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Dr. Evan Husted is a board certified emergency medicine physician who lives in South Philadelphia. He started his education receiving a BA in psychology with a focus on neuropharmacology from American University. Later, Dr. Husted graduated from the George Washington School of Medicine and Health Sciences. He opened Mindstream Medicine in 2023, a private practice providing a psychedelic assisted therapy by method of ketamine infusion and injection. Dr. Husted's
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Independent Ketamine Therapy Clinic allows an elevated level of attention and care. He uses ketamine therapy to help people with depression, anxiety, PTSD, and life transitions when traditional treatments have not been successful. Dr. Hustad, thanks for coming. Let's get started. So what led you to specialize in ketamine therapy? Good morning, Ronak. And please call me Evan. So my road to ketamine therapy started in the emergency department.
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So I'm a burned out ER doctor. That's how I came to be doing this. But the emergency room was where I gained my initial experience using ketamine. And in that context, it was for procedures that were going to be very brief but very painful. We used ketamine to help space people out when we had to reduce a dislocated joint or put a fractured bone back together in a splint.
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taking people out of the moment, but we use a much higher dose in the emergency room than I'm using in the clinic now. And it could lead to some anxiety reactions, and then I would have to administer a medicine to calm down the patient's anxiety, and they would usually have to sleep it off for a little while. So I wasn't actually very excited about working with ketamine in the outpatient setting.
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until I tried it myself as a patient. Okay. It was actually my primary doctor who turned me on to the idea of working as a ketamine provider. And at that time, I myself was experiencing a high degree of clinical burnout and she suggested I try it as a treatment. And after my first treatment, I experienced a boost in my mood that I didn't even really realize how badly I needed. And...
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When I went back to talk therapy after that initial treatment, I found myself opened up. I found myself able to go places in therapy that were difficult to talk about, difficult places to visit in your mind, if you will. And I became a true believer. And I really wanted to help share this medicine with others after all the benefits that I found with it.
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Right. And then how does ketamine work in the brain to alleviate symptoms of depression and anxiety? So there's actually a couple of ways that ketamine works. On the biochemical level, it induces a process known as neuroplasticity. So what this is, is when the ketamine molecule hits your brain cells, it tells them to reach out and form connections to neighboring brain cells. And what they found in...
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the brains of depressed people when they do autopsies is they find a diminished interconnectivity between the brain cells. So this is one way that ketamine helps reverse that process and allows you to build potentially new neural networks, new pathways to bypass problematic thought patterns or behavior patterns. That's one way it works. The other way is...
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The experience itself. So at MindStream Medicine, we administer enough ketamine so that the patient has a psychedelic experience. And this means that low-level ketamine, which is used by some providers and some therapists, will give you just a feeling of being relaxed, or some people describe it as a zen-like feeling. We like to get your dose experience up a little bit higher than that.
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so that you do feel a separation from the room and you have a diminished appreciation of your local environment. This means diminished sensation in your fingers and toes temporarily, but it also means turning down the volume on your anxiety, on the mood that you brought in there with you. And for some people, this means a break from persistent or intrusive thoughts of negativity or self-criticism that are with them all day.
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Your ketamine treatment journey is a brief vacation from all of that, from all those things you bring with you. And the experience itself can be beneficial and pleasant. And then you take what you remember from that experience, whether that be visuals or just emotions, and you take that back to your therapist and integrate that into your therapy and more broadly into your life. Okay.
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I mean, how do you determine if patients need ketamine therapy versus just traditional antidepressants? Well, I would say that almost universally, the people that reach out to us for help have already tried multiple medications and have usually already been in therapy for many years. We are very, very rarely the first stop for someone with a mental health struggle. Usually they've tried more traditional means.
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and we are an attempt for them to try something different, something new. So that hasn't really been much of an issue. I'd say almost everyone has tried other things before they looked to us. Right. Is it just anxiety and depression or does it treat other mental health illnesses? So anxiety and depression are the two that have the most research behind them at this point. But in recent years, very encouraging data has come back on...
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how ketamine treatments can help those with PTSD, which as you know is a very big problem in our society right now and is up there with anxiety and depression as something that's very common and really prevents a lot of people from living their best lives. Additionally, we do treat people who are suffering from...
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problems they're going through in terms of a life transition. And when I say a life transition, I don't mean strictly gender transition, although that would qualify as well. But I'm talking about loss of a spouse, loss of a loved one, changing a job, losing a job, moving to a new city. All of these things can be very psychically stressful.
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And ketamine has been helpful for people to help navigate changes in their lives. Right. And what does this session look like? So I know, like I see you with the big lounge chair and the big blanket. So for somebody that's new to this, what can they expect from their first session? So our intake process is free. So there's going to be two appointments before we actually do a treatment. And this is for me.
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It gives me a few chances to make sure that there's off-ramps if we don't think the patient is safe or appropriate for ketamine therapy. And on the other side of the coin, it gives a patient a chance to approach this thoughtfully and make sure this is actually what they want to pursue. But once we complete the intake process, which starts with a phone call, and then we do...
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We invite the patient to the clinic to do a medical evaluation. Once they complete the intake process, we determine whether they are more appropriate for intramuscular or intravenous treatments. And then we'll proceed with preparing them for one of those. So intravenous treatments are more common. I would say that's probably about 80% of what we do. So let me explain that process, because that would be for most patients. Mm-hmm.
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So your homework, when you come to your first appointment, your first treatment appointment, one, you need to come on an empty stomach for at least four hours. And this is because the number one side effect of ketamine is nausea. So we like to focus on prevention in that regard. So we want you coming with an empty stomach.
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and I will usually prescribe an antinausea, a medication of some kind for you to take prior to arrival. Once you come to the clinic, we're gonna check your vital signs, check your heart rate, blood pressure, check your heart rhythm, make sure all of those things are appropriate, then we'll have you use the restroom. I ask everyone to go and try to pee a little bit beforehand, and I apologize for treating them like a toddler, but ketamine does make some people
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it can irritate some people's bladder and make them feel like they have to urinate even when they don't. So if we have you evacuate your bladder just prior to the procedure, then if you feel like you have to pee, I can give you reassurance and say, you just went five minutes ago, Ronak, you're okay. And then you can comfortably slide back into your treatment. So once you've gone to the restroom, then one of our nurses will place an IV in your arm or your hand.
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and we will start to cocoon you and get you comfortable for your treatment. So as you said, you're in a, um, you're in a soft recliner. Uh, we have a weighted blanket for you if you like, we have, um, eye shades for you to wear to block the light of the room and we have headphones for you, noise canceling headphones. If you don't have a listening device of your own, uh, why
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the headphones. This is a pretty important part of the treatment, actually. So there's a lot of talk about the benefits of psychedelic medicines in the news today. And when people talk about an ayahuasca treatment or maybe a clinical psilocybin or LSD experience, people will talk about a guide, a psychedelic guide, someone to help shepherd you through the experience.
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because of the unique treatment experience of ketamine, there's no real good means of talking and communicating with someone when they're strongly feeling the effects of the medicine. So it's actually the music that you listen to that functions as your guide. So it's very important to choose pleasant and calming music. So...
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We do spend a good bit of time on this and intake and helping people to choose their own music because it should be something that's pleasant, something that takes you to a good space, we would say. However, you don't want something that is overly familiar or is going to take you to a specific time and place or an old relationship for instance, unless that is the intention of your journey, if you really want to go there, but otherwise you want to keep it kind of open.
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It's not recommended to have music with lyrics because that can be confusing in the space and sound like someone's trying to talk to you or give you commands. And the other thing I'll say about music is that some people, well, a good number of our patients have anxiety and they may be stressed out by the idea of picking their own music. Like, oh no, I'm gonna pick the wrong music and have a bad time, I'm gonna pick the wrong music and this is all gonna be a waste. So if people are intimidated by the idea of choosing their own music,
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We can help choose some music for them. Just some meditation, new age stuff with maybe some nature sounds in there calming and no one's had a bad time listening to that. So once you are comfortable, wrapped up, music is being administered, it's a 50 minute infusion and we determine the dose by your weight initially. But if you don't respond to that initial.
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dosage we can always add more if your heart rate and blood pressure are appropriate. And how long are these sessions? So door to door, walking in and walking out of the clinic, we budget two hours, but most people don't require that much time. The actual infusion time is 50 minutes. And for an intramuscular patient, we would do two to three injections to approximate.
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that 50 minute infusion. But the actual treatment time is 50 minutes for the IV patients. Now, during that 50 minutes, for about probably the first eight to 12 of those minutes, you're just feeling relaxed. You're feeling low level ketamine effects, which are anti-anxiety effects, maybe a little bit of giddiness, or maybe you get a little laughy.
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That's fine. But after that, about 10 minute mark, you transition to the dissociative state, which is the higher level of ketamine intoxication. And this is where you'll be able to get that vacation from yourself that we were talking about. Got it. And those effects last for approximately 40 minutes. And then when the infusion is complete, the nurse flushes the IV line to make sure you get every drop of the medicine.
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and then people will typically rest for 15 to 30 minutes afterwards. And then when they're ready to wake up, they'll start talking to us and we'll take another set of vital signs just to make sure that they've returned to their baseline. And then once they're able to safely walk themselves to the bathroom, they're ready to get their ride home. And that's something important that I didn't mention initially, but they're not allowed to drive themselves home after the treatment.
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Got it. Think of it like going to a short procedure at the hospital or someplace where anesthesia is administered. It's not safe for you to drive home afterwards. Yeah, makes sense. And then how frequent are the treatments? And I'm sure it depends on the patients, but what's the average kind of treatment sessions per month? Sure.
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Unlike some other medications or business model, the idea with ketamine treatments is to do decreasing amounts. So as little ketamine as possible and as few treatments as possible to gain the effect. How do we determine how many treatments? That's a good question. As you said, every patient, every individual is different.
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and we customize the treatment to their needs and their goals and how they respond. But usually we will start with weekly treatments and we'll start to space them out further as soon as the patient feels benefit, patient feels like they're reaching their goals, moving in the right direction. If someone comes to us and they're starting from a place where their symptoms are so severe that they have thoughts of harming themselves.
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struggle to get out of bed in the morning or to complete the normal functions of daily living, then that person will usually start with twice weekly dosing and then extend that out to weekly dosing as soon as they start to feel a benefit. Typically, people will do between four to eight treatments before taking a break and seeing how they feel.
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And then people are encouraged to come back for boosters if they feel that they feel they're returning to their previous state, they feel the benefits waning and so forth. But they found in studies that when they just do one off one time treatments of ketamine for depression and anxiety related disorders, that the benefits of one time treatments tend to wane at the 10 to 14 day mark. So ideally.
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after the first treatment, I'd like them to come back within two weeks so that we're stacking growth on growth and not allowing them to go back to their mental health baseline before returning to the clinic. Got it. And how do you assess the efficacy of the treatment for the patients? So it's a very subjective question. How am I feeling? How am I doing after these treatments?
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So I don't have a test or a form that I have them fill out to rate their mood, how they're feeling after treatments and between treatments. I rely on just their assessment and what the patient tells me. But in almost all cases, I like to work closely with their talk therapist and get input from their therapist in terms of how therapy is going, how they see the patient responding to treatment
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A self-assessment can be useful, but it's much more helpful if I'm able to get context from someone who's in a therapeutic relationship with them. And I will say also that therapy, I believe, is essential to unlocking the benefits of these treatments. So if you are not in a talk therapy relationship and you want to start treatments with us, we insist on...
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finding a talk therapist for you. And we do have a local network of talk therapists who are excited about working with our patients and doing this work. So I'm happy to play matchmaker for people if they're not already in a relationship. But the evidence has borne out that people gain more benefits and hold on to them longer if they're doing talk therapy in conjunction with the ketamine therapy. Okay. What are the long-term risks associated with this therapy?
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That is not well known in terms of these specific ketamine treatments because this is a relatively new use of the medicine. However, I will say ketamine was developed in the late 50s, early 60s and has been safely used as an anesthesia agent for over 60 years at this point and there have been no determinations that
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anesthesia or surgical use of ketamine has any long-term consequences in terms of mental health or physical health. So no known side effects of this therapy that are long-term. I can speak to short-term side effects and what they are and how we work to avoid them. One.
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known effect of ketamine is that it will increase heart rate and blood pressure, similar to moderate to strenuous exercise. Now in the intake process, I want to know what people's exercise routine is. Now, if someone does weight training and Pilates or, you know, they are obviously in good physical fitness, then I'm not concerned about the boost.
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to their heart rate and blood pressure the ketamine will provide. But if we're talking about someone who's deconditioned, then that's something more for me to consider. And I'm going to be less likely to aggressively increase their dosing if I'm concerned about what a heart rate or blood pressure boost would do to this person's health. So that's one thing to be very mindful of. The nausea and dizziness are the most common side effects.
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and we try to pre-treat people to avoid those with either a common anti-nausea medication or a scopolamine patch. So, scopolamine is most commonly used. It's a skin patch that's medicated that people will put on before going on a cruise to prevent seasickness. So, most commonly used for that, but I like people using it for their ketamine journeys as well because we're preventing both
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dizziness and nausea with the medicine. And additionally, scopolamine is supposed to have a mild antidepressant effect of its own. So I like to think it works synergistically with the ketamine. But those are the primary side effects of ketamine that we will see in the moment. But it's a medicine that's very rapidly metabolized, which is why we're able to do the treatment and have them walk out within two hours.
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that make you feel intoxicated as those are metabolized out and you kind of return to your baseline the other effects that it's having on your body or are diminishing at the same time. Mm-hmm. Yeah. And I think ketamine became like just a word in the mainstream when Matthew Perry died of the ketamine overdose. Can you talk to some of the myths or misconceptions about ketamine?
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Sure. Well, the Matthew Perry case, you know, it's tragic. And this is a person who obviously had a long struggle with, uh, with mental illness. But, uh, the fact that he was found in his swimming pool, uh, and had a high amount of ketamine in his system, like, this is just one of the reasons why I think home use of this medicine is dangerous. Uh, the particular characteristics of it, uh, the way it works is it,
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diminishes incoming sensory information into your brain. So it diminishes your ability to react to and interpret the environment around you. So that means, and Matthew Perry is not the first person to die from home use. This has even happened to ketamine researchers who self administered at home and then went out of the house without their code on and died of hypothermia.
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or maybe they thought it was a nice idea to have a bath after self-administering ketamine and they drowned in their own bathtub. So home use has the risks of you not being able to safely interpret your environment and leading to dangerous consequences. This is why I only administer ketamine in the clinic under supervised circumstances because you're not in a position to...
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take care of yourself well, which is why we're there to watch over you as you have your journey. Yeah, yeah, absolutely. So just want to shift focus a little bit. You talked about being burned out and you opened Mindshrew Medicine in 2023. Can you talk a little bit about the decision that led you to go private from being an emergency med doctor? Sure. Well, I...
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I had only worked for a large healthcare corporations during my career and I was ready to branch out on my own. But the idea of starting my own brick and mortar business was extremely intimidating. Initially, I had a business partner and we were looking to rehabilitate a clinic in Society Hill in another neighborhood in the city.
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And very quickly, the construction costs began to accumulate and, you know, led to direct increases in our anxiety about starting this venture. And for a short time there, I really wasn't sure that this was going to happen. And then it was my partner who discovered the Medco Share model. And it really blew us away.
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how affordable this was going to be in comparison to so building a building our own clinic or even rehabilitating an old clinical space. We were able to start here at a reasonable rent in which utilities were covered cleaning was covered even the disposal of our sharps was covered which is you know.
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otherwise something that I would need to find a private vendor to take care of. So a lot of the small things that would be distracting for a startup owner were just taken care of and I didn't need to worry about them. So it made it feel like a very safe place to get started. Yeah. We love having you here in the Philadelphia location. How about marketing? So what did you do once you started your practice? How did you attract the first few patients?
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Well, I made some mistakes. So initially, we have our website. And from the beginning, I mean, even six months before we opened, I was doing direct outreach to therapists to tell them who we were and explaining how ketamine therapy worked and how therapy was an integral part of unlocking the benefits, as I said before.
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I spent a good deal of money advertising on Facebook and Google for the first six months of operation and it got me nothing. Yeah, I think I have the same story as you. I was pretty surprised. I just kind of thought that everyone's on these two things or at least, I know the younger people aren't on Facebook, but maybe...
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My patients were there, but it got me nothing. All of my patients have come from either finding the website in a Google search or direct referrals from therapists or colleagues at this point. Got it. What's the most rewarding aspect about the work that you do now? Certainly the outcomes, hands down,
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So, I was a psychology student as an undergrad, and then I went to medical school, and everything we learned about mental health was that it's something that moves very slowly, and something where progress comes after months, after years. And for people who are in...
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really dark places or deep holes because of their mental health struggles, it's very discouraging to offer them a treatment plan where perhaps they'll feel better in six months, perhaps they'll feel better in a year from now. Being able to see people with depression that's been characterized as treatment resistant, being able to see them get their lives back, being able to see them go back to school.
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go back to work, just be able to find joy in things that had previously given them joy but had kind of been extinguished from their lives. Even just the way people walk and carry themselves can be tremendously different between the first time I interact with them and how they look after three or four treatments. It's really amazing to see what people are capable of. Because it's not...
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I don't think of the ketamine as changing them or fixing them. Ketamine is an anesthesia agent. And so what we're really doing with the ketamine is giving your brain a break and allowing it to heal itself. So everyone, I can't claim that ketamine is a plant-based medicine. It's not. It's certainly made in a laboratory. But it unlocks the ability for you to self-heal.
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And I think that's really wonderful. And that's definitely my favorite part of it. Right. I think everyone needs a mental break every now and then. Well, this was great. So thank you so much for coming on today. Where can patients find you? They can find us at mind Look there. We've got lots of blogs with useful information. And we have a contact form. And as I said, we're going to be doing a lot of stuff
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Our intake process is free, so I'm happy to talk to anyone if they have questions about ketamine therapy, like what it is, whether it's right for them. And feel free to reach out, even if you don't ultimately end up following through. I'm interested in educating as many people as possible. So yeah, reach out, happy to talk to anyone. Evan, thank you. Thank you, Ronak.
