About Dr. Michael R. Bridges, Ph.D 

Michael R. Bridges, Ph.D. is a former Associate Professor in Clinical Psychology at Temple University and a Licensed Psychologist in the State of Pennsylvania.

Dr. Bridges has 25 years of experience in providing psychotherapy, assessment, psychotherapy research, teaching, supervision, and continuing education. For six years, he worked as a clinical and forensic psychologist for the U.S. Department of justice and contributed to the scientific literature on the assessment and treatment of various types of offenders.

Steve Martorano
The Behavioral Corner is produced in partnership with Retreat Behavioral Health -- where healing happens.

The Behavioral Corner
Hi, and welcome. I'm Steve Martorano and this is the Behavioral Corner; you're invited to hang with us, as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner, please hang around a while. 

Steve Martorano
Hey, everybody. Hi, and welcome again to The Behavioral Corner. It's me, your favorite guy who hangs out on the corner, Steve Martorano. We are here to talk about behavioral health. That's what we do. And it's a huge topic. So that's why when people say what's the podcast about Steve, I say what's about everything because everything one way or another is going to affect our behavioral health decisions we make the way we feel...choices. We like to topic we can run far and wide. And I think we're going to do that today. With a...with a kind of exciting topic that you may be familiar with, as I thought I was, but really was in the dark about it. We're going to talk about a mind-altering drug as it has been described as ketamine, and its use now as a therapeutic tool for the treatment of depression. It's a very interesting topic. There are some very exciting things going on regarding issues in that regard. And so you know, what we do here in the Corner is we wait for interesting people to come by, we ask them if they know anything about the topic. And we're always lucky, we will be spoken to somebody who's an expert. And that's the case with our guests. Please welcome Dr. Michael Bridges. Dr. Bridges is a licensed psychologist. He's the former Associate Professor and Director of psychological services at Temple University in Philadelphia. And he has a clinical practice of his own for couples and individuals. And he treats them for a range of mood disorders, depression, anxiety, traumatic abuse, social phobias, and the like. So we welcome Dr. Michael Bridges to the Behavioral Corner. Hello, Dr. Bridges.

Dr. Michael Bridges
Hi, there, Steve. Thanks for having me. I'm really glad to be here today. To start off with I want to kind of emphasize that the part of what is now being called K.A.P or Ketamine Assisted Psychotherapy, that the area that I really have the expertise in is the therapy part of that. That I've been in terms of doing ketamine-assisted psychotherapy, I've had the great good fortune to the Velop, collegial and a kind of intellectual friendship with Dr. Jonathan Beatty, who has been a guest on your show before and has talked about, you know, neuropsychiatry and trance magnetic stimulation. But he and I met a few years ago when I was giving a presentation on kind of the research of the time about what many people are so excited about kind of psychedelic-assisted therapy and the Renaissance and using psychedelics and psychotherapy. And that's when we started talking about like, well, how can you do in actually a legitimate way what people are doing, like Michael Pollan and others have talked about using psychedelic substances that were once you know, well, still are illegal, but using them in legitimate clinical settings, to do psychotherapy. And I kind of want to emphasize that. I think at times, even with the psychedelic Renaissance, there is, maybe an excessive focus on just the molecule and what areas of the brain they are having an impact on and neglect the fact that this is always happening within a setting where there is a therapist, helping the person process, what's coming up. And that's why, you know, why people just dropping acid at a Dead concert or using MDMA at a rave or using ketamine as a club drug did not really you know, result in a lot of psychologically healthy self-actualized people, you know, may have been a good time. But that's not psychotherapy.

Steve Martorano
Excluding the deadheads from that category, because they're all well adjusted.

Dr. Michael Bridges
Yeah. But I also want to say that I kind of, in some ways, with a sense of pride will describe myself as a real psychotherapy nerd. And when you think of a nerd, it's like somebody that's kind of like maybe a little socially awkward, but they really get lit up about whatever their passion is, you know, they were a kid it was Dungeons and Dragons or collecting snakes, or whatever. It was a weird thing they did, but when I was 14 or 15 years old, I was reading like Freud, Jung, and Reich and learning about archetypes and keeping journals of my dreams and things and why was I doing it? Well, there was an intellectual interest. But I was also frankly, trying to figure out the abuse and trauma I already knew I had never repressed and trying to figure out this thing called therapy, how might that help me. And that then led to kind of this lifelong journey of being then a consumer of therapy, I've spent many years quite a few $1,000, trying different kinds of therapy with different kinds of therapists. That has been very good because I know what's worked, and what hasn't been particularly helpful. I've now come up on 30 years, close as a therapist with all kinds of populations. I mean, in my early career, I was a forensic, clinical psychologist for the Department of Justice. And I'm mainly...I worked with incarcerated inmates, sex offenders, people who had been males, and some of the most, you know, abused, traumatized individuals who ended up in prison. Now, there are all kinds of other reasons people end up in prison, you know, all kinds of racial inequities and things like that, but essentially, traumatized men end up with a label of antisocial personality and get put in prison. The next part of my career was I was a director, I became a clinical assistant professor at UNC-Chapel Hill, and I directed a dialectical behavior therapy unit, which in DBT is the treatment most empirically validated treatment for individuals with a borderline personality disorder. Now, there's a great deal of kinds of, you know, using that label, I think a lot of the people that were diagnosed with borderline, we'd say, actually have really complex Post Traumatic Stress Disorder, you know, traumatized, right, because...because they have some of the most abysmal abuse histories I've ever heard. Also, primarily as the ones that get labeled anti-social tend to be male. People that tend to be labeled with borderline personality tend to be labeled female. And primarily, the unit that I worked in, then were people that had been sexually, physically, neglected, all kinds of abuse and the presenting thing is that they do these sometimes bizarre things like cutting themselves.

Steve Martorano
Yeah.

Dr. Michael Bridges
I had people that have one arm for burns, and one arm for cuts. And they have these extremes of emotionally kind of label kinds of things. They, you know, you're, you're the ideal, and then you're horrible. Then you know, and sometimes that can happen in minutes, these kinds of things. So I'm kind of laying this out, just to say that you know, I've worked with some of the most traumatized and abused populations. And this kind of thing areas of life it really early on in my career, which then led me in early 2000, to coming up to temple where I had the position that you were talking about, but then that's where this other part of me, not just the practitioner, the scientists came online, where I then had the opportunity to start doing research on psychotherapy, where I was using kind of thing where we would have a camera both on the therapist, sometimes it was me, sometimes it was someone else, the camera on the therapy patient. We had them, we were measuring their heart rates with these kinds of high tech expensive monitors that now my Fitbit does a better job doing. Then go back and look at things like facial expressions, the heart rate, what would happen when somebody's would say break down and cry? This happens, of course, in psychotherapy. And sometimes that related to relief. And sometimes it led to them feeling worse.

Steve Martorano
Yeah. Before you go any further. I have a question about just that. I know, we're, we want to swing back into our topic. But when you videotape people in that therapeutic setting. Did you show it to...to...to the patient? Do they see their reactions?

Dr. Michael Bridges
Only occasionally, do we do that?

Steve Martorano
Oh, that would not be a good...that would not be a good thing for them to see the way they react?

Dr. Michael Bridges
Um, it wasn't...it would have taken a lot of time. It was pretty much like they were coming in, they knew it was going to be confidentially, but it was going to be viewed by people that were going to be writing their facial expressions...

Steve Martorano
....you are going to be measured...you are going to be measuring things.

Dr. Michael Bridges
Right, right, right. I have certainly at times and still encourage my clients if they want to like audio record our sessions, you know, and listen to them afterward. Because sometimes there are things like hearing my voice, are there things that you experience in therapy that are just, you know it right then and there'll be like a dream. If you don't write it down afterward, it'll kind of like evaporate.

Steve Martorano
...and happen to someone else or did I just imagine that? So I can see that your nerdiness has led us the right to where we are today. Because you've...you begin with a general interest from a personal standpoint, go into the field and then move it beyond that to the actual not just merely practicing this...this or this...this medical field but to find out you know what else is going on? What's you know, let's figure out what's going on. And what else is going on you guys listening are going to hear a lot more about this. The use of psychedelics is Dr. Bridges said, once some of the legal barriers are overcome and they are slowly happening, you're going to see what some people say is...is going to be a revolution in therapy for issues like depression. So let's get to the ketamine situation and we'll begin at the beginning. You know, what is ketamine?

Dr. Michael Bridges
So, ketamine is been around for I think now 70 or 80 years. It's primarily classified as what's called a dissociative anesthetic. It was used a lot in Vietnam because it was something that you could give severely wounded men, that would put them into a kind of sometimes it's called the "k-hole," where they would be feeling no pain. They would kind of go somewhere else. You can sometimes then keep them sedated like that because it might be hours before a chopper could get in to lift them out.

Steve Martorano
Sure.

Dr. Michael Bridges
They the...because it has an as an anesthetic for surgery and everything. It has great benefits like the one you have to give a lot before you would ever, you know have a lethal dose. Unlike every other anesthetic that is used, it doesn't depress your heart rate and respiration. So you don't have to be put on a ventilator. The problem they found when they used it with adults is there's this thing called the "emergence phenomenon." Meaning when they came out of the surgery, they would be kind of like disoriented. They would not be seeing reality as it was. They would maybe be saying they thought they had died and been floating out of their body. And so that was very disorienting, particularly for adults. Now, they still use ketamine a lot in pediatric surgery. When my daughter was about two and a half, she rolled off the side of the bed and just cut her ear open on a nightstand. We rushed her to CHOP. It was on a Sunday, they had a pediatric plastic surgeon on call that came in. And she's, of course, she's screaming all these people you know, with you know, their mask and everything on and lit up goggles, and they give her this shot of ketamine and she's just calmed down and it's kind of staring off into space. Now, she went through the surgery just fine. You can't even see the scar that was there. We're very thankful to CHOP we put her in a little seat and start driving back to, to Manayunk / Roxborough. And you can tell she's kind of looking around and smiling. You know, now what she was seeing, it was not freaking her out because she still had a child consciousness. But that's why they still use it with children. Now, this is the thing and I want you to get this emergence phenomenon. The sense that people wake up out of this when they've been in surgery, and they're tripping. That is what's disorienting what is seen as something that you don't want as a surgical anesthetic becomes exactly like keeping you in that sweet place where you are having. Even though ketamine works on really different systems under traditional psychedelics like psilocybin or LSD, it's still through a different route that gets to a place where really profound therapeutic kinds of changes start to take place.

Steve Martorano
And it's in that context, that phenomenon of emergence that you talked about. That folks like you and others have, what is it referred to as off label... use that...use that drug...

Dr. Michael Bridges
Off label.

Steve Martorano
... off-label sense, right?

Dr. Michael Bridges
That's right. That's right.

Steve Martorano
It's enough to go, "Wow, that phenomenon is not just a mere side effect. There may be something valuable about that experience that we should explore." And so the first use we talked about it off label was in clubs during raves just to heighten the whole experience of you know that kind of music and all that, and, I would guess save on liquor bills by the way. You wouldn't have to drink too much.

Dr. Michael Bridges
Bringing up the off-label thing. I think actually this is really important. I'm glad you did it because I want to make sure that we actually attended this. Ketamine is being used in many cases now off-label like in IV clinics for depression for anxiety disorders...for chronic pain.

Steve Martorano
So let me start...let in so so people understand "off label" is a term of art that means a substance that has a demonstrable use in one area Now has also been, we'll find out about ketamine as an application that's not strictly speaking what it's for.

Dr. Michael Bridges
That's exactly right. I mean, for example, I'm on hydrochloric thiazides, which is actually approved for being a diuretic. I take it because it helps me control my high blood pressure.

Steve Martorano
Me too.

Dr. Michael Bridges
And in fact, this is the thing I think your listeners should see. When I heard off-label, I thought, "Oh, people are doing something shady.

Steve Martorano
Yeah.

Dr. Michael Bridges
A medical practice could not take place if physicians didn't use things that were off-label.

Steve Martorano
Yes. Yeah. So I just want to make sure people understood by talking about people going, "Oh, let's use it for this and see what happens". Okay. It's a well-established principle, the use of stuff that is off-label.

Dr. Michael Bridges
What...what ketamine is also well established for and this has been researched for almost 10 or 15 years now, is -- a lot of it came from Yale University, they were kind of at the vanguard of this -- is that they did notice when ketamine was used in other situations with people that had been chronically depressed, it seemed at times that some of these people would have like an almost immediate alleviation of their depressive symptoms. So they started to look at this and much more, you know, I'm in clinical trials for the FDA and typically, this has been now what probably, many of your listeners may have heard something about...about using IV preparations of ketamine, where people who have treatment-resistant depression that's usually defined as you've, for some years, you've tried at least two antidepressants, SSRIs, you've tried therapy, nothing has worked. So you need to do something else. The standard IV approach is to have people come in usually, it's roughly like two to three weeks was two to three IV ketamine sessions. And that you're going to be in a clinical setting, you'll be usually in a recliner, you can listen to music if you want to. You'll be told, not that it's going to be necessarily therapeutic, but that you may see things and you'll have visions. You'll feel relaxed. You may feel that you're floating -- and that that will subside. There's a general sense in that community often that that emergence phenomenon, that kind of quasi-psychedelic stuff is like, that's not necessary, but we need to kind of like, you know, put up with that, so that you will then experience the relief that you're going to experience.

Steve Martorano
Yeah. So you talked about the IV administering the administration of the drug, and how is it administered now in the therapeutic setting.

Dr. Michael Bridges
There are still people that use strictly that approach. So again, compared to other psychedelics, one is that it's a schedule three medication. So that is up there with the kind of like Adderall or something like that. So it needs to be monitored, you know, by a medical professional, but it's not that difficult then to have access to it. It's...it's been off-patent since the 80s. So it's not that expensive, any longer. And that it also is very...it's multimodal in how you can administer it. It can be through IV. It can be an IM. It can be an oral lozenge. It can be in an inhalant. So, almost any way now...there's different things like you're going to get much more immediate effect, it's going to be stronger, and we'll get more of the ketamine dosage, say milligrams in an IV versus milligrams that you're going to inhale.

Steve Martorano
And the condition of the patient determines how you would administer ketamine, right?

Dr. Michael Bridges
I mean, well, it's also it's all about the set and setting. So let me kind of then bring you to how we're actually doing it -- you know, Dr. Beatty and I are using when we do ketamine-assisted therapies. We actually have chosen to do and this is primarily Dr. Beatty's selection to use the inhalable version. And there are a couple of reasons for this. One was he is working with a version of ketamine that was developed by Johnson and Johnson S Ketamine Spravato, that has a very protocol where you do inhale it -- often taking it with another antidepressant. But that's not necessarily, you know, a therapeutic approach. It's, it's essentially kind of for its antidepressant effects. What we found is by using the inhalable versions, the clients that we work with actually like -- because many people come in with a great deal of anxiety about experiencing this. They are often like people that have been traumatized or have you know, anxiety, they want some control over this. So we do it in the following way that to begin with, they are in control, they have their own little you know, thing that has an inhaler that has their name on it's prescribed to them, it is kept at the office, but they will then say do six inhalations That's a kind of mild dose of ketamine. And we allow usually about 10 minutes for that to take place. At that point, usually, particularly if this is the first session, one thing, well, one thing that will happen is the person will primarily start to feel relaxed. They'll still be in the room, they...there won't be any sense that they're tripping, or they're losing control. Usually, there's a sense of relief, and just a kind of physical, and emotional relaxation. After about 10 minutes, if everything's going well, then we'll offer say, another six ventilations. And that is usually at the point where they will have absorbed enough in that another five or 10 minutes after that, that's when usually the client will choose to lie back. They'll either close their eyes or as people who may have seen, things on psychedelic therapy, we have eyeshades, if they want to put those on, they can put on headphones or earbuds. We do make if they're going to listen to music, we do kind of have a particular playlist. It's good to listen to music that you frankly, aren't that familiar with, (because) now that you want to open up kind of neural pathways that you don't want to kind of, you know, just have the same old pathways re stimulated, you want to take them to kind of rounds that are nonverbal instead of verbal. And that usually works better for what's going to happen next.

Steve Martorano
Well, you know what, this is fascinating stuff. I could talk to you about the musical...I was a disc jockey earlier in my career and you know, the idea that somebody else is gonna choose your music is already dicey. But that's a great topic. I'd love to get to. I want to reintroduce my guest, Dr. Michael Bridges, and licensed psychologist, he and his colleague, Dr. Jonathan Beatty, are at the forefront of treating depression, with the drug ketamine. Beautifully described the outward picture of what goes on in the administering of the drug and the effect it's having. Let's get now to what ketamine is actually doing. What's it doing? And I know, in other words, how it works. And I know one of the things you want to make a particular point about regard to this is something called the "default mode of our minds." Because people go, Well, what's the big deal? These guys are giving you drugs that you get trippy and you feel better for an hour? You're going way beyond that notion.

Dr. Michael Bridges
Right, right.

Steve Martorano
But this thing about the default mode. So what is our default mode?

Dr. Michael Bridges
So the default mode, Michael Pollan, you know, who wrote the book, How to Change your Mind, that was really one of the sparks, you know, journalistic sparks, that kind of brought about partially the psychedelic renaissance that we're experiencing, said that if the ego, you know, kind of the sense of I, who I am, has an address, it's the default mode. So I'm not going to name all the neurological neuroanatomical substrates as the default mode. But this is the metaphor that people that have greater minds and I that have worked in psychedelic-assisted therapy, talk about the default mode, and also what substances like ketamine, how it kind of resets that. That the idea is, if we think about it, that we're born there, you know, to some extent, we bring in temperamental things. It's not exactly of course, that our nervous system, the brain is going to be a complete tabula rasa. But if you imagine in some ways, kind of our nervous system is a hill with just freshly fallen snow on it. Then, of course, we begin to have experiences not necessarily just traumas, but we have experiences with our caretakers, we learn things, we have things that are hurtful, and we have things that are loving and exciting. And as we have these experiences, you know, neurons fire together, wire together. And in this metaphor, it becomes like when you go out onto that hill when you were a kid with your sled, and nobody has gone on it yet. And you start sliding down, and then you come back up. And of course, if you go back down that same groove, there's going to be more eyes and you're going to go faster, and then your friends come, and then everybody comes. And then after a while, people are going to be doing it everywhere and skiing here and there. But there's going to be grooves that if you come there and you just throw down, you're gonna go down those same grooves.

Steve Martorano
The same grooves, which is the reason that you might want to steer someone away from the music they've been listening to for the past 50 years or 40 years because you've been down that side of the hill.

Dr. Michael Bridges
You've been down that side before you and so we can function without a default mode. I mean, just one that anybody can identify with is remembering what it was like when you were 16 and taking drivers out or learning to drive a car and how you drive a car now. There are so many things that go on. I mean really fine-tune things that you had to concentrate on for all you were worth. When you were first learning to drive a car, you have conversations and listen to music and change stations, and oh my god, somebody just hits the brakes and from it. And you do that without a lot of thinking, that's those kinds of neural grooves that are well worn in and rehearsed now.

Steve Martorano
And that context is perfectly easy to see how people who are suffering from really problematic mood disorders like depression, need to get off that track.

Dr. Michael Bridges
That track that is so automatic with them, when they wake up in the morning, the groove they start down is "you're a failure." Let's think about the last 50 years of your life and every failure you've had. And that's really the way some people start out.

Steve Martorano
When you're first waking conscious thought, every day is filled with despair, and uselessness you can see how the whole thing would begin to fall apart. So this anesthetic somehow or another, in addition to numbing pain, creates this euphoric sense, allows all that to sort of disappear and that's where you talk about the therapeutic benefits of this. That's where the work has to be done, right?

Dr. Michael Bridges
So the idea of resetting the default mode is that a medicine a molecule, say like ketamine, it's also, of course, been applied to the psychedelics is like, it takes your mind. And it's like, your mind is a snowglobe. And you shake it up. And so for a period of time, the molecule turns off those grooves. And there is a moment then where you said euphoria, but I actually do think that this is really an important phenomenon. Well, it's like this: One, people start to notice. This is like the...I'm going to walk you through what my clients tell me it's like, as they start to experience ketamine.

Steve Martorano
Yeah.

Dr. Michael Bridges
One is there's that almost immediate relaxation. A sense of like, what people will often talk about, I remember one woman saying, I can feel it, she says, Wow, I feel like that's the first breath I've taken and taken in weeks, it feels like there was a weight just lifted off my chest. So there's immediate physiological and emotional relaxation. Then there is a sense, the second phase is kind of a place of peace, and quiet. And they will then say, it's like, "I don't hear that voice that tells me I'm a failure." "It's funny, I'm not thinking of being suicidal, anymore." "Wow, I'm not ruminating about my bank accounts anymore." I have a lot of respect for the word relief. It's such a relief.

Steve Martorano
And what's interesting is, and I guess this is a universal phenomenon is that for many people, that's the first time they can feel and are aware of an alternative to feeling bad.

Dr. Michael Bridges
You're exactly right. I mean, that is really to hear somebody say, "I cannot recall a time in my life, where my mind has been this quiet."

Steve Martorano
Yeah, you know what, it sounds an awful lot like and this is a kind of creaky analogy, but when the computer's not cooperating, I don't care what your level of expertise is. The first thing you need to do is reboot the computer.

Dr. Michael Bridges
Right? Yeah, yeah, yeah, yeah.

Steve Martorano
But it's sort of like that, right?

Dr. Michael Bridges
It works. But there's something of the sense it's like, if in the human brain, the micro biocomputer of the brain, what is happening is, if you can unplug just those parts of the default mode that have that old depressive, maintaining trauma, maintaining loops, if you in some ways that snow would fall on your amygdala in your limbic system, and start to cool that down. Then that's again, that's like the next phase. There's, there's kind of the relaxation, there's the great relief and peace of like, I don't feel those negative thoughts anymore. Then the third phase is when the door opens. And there is a phrase in psychedelic-assisted therapy that we also applying ketamine that the scientists in me just couldn't stand it was like "trust the medicine" and...and that to me is just like, you know, I imagined Jeff Bridges as The Big Lebowski, "You have to trust the medicine man, just let it happen." The client and I have intentions for the session. We may be going back and looking at very dramatic things...that might be your intention. Once the ketamine kind really starts to have this kind of now moving into a more psychedelic-like territory, these are the kinds of things that will happen. So a young woman with one, a horrendous abuse history, long history of actually really serious suicidal attempts. We're going to kind of like, try to work, go back and examine some of these traumatic things from a different place. But what she starts to describe is as follows. "Wow, it's like I'm seeing sand. It's just like sand. You know, swirling in the wind, it's really kind of beautiful. Oh, it's like the desert. I'm walking in the desert. And I can see the stars. Oh..." She grew out in Nevada, out in the desert. She says, "I remember when I was a little girl, you know after I'd been abused, or my parents were getting drunk and fighting, and I come out in the desert. And I'd walk like this, and I'd look up at the stars.

Steve Martorano
Her happy place.

Dr. Michael Bridges
Her...her...yes, her happier place. If you're in a situation where it's clinical. It's just like, oh, you know, you're talking about oh, yeah, well, there's no desert here. That's nice dear, you know, we'll just wait. It'll pass in a little bit. Instead, that's when the door opens up. Now, two words that people often use are "awe" and "wonder." This is beautiful. That it's not just this is the place where I escaped from that it's when I look up at the stars. I remember what it was like, in some ways to be in that childlike state of consciousness. That was as people will some somebody was telling me on Friday, it's like I remember how it was before the bad things happen.

Steve Martorano
Sure., it's an interesting phenomenon. People who've taken LSD under the right circumstances, will tell you, in my experience will tell you, they'll say things like, "I felt aware. It was like a revelation about everything." Nothing I can specifically describe to you. But suddenly, as you said, there was the "ahhhh" moment.

Dr. Michael Bridges
Yeah, now, I will say that probably the doses...I mean, does have a lot to do with it.

Steve Martorano
It totally does. We probably...I think for people to get to a ketamine dose where you're like that -- I'm all one with the universe -- and people can have those experiences, those could be useful. We try to stay a little bit on the side of that to do therapy. Ultimately, I think Steve ketamine helps people get to, and it's not the only medicine, but it's often where we haven't been able to get through just through therapy alone is that they are able to not only get free of those repetitious, you know, negative thought patterns, or repetitious free experiencing abuse, they move into a place where they are able to observe themselves from a place of compassion. So the same woman that I was talking about a little bit later in that session, started to say, "You know, I'm thinking Dr. Bridges about all those times I tried to kill myself." And I'm kind of thinking, "Wow, this isn't where I thought we would go today." There were very serious attempts when she was a teenager, and she's lucky to be alive. Usually, ketamine makes people have this more positive kind of vantage point. That didn't seem to be what was happening, though, I did notice she wasn't talking about the suicide attempts with a sense of the kind of like, angst or pain. And then I could see, like, tears started to stream down her face. And she says, "You know what, I'm thinking, it's like, I'm so glad I'm alive."

Dr. Michael Bridges
Yeah.

Steve Martorano
Yeah,, yeah.

Dr. Michael Bridges
"I'm so glad I'm alive. It's like, Oh, my God, all the cool things I've done, you know, I, I've got a degree and I'm...I'm doing what I want to do. It's like, I'm so glad I'm alive."

Steve Martorano
So let me ask you this because this is another phenomenon that people will tell you about. And that is that experience. We'll call it a psychedelic experience, although it's not strictly that, is short-lived. How does someone who you treat take the experience of ketamine treatment with them after the session? Because there's not going to be...they're not going to be in the desert with the sand all the time.

Dr. Michael Bridges
Well, that's so incredibly important question Steve, but this is actually one of the things I'm because this is another aspect of ketamine that seems to be unique to it and why I think it's so not just that it's legal, but why it's particularly helpful for the substance that it is. We know from research largely in animal models that ketamine after administration, like there's what the person the experience like a profound sense of being alive. It carries...there is a halo because it continues to do things at a neurological level that are really beneficial for days after. So that is where there is an antidepressant effect that carries over.

Steve Martorano
It's amazing.

Dr. Michael Bridges
So one of the things again, for example, that's been found that I do think is unique to ketamine. The other psychedelics don't do this is there's this thing called neurogenesis that we know people that have been for long trauma, for long depression, like dendrites in their hippocampus, you know, area of the amygdala that processes emotion...emotions into kind of memories that can be assimilated, dendrites really just kind of start to shrivel up over the years. And there are dendrites in areas that go to the frontal lobes that have to do with the kind of, you know, our ability to plan and have forethought and kind of manage your emotions also kind of shrivel up. Ketamine, actually, over time, seems to actually the dendrites start unfolding, it actually seems to be repairing some of these neural pathways.

Steve Martorano
You know, the more we learn about brain chemistry, the more amazing the whole thing becomes the idea that you know, things like trauma, and depression, can actually destroy gray matter in your head, that we are capable under the right circumstances, to have the mind rebuild itself is extraordinary. I mean, it's extraordinary. It's still one of the great mysteries of all the mind. The more we learn about it, the more fascinating it gets. Can we...can we...

Dr. Michael Bridges
How to maintain those things is...one, I usually have a session the next very next morning with the birds. And I'll even talk on Saturday because I and this is what I've shared with Dr. Beatty is like it was one of the things that just was kind of unexpected like the person would come on their Zoom screen. And I'm kind of like, you know, "Hey, Dr. Bridges," and like, again, they're, you know, they're smiling, their faces lit up, there is a little bit more kind of like clarity and energy in their eyes. And it's like, I haven't seen this. I haven't seen this person. I may have been with them for months, but who showed up. You know, and they are saying things like, I remember a young man that I'd seen since he was a teenager that, you know, he would be hospitalized for suicidal thoughts. And certainly, I helped get him to a better place. But the next morning, he's saying, "You know, Dr. Bridges, like I've lived here all my life. And as, you know, I was driving around this morning looking at the houses, all these, you know, old stones that were quarried around here." He said, "I don't think I've seen the place I've lived in for years. And I saw it this morning."

Steve Martorano
Yeah, yeah, that veil, cloud lifts. It's amazing. So this is all FDA-approved, right? All of this of these treatments are approved.

Dr. Michael Bridges
Well, again, off-label. It's off-label. If we're talking like FDA approval for let's say MDMA for you know, severe chronic PTSD, that is going through FDA trials that are now in the third levels that we're expecting within the next couple of years, they will approve that. Still, this is the thing...because I was accepted to go into the MDMA maps training, and I was really excited about that. But this is what I think the public should know, is I'm incredibly excited about that, as is every therapist and psychiatrist I know. But even when it gets FDA approval, there's going to be a select handful of clinics throughout the country that has FDA approval, and they're going to have to do the thing of kind of, you know, screenings...getting on a waiting list...

Steve Martorano
You know, again, we're not talking...again, we're not talking about a magic bullet or a wand...

Dr. Michael Bridges
What we're talking about is availability, Steve. It's like it's gonna be you know, everybody's waiting for this to happen. But still, I would imagine, even when all the clinics that the FDA is going to approve in the first year or two are open, there are hundreds of people that are gonna be on his waiting list. Ketamine is available right now.

Steve Martorano
Right now. Yeah. Tell us and I gotta we're gonna sum up here quickly. I know there's much more to talk about it. You're going to be a great resource that I hope going forward. Well, if you guys, I'd like to have you and Jonathan Beatty back together the next time we talk about this, but finally, just a couple of things, sort of prosaic things and this is the big one. Is this an expensive therapy? What are the costs associated?

Dr. Michael Bridges
The medicine itself isn't expensive. And, Jonathan, I am doing what we can, I mean, I will say like I, you know, it's what I'm why I've been a scientific and professional success and not necessarily business success. Like, on my side, what I do is I just charge people, because I have a sliding fee scale. So some people will pay me $225 an hour without blinking an eye because they are in that. If I spend two hours with them doing ketamine-assisted therapy, then they will pay me my full fee.

Steve Martorano
Is this all covered by the private payer to the insurance companies...

Dr. Michael Bridges
Unfortunately, now, Dr. Beatty does the S Ketamine one, which will just purely use it not so much their psycho therapeutically, but as an antidepressant. Going through the proper hooks, insurance will pay for that.

Steve Martorano
Okay.

Dr. Michael Bridges
Th...the...the off label uses and we're known now is all private pay. So...

Steve Martorano
It's a great topic again, as you point out correctly, ketamine is real, often very, very effective, and available right now. And it's just the point of the spear with regard to these other therapies that might emerge out of psychedelic drugs. So we're glad we found you, you guys are going to be at the forefront of everything that's happening. Michael Bridges...Dr. Bridges, thanks for joining us on the Behavioral Corner. We'll have you back again soon -- you and Jonathan. I'd love to do that.

Dr. Michael Bridges
That sounds great. Steve, thank you.

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