Resolving Trauma & Depression: The Future of Integrative Psychiatry with Dr Will Van Derveer

SHOW NOTES

Shownotes: 

🌐 𝗪𝗲𝗯𝘀𝗶𝘁𝗲:  https://psychiatryinstitute.com

📱 𝗢𝗳𝗳𝗶𝗰𝗶𝗮𝗹 𝗦𝗼𝗰𝗶𝗮𝗹 𝗠𝗲𝗱𝗶𝗮 / 𝗖𝗵𝗮𝗻𝗻𝗲𝗹𝘀

𝗙𝗮𝗰𝗲𝗯𝗼𝗼𝗸: @integrativepsychiatryinstitute

𝗟𝗶𝗻𝗸𝗲𝗱𝗜𝗻: @integrative-psychiatry-institute

𝗜𝗻𝘀𝘁𝗮𝗴𝗿𝗮𝗺: @integrativepsychiatry

𝗧𝗿𝗮𝗶𝗻𝗶𝗻𝗴 𝗣𝗿𝗼𝗴𝗿𝗮𝗺𝘀:

Year-long Psychedelic-Assisted Therapy Training
Nutritional Psychiatry Fellowship

00:00 – Introduction to integrative psychiatry

02:40 – Why mental health diagnosis lacks objective testing

04:50 – Integrative vs conventional psychiatric models

07:45 – Antidepressant statistics & systemic challenges

09:30 – Psychedelic therapy legal landscape

12:20 – Integrative Psychiatry Institute training

14:00 – Ketamine without therapy: risks & concerns

16:15 – Psychedelics as catalysts for transformation

18:45 – What “resolution” really means

21:00 – Mystical experiences & long-term impact

23:20 – Dr Van Derveer’s personal journey

26:00 – Celiac disease case & nutritional psychiatry

29:00 – Mitochondria & inflammation

36:30 – Ketamine vs Psilocybin vs MDMA

41:30 – Therapy integration & preparation

46:00 – State change vs trait change

49:00 – Therapist’s role & inner work

51:00 – The importance of the healer’s own journey

Resolving Trauma & Depression: The Future of Integrative Psychiatry with Dr Will Van Derveer

Dr Ron Ehrlich (00:00)

Hello and welcome to Unstress Health. My name is Dr Ron Ehrlich.

Well, to any regular listener of this podcast, you will know that I enjoy inviting and speaking to practitioners, health practitioners with an integrative approach. And I also find it fascinating to explore what took them to that approach because almost every, well, every medical practitioner is, is a product of their own education and their own education is most definitely not an integrative approach. 

It’s often a pharmaceutical approach and that’s when they feel like they are really being doctors. Well, anybody that goes to see an integrated practitioner knows that there is so much more to that and it’s a very empowering experience. Well, today we are exploring integrative psychiatry, mental health, the use of psychedelic therapy and nutritional therapy and ketamine therapy to deal with some intractable mental health issues. So my guest is Dr. William Van Derveer and is Will rather is a psychiatrist and educator and co-founder of the Integrative Psychiatry Institute. 

Now with over 20 years of clinical experience, Will has led Integrative Psychiatry, Psychedelic Therapy psychedelic assisted therapy, psychotherapy, ketamine therapy and nutritional mental health treatments. Now these are all unique. Now today we examine how trauma, stress, biology and consciousness intersect and what genuine healing in mental health really looks like. I hope you enjoy this conversation I had with Dr. Will Van Derveer.

Welcome to the show, Will.

Dr Will Van Derveer (01:58)

Thank you for having me.

Dr Ron Ehrlich (01:59)

Well, this subject that we’re to be dealing with today, of course, mental health is huge and growing problem, arguably undiagnosed or overdiagnosed, depending on your perspective and the use of psychedelics and nutrition and ketamine. We’re going to be exploring all of these things, but mental health as diagnosed. mean, we live in a world of evidence-based medicine and what tests, do, how do we establish a diag.

Is there any clinical tests that one can do? Blood tests, blood pressure, hormone levels. What’s the evidence for mental health diagnosis?

Dr Will Van Derveer (02:42)

And that’s one of the biggest problems is we don’t have great testing. Yeah, you hit the nail on the head You know in the integrative work that that we teach and live by in our Institute we Teach people we teach practitioners how to identify and resolve a wider range of root causes than What I was taught in medical school or what you know, a typical doctor would think about for mental health. So for example when you ask the question what

You know, is there a test? Well, a person who looks depressed, let’s just take depression, for example. That person could have a thyroid condition and you certainly could diagnose that with a blood test. That person could have a very low vitamin D level, diagnosable by blood test. That person could have a very disordered gut microbiome that you could test and report back with. They could have Lyme disease that could

show on a blood test. But the wide, the majority of what we see comes with a wide variety of different results on labs that are mostly inconclusive, typically. So it remains a field that’s quite subjective.

Dr Ron Ehrlich (03:57)

I think, I think it’s worth, that was a little bit of a loaded question I know, but it’s one that I’ve, I’ve interviewed many psychiatrists on my program over the many, over the years. And I think it’s worth, it’s a sobering fact to reiterate that there is a subjective nature to many of these diagnoses, which is fine. And I love your approach of integrative psychiatry and a lot of the things we’re going to be talking about today.

You’ve said that unresolved trauma I know lies at the core of many psychiatric symptoms and how does an integrative psychiatry psychiatry fundamentally differ from the standard model when it comes to managing chronic stress and mental health issues? You’ve already mentioned a couple of things, but I wondered if you might just talk about that paradigm, the difference between an integrative and a more traditional, if you like, approach.

Dr Will Van Derveer (04:51)

Right, well thank you for asking. This is near and dear to my heart and I do my best to get the word out. So thanks for the opportunity to stand in my soapbox for a moment.

The problem with how I was taught to practice psychiatry is that we use medication to suppress symptoms and we don’t go much further than that. There are some dinosaurs like myself who provide psychotherapy with medication, but by and large psychiatrists are medication only providers. So, medications, when they work well, which unfortunately happens, for example, in depression and only about 30 % of the people who seek care. 

They suppress symptoms. They might make you able to function or cope, but they don’t deal with all the problems that are contributing to your depression. Chronic stress, you mentioned. So the chronic stress of being a human in the 21st century, the chronic stress of the barrage of information through social media, the chronic stress of climate change or political unrest, especially here in the US right now. 

The chronic stress of having a job that you don’t love or not having great relational tools and how to resolve conflict with your partner at home. The stress of raising children in an environment where social media is eroding their mental health and facing the difficult decision as a parent, and I can relate to this, went through this with my child, of do I isolate my child and say you can’t use all the social media?

and make you the weirdo at school? Or do I make the developmental psychology intelligent choice of limiting that for you? ⁓ So we’re living in a different world now. There’s a lot of worry about jobs going away from AI, for example. There’s a lot of reasons why we don’t sleep as well as we used to. I could go on and on about the causes.

Your question was about how do we deal with it? So first of all, we acknowledge that humans are complex. We acknowledge that having enough steps or enough activity, physical activity in your life is essential to maintaining well-being. We acknowledge that adequate nutrition is a critical part of mental health. 

We acknowledge that healthy relationships that are fulfilling are an incredibly important part of longevity and general well-being. So we might use medication in a sparing way at a minimum dose or a minimum duration of treatment while we really try to resolve these other targets for treatment. So that’s the best way to describe this broader approach.

Dr Ron Ehrlich (07:44)

It is, I mean, it’s absolutely music to our ears and it’s a theme that we’ve explored over the 10 years that I’ve been doing the podcast. So this is really music to my ears. It’s sobering to know that in Australia, one in six Australians are on antidepressants. Yep. That the 95 % of prescriptions written for antidepressants in Australia are written by GPs and the average GP appointment goes between.

Dr Will Van Derveer  (08:10)

Okay.

Dr Ron Ehrlich (08:14)

between 8 and 15 minutes.

Dr Will Van Derveer  (08:17)

Wow, that’s so sad.

Dr Ron Ehrlich (08:19)

Those three statistics are quite incredible given what you have just defined as the difference between an integrative approach and what people may know as the standard approach.

But, ⁓ but of course you mentioned so many things there about conflict resolution, know, resolving conflict, something that is sort of almost built into business models. Nowadays, the challenge digitally of the digital world, again, engagement and the business model. And of course the, importance of relationships. And I think Harvard have done the biggest study ever on relationships approach, psychedelic approach. 

And it’s a subject that we have explored a few times on our podcast, but the integrative psychiatry Institute, the IPI is year long, psychedelic assisted training therapies, attracting a lot of attention internationally. What makes this approach so effective for things like treatment, resistant anxiety, depression, trauma, and, what surprises many clinicians when they learn about it properly. What makes the approach different and what surprises practitioners?

when they engage with it.

Dr Will Van Derveer (09:33)

Right. Well, it’s very new, very different inside of the mental health world to be talking about psychedelics. And it’s very exciting that Australia has put the staff in the ground and said, okay, we’re going to give this a roll and see how it goes. Quite bold from our perspective over here.

Dr Ron Ehrlich (09:50)

That is not the case in the States. You’re talking to me from Boulder, Colorado and the U S what is the legal position of psychedelic assisted therapy in America?

Dr Will Van Derveer  (10:01)

Well, I’ll try to keep this concise because it’s a very, unfortunately, it’s a complex reality. So we have ketamine therapy, which we could talk about later if you want to. We will. That is on what we call DEA schedule three. So it’s readily available. It’s fully legal federally. So you can go into ketamine therapy anywhere in the United States or in the world, almost anywhere in the world. There are countries in Europe that haven’t embraced it yet, but it’s a legal ⁓ psychedelic drug.

We have psilocybin that’s been approved here in Colorado and also in Oregon. And we have run trainings in both states, training therapists how to work with psilocybin. And then we have MDMA, which unfortunately was not approved by FDA in the summer of 2024. So there are a couple of pharmaceutical companies that have developed patented psilocybin molecules that are reaching the end of the final phases of FDA research and may be approved later this year or early next year. 

I’m personally hoping that we get a federal approval as soon as possible because each state has its own rules and its own training requirements, its own sets of very high fees for licensing therapists, expensive regulatory systems that cause the medicine to be expensive. know, people need to travel if they want to have psilocybin therapy to Oregon or Colorado, which is expensive. it’s, and many centers, unfortunately in Oregon are closing because it’s too expensive in Oregon to provide the treatment. the state by state experiment is not going well so far. 

And we have other states that are trying to adopt these laws, but personally having been in the trenches with the state models, I would really prefer to see us take action on a federal level as soon as possible. So when I said that Australia had embraced something different from the US, my understanding was that you had a federal ⁓ authority for certain doctors to prescribe MDMA therapy, which we don’t have yet here.

Dr Ron Ehrlich (12:15)

Right. But the IPI, tell us a little bit about, that Institute and the approach, how it is approached.

Dr Will Van Derveer  (12:24)

Thanks, Ron. Well, we’ve trained a number of Australian therapists in our program, which has been fun. And some of them are working in clinics providing MDMA therapy in Australia, which is really exciting. The program we run covers the three medicines, MDMA, psilocybin, and ketamine on the idea that some people will find jobs in clinical trials or they live in states where hopefully we’ll see a federal approval at some point, or they can begin working with ketamine therapy right away. 

So we locate  psychedelic therapy inside of this integrative framework, which is different from how most people are approaching psychedelic therapy. And we could talk about that too. So the conventional or the traditional approach, the pharmaceutical approach in psychiatry is also being applied to psychedelics where most of the ketamine provided in this country for mental health problems is provided without therapy. So you sit in a dark room, there might be other patients in the room with you. There’s no therapist.

There might be a roaming nurse to check on you, but you’re having a psychedelic experience. And if you’re not familiar with having experiences like that, you could have trauma come out during the session and nobody’s there to help you. So unfortunately, that’s how a lot of the ketamine work is being done here in the U.S. But there are clinics that are embracing and taking a big stand for the psychotherapy component of it, which is critical because again, if we’re looking at resolving root causes, then we want to discover and handle the trauma that may come out effectively and not just re-traumatize the person by not having enough support in the room.

Dr Ron Ehrlich (14:03)

Well, I mean, the, you, you were also mentioning exercise and vitamin D and thyroid function and sleep. mean, ⁓ you know, I think this is probably what distinguishes a more integrative approach from the standard model anyway. I imagine.

Dr Will Van Derveer  (14:20)

Yes. Yeah. So the trouble with psychedelic therapy that is not framed inside the integrated model is that, you know, we have these clinical trials now that show that follow people for six weeks or eight weeks or 12 weeks. And oftentimes, the participants do well for a few weeks.

And if you work with ketamine as a mental health treatment, you know, pretty quickly that the effects, the benefits tend to wear off within a few weeks, which is a huge problem because the last thing I want to do as a psychiatrist is tell somebody they need to come back and get ketamine again, because it’s stopped working. I mean, the person, maybe the person was on Prozac before and now they’re on ketamine. Prozac arguably is less toxic and dangerous than ketamine in the long run.

So now you’ve got a person who’s on a controlled substance that could be addictive and now they’re having to come back and get it over and over again. So what people are not understanding inside of this maybe hype or hysteria around psychedelics is that you can’t bypass the things that keep you well. You can’t not deal with your relationships. You can’t not deal with your diet. You can’t not deal with your sleep and your media addiction and so on.

And doing all that hard work of behavior change is very, very difficult and it takes time and effort. the bonus or the benefit of the psychedelic in that framework is as a catalyst to help someone connect with deep empathy for themselves or a deep sense of belonging or connection to the universe and recognizing your own inner divinity, for example. And these mystical experiences can be incredibly transformative there a moment in time and then you have to do the work to make a new baseline to make a new reality.

Dr Ron Ehrlich (16:17)

I mean, we could be talking about any health condition and our modern healthcare system by and large in the majority of cases, I think we could argue about whether it’s 80 or 90 % or more or less, but around there is very much on symptom based pharmaceutical management issue. the integrative approach always stands out as looking at root cause. I know that.

It’s we’ve done a program on trauma and it was once described to me as, a, event which just kind of circulates, goes round and round in a part of your brain that just gets stuck. It’s the trauma being relived, being re re experienced over and over in your head. 

And one of the exciting things about the psilocybin or the psychedelic approach, be it MDMA or psilocybin or or ketamine is the opening up of pathways within the brain, literally the opening up of pathways, allowing you to process it.

Dr Will Van Derveer  (17:21)

Absolutely.

Dr Ron Ehrlich (17:23)

Is as you use the word catalyst to unlock that potential must be quite exciting.

Dr Will Van Derveer (17:31)

It is incredibly exciting. It is. mean, as, as a practitioner, it’s like watching the highlight reel of your, you know, rather than sitting through a three and a half or four hour game of your favorite team, you know, you’re watching the four hours happen in super, you know, fast forward. So you’re seeing the changes happen. For example,

You know, in some of the clinical trials I was involved in, we had people who had been suffering for 29 years on average with PTSD before they came into the MDMA study. Some people had hundreds of therapy sessions. There was one person at over a thousand therapy sessions prior to coming into the study. And to see those people get well and resolve PTSD where they don’t meet the diagnosis anymore after three sessions was just mind blowing as a practitioner and of course it makes you wonder why are we telling people that they need to try and fail you know x y and z therapies before they can have access to this treatment why should they suffer for three years or five years or 15 or to 30 years before having an effective treatment

Dr Ron Ehrlich (18:45)

You used a word there, which I think we need to highlight and repeat again, because it’s not a word that’s often used in mental health issues. said resolve resolve. Now that’s, that’s just not a word that many mental health practitioners use. And I think we need to, to just come back to that a little bit, because I mean, managing a chronic mental health issue is a great business model just not a very good health model but here we have something you use the word resolve please explain that a little bit more.

Dr Will Van Derveer (19:23)

Well, in the MDMA work, have long-term follow-up. And the remarkable thing is that most of the people who achieved remission, stay in remission through the long-term follow-up. And we’re talking about three exposures to MDMA in the case of this body of work that I’m talking about. 

With psilocybin, which has mostly been studied for chronic depression, one or two psilocybin sessions is showing across multiple studies six months to 12 months of relief from depression. So, you know the the the prospect of someone needing to take psilocybin once a year, ⁓ you know a few times in their life total versus treatment as usual that you and I have been talking about, feels it A it feels less toxic B it feels a lot more affirming and hopeful for someone’s condition. So

These connections in the brain, it’s very interesting when you sit in the room with someone who’s having a psychedelic therapy experience. Some version of the metaphor, I’m seeing my life, I’m above the forest, I can see the forest for the trees. I see what happened, I see that I was there, I see that I participated, I had my part to play, but it’s not my fault. I’m not to blame for the car accident or the death or the…

terrible thing that happened and it’s time for me to move on and live my life. You don’t have moments like that in ordinary therapy very often as a practitioner.

Dr Ron Ehrlich (21:00)

I mean, I think, and I’ve had this experience myself in therapy with the psychologist. So I have speak from some experience, but the, the difference, of course, you use the word catalyst to open up those pathways. I can only imagine that an integrative approach would be a great way of solidifying the foundations on which that catalytic experience has occurred.

And I think there are very few mental health or healthcare therapies where people would describe them as one of the five top experiences of their lives. mean, let’s just reflect on that for a moment too. That obviously.

Dr Will Van Derveer  (21:43)

Yes, the work of Roland Griffiths out of Johns Hopkins, mystical experiences and so on, ranking an experience from therapy on the same level as the birth of a child or a marriage day, quite remarkable. And these experiences stick with people, you know, and they carry them, especially in the case of psilocybin. It doesn’t appear that, I mean, first of all, it’s important to say that

Outside of ketamine, ketamine is a different animal, outside of ketamine these drugs do not appear to be drugs that people become addicted to. They in general don’t go looking for opportunities to use the drugs after the treatment because the whole experience of this catalytic moment is so sacred and meaningful that it wouldn’t make any sense to approximate it in ordinary life.

Dr Ron Ehrlich (22:34)

Yeah. Yes. I, I would concur with that because it was quite an interesting, a very interesting, that’s an understatement, a very interesting experience for me. And one that I’ve reflected on, and this was probably two years ago that I’ve reflected on many times since then, but I had no desire to go back and, I must try this again next weekend. You know, that was terrific. No, no, it wasn’t like that at all. 

I’m interested though, Will, because you have been in healthcare for some years and you went through traditional training. I’m always interested to hear the personal story, the epiphany or what promote, prompted the change in your approach as a psychiatrist, as a medical practitioner.

Dr Will Van Derveer  (23:20)

Thanks for asking. There have been a number of inflection points.

The first one happened, I graduated from my psychiatry training and I had the tools that they teach and you know that you get board certified to provide and those things included of course medications and some forms of therapy. So I was doing cognitive therapy and a little bit of psychodynamic work looking at people’s histories from their childhood and I was helping.

But there were a lot of people who didn’t respond to the medications, which is what we now know is the norm, is more than half of people who take medications in my world don’t get what they signed up for. They get side effects or they get ineffectiveness. So I was growing more and more desperate. And just a couple of years after I graduated from my training, this is more than 20 years ago now, I quit psychiatry thinking, okay, well, I’m going to go do something different. 

And one of my patients, who I had treated prior to quitting. This is the first time I quit psychiatry. There were other ones later. But this time I ran into one of my former patients and while I was on this break from psychiatry and he pulled me aside. This was a guy who a lovely gentleman in his mid thirties. He had terrible anxiety, social anxiety, agoraphobia, which is a fear of going outside of his house. He couldn’t travel. He couldn’t date. He, he had an interesting

symptom that didn’t make sense to me at the time, but he said that whenever he ate a sandwich at an airport, he got very panicked and I didn’t think anything about it because I didn’t know any better. So I quit psychiatry. I ran into this guy on the street and he said, look, I want to thank you for being a kind doctor who clearly cared about me, but I want you to know that after you left your practice, I went and was tested for celiac disease. came back positive.

And I stopped eating wheat and over the course of about six weeks, my anxiety melted away and it was completely gone. And the SSRI medication and the benzodiazepine that you had prescribed me, I gradually tapered those off for the next six weeks and I still have no anxiety. And he still lives in Boulder and I keep up with him. He’s still without any anxiety. He went on to date the woman that he would sit in my office and say, I can’t ask her out even though I want to.

They have two kids. One of them was tested positive for celiac right away. So that child will not have the journey that he had with problems from eating wheat. So that was a huge wake-up call for me. And I realized that I didn’t have the knowledge I needed to be effective. And so that led me into this whole integrative question and going and doing a lot more trainings and learning about infections and gut microbiome and chronic stress and adrenal fatigue and learning how to prescribe hormones and vitamins and assessing for nutritional deficiencies and trying on different frameworks for understanding even more severe conditions like bipolar disorder and schizophrenia and really interesting work that’s been done in those fields that’s not well known, but good science and started trying different things. And I’m very grateful to my patients for going along on that ride and

You know, as best we can using the evidence and following the evidence. But when you, when you go outside the mainstream, there’s less evidence to support what you’re doing. So you have to be mindful of that and, you know, tell people that that’s what’s happening when you’re recommending a, you know, high dose niacin for schizophrenia, for example. ⁓ so that, that was a big wake up call. And then I, the, the psychedelic piece came later for me.

I was a very straight kid. wasn’t, I had never tried a psychedelic in high school or college or any time prior to getting a call from a friend of mine who asked me if I would consider getting involved in this MDMA assisted therapy trial. That was about 15 years ago. And my response to him was, well, isn’t that the stuff that causes holes in your brain and the kids party with and get in health problems with it raves and so on.

He said, well, why don’t you look at this study that was just published about a small group of people with PTSD. And I saw that the paper was reporting 80 % resolution of PTSD after three sessions. And I thought, wow, I’m lucky if I can get 20 % resolution of PTSD. you said, these are rare terms to use in the field of mental health.

So that got my attention, I got involved and I saw what was happening in the room and I got to refer some of my own patients into the trial we were doing and see them heal. So by the time I was done with that trial, it was clear to me that I needed to be an instrument in helping this work become more mainstream.

Dr Ron Ehrlich (28:29)

Well, you’ve mentioned nutrition there and nutrition has been a focus of my professional life for over 40 years. And, functional medicine is a, is a huge and growing area. actually interviewed the father of functional medicine a few weeks ago, Jeffrey Bland.

Dr Will Van Derveer  (28:47)

I saw that on your podcast,

Dr Ron Ehrlich (28:49)

Yeah. And he’s been a mentor of mine. did his first course in 1981. Wow. it came as cassettes. was mailed out as a cassette audio cassettes, but you know, and you mentioned niacin and B3, Different forms of vitamin B, nicotinamide and the more active form. Nice. And we’ve done programs on that. And I’m actually on the board of the orthomolecular medicine.

Dr Will Van Derveer  (29:15)

amazing.

Dr Ron Ehrlich (29:16)

Yeah. So you’re talking my language here, nutrition and mental health are not often connected. mean, nutritional nutrition and health, sadly, right. A lip service is paid to them, but your nutritional psychiatry program. And you’ve just mentioned gut health. I’ve got a gut feeling that there’s a real thing there. Inflammation and interestingly, mitochondrial function. And now that is the buzzword in every health.

You go to a course on autoimmune metabolic health. My condo health is there. go to a course on cancer, metabolic health, mitochondrial health is there. go to a course on anything. Not surprisingly. It’s how it manifests itself. That is perhaps has a genetic component here, but there are many commonalities here. Aren’t they? often do you see mental health symptoms?

Resolve or well, you’ve already said resolve or significantly improve when those foundations are addressed. What kind of response do you get to just foundationally sorting out a person’s nutrition first? 

Promotional:

Hi, Dr. Ron here, and I want to invite you to join our unstresshealth community. Now, like this podcast, it’s independent of industry and focuses on taking a holistic approach to human health and to the health of the planet. The two are inseparable. There are so many resources available with membership including regular live Q &As on specific topics with special guests including  many with our amazing unstresshealth advisory panel. Now we’ve done hundreds of podcasts all worth listening to with some amazing experts on a wide range of topics. Many are world leaders, but with membership we have our unstress GLAM podcast series where we take the best of several guests and carefully curate specific topics for episodes which are jam-packed full of valuable insights. So join the

UnstressHealth community. If you’re watching this on our YouTube channel click on the link below or just visit unstresshealth.com to see what’s on offer and join now. I look forward to connecting with you.

Dr Will Van Derveer (31:39)

Well, there are a couple of caveats. The first one being how disordered is the nutrition at the beginning? So, you know, the delta that you’re going to see between the starting point and the end point has something to do with where the person’s starting. So, for example, if you came to my office, I assume you probably have excellent nutrition given your education. Maybe that’s not a fair assumption.

Dr Ron Ehrlich (32:07)

Like, I try to do my best. work on an 80 20 rule and if 80 % of what I do is good, then I can live with that. When I’m really on fire, I’m a 90 10 person and at various points in my life, I’ve been a hundred percenter and I’ve been such a pain in the ass. No one wants to even socialize with me. So there’s a balance there, isn’t there? But 80 % is a baseline that I think is.

Dr Will Van Derveer (32:33)

That’s fantastic. So that’s one piece is how much change can we expect based on what the person’s starting point is? And I’ve certainly seen people go from a mostly fast food, high pro, know, pro-inflammatory sort of anti mitochondria diet to a dramatic shift in mental illness conditions by improving the macros and the micros and really going after inflammation as much as we can and following it along. 

That’s, you know, one of the nice things about inflammation is it’s not hard to follow with blood work. The other piece that the other caveat you already mentioned, which is a beautiful way to talk about it is the relational and social component of a person’s mental health. So if their social world is very isolated, very bleak or high conflict, then

The nutrition in my experience, even if it’s robust, even if they’re at that hundred percent mark you were talking about is probably not going to overcome the cortisol bursts and all the, ⁓ or, you know, chronic despair and existential challenges. Again, people are complex. So one person’s going to have a massive boost from only the nutrition. Another person is you know, not going to see as much benefit from that. And I think a lot of it is what you said of the pathways and the genetics involved in that.

Dr Ron Ehrlich (34:09)

I love that actually though, Will, that you’ve drawn that really important point about where is a person starting from, because that transformation from fast food, almost exclusively processed diet to just a nutrient-dense diet. We’re not even talking about food sensitivities or gluten sensitivities or whatever is huge. You also mentioned relationships and those certainly have been something that I’ve focused on too.

In more recent times with mitochondrial functions, circadian harmony is another, this is a whole new area as we focus on, on mitochondrial metabolic health, the importance of circadian. mean, as I say, I’ve been in practice for 45 years, but it’s really only been in the last five or 10 that I have truly focused my own health and my patients’ health on circadian harmony.

Dr Will Van Derveer  (35:06)

It’s so fun to be in the field right now because we’re learning so much more than we were for decades. There were a couple of decades there where it felt like it was pretty much crossing the desert and there weren’t as many new phenomena coming. we have much, you know, the functional medicine continues to grow. And like you said, inside of the mitochondrial conversation, there’s a lot of hope of getting somewhere with people who were very stuck for a long time.

Dr Ron Ehrlich (35:34)

Hmm. It’s also interesting to hear you use the words. It’s exciting to learn because I think there are many medical practitioners. don’t want to be too negative or disparaging here, but many medical practitioners who feel that if they haven’t read it, then it’s not worth reading. It’s not worth knowing. And if they don’t know it, then it’s all in your head or it’s genetic. So I think it’s interesting. I like yourself.

The more I learn, the more I realized there is to learn. I find that exciting, but for some people, not so you’ve mentioned ketamine a few times. And, and, you know, that is an area that I must admit, I know very little about it’s become a significant part of mainstream mental health. When can it, when is ketamine most effective? How do you make that decision about, know, we’re going to go psilocybin, we’re going to go ketamine, we’re going to go MDMA. What, what, what prompts you to use ketamine?

How is it used?

Dr Will Van Derveer  (36:33)

Well, ketamine for a long time prior to even state approvals of psilocybin was the only game in town. you know, we used it for many different targets. Acute depression, chronic depression, the long-term treatment resistant depression tends to be a highly inflammatory condition typically. Ketamine means a very strong anti-inflammatory. Interesting.

So it has that acute effect on inflammatory pathways in the brain.

The advent of psilocybin creates a of a decision tree where you could say, well, this person has chronic depression. What are you going to use to treat this? And as I said before about ketamine benefits not lasting for very long, I think if you present most people with the facts of the likelihood, we’re in a, let’s just say we’re in a pharmaceutical traditional model and we’re not in the integrated model just for a moment even though it’s painful to go into that even from

Dr Will Van Derveer (37:44)

All the other variables are the same and we just trade out psilocybin and ketamine. Ketamine has a unique, very powerful anti-suicidal thinking effect that seems to be unique about ketamine. So much so that emergency rooms that tend to treat people who are with acute suicidal thinking are giving people ketamine in an emergency room and seeing it diminish or resolve pretty quickly, within a few hours sometimes which helps keep people out of the hospital, which keeps, you know, the insurance companies happy. 

And hopefully it keeps the patients happy, more importantly. So in a world where everything is available, which we’re not quite there yet, but if we have MDMA, psilocybin and ketamine all available, my drug of choice in treating PTSD would be MDMA. If the person’s medically appropriate for MDMA treatment, and there are people who are not,

There are also obviously rule-outs for ketamine and for psilocybin as well. But I think that the evidence base and my own experience in clinical trials watching people with chronic PTSD kind of wake up and walk away from their PTSD is just quite remarkable with MDMA. So you can treat PTSD and trauma with psilocybin and ketamine. 

You know, there are studies, not very big ones, but there are studies with those drugs to treat that condition. But it seems like the long-term minimal intervention play is going to be psilocybin for depression and MDMA for PTSD. But I think ketamine will continue to have this almost urgent or acute rescue role. But I think as I said, you know, once people have enough ex-

The practitioners have enough experience under their belt to know the differences and the pros and cons and the drawbacks and benefits. It’s going to be a little hard to offer a patient something that might wear off in a few weeks and then they need to come back and keep coming back and keep coming back. 

And then of course there’s the risk of ulcerative cystitis, which is an irritation of the bladder that comes from chronic ketamine administration. It’s not common, but it does happen. Even people just getting ketamine for medical use. it’s going to be interesting. Obviously there are also other compounds that are being developed right now that we’re not even talking about. It’s probably beyond the scope of this conversation, but there’s a lot happening in the field.

Dr Ron Ehrlich (40:17)

Well, I can only imagine, I can only imagine the drug companies would be falling over themselves to come up with a patented because psilocybin has been around for quite some time. Thousands, thousands, not millions of years. And that’s a problem for the healthcare industry, because if you can’t make a huge profit out of it, it may not find its way in, but you’ve mentioned therapy as being an important part because

Dr Will Van Derveer (40:31)

I’m gonna wait now for-

Dr Ron Ehrlich (40:45)

So much of this as you’ve used the word catalyst before opens up a pathway. know in my own experience, a session before this with the psychologist was a discussion about what my intention was. What did I hope to achieve? What did I hope to explore? And I can just imagine that this being a catalyst for more complex issues would open up a pathway for therapy that you could have only dreamt of.

When you graduated, what sort of therapies are you using? Cause I know this is a big philosophical question, isn’t it? Because there are so many different ways of approaching it. How do you incorporate talking therapy? I’m assuming that’s what you’d be talking about here. Talking therapy, psychotherapy into the use of these compounds.

Dr Will Van Derveer  (41:36)

Well, I think one of the most powerful ways to incorporate psychotherapy with these compounds is to develop a strong therapeutic alliance to a good relationship prior to the dosing session. And sometimes that process is difficult because trauma that has roots in relationships. So interpersonal trauma can make it very difficult for a person suffering that condition to trust caregivers or therapists.

And this is another reason why MDMA therapy, think, is an incredibly powerful option for PTSD is because of its unique boost of the hormone oxytocin that allows someone to not only feel self-compassion, but also to trust the caregivers more effectively, more quickly. So much so that it’s a common phenomenon on the morning after an MDMA therapy session to have what

Some people call it therapeutic hangover where you start doubting, you start wondering, how did I trust these people that I don’t even know so much that I told them things I’ve never told anyone in my life? And it’s scary to be facing that the next day. And it needs to be acknowledged and understood for the trainees who are going to be providing this therapy that that’s a risky window for the patient.

You were asking me about therapy and how to use it. Talk therapy is quite difficult to, it doesn’t even really make sense when people are having trouble following language to do, for example, if you were going to conduct cognitive behavioral therapy while someone’s on.

Dr Ron Ehrlich (43:21)

Yeah, no, I, mean, when you’re on psychedelics, metacadamine, MDMA, there’s no time to be talking, no time to be talking to anyone. They’re very much in their own head. Right. I mean, around it, around that session, because I don’t think, well, we’re assuming that everybody knows what, how this is administered and how this is used. So let’s come back to 101. A patient walks into your practice as a new patient and ⁓ looking towards this. mean, run us through briefly how that would be.

Dr Will Van Derveer  (43:56)

Well, we would, ideally we would offer a handful of preparatory sessions at not just one, but a few. And this is how the research was conducted with MDMA therapy is three preparatory sessions once a week, 90 minutes each, and then a dosing session. The dosing session is anywhere with ketamine, two hours, three hours up to with MDMA could be six or eight hours. Silicebin about the same length of time. ⁓

There are studies on LSD. LSD is a very long experience, 12 hours. So these are long sessions for therapists to sit in. And that’s a whole nother conversation about the practicality of that. So after the dosing session, we like to provide a handful of integration sessions to discuss the insights, the take home messages, the pieces that are going to be anchors for the person to come back to and the future to remind them of the possibility that was experienced during the dosing session. 

Because dosing sessions really are glimpses of possibility. They don’t establish in and of themselves a new reality, a new baseline. There’s a religious scholar from UCLA named Houston Smith who said, you know, the purpose of spiritual practice is to change, is to go from state change to trait change. And I think it’s a beautiful way to think about psychedelic therapy is you’re having a state change with these connections and pathways in the brain that you mentioned before. But those connections are very temporary. There’s a window that opens up where new things can happen. But the window doesn’t stay open. And so the behavior change needs to start to take place. So from an integrative perspective, we would use the preparatory sessions

Sure, we would talk about intention, absolutely. And we would answer questions about the fears that a person has about what they’re about to experience, informed consent, all the things. But we would also try to identify what the targets are going to be for behavior change after the dosing session. So we’re already doing integration before the dosing session in a way. So, you know, if when you work with people the way I have for many years who have severe depression,

Having that person in your office for the first time and saying, you know what, you don’t exercise. You need to put on your running shoes and that’ll, you know, that’s gonna make a big difference for you. It’s not the way you approach that, you know?

Dr Ron Ehrlich (46:36)

Yes, I’m sure experiences taught you that that’s probably how you did approach it when you learnt about how important it was. It’s the delivery. always like in sometimes healthcare delivery to a stand up comedian’s routine. you see what works with the patient and then you reflect and go, yeah, look, I know I felt better, but I’m not sure the patient did.

Dr Will Van Derveer (47:00)

There was a famous physician, I’m trying to remember who it was, might have been William Carlos Williams who said that our job is to entertain the patient while the patient heals themselves.

Dr Ron Ehrlich (47:09)

I’ve read that I thought it would might’ve been Voltaire as well. There’s been a few people that have said that, but that there’s a certain, there’s a lot of truth to that. I’m, I’m so, I mean, this is why anybody listening to this, be they a practitioner or a patient, if we were talking about the standard model of healthcare, which often involves the prescription of a medication and a practitioner or patient is listening to this thinking, well, this is a different medication.

 Dr Will Van Derveer  (47:18)

I think so.

Dr Ron Ehrlich (47:38)

You know, isn’t this great and it’s going to be really effective. Well, that’s really not using it the way it could be or should be. And this is why the integrative approach, your preparatory sessions, then your sessions afterwards in to, to bed in literally bed in foundational things to make the foundation on which a person proceeds strong are so important.

 Dr Will Van Derveer (48:04)

Well, there’s a lot that is important about education. When I was trained as a psychedelic therapist 15 years ago, I didn’t understand that, ⁓ I didn’t understand what I know at all I was as a practitioner. I didn’t realize how much gratification and ego support I was getting from saying the smart thing that someone said, yeah, that’s a really interesting way to think about that. It’s very unhelpful to interpret

someone’s experience when they’re on a psychedelic medicine. The purpose is for them to connect with their own inner wisdom, their own inner knowing, and for the client to have that space protected for them so that they can do that work. And that’s a very different model for clients and practitioners.

Dr Ron Ehrlich (48:53)

Sorry. Well, I was going to say part of the problem I think is that the way we learn as practitioners is very didactic. Yes. We go to a lecture, we sit and listen to the expert, we take notes and then we convey that knowledge, but that’s not facilitating a patient’s healthcare journey by lecturing them, is it?

Dr Will Van Derveer (49:15)

No, no, it’s not. It’s really not. so this, it’s quite revolutionary actually, the paradigm that the doctor or the therapist, you know, the person who’s got the authority and the power in the situation is not the holder of the healing process actually. They are the protectors of the space so that the healing can occur. 

And you know, that can sound a little woo woo or it can also sound a little frightening for patients who are used to being told that, here, put this in your mouth and you’re going to feel better, or I’m going to tell you how to live your life and you’re going to do, if you follow my instructions, then you’re going to do great. If you don’t, you won’t. So it’s a very empowering approach to make it between the client and himself rather than to be the, ⁓ you know.

Dr Ron Ehrlich (50:08)

Hmm. Well, I’ve often said, and I don’t think many of our listeners in this program would be that person, but if the only thing you know about healthcare is your doctor’s phone number, you are in serious, serious problem. But that brings us to another point about the healers own journey, because we’ve been very focused on, on, on, we’ve had some great stories about doctors.

Going through their own epiphany. And in Australia, there was a study done a few years back, which identified that 60 or 70 % of medical practitioners and nurses and medical students for that matter, suffering from burnout characterized by the acronym D I E D disengaged, I feeling ineffective and E being exhausted. So the healers own journey is really important here. mean, I know you believe clinicians.

Should undertake their own healing work. given those statistics, that’s pretty important. How does a, how does a practitioner’s personal inner work affect patient outcomes and especially trauma informed and psychedelic assisted care? mean, you must, I know you didn’t as a student experience this, but you must have personally since then.

Dr Will Van Derveer (51:23)

I have sense, yes. It’s critical. The best way to describe the inner landscape to people who haven’t had a psychedelic experience in my latest draft of trying to explain that to people is that it’s a little bit like the movie The Princess Bride or one of these movies that’s a fairy tale environment where you have fire swamps and you have beautiful castles and you have meadows and you have scary places. 

And when you take a psychedelic, you don’t know where you’re going to go. You could go to a very beautiful place, it could be very scary. And if your job in the psychedelic session is in the seat of the guide or the therapist, and you yourself as the guide have not explored those dark and scary places inside of your own mind, then you’re much more likely to act impulsively on your own anxiety and intervene and pollute the environment that the client is trying to heal inside of. 

So this is one of the reasons why people who are very experienced with their own personal journeys and healing, it doesn’t have to be with psychedelic medicines. People who have had near death experiences or mystical experiences that were not caused by a psychedelic medicine, all kinds of life experiences, the death of a child, you know, I mean, things that are very difficult. They prepare you to hold space for people who need to move through these difficult parts of the landscape. 

So it’s ⁓ a common phenomenon for people who are in the beginning of the work, I’m talking about the practitioner here, to not appreciate how dark and scary and difficult it can be to be in some of these places in one’s own mind. And so the view, again, I love this view because it’s very different from what I was taught in psychiatry is that what we’re going after is wholeness. We’re going after not trying to get on the sunny side of the street and stay away from the shadow, but we’re trying to embrace the wholeness of what we are as human beings. And when we do that, we can feel incredibly empowered to face whatever adversity and challenges we’re going to face in our lives going forward. Because life is full of that. It’s full of big challenges.

Dr Ron Ehrlich (53:44)

And given those statistics that I just shared with you about the mental and pride and even about physical, but the mental health of health practitioners delivering our healthcare system. ⁓ boy, is even more critical than ever.

Dr Will Van Derveer (54:01)

Very disturbing. It’s a very stressful career choice on the level with first responders like paramedics and firefighters and anyone who’s on the front row of human suffering. this concept of, or not concept, but experience of not having the tools or the resources to be effective in the healing process is very common. I remember reading somewhere that best recipe for burnout is to have maximum responsibility with minimum ability to affect one’s environment. And I think that’s how a lot of physicians feel.

Dr Ron Ehrlich (54:41)

Just unpack that a little bit more for me because that’s quite a big statement that, you know, yes, try to expand on that a bit.

Dr Will Van Derveer (54:49)

If you work in a healthcare system, the rules are quite clear what you’re allowed to do. It might not even be allowed to hold someone’s hand, you know, in certain circumstances, a patient who’s going through a procedure or something like that. There’s a formulary of drugs that you’re allowed to prescribe and you’re not allowed to spend more than 10 or 15 minutes with a patient. Maybe you have a quota and you’re supposed to see 40 patients a day, like is common in primary care.

These are formulas for burnout because the level of responsibility doesn’t go away. It increases the more people you see, the more patients you see. and then of course we also have the other issue with paperwork and people trying, imagine trying to see 40 patients a day and having a note on every patient. And when do you do that? And a lot of practitioners are going into their electronic medical record at night after dinner, hopefully with their family. 

And then you know, working to write their notes for a couple of hours after that. And it goes on and on. mean, the debt, I don’t know how it works in Australia, but here it’s very common for people to have hundreds of thousands of dollars of debt coming out of medical training. And if you go into primary care, then you know, you’re expecting a salary of 150 or $200,000 a year. And then you’ve got student loans for 30 years. I mean, it’s really bleak. It’s terribly bleak.

Dr Ron Ehrlich (56:15)

Yeah. It’s you’ve described the medical system here in Australia as well. And for that reason, it’s not that surprising. Eight to 10, eight to 15 minutes. You’ll be investigated. If you have longer appointments, you’re seeing 30 to 40 or 50 patients a day and you’re feeling disengaged. may feel a little ineffective and not surprisingly exhausted. Look, this has been a great discussion, Will. And I just want to finish up with one last question because.

We are all individuals on a health journey in this modern world and taking a step back from your role as a doctor, as a psychiatrist, just as an individual. What do you think the biggest challenge is for us as individuals on that journey in this modern world?

Dr Will Van Derveer (57:03)

Well, I think I’m going to go full circle back to your comment about the Harvard study in the beginning and the issue of meaningful, deep relationships. I think that is one of the biggest challenges, is in a world that’s marked by fragmented attention and the hustle and the go, go, go and the constant barrage of the phone and the media, it’s difficult to slow down and really be present and listen to the people.

Who are right in front of us. So the more we can do that, I think the more we can feel the, we can taste the marrow of life just in the immediate moment of being really present with another person. And practicing that as much as possible, I think is a really healthy antidote to some of the modern ills that we face.

Dr Ron Ehrlich (57:55)

Well, we’ll on that note, I’ve really enjoyed being present with you here today and thank you so much for sharing your knowledge and wisdom. We’ve been looking forward to this conversation for quite a few months and I’m glad we’ve had it. Thank you so much for joining us today.

Dr Will Van Derveer (58:10)

been great to be here. Thank you so much, Ron, for doing this.

Promotional  (58:13)

Feeling stressed, overwhelmed? It’s time to unstress your life. Join the unstresshealth community and transform stress into strength. Build mental fitness from self-sabotage to self-mastery. And together, let’s not just survive, but thrive. Expert led courses, curated podcasts, like-minded community and support and much more. Visit unstresshealth.com today.

Disclaimer:

This podcast provides general information and discussion about medicine, health and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.

Transform your health with the Unstress Health Membership