Should Psychedelic Therapy be Included in Workplace Wellness Initiatives?

She is the CEO and co-founder of workplace mental health benefits company, Enthea. We're going to be chatting about the reality of psychedelic therapies for mental health in the workplace, changing perceptions and what this actually looks like in practice. Sherry, welcome.

I chose to work in very resource constrained environments and be in country a hundred percent of the time. Sometimes people may choose to do this kind of work, from home and be based out of New York or DC, depending on which organization they work for, but I actually chose for a full 10 years to be in country and worked in some more difficult places like Afghanistan, Yemen, Syria, Malawi, Niger, the list goes on.

And in that time, I really saw firsthand what mental health was doing, like we hear about this global mental health crisis. I really witnessed it firsthand, especially in times like post conflict, post war or after generations of poverty have affected people and just all of the issues with barriers to access to mental health services, especially in a low income context. I also kind of concluded from everything I saw that you can't fully address poverty without addressing mental health.

So all of this to say, it's a very long winded way of saying that I became increasingly interested in finding solutions to solve for mental health because I was witnessing, the effects of it firsthand. And I was pretty surprised to see that the ways we are treating mental health aren't really working. And as I was looking at the data, and as I was looking at clinical trials, we don't have a lot of evidence to show that how we're treating mental health actually gets to the root cause.

Antidepressants and talk therapy, sometimes they help alleviate symptoms. They help some people, sure. But for most of the people that try these approaches, they mask symptoms, really, and again, don't get to the root cause of our mental health conditions. And after doing more and more research, I stumbled upon all of this data in the psychedelic space. So looking at psychedelic assisted therapy to treat mental health. And I found the opposite.

I finally found something that appeared to treat the root cause, get to the source of people's trauma, help people actually feel better. And I was surprised that these medicines were not easily accessible or affordable. And ultimately that led me to leave my very fulfilling, impactful career to help get people access to psychedelic assisted therapy.

So just imagine if 7 out of 10 people are, like, really suffering from a mental health condition. So much so that even if you give them access to basic education and basic health care and infrastructure and jobs and cash, they can't get out of poverty, like that is a pretty dire situation. And then, kind of add on to this. One of the things that really surprised me is that when I read that antidepressants only work well for 15% of the people that take them.

And this is a pretty perhaps crude or direct thing to say. But if we treated physical health the way we treat mental health, everyone would be dead, right? And so, or almost everyone would be dead. And so then when I said like stumbled upon what was happening in the psychedelic space for people who don't know, and I'm sure we'll get into it more on this show.

What I mean by that is the data tells us that anywhere from depending on the medicine and the treatment protocol, but anywhere from 60 to 80 percent of people who complete psychedelic assisted therapy at 12 months follow up, no longer present indications of their initial diagnosis, meaning they'll no longer be depressed 12 months later, they'll no longer have PTSD and that doesn't mean they're doing psychedelics every day. That means they did 1 to 6 sessions and 12 months

later with absolutely no medications, no medicine, they no longer feel depressed. That's mind blowing. And so like, that's what motivated me to do this whole career transition because I had just couldn't believe that there was something out there that was curative.

However, now, things have changed a lot in the last three years. There's been more data, there's more broader public reception, like positive reception towards psychedelic therapy, FDA granted, MDMA and psilocybin breakthrough status and are fast tracking their approval. There's been a documentary on Netflix called 'How to Change Your Mind', like CNN, Fox, the VA.

It's like so many different organizations and entities on like, both sides, conservative and liberal have shown support for psychedelic therapy. So the conversation with employers has shifted because there's a little bit more awareness. You even have celebrities like Joe Rogan and Mike Tyson and Lamar Odom and Gwyneth Paltrow and Christina Teagle, is that her name?

And then the other thing that has changed the conversation with employers is really the data. So, the data kind of speaks for itself, and what we've been able to show is that, like, even just with Enthea, with people that have completed ketamine therapy, we've seen an 86% reduction in PTSD, a 67% reduction in depression, a 65% reduction in anxiety. And we've also seen that at one year follow up, people that did ketamine assisted therapy, 82% of them were no longer on antidepressants.

So when I begin a conversation with an employer, even if they were perhaps conservative or hadn't heard of psychedelics, but I begin with, did you know that there's a way that people that are currently costing your company a lot of money because they're on all these antidepressants, they can get off of them? I mean, that sort of changes how the conversation goes and employers are really struggling to find solutions that work.

What's been happening in recent years since COVID is most employers, in fact, 7 out of 10 employers in the US have improved their benefits offering, right? Especially since COVID, but you have 69% of employees saying they're not getting the mental health care they receive. So something's not working. If employers are improving their offering, most employees are saying they're still not getting the care that they need, and most are showing signs of stress and burnout. Something's not working.

We're investing in solutions and not seeing outcomes, and so the conversation with employers has shifted because they're so desperate to find something that has outcome.

So I'm just curious, like, do you think that that sort of opened people's minds a little bit compared to where we were with like the drug war narrative 20 to 30 years ago?

And I'm not sure what the adoption has been like, but the indications for psychedelic assisted therapy are fairly different. You can use catamine assisted therapy for chronic pain and migraines as well, but mostly these are used for treatment resistant behavioral health conditions. I'm sure there's a relationship.

I haven't been so involved in the medical marijuana space, but I think what's really helped like going back to not just the celebrities, just the media awareness, every mainstream media publication has covered psychedelic therapy recently. There's been a huge boom in terms of investment, like the flow of money to the psychedelic space, the psychedelic industry, and a lot of companies in the psychedelic industry popping up.

And then there's just so much evidence, like the fact, going back to these clinical trials, the fact that, now MDMA, commonly known as ecstasy, the submission to the FDA for approval of MDMA was submitted in December, and they've just recently said that this is scheduled to be approved in August of this year. So things like this, I think, are really shifting the narrative and getting people comfortable with the idea of using like a psychoactive substance for healing.

And I think one more thing to add on that is really,

there are more and more stories being shared. So people are getting, are more comfortable now sharing experiences that of their own experiences with psychedelic therapy. And this is like shifting the narrative a lot and reducing stigma.

We have like 60 years of data on safety and efficacy. That's one. And then in terms of how it works. So Ketamine works on the NMDA receptors in the brain, which is a type of glutamate receptor. I won't get into too many technical details, but by blocking NMDA receptors in the brain, the use of ketamine leads to rapid changes in neuroplasticity and the increase of neuroplasticity or synaptogenesis in the brain. So it leads to this ability in our brain to create new patterns.

By the way, psychedelics in general are one of the few substances that we know help increase neuroplasticity in the brain. And why that's important is if I have treatment resistant depression or anxiety or PTSD, I may get stuck in negative thought patterns for decades. I might be stuck ruminating for decades on negative things. And this increase in neuroplasticity allows me to get to that root cause and form, new patterns and new pathways.

The other thing about cutting in and how it works is that it works on the default mode network in the brain. So, the default mode network is active when we are reflecting, maybe we go for a walk and we're thinking about things, our default mode network or we're lying in bed and we're thinking about things. Our default mode network will be active and that's healthy. But in people with anxiety, PTSD, depression, the default mode network is too active, thinking and ruminating way too much.

And so Hetamine helps reduce activity in that part of the brain. So that again, we can like have this sort of, scientists call it like ego dissolution a little bit, but this ego death and sort of this resetting of the brain in a way. So that's kind of how it works at a high level on the brain.

There's more I could say in terms of, there's some evidence I think of like anti inflammatory effects of ketamine, but what's really interesting specifically about ketamine that is not as true for other psychedelics is that it's the only substance we know that starts working in as little as four hours. And what I mean by that is like, especially someone who is suicidal, it reduces suicidal thoughts in as little as four hours, which is what makes it like an incredibly powerful lifesaver in a way.

We recently had a patient at India who was in a very suicidal state and we got them ketamine treatment like that same day because of how urgent the case was and then two weeks later we checked up and they're feeling much better. But there's like very few options for people in this state to actually like have a neurological and physical response in the brain that you actually feel better in such a short amount of time.

So, with any given behavioral health condition, be it depression or PTSD or anxiety or addiction. Actually, what we don't talk about enough is that 30 to 60 percent people with these indications are treatment resistant, meaning that they've tried one or more treatments for a significant amount of time, and it hasn't had any effect on them. And it's safe to conclude that it won't have any effect on them, meaning there's nothing we're currently offering that will help them feel better.

And this is where, specifically, like, ketamine therapy has proved to be extremely beneficial because it's the only thing we've seen work on those treatment resistant populations. So, especially for people who are feeling hopeless, they've tried different treatments, they've, been suffering for depression for a significant amount of time or suffering from addiction or anxiety for a significant amount of time. And they've actually tried something and that thing has not worked for them.

This is where ketamine assisted therapy can really bring hope to people. And, from an employer perspective, we're spending in the US over 200 billion a year just treating mental health. We are spending half a trillion dollars a year in the indirect cost in terms of like retention, having to hire someone else, lost productivity, absenteeism, presenteeism. So there's like a huge benefit to employers, but from a person perspective, which is like, to me, it all starts there.

Like in my, just even you David, not to like put you on the spot, but just given the statistics, I'm sure someone you love and care about is suffering right now and hasn't been able to get the treatment they need. And this is actually something that provides hope.

And so like, I've seen, I've known people who microdose mushrooms and they've swear that that has changed their lives, and so, yeah, I think that we can all, like, understand that, like you said, antidepressants only work for a certain group, like, it's, the numbers are kind of startling

how ineffective they are. I've seen that play out with family members, with friends, where it just didn't have the effect that was, it was intended to. But so I'm curious to like, tell me a little bit about the process a patient would go through if they had access to these benefits, right? So like, what is diagnosis and sort of gaining access to these treatments look like? How involved are they?

Does it have to be done under the supervision of a medical team or is essentially just like any other medication?

It starts with medical and psychiatric screening or psychological screening to make sure that the person is a good fit. So, if this person was like a plan member within DL, or even if they weren't, they would approach a clinic where they could get ketamine assisted therapy. Before they were administered any ketamine, the person at that clinic would do a full medical and psychological assessment to make sure they are a good candidate.

There are a few cases in which someone may not be a good candidate. For example, if someone is currently pregnant or has extremely high blood pressure, they may be screened out as an example. In cases of addiction depending on the practice and the protocols in place.

I know I can speak for Enthea and our protocols, depending on the substance they're addicted to, it's usually asked that they are off of that substance for like at least a small amount of time before they can go forward with the treatment. So first is the assessment to make sure they're a good candidate.

Then is what we call preparation and so these are actually like one to three sessions with a therapist without administering any kind of psychedelic substance or any kind of ketamine where you're doing therapy sessions, but there's like an intentionality behind it. So you're doing these therapy sessions in order to prepare for your 'medication session'.

So you're really talking to your therapist and giving context as to like what you're hoping to gain from your medicine session, why you're here, what's been, troubling you. After those cooperation sessions, which I'm going to like double click on the importance of like just having those intentions, because going into like an altered state without intention is not a good idea. So after those preparation sessions is what we call the medication session.

So this is when ketamine is administered in clinic. And you will have someone who is licensed and able to administer the ketamine for you. Depending on how ketamine is administered, the person that you need in the room varies. It can be administered by a nurse if it's like I or I am. You don't need a nurse if you're doing it orally. There's like a lozenge form of ketamine that you could be administered as well. That makes it easier.

And so the ketamine is administered, you have these medication sessions and you have, again, a therapist in the room that is there to guide you through this kind of process as you're in this altered state. Now there are some variances in how clinicians choose to practice. They may choose to like really be guiding you and doing like therapy while you are in that intense altered state on the ketamine.

That's about 60 to 90 minute duration, or 45 to 90 minute duration, and you are in this altered state, and you may be talking to a therapist during, or they may wait until the effects have subdued a bit, and you talk to them immediately after. Or so you're not alone, you're there with someone, but they may actually wait to have that therapy session within the next 72 hours.

So there's different options in this protocol depending on what works best for the patient and what the clinician is used to doing. But you are doing medication in conjunction with therapy, if that makes sense. So you're in this altered state, your brain is active, there's increased neuroplasticity, there's synaptic degeneration, there's lots happening in your brain that we talked about, especially with the NMDA receptors, and again, the increased neuroplasticity.

And then you are talking to therapists to take advantage of this state that your brain is in within 72 hours and then after you might do with ketamine therapy 1 to 6 sessions of that. And that's a rough guide. It could be the case that someone needs 7 or 8, but in my experience, we've always seen it fall between 1 to 6 sessions.

And following those medication sessions, we do what's called integration, which is post all of these ketamine sessions, you have a few sessions to talk to your therapist to really integrate everything that was learned in that altered state and bring it into your everyday life. And that's what leads to that lasting change. Like when I mentioned that at one year follow up, 82% of the people that completed ketamine therapy with Enthea are no longer an antidepressant.

That's largely because they completed that integration. So it's really important that you do your experience and then after the experience, you have a few sessions to sort of cement everything that you learned. Sorry, that was a very long answer, but I think I just wanted people to understand that this isn't like, you go in and you do some ketamine and then you be off on your way and that's not what this is.

like you're on your own. This is going to be something where you're assisted, you have support, that kind of thing. So if you could make one final point to someone who's considering offering these benefits to their employees, what would you say?

But on a more serious note, really look at like, thank you for even considering this, but also I would encourage them to take an honest look at how their employees are doing right now and employers do this in different ways and have different ways of like analyzing claims data or engagement surveys, or, different ways of collecting data from the employees. But chances are, if they do take that honest intake of how their employees are doing, they will see that their employees are not doing well.

Unfortunately, that's the reality across the board. I think there was a Surgeon General's warning this year that 76% of U.S. employees have at least like one mental health symptom. So, so this is, I laugh out of like, hurt actually, it's like a coping thing. Like it, it's so sad that this is our reality.

So if they're interested in offering this, try to be open minded, understand that ketamine is legal and FDA approved and available nationwide that we're not just trying to, give people a drug and hope that maybe they'll feel better, that there's real data and evidence to show incredible patient outcomes when you combine ketamine with therapy. And yeah, and to contact Enthea so we can talk about it.

Like, because there's about to be, I hate to say it, but like, it's not going to be so task based because there's going to be this machine that does things better than you and faster than you in a lot of cases for a lot of our jobs, you know, this thing can write its own computer code. It can do all kinds of things that we've relied on a heavily like skilled workforce, but skilled in sort of tasks, right?

It's not going to be so much task based, it's going to be skills based and the skills are going to shift. So what does that look like? Like that is going to be for the next 10 years, I think just a fascinating journey to be on. I don't think we're all going to lose our jobs. I don't think it's going to be some doomsday scenario. Like some people are predicting. I also don't think it's going to be euphoric and without pain points and without like some discomfort amongst people in the workforce.

So it's going to be a little bit of a mixed bag there, but a rethinking of like, what your career looks like. The career ladder, that's dead, you're going to go side to side. It's more of like the lattice thing, right? A lot of the people that we talk to, that's what they're talking about. It's like internal talent marketplaces, career lattices, rethinking people's development and how they move forward.

And then around some of this other stuff like wellness, the flexibility that people have come to expect post pandemic. All of this is going to be in flux a lot over the next decade, as Gen Z becomes even more prominent in the workplace. This is a generation that really likes to talk about mental health, right? So, like, we're going to have, I think, even deeper and more extensive conversations. And that's part of why I wanted to bring you on, right?

Because, like, this is a part of that conversation. So, yeah, I think those are kind of like some of the big ones. I don't know if that totally answers the question, but I'm ranting a bit.

I don't know exactly what it's going to look like in the end, and I'm going to have to work with other people to make it a reality, but it's going to be fun and interesting, and I'm going to learn a bunch of stuff that I didn't know anything about when I woke up this morning. So, like, it's worth doing it.