Episode 60 – Why Music Is More Than Background Noise in Ketamine Therapy (Soundbites from the Vault)

Episode 60 – Why Music Is More Than Background Noise in Ketamine Therapy (Soundbites from the Vault)

We're taking it a little easy in July, and in the spirit of that, we're launching something new: Soundbites from the Vault. These are shorter, standalone segments from earlier episodes that we think are worth revisiting, easy to digest, and immediately relevant to your practice. For our first soundbite, we're revisiting one of our favorite conversations from Episode 32 with Steve Gelberg, author of Tuning In: Experiencing Music in Psychedelic States.  Steve spent years researching the intersection of music and psychedelic-assisted therapy, and what he shares here has direct practical implications for how you're running your ketamine sessions. This segment gets into something most providers haven't thought deeply about: music isn't just filling the silence. It's doing active therapeutic work, from calming a patient's first fear response as ketamine comes on, to opening access to the subconscious material that makes treatment meaningful.  Steve also covers the practical side, including what types of music to use, why lyrics are generally a problem, and how to think about the classical versus ambient debate without getting dogmatic about it. If you've been using the same playlist since you opened, this one is worth 15 minutes of your time. What You'll Gain: · Why music and psychedelics share a unique therapeutic synergy rooted in how both interact with emotional and subconscious experience · How the right music can calm the ego's fear response during the onset of a ketamine session and support deeper therapeutic outcomes · Why lyrics are generally avoided during psychedelic-assisted therapy and what instrumental genres tend to work best · The case for neoclassical music as a middle ground between classical and ambient for ketamine sessions · How to think about patient-chosen music versus therapist-curated playlists, and why avoiding dogma matters more than finding the perfect answer Episode 60 show notes: 00:00:00 Teaser: "The right kind of music…” 00:00:33 Episode Introduction and Soundbites from the Vault Launch 00:01:32 The Shared Ontology of Music and Psychedelics 00:03:37 How Psychedelics Open the Emotional Sphere of Consciousness 00:04:41 The Unique Therapeutic Synergy Between Music and Ketamine 00:05:08 What Music Is Actually Doing at the Onset of a Ketamine Session 00:05:55 How Music Helps Surface the Root of Depression, Phobias, and Trauma 00:07:01 Music as an Ancient and Primal Human Tool: Lullabies and Soothing 00:08:25 The Case for Healing Female Voices in Psychedelic-Assisted Therapy 00:09:41 How to Choose Music for Ketamine Sessions: A Provider's Guide 00:10:23 The Classical vs. Ambient Debate: Origins and Context 00:11:36 Why Lyrics Are Generally Avoided During Ketamine Therapy 00:12:39 Neoclassical Music: The Best of Both Classical and Ambient 00:13:39 Avoiding Agitating or Overly Dramatic Music in Sessions 00:14:11 Patient-Chosen vs. Therapist-Curated Playlists 00:15:12 Why There Should Be No Dogma Around Music Selection 00:15:48 Episode Ending and Resources Thanks for listening 📝 Want Steve's exact playlists and a link to his book? Everything is in the show notes at https://www.ketaminestartup.com/podcast/episode-060#links [https://www.ketaminestartup.com/podcast/episode-060#links]

Episode 59 - Rethinking Set and Setting: Dr. Roberto Malinow's Revolutionary Hypothesis on How Ketamine Actually Works

This week, host Sam Ko goes upstream from our usual clinical and business topics to sit down with Dr. Roberto Malinow, emeritus professor at UC San Diego, member of both the National Academy of Sciences and the National Academy of Medicine, and one of the world's leading researchers on synaptic plasticity and NMDA receptor biology. His work has been cited more than 30,000 times, and his recent perspective piece takes a very different view of what's actually happening during a ketamine infusion. The core of this conversation is his hypothesis that ketamine works by selectively weakening hyperactive brain circuits, but only the ones actively firing while the drug is on board.  It's a finding that raises some genuinely uncomfortable questions about the standard set and setting approach, and points to chronic pain treatment as a practical place to start testing these ideas clinically. You'll also hear about the brain's "disappointment center," the lateral habenula, and why it may be hyperactive in depression, the Stanford anesthesia study and what it suggests about brain activity during treatment, and a wide ranging look at consciousness, optogenetics, the gut-brain connection, and what basic science still doesn't fully understand about how psychiatric drugs work. What You'll Learn in This Episode · Revolutionary ketamine mechanism - How Dr. Malinow's hypothesis suggests ketamine works by weakening hyperactive brain circuits, but only when those specific circuits are actively firing during treatment · The disappointment center concept - Understanding the lateral habenula as the brain's disappointment center that inhibits dopamine and may be hyperactive in depression, serving an evolutionary purpose in reinforcement learning · Challenge to set and setting orthodoxy - How activating negative thoughts or painful experiences could possibly enhance therapeutic outcomes · Neuroplasticity fundamentals - How synapses can be rapidly modified and why NMDA receptors are crucial for both strengthening and weakening neural pathways, forming the basis for learning and memory · Rapid vs. delayed therapeutic effects - Why ketamine can work almost immediately while traditional antidepressants take weeks, and what this reveals about different mechanisms of action · Chronic pain treatment implications - How activating pain circuits during ketamine infusions might be more effective than current protocols, and why chronic pain could be the ideal testing ground for this hypothesis · Basic science translation - How laboratory findings about synaptic plasticity and NMDA receptors connect to real-world therapeutic applications in depression, PTSD, and pain management · Optogenetics technology - How scientists can now deliver light-sensitive proteins to specific neurons, allowing precise activation or inactivation of brain circuits to study behavior and memory · Memory manipulation research - Fascinating studies showing how specific memories can be turned on and off using targeted brain stimulation, with implications for trauma and addiction treatment · Consciousness and synaptic function - Exploring the complex relationship between individual neurons and higher-order brain functions, and why bridging these levels remains challenging Episode 59 show notes: 00:00:00 Teaser: Those hyperactive circuits… 00:00:24 Episode Introduction and Guest Overview 00:01:12 Sam Introduces and Welcomes Dr. Roberto Malinow 00:02:41 Background: From Reed College to The MD/PhD Path 00:05:17 Why Basic Science Won Out Over Clinical Medicine 00:06:06 The Lecture That Started It All: Professor Rodolfo Llinás and Synapses 00:06:51 How Ketamine Interacts with the NMDA Receptor 00:07:47 The "Disappointment Center": What the Lateral Habenula Does and Why It Matters in Depression 00:09:16 The Standard Set and Setting Approach in Outpatient Ketamine Clinics 00:10:12 The Three-Part Hypothesis: Neuroplasticity, Hyperactive Circuits, and Negative Thoughts 00:11:49 Written Exposure Therapy and PTSD: Priming Circuits Before the Infusion 00:12:53 Chronic Pain as the Easier Testing Ground for the Hypothesis 00:14:20 Activating the Pain Pathways During a Ketamine Infusion 00:17:23 The Anesthesia Study (Heifets/Stanford): Why the Brain Needs to Be Active 00:18:48 What Would a Human Study Design Actually Look Like? 00:20:41 Animal Study Evidence Supporting the Active-Stimulus Hypothesis 00:21:33 Zooming Out: Synapses, Consciousness, and the Shakespeare Analogy 00:23:18 Optogenetics Explained: Using Light to Control Specific Neurons 00:27:31 What Don't We Understand About Depression? 00:28:29 Lateral Habenula in Animal Depression Models and Dr. Malinow's Own Experiments 00:29:13 The Dystopian Scenario: Using Ketamine-Like Drugs to Wipe Out Ideas 00:31:31 Common Misconceptions Clinicians Have About Synapses 00:32:47 What Surprised Dr. Malinow Most About Studying Synapses 00:35:15 Why Ketamine Works Rapidly While SSRIs Take Weeks 00:37:30 The "Party Trick": Learning Is Neuroplasticity in Real Time 00:39:13 NMDA Receptors and Their Role in Learning and Memory 00:39:47 Optogenetics Research: Turning Fear Memories On and Off in Animals 00:42:08 Glutamate: 90% of Synaptic Transmission Explained 00:43:55 Synapses in the Gut: The Enteric Nervous System 00:45:58 The Gut-Brain Connection and Future Research 00:46:23 Papers Worth Reading in the Ketamine Space 00:47:50 The Psychedelic Renaissance: Psilocybin, the Disappointment Center, and What's Next 00:50:20 Could the Activation Hypothesis Apply to Psilocybin and MDMA as Well? 00:52:57 Rapid-Fire Questions Begin 00:53:19 Time Travel 00:54:19 Hidden Talent 00:54:48 Alternate Career 00:55:42 Advice to 18-Year-Old Roberto 00:56:29 Final Thoughts and Call to Action for Clinicians 00:57:00 Where to Find Dr. Malinow's Research (UCSD Website) 00:57:40 Sam's Closing Remarks 00:58:32 Episode Ending Thanks for listening Connect with Dr. Malinow: Website: https://biology.ucsd.edu/research/faculty/rmalinow [https://biology.ucsd.edu/research/faculty/rmalinow] Email: rmalinow@ucsd.edu 📝 Complete show notes with resources and  links, please visit https://www.ketaminestartup.com/podcast/episode-059 [https://www.ketaminestartup.com/podcast/episode-059] Follow us on Linkedin [https://www.linkedin.com/company/ketamine-startup] Ketamine StartUp Website [https://www.ketaminestartup.com] YouTube [https://www.youtube.com/@ketaminestartup] 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist [http://www.ketaminestartup.com/checklist].

Episode 58 - From Finance to Purpose: Why Dr. Marc Smith Chose Healing Over Hedge Fund Trading

In this conversation, Dr. Marc Smith shares his journey from hedge fund trading in New York's financial district to building an integrated ketamine psychiatry practice in California.  After three years in finance doing trading and sales, Dr. Smith made the bold decision to completely pivot his career toward medicine, driven by a desire for purpose and meaning that his financial career couldn't provide. Dr. Smith's path took him through Columbia University for medical school, followed by psychiatry residency at USC, where he discovered his passion for interventional treatments like TMS and ketamine therapy.  His unique perspective, having worked in both profit-maximizing finance and purpose-driven healthcare, provides valuable insights into the challenges of maintaining ethical medical practice in an increasingly commercialized healthcare environment. Dr. Smith's practice, Clear Ketamine + Psychiatry, represents an integrated model where he personally handles psychiatric evaluation, preparation therapy, ketamine treatment administration, and post-treatment integration sessions. What You'll Learn in This Episode · Career transition insights - How Dr. Smith navigated the complete pivot from finance to medicine, including the challenges and rewards of choosing purpose over profit in healthcare · Mental health crisis analysis - Dr. Smith's perspective on factors contributing to rising depression, anxiety, and suicide rates, including social isolation, technology impacts, and healthcare access barriers · Treatment-resistant depression understanding - Why 30% of patients don't respond to traditional antidepressants and how ketamine offers a different mechanism through NMDA receptor antagonism and neuroplasticity induction · Integrated practice model - Dr. Smith's unique approach combining psychiatric evaluation, preparation therapy, ketamine administration, and integration sessions all under one provider rather than outsourcing components · Intentions versus goals framework - How to help patients set internal emotional states they're striving for (intentions) alongside specific, measurable functional outcomes (SMART goals) for comprehensive treatment planning · Ketamine as catalyst concept - Understanding how ketamine works like "jumpstarting a car" to improve mood and motivation, while ongoing therapy and lifestyle changes provide the maintenance needed for sustained improvement · Ethical practice building - Dr. Smith's mission to combat ketamine stigma through evidence-based protocols while addressing concerns about recreational associations and inappropriate use in the field · Private practice autonomy benefits - How owning your own practice allows values-driven decisions that may conflict with profit maximization, contrasting with private equity-driven healthcare models · Business building practical advice - The importance of talking to other practice owners, understanding it's a marathon not a sprint, and knowing your limitations to outsource effectively · Biopsychosocial treatment approach - Addressing biological, psychological, and social elements of mental health through medications, therapy, exercise, sleep, nutrition, social connection, and nature exposure Episode 58 show notes: 00:00:00 - Teaser: Profit vs. Purpose in Healthcare  00:00:35 - Episode Introduction 00:02:03 - Dr. Smith's Background: From East Coast to Medicine  00:02:30 - Career Transition: Three Years in Financial Industry  00:04:12 - Discovering Psychiatry Through Clinical Rotations  00:05:32 - Why Psychiatry: Deep Relationships and Human Connection 00:08:50 - Tools in the Toolbox: TMS, Ketamine, and Treatment Options  00:09:30 - The Leap: Stepping Away from Finance Success  00:11:17 - The Marble Metaphor: Chiseling Away What We Aren't  00:12:46 - Self-Actualization and Gratitude in Medicine  00:14:01 - USC Residency and Academic Reception of Ketamine  00:16:54 - Evidence-Based Medicine and the Slow Pace of Change  00:19:17 - Mental Health Crisis: Social Isolation and Technology  00:22:50 - The Invisible Nature of Mental Health Challenges  00:25:28 - Private Equity vs. Patient Care: The Business Tension  00:30:18 - Private Practice Autonomy and Values-Based Decisions  00:32:15 - Clear Ketamine + Psychiatry: The Integrated Model  00:36:11 - Treatment Protocol: Six Sessions with Therapy Integration  00:37:56 - Ketamine as Jumpstart: The Car Analogy  00:42:00 - Intentions vs. Goals: Internal States and SMART Outcomes  00:46:30 - Ethical Standards and Combating Ketamine Stigma  00:50:15 - Practice Building Advice: Talk to Other Providers  00:52:55 - Rapid Fire Questions: Book Recommendation  00:54:52 - Last Meal  00:55:52 - Pickleball Obsession and the Philosophy of the Game  00:56:50 - Time Travel 00:58:46 - Alternative Career 01:00:04 - Advice to 20-Year-Old Self 01:01:53 - Contact Information and Practice Details  01:03:03 - Final Thoughts: Gratitude and Evidence-Based Care  01:04:20 - Ending and Resources Thanks for listening Connect with Dr. Marc Smith at: Website: https://www.clearketapsych.com [https://www.clearketapsych.com/] Instagram: @clearketapsych [https://www.instagram.com/clearketapsych], @marcsmithmd [https://www.instagram.com/marcsmithmd] LinkedIn: www.linkedin.com/in/marcsmithmd [http://www.linkedin.com/in/marcsmithmd] Google Maps: https://maps.app.goo.gl/GCHVy8q183c7WvfLA [https://maps.app.goo.gl/GCHVy8q183c7WvfLA] 📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-058 [http://www.ketaminestartup.com/podcast/episode-058] Follow us on Linkedin [https://www.linkedin.com/company/ketamine-startup] Ketamine StartUp Website [https://www.ketaminestartup.com] YouTube [https://www.youtube.com/@ketaminestartup] 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist [http://www.ketaminestartup.com/checklist].

Episode 57 - Beyond the Physical: Why Treating Chronic Pain Requires Healing the Whole Person with Dr. Michelle Weiner

In this conversation, Dr. Michelle Weiner shares her evolution from chief resident in interventional pain medicine to pioneering integrative practitioner who treats chronic pain through a biopsychosocial-spiritual lens. Double board-certified in Interventional Pain Medicine, Physical Medicine, and Rehabilitation, Dr. Weiner reveals why traditional procedure-focused approaches often fail chronic pain patients and how she discovered more effective ways to create lasting healing. Dr. Weiner's journey started with her background in nutritional science and athletics, leading her through physical medicine and rehabilitation before specializing in interventional pain. But day after day of performing procedures without truly connecting with patients left her frustrated and seeking deeper solutions. Her introduction to medical cannabis as chair of Florida's advisory committee opened her mind to personalized medicine and treating the whole person rather than just diagnosis codes. You'll hear about her unique approach to fibromyalgia, which she reframes as "central sensitization" to empower rather than limit patients. Dr. Weiner explains how trauma and adverse childhood experiences prime the nervous system for hyperreactivity, leading to chronic pain that becomes centrally mediated rather than structurally based. Her practice now integrates cannabis protocols, ketamine therapy, and comprehensive team-based care to address the root causes of both physical and emotional pain. Dr. Weiner also shares her personal ketamine experience during training, including a profound vision that later manifested in real life, demonstrating the spiritual dimension she now incorporates into treatment. You'll also hear practical insights about building an integrative practice, the importance of set and setting, and why true healing requires addressing the person with the diagnosis, not just the diagnosis itself. What You'll Learn in This Episode · Career transition insights - How Dr. Weiner evolved from high-volume interventional procedures to relationship-based integrative medicine and why she felt traditional approaches were "stringing patients along" · Central sensitization framework - Why she avoids the term "fibromyalgia" and instead explains central sensitization to empower patients and create hope rather than diagnostic limitations · Biopsychosocial-spiritual model - How incorporating the spiritual dimension creates awe-like effects and connections that traditional medicine misses, supported by neuroscience research · Medical cannabis integration - Her role on Florida's Medical Cannabis Advisory Committee and how cannabis opened conversations about personalized medicine and treating individual endocannabinoid systems · Trauma's role in chronic pain - How adverse childhood experiences and physical trauma prime the nervous system for hyperreactivity and chronic pain development · Practice building strategies - Practical advice about insurance credentialing, marketing to other providers, creating therapeutic environments, and building multidisciplinary teams · Set and setting importance - Why the physical environment, staff training, and patient preparation are crucial for maximizing ketamine therapy outcomes · Patient education approaches - How she explains that healing happens during the neuroplastic window after ketamine, not during the infusion itself, and why "more is not better" · Team-based care model - Working with coaches, therapists, and specialists trained in pain reprocessing therapy and somatic approaches to support comprehensive healing Episode 57 show notes: 00:00:00 - Teaser: Heart-Forward Medicine and True Passion  00:00:19 - Introduction and Dr. Weiner's Background Overview 00:02:00 - Educational Journey: From Nutrition Science to Pain Medicine  00:05:13 - Colleague Reactions to Non-Traditional Approach 00:08:37 - The Pivotal Moment: From Procedures to Purpose  00:11:04 - Cannabis Integration and Personalized Medicine Discovery  00:13:43 - Biopsychosocial Model and Pain Neuroscience Education  00:17:09 - Trauma Patterns and Chronic Pain Development  00:19:54 - Reframing Fibromyalgia as Central Sensitization  00:23:54 - Adding the Spiritual Dimension: Biopsychosocial-Spiritual Model  00:29:07 - Personal Ketamine Experience and Training Story  00:34:22 - Practice Building: From Employee to Business Owner  00:38:18 - Set and Setting: Creating Therapeutic Environments  00:41:48 - Patient Misconceptions and Education Strategies 00:47:08 - Rapid Fire Questions:  00:53:55 - Advice to 18-Year-Old Self 00:55:34 - Final Thoughts: Pain Complexity and Nervous System Healing  00:56:32 - Contact Information and Practice Locations  00:57:29 - Ending and Show Resources Connect with Dr. Weiner at: Website: www.drmichelleweiner.com [http://www.drmichelleweiner.com] LinkedIn: https://www.linkedin.com/in/michelle-weiner-do-mph-276b34b9 [https://www.linkedin.com/in/michelle-weiner-do-mph-276b34b9] Facebook: https://www.facebook.com/drmichelleweiner/ [https://www.facebook.com/drmichelleweiner/] 👉 Disclosure: Some of the links in these show notes are affiliate links. If you choose to make a purchase through them, we may earn a small commission at no additional cost to you. Thanks for supporting the podcast! Selected Links From the Episode: 📕The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma [https://amzn.to/4nz0qwy] by Bessel van der Kolk M.D.  [https://amzn.to/4nz0qwy] 📘The Awakened Brain: The New Science of Spirituality and Our Quest for an Inspired Life [https://amzn.to/3POPKgX] by Lisa Miller. [https://amzn.to/3POPKgX] 📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-057 [http://www.ketaminestartup.com/podcast/episode-057] Follow us on LinkedIn [https://www.linkedin.com/company/ketamine-startup] Ketamine StartUp Website [https://www.ketaminestartup.com] YouTube [https://www.youtube.com/@ketaminestartup] 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist [http://www.ketaminestartup.com/checklist].

Episode 56 - Breaking: Four Major Developments Reshaping Ketamine and Psychedelic Therapy

In this news roundup episode, we're covering four major developments that have emerged in recent months, all pointing toward increased accountability and oversight in the ketamine and psychedelic therapy space. This isn't our typical interview content - it's breaking news analysis that every provider in this community needs to understand. We start with the final chapter of the Matthew Perry case, where Jasveen Sangha, known as the "Ketamine Queen," received a 15-year federal prison sentence, while Dr. Salvador Plasencia was sentenced to 30 months for distributing ketamine outside proper medical supervision.  Then we cover France becoming the first country to formally authorize IV racemic ketamine for adults in severe suicidal crisis, with rigorous hospital-based protocols that raise the bar for clinical standards globally. We continue with updates on Texas Medical Board's proposed ketamine regulations moving toward mandatory clinic registration and stricter oversight, followed by analysis of President Trump's executive order accelerating psychedelic research and creating new federal pathways for investigational compounds.  We wrap up by connecting all four stories to show how legal consequences, international standards, state regulations, and federal policy are collectively signaling that oversight conversations are now happening at the highest levels of government and the field is entering a new era of accountability. What You'll Learn in This Episode · Legal accountability implications - How the Matthew Perry case sentencing creates new precedents for physician responsibility when ketamine treatment moves outside supervised clinical settings · International standards development - France's groundbreaking authorization of IV racemic ketamine for suicidal crisis and what their rigorous hospital-based protocols mean for global treatment standards · State regulatory evolution - Current status of Texas Medical Board's proposed ketamine regulations, including mandatory clinic registration and enhanced oversight requirements moving toward a June 2026 vote · Federal policy landscape changes - Analysis of Trump's executive order accelerating psychedelic research access and what new federal pathways mean for the broader psychedelic therapy field · Clinical framework implications - How France's high-surveillance psychiatric intervention model differs from wellness-oriented approaches and why this distinction matters for field credibility · Oversight trends analysis - Why legal consequences, international standards, state regulations, and federal policy are all pointing toward increased accountability requirements for providers · Risk assessment insights - Understanding where legitimate treatment can break down and how unmonitored use creates legal and ethical liability that traces back to prescribing physicians · Future preparation strategies - What these four developments collectively signal about where field standards are heading and how providers can prepare for increased scrutiny Episode 56 show notes: 00:06 Episode Introduction 01:28 Matthew Perry Case: The Final Sentence 03:47 France Authorizes IV Ketamine for Suicidal Crisis 07:03 Texas Medical Board Update: PKT Rules Still Pending 08:37 Trump Executive Order: Federal Fast-Track for Psychedelic Therapy 10:43 The REMS Advantage: What Regulatory-Ready Looks Like 12:34 Final Thoughts Thanks for listening Selected Links From the Episode: 📖Prefer to read? Check out our related blog post: Ketamine Therapy Regulations Spring 2026: Perry Sentencing, Texas Rules, France Authorization, and Federal Policy Shifts [https://www.ketaminestartup.com/blog/ketamine-regulations-spring-2026-perry-texas-france-federal] 🎧Listen to the full story about what’s about to happen in Texas: Episode 049 - Texas Medical Board Proposes Comprehensive Ketamine Therapy Regulations - What It Means for the Industry [https://www.ketaminestartup.com/podcast/episode-049] 📋Episode references and sources [http://www.ketaminestartup.com/blog/ketamine-regulations-spring-2026-perry-texas-france-federal#ref] 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-056 [https://www.ketaminestartup.com/podcast/episode-056] Follow us on Linkedin [https://www.linkedin.com/company/ketamine-startup] Ketamine StartUp Website [https://www.ketaminestartup.com] YouTube [https://www.youtube.com/@ketaminestartup] 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist [http://www.ketaminestartup.com/checklist].