AMA Wed 4/29: psychedelic medicine expert from Stanford

Ask-Me-Anything (AMA) on Wed April 29 from 4:30-6:00pm PT

We are very lucky to announce that Dr. Laura Hack, MD, PhD, is joining as a special guest to do an AMA on Wed April 29 from 4:30-6:00pm PT. Dr. Hack focuses on treatment resistant depression (TRD), ketamine/esketamine treatment, transcranial magnetic stimulation (TMS), psychedelic medicine, and precision mental health. Dr. Hack is a clinician and instructor at Stanford University School of Medicine and the Palo Alto VA Medical Center.

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Dr. Hack trained in the TRD clinic at Emory University School of Medicine, a renowned medical school where she completed her Psychiatry Residency. At the Palo Alto VA Medical Center, she treats patients in the TMS clinic and is co-leading the launch of an esketamine clinic. She is also working with her mentor Dr. Leanne Williams to launch a precision psychiatry clinic at Stanford.

She is a translational clinician with a research passion for integrating multiple types of biological and environmental data using advanced analytic techniques into a neuroscience-based taxonomy of mood, anxiety, and stressor-related disorders. She envisions herself as a ‘psychiatrist of the future,’ incorporating genetic information, brain imaging, blood-based markers, and data from wearable sensors into diagnostic and treatment decisions to help relieve the suffering that arises from our current trial-and-error approach. Her research in precision mental health has been extremely exciting and she works with Stanford’s new Center for Precision Mental Health and Wellness directed by Dr. Leanne Williams – the first center of its kind.

Dr. Hack studied Neuroscience as an undergraduate at the College of William and Mary before earning her M.D. and Ph.D. from Virginia Commonwealth University. Her Ph.D. was in Human and Molecular Genetics and her dissertation work focused on the genetic underpinnings of alcohol use disorder and related phenotypes. She completed residency at Emory University School of Medicine, where she was Chief of the Research Track. Her residency research involved the use of epigenetic data and machine learning approaches to gain insight into the individualized nature of suicide and stressor-related disorders. Her current research focuses on refining neural circuit-based biotypes of depression and anxiety to better inform selection of effective therapies from the initiation of treatment and relieve the suffering that comes from poor treatment selection.

In her free time, she enjoys travel, vegetarian cooking, and spending time with her family, friends, and polydactyl cat.​

We are very lucky to have her and are grateful for her time. We’re posting this thread early to field questions, so fire away! Please add any questions you have to this thread and stay tuned for the actual event – Wed April 29 from 4:30-6:00pm PT. You can ask anything, especially questions related to the use of ketamine and psychedelics in medicine and psychiatry, precision mental health, the changing paradigms of mental health care and patient access, and scientific research on novel mental health treatments.

Format: Dr. Hack will post written answers to questions/comments directly on this thread, starting at 4:30p until approximately 6:00p. Thank you!

The information on this website and this discussion thread, including content written by healthcare professionals, are for general educational purposes only and are NOT a substitute for professional medical advice, diagnosis, or treatment. The information on this site is not intended to diagnose, cure, or prevent any disease or disorder of any kind. The use of any information provided on this site is solely at your own risk. Please consult your physician or other qualified medical professional for medical advice.

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Amazing thanks for doing this

Do doctors see psychedelics being used as widespread treatment in psychiatry? how long will it take to get there

Do doctors think psychedelics will help a lot? or is it mostly hype. What is the research like since I don’t really know what the state of all that is

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I have a couple of questions:

  • I know psychedelic treatments aren’t reimbursable right now. When do you see this being something insurance covers?
  • To be honest, I would like to try an experimental treatment but am afraid of the stigma associated with it. How woulkd you help explain this to people who might not understand it, like a hesitant significant other/family member?
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Hi! and yes thank you so much for offering this. Will there be low dose psilocybin trials we can get in to any time soon that will allow us to take a dose in our homes, without having to travel across country for the study and if so when might these happen? Is it already happening and if not How far out are we from having MDMA or low dose psilocybin counseling sessions available. Thank you

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This is so useful thank you! I was specifically wondering about ketamine. My understanding is pretty basic so would love to learn a bit more about it and how it’s come to be associated with treatment-resistant depression.

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Good Morning Aerian!

I am so happy you asked about how Ketamine fits into the overall treatment for Treatment-Resistant Depression.
New patient guide for ketamine
This is an excellent page to start learning more about this.

Hope all is well and you’re taking care of yourself.

Wanted to link this page, Mental Health During COVID. It has excellent website and tools available for FREE! so that you can get started to feeling better amidst these uncertain times!

If you have any questions about them specifically, the Osmind team is happy to help.

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Hi Dr Hack, what a great resource! Thank you for your time. I’m a Kiwi who had 7 infusions in LA earlier in the year. I was due to go back for boosters about now, but obviously can’t I use troches every 2nd night to maintain the benefits. I found a Psychiatrist here who had experience with ketamine for depression - he says that troches are just as effective as infusions and I don’t need to go back for IV, anyway. I’ve heard contradictory perspectives - from the clinic and the limited amount I’ve read online. Can you point me to any evidence around this? Or do you have a view? Many thanks

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Thank you so much, Dr. Hack. I am in ketamine treatment using quick dissolve tablets at home. I have not seen info on this delivery method in wider use, and I would like to know if there is good info on how this relates/correlates to the research on infusions?

I look forward to reading more about your work. It sounds fascinating.

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  1. What do we know about therapeutic ketamine’s affect on cognition or attention?

  2. To what extent do you think that different depressive symptoms will respond better to different treatment? In particular, it seems like there is a consensus online of patients that serotonergics tend not to help anhedonia and sometimes make it worse by numbing emotions, but no psychiatrist I’ve talked to has recognized this.

  3. From this paper: “Hashimoto and colleagues were the first to report superior and longer-lasting antidepressant actions of ®-ketamine compared with (S)-ketamine in rodent models 116–118. These findings were subsequently replicated by Zanos et al. (2016), who showed that (S)-ketamine’s antidepressant behavioral actions require higher doses compared to those of ®-ketamine”

It seems to me that esketamine is probably a less effective antidepressant than racemic or r-ketamine. Do you agree and if so, why only the former at your clinic?

  1. Is there any compelling reason for patients to try something like an SSRI before ketamine or psychadelics, given the capacity for the former to cause withdrawal issues and side effects past discontinuation?

  2. Have you heard of or read the book “Good Reasons for Bad Feeling: Insights from the Frontier of Evolutionary Psychiatry”? Do you think that understanding the evolutionary origins of diseases or of our susceptibility to diseases is important for clinical practice?

Thank you!

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wow you’ve definitely done some research! cool questions :slight_smile:

Thank you Dr. Hack - I really appreciate your time. I had a more basic question - i’ve heard about precision medicine but not really in mental health. what does that look like and when will it come to help people? The new center you’re part of at Stanford sounds cool, I guess when will that become the new normal in mental health? I think we really need it so thank you for working on that research

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Hi,

I’m an autistic who’s written about my positive experiences with LSD. In another autistic memoir, Switched On by John Elder Robinson, the author’s experience with TMS and the resulting breakthroughs in sensory attunement seem remarkably similar to my own breakthroughs via 5-HT2A agonists. Any idea as to what correlations could inform these similar modulations seem in both TMS and psychedelic sessions with autistics?

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I’ll put it this way, sometimes you have to go out of your mind to use your brain. That was how Tim Leary would put it, in fact that’s exactly where he was coming from. If you have not had a psychedelic experience, like Aldous Huxley was fond of putting it about mescaline, I think it’s a marvelous experience that everyone should have at least once in their lifetime.

I once was afraid to look inside, and ego death is a unique experience, I know that’s hard to fathom unless you are experienced, but I actually died for real in a car wreck 16 years ago, internal organs were ruptured, and my neck was broken. No heart beat, no bp, zero respiration, flat line dead. They had to break my ribs to start my heart, they saved my physical life, but I lost any connection with any thing spiritual and in loosing that, I lost my life. I have PTSD to this day, flashbacks and morbid thoughts every day, by the hour.

I’m trying to deal with the physical pain, as after the impact I have never been pain free, what ever that is. So my issues relate to both the physical pain, and the emotional pain of resulting horror story I’m living in, an unwanted life I could have never dreamed of.

But to the point, about psychedelic drugs and the ego death aspect of the experience, is after having experienced the real death, they’re is no drug experience that could ever, ever be as bad as the real deal. I would gladly take a dose of Ketamine without fear believe me. PTSD kills one inside before they ever commit self harm or the end of it.

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wow, @Helpseeker1 , i’m very sorry to hear about your PTSD and the pain you have to live with. It sounds very difficult, and I wish I could help besides giving you my support and sincerest best wishes here :pray: :pray: Thank you for sharing your story ~
It sounds like psychedelic drugs can have immense healing power. I can imagine that it could be like a reset button almost
It’s kind of crazy how much I learned back in high school health class about how psychedelics were supposed this super crazy terrible thing. Of course lots of politics behind this. But in reality it seems like it is a powerful and wonderful tool for healing.

I guess a question for Dr. Hack is do people in all those top medical schools starting to think about psychedelics as a healing tool? How long will it take for this to happen
Stigma is crazy and harmful!!

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@angelina said (in a separate post)

I recently found out about Cervella , which is a more subtle-looking Cranial Electrotherapy Stimulation device. I’m curious if anyone has tried this or other devices, and what you think. What is the sensation like (is it strong, do you notice something)? Did it work for you, or did you have any side effects?

Thanks!

I’d be curious to learn more about Cervella but also cranial electrotherapy stimulation in general. As stated above, does this stuff work? side effects?

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Dear Dr. Hack,

How do you find a balance between creating positive and good expectations for psychedelic medicine (which are highly sensitive to expectancy effects) and helping patients cope with “psychedelic disappointment”?

The latter seems to be a common phenomenon with all the hype, and many people with treatment-resistant depression hoping for a magic bullet.

Also, I’m curious about availability for EU-based patients for treatment in the EU, but I’m not sure whether you can say anything about that.

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One of the most important things about using psychedelics responsibly is making sure you’re in a pleasant environment you feel comfortable in. A clinical office with a nurse you don’t know isn’t a comfortable environment for a lot of people. What can be done to remedy this? Is there any research being done into therapeutic environments for treatment facilities?

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Hi Dr. Hack,

Thank you so much for doing the work you do. I was wondering if you know anything about the use of ketamine for treatment resistant depression and estimated length of treatment. Is there any data on oral ketamine in the form of troches or lozenges taken at home and the efficacy and safety of longer term (months to years) maintenance treatment? I’ve heard and read about side effects from heavy recreational use, including hemorrhagic cystitis, and was wondering if this should be a concern for patients taking ketamine therapeutically and as prescribed a couple days a week.

Additionally, I was wondering if there is any data or you have any experience with the combination treatment of ketamine in the setting of TMS or even ECT?

Thanks!

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Is this this therapy very expensive? Would I be risk losing my SSI or other benefits for pursuing and using these treatments? What are resources for finding local doctors who use this kind of therapy?

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Delighted to be part of this and great that there has been so much interest! Let’s get started on this AMA!

Proof:

Stanford profile: https://profiles.stanford.edu/laura-hack

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