Episode Transcript
[00:00:01] Speaker A: You're listening to the Doc Lounge Podcast. This is a place for candid conversations with the healthcare industry's top physicians, executives and thought leaders.
This podcast is made possible by Pacific Companies, your trusted advisor in physician recruitment.
Welcome back to the Doc Lounge Podcast. I'm your host, Stacey Doyle, Senior director of marketing at Pacific Companies.
And today we're exploring one of the most exciting and transformative frontiers in modern medicine, integrative approaches to mental health care. My guest is Dr. Will Vandeveer, a pioneering psychiatrist who began disillusioned by the limitations of conventional treatment and decided to chart a new path forward.
After two decades of developing innovative integrative methods to address the root causes of mental health symptoms, Dr. Vandevier Co founded the Integrative Psychiatry Institute, which now trains hundreds of clinicians each year in cutting edge modalities like psychedelic assisted therapy and trauma informed care. His mission Is to train 10,000 providers by 2028 and bend the arc of mental health care globally. He's also been on the front the forefront.
He's also been on the front lines of staffing and supporting clinical trials and in psychedelic therapy. And he has an upcoming book that explores this revolutionary new treatment, offering insight into how it's reshaping our understanding of healing, trauma, and transformation. We'll talk about how these breakthroughs are redefining care for conditions like PTSD and depression, what clinicians can learn from integrative psychiatry, and why healing ourselves as providers may be the key to helping others heal. Dr. Vanderveer, welcome to the Dog Lounge. We're so excited to have you on.
[00:01:49] Speaker B: Thank you, Stacy. It's wonderful to be here.
[00:01:51] Speaker A: Well, we're excited to have you on. You know, mental health is a topic we've really tried to, you know, bring more awareness to on our podcast, obviously, but I really would like to hear, you know, tell us a little bit about your background, how you got into the specialty, and where you are today.
[00:02:11] Speaker B: Well, thank you. I started out my training very excited to learn psychiatry. I learned the conventional approaches, and when I got out of residency, I had the ability to start a private practice right out of the gate, which was amazing. And I started using therapy, talk therapy, and medications with my patients.
And at the time, I thought that those two tools would cover most things for most people. And boy, was I wrong. There were way too many people who were continuing to not respond to medications, not tolerate medications, not be able to continue therapy when, you know, we'd been at it for six months or a year and they needed more and so on. So I got very discouraged and I actually quit psychiatry a couple years into my career and I kind of went on a walkabout looking for better answers. And one of the things that led to was finding out that there was a gut brain connection that I didn't learn about in medical school or psychiatry residency.
And when I went down that rabbit hole and I started learning about how the gut microbiome and the condition of the gut lining and the ability to absorb nutrients and the role of diet and mental health, it started to take shape as recommendations for patients as both adding on to what I was doing with medication and therapy, but also in some cases, treating people without medications or talk therapy and just going with balancing hormones and dealing with inflammation and working with diet and treating parasites or bad actors in the gut. That, as a psychiatrist, it was a little weird. You know, we, we tend to say, well, you know, we're going to look at your stuff, but we don't necessarily do gut testing and actually look at poop to see what's going on. So that was a big movement forward.
And then I started learning about all of these other ways that people can get sick with mental health.
I learned about the role of infections, I learned about the role of environmental toxins like pesticides and the role of mold in moldy houses is definitely underestimated in terms of mental health.
And then I got invited to be a part of the clinical trials that you mentioned earlier in working with MDMA assisted therapy for chronic tremor resistant ptsd.
And it just blew me away that people who had been stuck for decades in their PTSD symptoms could get well within a few months of the protocol we were running. And I'm happy to go into the details if your audience would like to hear that. But the punchline is that we brought people in the study that I was most involved with.
We treated about 30 people with the protocol, which involved MDMA assisted therapy on three occasions, one month apart from each other.
And these folks, on average had almost 30 years of PTSD symptoms coming into the study. So these were people who'd been sick for a very long time. They tried all kinds of medications and therapies, and at the 12 month follow up, 3/4 of them no longer met criteria for PTSD.
So to take a group of people who are that deep in what in medicine we would call treatment resistant ptsd, I don't love that term because it tends to sort of put the blame on the patient, when actually as practitioners, as doctors, we need to, I think, acknowledge that we're not Omniscient. And sometimes we have to go and learn new things, which inevitably leads to more benefits for our patients.
So anyway, the point is, I'm. My career has been about looking for better answers for, for my patients. For.
[00:06:21] Speaker A: You might have froze. Can you hear me?
[00:06:24] Speaker B: Yes, I can hear you and.
[00:06:28] Speaker A: Hello? Hello?
[00:06:28] Speaker B: Yes, hello, can you hear me?
Hello?
[00:06:34] Speaker A: Okay, now I can't. Okay, okay, now it's back. It froze for like a few seconds. But you're back.
[00:06:43] Speaker B: You were frozen too, because you.
[00:06:45] Speaker A: Yeah, okay, it could be me, it could be both of us.
Go ahead, tell us. So you were saying. Okay, so. So the 75 tell the percentage of, of who got rid of this.
[00:07:00] Speaker B: Yeah. So in, in this study, which we, we published the paper in 2018, we, we saw that this group of people who had about 30 years of PTSD symptoms coming into the study, who received MDMA on three occasions over a five month protocol.
At the 12 month follow up, three quarters of them didn't have PTSD anymore. So that was quite remarkable.
And for the listeners in the audience who work with PTSD a lot like I have, you'll probably, your jaws probably dropped right now thinking about, like working with folks who are that deep in severe ptsd.
It's unheard of to be able to take three quarters of those people through a protocol that's so short and see them and also expose them to a medication only three times and see them. That many people get well.
So that was a huge reckoning for me in my career. Thinking about, well, I've been trained to use SSRIs and, you know, talk therapy or maybe other trauma protocols like emdr for example, and those work really well for certain people. But there's a vast majority of people who don't get well with the ordinary treatments.
So that's why my career turned toward opening an institute and starting to train people in how to look for these root causes.
Some of it is trauma, some of it is these more biological things like the gut brain connection we mentioned before.
But we need more people to know about these ways of working with the root causes so that we can hopefully have our patients exit from psychiatric care. I mean, that I think should be the goal.
And unfortunately, I think psychiatry as a field suffers from this kind of pessimism that, hey, you're going to be on these medications for the rest of your life and I'll be here for you and you'll come in quarterly and I'll prescribe the medications and that's about as good as it gets.
And it's just very sad because there's such an opportunity here that's missed if we take that more, I would say if we're shooting that low with what we're trying to accomplish with people.
[00:09:12] Speaker A: Well, I think that's impressive to hear about.
This is a really more integrated, I would say, more innovative approach where you're taking some kind of newer ideas and testing it and then actually putting it through, you know, like you're saying a clinical trial to see what are the results and can this benefit more people than what we've been currently been doing for many years? And I know that I've talked to several experts in the field where they say there's been a lack of innovation. It's been kind of this stagnant.
[00:09:42] Speaker B: Absolutely.
[00:09:43] Speaker A: Field. So I really think that that is so amazing that you're trying to get these new approaches out there. So tell us, I mean, obviously you went about and you founded this institute.
I'm assuming that shook a lot of work and energy. So tell us about it and you know what you're trying to do with it right now.
[00:10:03] Speaker B: Yeah, well, my co founder Keith Kurlander and I, we were old friends and he's a therapist in my town and we knew each other well and we came together in 2018 with this kind of impossible goal of training 10,000 people in 10 years.
And now we've trained more than 3,000 people since we started. So we're well on our way to the 10,000 mark.
But our trainings are generally very in depth. They're, they're long trainings. They tend to be a year in length, most of them.
And we're trying to help people get comfortable with a very different approach to mental health care.
That's evidence based, but it's an emerging evidence base. So for example, the psychedelic therapy world is, is emergent. I mean, we have a bunch of phase three trials going on with different compounds.
We have a number of pharmaceutical companies that are developing novel compounds in the space.
And so as you mentioned earlier, it's a very exciting time actually to get involved in mental health care because there are new tools coming out after a very long drought.
Pharmaceutical companies basically gave up on neuroscience about 20 years ago and there really hasn't been any innovation.
So it's a good time to pay attention and get involved. And outside of ketamine, which is the currently approved psychedelic drug you can use, it's off label.
The generic one is, but we have the brand name Spravato, which is the left handed version of ketamine so it's, it's essentially very similar to the generic version, has gained official indication from FDA for depression, which is great.
There are other compounds like, for example, psilocybin is in phase three studies for depression. So I'm really excited about that as a possibility. We also have two states that have legalized the mental health treatment with psilocybin, Oregon and Colorado. I happen to be in Colorado, so that was fortunate for me since I'm into trying to make innovations in the field. It's fortuitous that we can now begin to use psilocybin in Colorado.
[00:12:35] Speaker A: Tell us, what are some of the initial impacts that you've seen from being able to use psilocybin as a treatment for depression?
[00:12:45] Speaker B: Well, the clinical trials are very exciting. With psilocybin, we see people with significant depression experiencing enough relief to where they feel way more functional for up to six months or even a year after one psilocybin psychotherapy session.
So if, if I'm a person with depression and I've been coming to see my therapist once a week for a long time, or I've been on medications for a long time and the opportunities presented to me to go and have one session with psilocybin, that might stead me well for, you know, months or years.
I'm probably going to choose the latter option because that way I can live without suffering the daily side effects of medication, which are substantial for a lot of people.
And I also don't have to go through the expense and the hassle of going to therapy every week or getting my medication refills and so on.
And there can be metabolic negative effects over the long term with the daily psychiatric medications as well.
So the main thing I want to share is that psilocybin appears to be something that you can take once or twice and have a very long term benefit with basically not having to take more of it.
And to me as a psychiatrist, that's really the name of the game is how do we get people moving out of.
Let's, let's give them the help that they need, but let's make it short term and interventional as much as we can and get them moved on.
[00:14:26] Speaker A: It does sound like a better approach. So tell me. I know that there's a lot of hype in the media around, you know, psychedelic therapy.
What is something that you want to kind of clear up? What's a miss, you know, conception that you often encounter?
[00:14:42] Speaker B: That's a great question.
You know, our culture and psychiatry is sort of a concentrated version of this cultural messaging is that the compound or the molecule that you put in your mouth is the treatment.
So the difference with psychedelic therapy that's really important to understand, and it's kind of hard to understand if you're used to this pharmaceutical narrative or the pharmaceutical model, is that the therapy is the treatment, and the drug supports the effectiveness of the therapy.
So another way to say it is that the drugs that I have prescribed for decades that I, you know, can help a lot of people, and I still prescribe them, it's useful to prescribe them, are used to suppress symptoms, generally speaking. So a person has depression, the Prozac suppresses the depression. It helps a person cope.
But. But helping you cope by suppressing your symptoms isn't addressing the root cause of the problem.
So what happens with a psychedelic drug is that it's evocative instead of suppressive.
And the reason I'm kind of belaboring this point is that the prescriber and the patient both might be suffering under the idea that the medication is the treatment as opposed to the medication evokes what needs to be worked with in therapy so that you can eventually put psychiatry behind you.
So here's a good example.
I've been prescribing ketamine now for almost 10 years.
And ketamine clinics are common now. They weren't when I started, but they are now.
And the common model with ketamine treatment for depression is you come in and you get six sessions in three weeks, and you then are told by the ketamine doctor, you're going to come back now in about a month, and we're going to be starting what we call maintenance ketamine.
So that person who maybe used to take Prozac and now they're taking ketamine are still dependent on the medication to function. It's sort of like you're putting air in the inner tube in your bike tire that has a hole in it, and you just keep pumping it up rather than replacing the inner tube.
So every month you come in and you get your tire pumped up, and then you go home, and then you have to come back in a month, and you. You're now, you're committed to the. The maintenance on this drug.
What I recommend and what we teach our practitioners is that you use the ketamine treatment as a catalyst to.
It's like a tow truck. It gets you out of the ditch so that you can get on your way.
But nobody wants to ride on the back of a tow truck throughout their life, right? It just doesn't make sense.
So what we can do with the catalyst, if we look at ketamine treatment as a catalyst, we can say, okay, how are you doing with your nutrition? How are you doing with your sleep? How are you doing with your relationships? How are you doing with your physical exercise?
Let's take a look at your genetic vulnerabilities to this, that and the other thing.
If you may have some issues with some of these more esoteric things like Lyme disease or maybe having a mold exposure, we can test for that, we can treat that.
So we can't just narrowly define psychiatric treatment as this medication, and this medication is going to work, or it's not going to work, and if it doesn't work, we'll go to a different medication. It's just part. That's part of the problem of how we ended up in this mess with this mental health epidemic globally.
[00:18:29] Speaker A: Well, and it sounds like it also goes back to what you're originally leading with at the beginning of the podcast about. You really gotta identify what, you know, the root cause of the symptom is. Is it unresolved trauma? Is it kind of these, like you were saying, those other pieces of your overall health that's contributing to, you know, the mental health, you know, issues that a client may be dealing with or patient might be dealing with.
I know that you have definitely given a lot of hope to, you know, veterans or, you know, others that are struggling with PTSD or, you know, or depression with these, you know, psychedelic therapies.
Do you want to kind of just give some overall, like a story or just let people know what they really can see in terms of a transformation?
[00:19:21] Speaker B: Sure, that's a great idea.
I'm thinking about a person who was a combat veteran who came through one of our studies, who.
Well, let me. Let me back up and. And give a little more context there. There is this concept in military PTSD of the moral injury, and this. I'll explain it, because some people may not have heard of it, but maybe a lot of people in the medical audience have heard that term before. But moral injury is when you have an experience that basically insults your whole system of morality, your system of right and wrong.
And what I found in working with veterans is that every single veteran I've worked with went into the military with a beautiful intention of protecting something worth protecting.
And as we know, from all the way back to the Vietnam War, at least a lot of veterans get a lot of negative opinions about war when they come back from protecting our country.
And it's tragic because the, the intention of, of protecting something sacred is such a beautiful intention.
So what can happen in combat sometimes is and, and has happened a lot in recent wars. The veterans I've treated, talking about these stories of commanding officers who have been so deeply impacted or traumatized, I would say, using a psychiatry framework, that the idea of shooting a civilian or the idea of killing a child, for example, in the combat theater is not something that they would hesitate about anymore. And so the people around them, around this deeply traumatized individual can sustain moral injury from witnessing or being a part of deployments or events that occur in the battlefield that go against the morality of the soldier or of, of the individual on the battlefield.
This gets particularly complicated when you have children carrying IEDs in Afghanistan, in Iraq, for example.
And what happens when that child gets shot, for example, and come to find out that that child wasn't carrying an ied or, or maybe they, even if they were, as a child, is being killed right on the battlefield.
So this experience of moral injury can haunt people for months, years, decades, an entire lifetime of second guessing, regretting, feeling like their soul has been tainted in some way.
If they believe in heaven and hell, they know for sure that they're going to hell because of the things that they did or the things they didn't do, the things they saw that they bore witness to, that they allowed.
So what I've seen that is so beautiful about the work with MDMA assisted therapy is that first of all, it creates an environment, a chemical environment in the brain, in the nervous system, where a person who's experienced a moral injury like that can for the first time see.
They can review the memory of the thing that happened without this incredibly heavy self judgmental self, the critic, and they can begin to look at what happened to them from a bigger perspective.
People often describe this when they're on MDMA, of seeing the forest for the three, for the trees, or having a 30,000 foot view of what happened and like, oh, there I am, I'm on the battlefield, this happened and it's not only my fault, right? There was a bigger context.
And self forgiveness can begin to be processed in that field in the therapy session with the support of the mdma.
And these experiences of self forgiveness and self compassion are so powerful that they last for long periods of time.
In some cases. It seems like with MDMA therapy, those are durable, permanent changes for the individual.
So these kinds of experiences of healing are very difficult to access for people without the support of a psychedelic like mdma and when you're in the trenches with people like I have been for so long, and you're working with people in psychotherapy without the support of mdma, sometimes that self forgiveness is just like an idea that person can never access, can't feel it.
But the chemical effects of MDMA are set up in such a particular way that it supports that experience very dramatically.
So it's exciting to have this support for the work and allowing people to access these difficult memories and gain a different perspective.
[00:25:05] Speaker A: Well, that really does sound like a breakthrough treatment because it's able to get, you know, these different patients to a whole nother level of, you know, be able to view something completely differently and kind of take that judgment, like you said, away from it, which sounds incredibly, incredibly important in a healing journey. So thank you for sharing that. I mean, I want to hear from you. Just looking ahead. I mean, you mentioned your clinical work, your, your institute and your upcoming book. What's your vision for, you know, where mental health care is headed in the next decade?
[00:25:43] Speaker B: Well, one more word about the MDMA story. It went before FDA for the end of phase three evaluation last summer in August of 2024 and it didn't pass. And there are some changes and some additional data that needs to be collected by the company that is bringing that to market.
So hopefully, to answer your question about the future, we'll be seeing a review or there could be an additional study that's needed, but we'll see another review of MDMA therapy for ptsd.
I personally think that will be one of the biggest breakthroughs in mental health since the advent of psychotherapy in the first place.
We also have these other compounds, as I mentioned, psilocybin in phase three.
LSD is being studied for generalized anxiety disorder. That's going to be heading into phase three soon.
And several dozen compounds that are kind of spin offs of these older psychedelic compounds that are at different stages in the pipeline of drug development. So as I said, it's a very exciting time. So I'm hoping that in the next year or two we're going to see a, a federal approval.
It's a bit of an awkward sort of almost like a teenager phase of development here where we have a couple of states that have it and then the rest don't. And it's really complex to navigate and you know, people having to travel from outside of the states to go get the therapy where it's approved and so on.
So I think it will be a welcomed relief to all of that kind of chaos to see a federal approval where anybody in any state can begin to access this really important treatment.
[00:27:33] Speaker A: Thank you for sharing that future vision. And I want to give you the opportunity to let our listeners know about your book, when it would be coming out and everything that it's going to cover.
[00:27:46] Speaker B: Thanks, Stacy. The book is called Psychedelic Therapy. Not a very original name, but it tells you what it's about and it's a guide for anyone who is considering the possibility of going through the process of psychedelic therapy.
There are many people who have tried to get well and in good faith spent their time and their energy and their resources to try to get well from therapy or medications and who haven't gotten enough benefit from those traditional federally approved ways.
So most of those people are not out there looking to go to Burning man or to do psychedelics recreationally, but they're in deep trouble and they need help. So that's what this book is for, is to walk people through the process. And so for folks who have a family member or a dear one in their life who's suffering, or for folks dealing with PTSD or depression, that that's who it's written for. It'll come out in March and I'm told by the publisher, Shambhala Publications, that the pre sale will will be starting toward the end of this year. So we're excited for that to come.
[00:29:04] Speaker A: Out perfect for the holidays. Everyone can get their pre order in and I want to make sure you achieve your milestone of 10,000 clinicians that you're training with within your institute. So tell us how anyone can get involved if they want to be, you know, a part of the Integrative Psychiatric Institute.
Are you training psychiatrists, you know, psychiatric nps? Let us know.
[00:29:35] Speaker B: Kind of, yes.
[00:29:35] Speaker A: Who's been to.
[00:29:36] Speaker B: Thanks, Stacey. We treat or we treat. We train folks who have some background in counseling or mental health, including family medicine, internal medicine, certain people who maybe have a different training background but have accumulated enough experiences and trainings in mental health care to go through a program. But mainly it's for people who have been trained specifically in mental health care.
So psychiatrists, advanced practice nurses, PAs, psychotherapists, those folks and people can find us at our website, which is psychiatryinstitute.com and you can see all the programs we're offering there.
[00:30:26] Speaker A: Fantastic. Well, we will link that in all of our material that we release with this podcast so that everyone can get ahold of you and get that training. And it sounds like just such a way to really expand, you know, this, this new innovative approach that you have learned and embraced and you know, been a part of with from a clinical trial standpoint as well. So I want to thank you so much, Dr. Van der Veer, for being on today. And we really, really learned a lot. So thank you.
[00:30:56] Speaker B: Well, thanks for having me, Stacey. It's been a blast.
[00:30:58] Speaker A: Thank you to all of our listeners. If you would like to be notified when new episodes air, make sure to hit that subscribe button. And a big thank you to Pacific Companies. Without you guys, this podcast would not be possible. If you would like to be a guest, Please go to www.pacificcompanies.com.
[00:31:16] Speaker B: Thank.
[00:31:24] Speaker A: You.
