also see it with things like autism and ADHD as well. And we know that if sleep is dysfunctional, it makes treatment for these disorders very difficult. We need to obviously treat the mental health disorder, but we also need to proactively address sleep issues as well to get the best outcomes for your patient.

So we have a lot of mental health providers that use our device to evaluate their patient’s sleep in the long term .

Bruce: two criticisms of at home sleep studies that I’ve heard of before, not Wesper, but in general, is that I’ve heard that they tend to underestimate sleep issues compared to the gold standard of being in a lab, which it sounds like you also addressed. And then the other one is that it’s really a one and done, maybe two night.

Type of evaluation and then you’re done with that usage of the at home sleep study But it also sounds like Wesper you can continue to track does that ability to continue to track the patient’s treatment over time make the device more expensive because it is reusable or can you talk a little bit about the cost or the trade off there of being able to track longitudinally over time

Chelsie: That’s a really good question. So the criticism of home sleep, that’s not as accurate. Used to be an accurate criticism, but sleep tests are getting more accurate. Every single year. Sleep tests are practically in line with the hospital studies. Now, however, you bring up a really good point, which is a single study is not necessarily representative of a patient’s typical sleep.

So clinical studies have shown that. About 70 percent of patients have variation in their sleep from night to night. I’ll use sleep apnea as an example. If we looked at sleep apnea patients and we tested them over multiple nights, As opposed to a single night, we would find that roughly half of those patients can have both normal looking tests where no sleep apnea is present and abnormal looking tests where they are positive for sleep apnea.

This means that patients are at really high risk for being misdiagnosed if we base their sleep study off of a single night. by Incorporating longitudinal testing as standard and sleep medicine. This is removing this risk completely. And the more test your patient is able to take, the more accurate the data is going to be as far as not only what sleep disorders they have, but how severe their sleep disorders are as well.

This allows us to not only confirm that our patients have a sleep disorder, but it allows us patients more effectively. As far as cost we are currently working on a subscription model, so our patients pay a low cost every month, and that allows them unlimited testing. As for provider based models, that really depends on the hospital, the provider.

Bruce:

There’s a provider model as well. So the provider would be paying Wesper and then deciding how to use those devices with their patients. Is that how it works?

Chelsie: Yeah, so generally, We’ll offer a per test for Wesper. But again, compared to other sleep tests and hospital sleep studies, we’re very affordable.

Bruce: Nobody really talks about that in regard to the quote unquote gold standard of doing a in lab sleep study. It always feels your sleep study was normal in the lab. That was the best thing that they could have measured.

Therefore you don’t have it when it’s probably highly possible that it was a very uncomfortable experience. The individual didn’t get a typical night’s sleep in the lab, but I never really hear that being taken into consideration when evaluating the data from the laboratory sleep study.

Chelsie: I think it’s a pretty well known issue in sleep medicine. The issue really has to do with like insurance and what insurance will allow you to bill for. Hospital sleep studies are incredibly expensive and most of the time we simply cannot bill for multiple nights. So home sleep tests, just because they’re a lot cheaper., they’re easier to run,

Bruce: Are there certain diagnoses that are more difficult or challenging with Wesper such as periodic limb movement syndrome that might be difficult to pick up with your study versus some other study that has a video input?

Chelsie: That’s a really good question. We’re actually developing periodic limb movement for our device. The nature of our sensors is they can be placed anywhere on the body, including the legs things like periodic limb movement disorder you have to follow a very. That of criteria as outlined by the American Academy of sleep medicine.

So periodic limb movement, not only is looking for movement on the limb, but they have to move in a certain rhythm over a certain period of time and you also have to determine that the limb movement was not caused by something else, like sleep apnea, for instance. These are all things that need to be considered.

There’s always going to be challenges with developing that technology, and of course, Wesper is not going to be able to detect every sleep disorder. There’s over 80 sleep disorders, and Wesper, just by the nature of some of these sleep disorders, Wesper really can only just, potentially. Diagnose a handful of them.

Most sleep disorders are diagnosed through questionnaires. You don’t even need a sleep study for them. We could possibly integrate questionnaires into our system as well that recover those sleep disorders as well.

Bruce: There are many different types of sleep disorders, and I’m sure they all vary in prevalence and it sounds like if an individual starts off with Wesper and over, what’s the recommendation, a couple of weeks of time, if there’s no underlying issue, what would be the next step?

Chelsie: So we recommend that our users take three to six tests to start for a baseline data collection. Three is pretty much the minimum amount of tests you want. Six is the kind of like the ideal number. And that gives us a pretty good understanding of what your sleep looks like normally. Our patients have the option of consulting with me.

I’m the staff sleep expert to go through their data with a fine toothed comb and I can identify things that would indicate that you might have insomnia you might have Sleep apnea or a wide variety of other sleep disorders as well. But just because patients have, that come to us have usually been struggling with sleep problems for a really long time the majority of them do have Sleep disorder, whether that is insomnia or sleep apnea or another, very few have no sleep issues at all.

And there’s always ways to improve sleep. So if an individual is positive for a sleep disorder, then we will route them to the appropriate pathway. Usually that’s a sleep physician who will then go through their tasks, confirm that they have a sleep disorder. They’ll meet with that sleep physician. thEy will get their diagnosis and potentially go on a therapy and then we can also track them afterward to see how they’re going on their therapy. What kind of improvements they’re making if there’s no obviously disorder, but they are still having sleep issues. We can consult with them on how to make some lifestyle improvement. So improve their sleep hygiene use techniques to deal with things like anxiety and stress before bedtime.

If we suspect it’s another problem altogether and sometimes. Disfunction can occur because of other health issues. Things like mental health problems immune system issues, hormonal problems, things like that, then we would make the recommendation that they see a specialist

Bruce: One of the most interesting sleep disorders and I forget the exact phrasing of it is where an individual thinks that they’re not sleeping, but they actually did sleep. They think that they had insomnia, but they actually were sleeping for some portion of the night. How would Wesper go about evaluating that if it could without having an EEG to detect.

Whether or not they’re in any sort of sleep rhythm. Is it really accurate to extrapolate from body movement positioning alone to detect something like that?

Chelsie: Yeah, so that’s a good question. So what you’re talking about is a condition where that’s very common in insomnia, where a patient perceives that they were not sleeping when they actually were, and a lot of times this happens because we have four stages of sleep. We have three non REM stages, stage one through three, with stage one being the lightest stage and stage three being the deepest stage.

And then we have a REM sleep stage when we’re dreaming. So stage one sleep is very light and it feels like you’re awake. So you do have Some level of awareness of your surroundings, but your brain is actually actively in sleep. So people who are highly sensitive can perceive this as being awake.

Now, the way Wesper might. detect this is we can accurately predict when somebody is not only asleep, but whether they’re in light sleep, deep sleep, or REM sleep. And we base this off of a few parameters. So first we look at their respiration because people’s respiration changes depending on what sleep stage they’re in.

So somebody in light, Sleep might have a slightly lower respiration. Somebody in deep sleep is going to have a very low rate of respiration. And then somebody in REM sleep, their respiration is going to be all over the place. It can be fast, it can be slow, but it changes very frequently. We also look at heart rate, which is very similar to how it changes to respiration.

We look at body movement, and we can also detect things like your core body temperature and things like that. So all that information taken together gives us a fairly accurate assessment of when you were asleep and when you’re awake even though we cannot monitor your brain waves directly like an in house.

I will throw it out there that wearables will never be as accurate for sleep wake protection as an in hospital sleep study.

Bruce: Would it be helpful to add another electrode behind somebody’s ear or something like that in a less intrusive place, something to get those brain rhythms that way to more closely link the data between the movement and the brain wave itself?

Chelsie: It’s certainly possible. It’s not something that we’re technically looking into at this time. The only issue with that is monitoring brain activity from one area of the brain doesn’t really give you an accurate representation of what is happening in the brain globally. So that might not give you enough accuracy to say for certain that somebody is asleep or awake or if they’re in specific stages.

So it’s really more about taking all of Those metrics that I mentioned earlier, and using an algorithm that has trained itself to very accurately identify when somebody is asleep versus awake. One of the ways we do that is we take our artificial intelligence, our algorithm, and we train it against hospital PSG sleep studies that have already been conducted so our algorithm can look at somebody who we know for sure was asleep because they had the PSG.

Bruce: What kind of feedback do you get from either patients or clinicians about the system and how have you incorporated that to make any sort of adjustments improvements thereafter?

Chelsie: So the main feedback we get is how easy we are compared to other sleep studies. We’re super simple and we’re patient friendly. We designed our technology to be friendly for elderly patients that may not necessarily be super tech savvy. And the reason for that is because a high percentage of our patient population is they’re senior citizens, they’re older senior citizens tend to have higher rates of sleep disorders like sleep apnea. So it’s got to be very simple at that up, and it has to work consistently. And it also has to be very comfortable to where the other thing that our provider really appreciate is our longitudinal testing capabilities. That really sets us apart from other sleep tests, which are more limited in their repeat testing.

And finally, a lot of our providers are really happy with the fact that we involve our patients in their own healthcare journey. People can be very I think they can be a little bit resistant to medicine. Sometimes they can be a little bit distrusting of providers. I’m sure most of us have run into this at some point.

And so what we find is allowing the patients to be involved with their own user report really helps them understand, like, how bad their disorder is, how problematic it is, how it’s affecting them. They can actually watch their improvement in real time once they get on therapy. And this is just a huge motivator, and we find that it speeds up the testing process.

Bruce: Can a patient have a face to face visit with a sleep expert at Wesper to go over the data or is it more of a report based interpretation that gets sent back to the patient for them to read?

Chelsie: They have both options. They receive their nightly reports immediately after they stop their tests. tHey also have the option of meeting with a sleep expert. Currently, that’s me. We’ll probably bring more sleep experts on to staff eventually as we get bigger. And what I do is before I even meet with the patients, I go into their profile.

I go through every single one of their tests. I look at key indicators for sleep disorders or sleep issues. I look at their history. So our patients fill out questionnaires about themselves and what they’ve been struggling with and their main reason for wanting to test with Wesper. We also ask a series of questions before and after each test about their habits immediately before they took the test.

So these are things like, how were you feeling? Did you eat a big meal? Did you take any medications? Are you using any therapies? And then when they wake up in the morning, we’ll ask them questions like, how do you think you slept? Did have any issues last night? Do you feel like you slept better than usual? Worse than usual? Things like that. so I can really create a story and picture of our patients and then I take a good half an hour, sometimes longer than that. Do consult with our patients. I listen to what their major concerns are. We go through their tests and find detail and then I help them with a pathway forward to improve their sleep.

Bruce: I’m sure a lot of people are probably wondering whether or not it’s covered by insurance. Could you answer that question for us quickly?

Chelsie: Yep, so currently we’re not accepting insurance. That is something that we are looking into. We’re currently, any patients that come through us, it’s out of pocket. We’re very inexpensive, so it’s not a huge cost, but we would like to offer insurance coverage in the future.

Bruce: What kind challenges lie ahead for you? It sounds like Wesper is at the forefront of innovation, wanting to constantly improve. Where do you see the company growing or adding to their current setup to maybe make some improvements or expand the scope of treatment for patients?

Chelsie: So I think the main current challenge is integrating into hospital systems right now. Even though about 50 percent of patients who are getting sleep tests are tested by home sleep tests, integrating into hospitals can be a little bit tricky. A lot of physicians are resistant to home sleep testing for a variety of reasons, primarily because in hospital sleep studies are all they know.

It’s all they’ve been doing for a really long time. So there is a trust factor there. That’s a big hurdle for home free testing companies. Another issue is every clinic is a little bit different, so their requirements for what the sleep report looks like or. The patient portal. They’re all slightly different.

So being able to adapt to each clinic needs can be difficult. Not insurmountable, but it is something that takes time and effort are on our end. And because we are a small startup there’s only so much we can do at this moment, as far as where we’re going in the future, 1 of our major focuses is to get involved with other areas of health care where sleep is a major risk factor for certain diseases.

So I’ll give you an example. Cardiology is a major area where sleep often plays a huge role in a variety of disorders. Sleep apnea, for instance, is associated with almost every type of cardiovascular issue, whether it’s coronary artery disease, arrhythmias, stroke, you name it. Arrhythmias in particular, arterial fibrillation.

50 percent of those patients have sleep apnea and sleep apnea is the primary cause for why patients develop those so cardiologists are starting to learn that it’s very wide to also test their patient’s sleep. Along with treating them for their cardiovascular issues mental health and psychiatry and therapy is also another big area because like we were talking about earlier, almost every single mental health disorder has a sleep component.

And if you do not fix the sleep, it’s going to be very difficult to treat your patients. So understand whether or not they have an underlying sleep disorder.

Bruce: Let me ask a follow up question about how you said that one interest was getting into the hospital systems to test sleep issues in a hospital system. Does evaluating the data of an individual who is laying in a hospital bed differ at all compared to evaluating that data of an individual who may be in their own bed due to the fact that maybe the bed is more narrow they’re more restricted by an IV, or maybe it’s tilted upward and they’re less likely to roll over on their stomach, given the fact that it’s tilt, the back is tilted upward.

How does that work? How does that vary in terms of your interpretation of that data?

Chelsie: hospitals are Not comfortable. If you’ve ever spent time in a hospital, I certainly have. I’ve even undergone two in hospital sleep studies a while ago, about 10 years ago, but they’re not comfortable. You’ve got a bunch of wires and sensors all over your body, on your head, on your nose, strapped around your chest and your legs.

It’s very restrictive to patients, so most of them have to sleep on their backs simply because they’ve got all these wires on them. Back sleeping does not necessarily promote good respiration in patients, especially sleep apnea patients. We see that sleep apnea tends to be worse when you’re sleeping on your back for most patients.

Numbers can be inflated, and it’s not really giving you an accurate look at how somebody is sleeping normally. Hospitals are also right. They’re loud. People are walking in and out of your rooms. It’s not conducive to good sleep at all. So we find that people tend to sleep lighter in hospital settings, and they also tend to get less sleep on average.

You really only need four hours of sleep to diagnose. Somebody with a sleep disorder, but still, it’s not going to give you a complete look at what their sleep looks like naturally. So really, being able to have somebody in their own bed in their house and their normal environment, it’s actually going to give you a more accurate look.

Bruce: thought it was sad and a little bit ironic when I was a medical student, and we were pre rounding at 430. And asking the whole list of questions and one of those questions being how did you sleep and patients typically looked at you like, what do you think? Because obviously I just woke them up at four in the morning to ask them a bunch of questions after they probably went hours upon hours trying to ignore all the beeping around them and all the other interruptions.

And I wish hospitals in general were a little bit better at prioritizing sleep for overall well being and recovery and healing than they are. But I think they’re getting better at that overall.

Chelsie: One thing I have noticed lately in the industry is doctors who do rely on in hospital are now starting to add home sleep tests on top of that. So they’ll do the initial and then they’ll send their patient home with a home sleep test to confirm the results or they’ll do it in the reverse where they will send their patient with a home sleep test and then follow up with a PSG later to confirm.

I think in that regard, it gives you a much better look at somebody’s sleep in a natural setting, but also with the rigorous testing of a PSG as well. So that’s a great combination. I really think it also depends on the patient and what sleep disorder you’re actually testing for.

Bruce: What kinds of recommendations would you have for somebody who is interested in innovating in the field of mental health or sleep or biotechnology?

Chelsie: So If you are somebody who works in mental health one thing that you should be assessing is sleep whether that’s through questionnaires. And I know a lot of mental health professionals do use questionnaires, but if there’s any indication that there is a sleep problem, which more than likely there will be, It’s very important that you rule out some of the more common sleep disorders, because they are so prevalent.

And you can help your patient with sleep hygiene, you can help them improve their habits, but if there is an underlying sleep disorder, you’re not going to be able to do anything until that sleep disorder is addressed. So using a technology like Wesper can help you not only screen your patients for sleep issues, but they can also help you confirm that your patient does not have a sleep disorder, or if they do get them treatment for that sleep disorder.

So a lot of our providers. Have a Wesper for kits on hand and they will give the kids out in their standard protocol. It is written into their protocol. It is already built into what the patient is paying for and it’s just a part of their normal treatment

Bruce: Are there any types of novel treatments within the field of psychiatry or sleep other than your technology that really excites you and things think that are going to be up and coming in the future?

Chelsie: not related to sleep at all. I think what we’re doing with psychedelics is incredibly interesting especially for treatment of chronic depression. In particular I’m somebody who suffered from depression, and I know that if you’re treatment resistant, it can be a very bleak outlook for you, and it feels like nothing is working, but the information that is coming out about psychedelics things like ketamine, for instance, very promising, very interesting I’ve had colleagues working on things like ketamine therapy with amazing results.

I’m interested in seeing how this expands. I know it’s a little bit tricky with the legal process, especially in some states. I live in Michigan where ketamine therapy is, it’s legal and we have clinics. And it’s just incredibly interesting and promising to me. The other areas I’m really interested In would be things like how your gut flora and your gut bacteria affects mental health.

Bruce: Is there any data on how ketamine or psilocybin affects sleep?

Chelsie: Yeah, that’s a good question. So what we know so far, and this is very new, young research, again, it goes back to the legality of using these substances on patients. Psychedelics, ketamine affects your sleep architecture. So we know that patients that have been on it their sleep architecture, meaning how they move through each sleep stage is altered.

Now, this can be both a good and a bad thing. It can be a good thing for patients with depression, for instance, because patients with depression have too much REM sleep on average. Depressed patients go into REM sleep earlier on average than healthy patients, and they spend way too much time in REM sleep.

We I think that inhibiting REM sleep, and medications like SSRIs already do this to an extent, is actually very beneficial for patients with depression. So if psychedelics are able to do this too, meaning if they’re able to inhibit or change the way a person cycles into REM sleep this may be one of the reasons

Bruce: I’m sure we’ll have to have you on again in the future to talk about any sort of additional studies that have come along , in regard to psychedelics and its intersection with sleep issues

Chelsie: the main issue is sleep disorders are super common in the general public. Most people are not getting diagnosed or treated. Most people don’t even know they have a sleep disorder. It’s more prevalent than we think it is. And every year that percentage of people who have things like sleep apnea and insomnia is rising.

So it went from 10%. Now it’s closer to 20%. It’s creeping up to 26%. THe fact that we have so many undiagnosed, untreated people means that these chronic health conditions are going to continue to increase in the population.

If you’ve had sleep problems for years, or your patient has struggled with sleep for years, they’ve tried all the typical things, they’ve tried good sleep hygiene, they’ve tried exercising more maybe they’ve tried some insomnia techniques that we teach in Cognitive Behavioral Therapy for Insomnia, and nothing has worked. That’s a very strong indicator that your patient probably has a sleep disorder and needs help. to be tested. Sleep disorders are highly prevalent in our society, especially insomnia and sleep apnea, and they’re becoming more common. Most people are not screened, tested or diagnosed, because they don’t even know what to look out for and other professionals are not aware of the symptoms and how it might be affecting your patient.

So don’t wait, get them tested.

Bruce: It was really a pleasure having you on the show. I thought this was a really interesting , conversation to get to know you better and get to know Wesper better. I do think that there is a shortage of really good, easy to use at home sleep study tests out there. And so therefore I’m so grateful and glad that you were able to talk to us a little bit about Wesper and why it’s so valuable and the reasons that using the test long term can be so useful to patients.

So I appreciate you so much. Thank you.

Chelsie: Oh, thank you for having me.

Bruce: I’d appreciate it if you please like and share the podcast with your colleagues. It would be especially helpful for us. And if you’d like, please leave us a rating on your favorite podcatcher. If you’re a clinician, I developed a course on how to start a private practice. And for patients, I’ve also developed a course on ACT and CBT based lessons for treating and helping anxiety.

And you can find those all on our website as well. Thank you so much. And I’ll see you in the next episode.