138- Mental Health, Plant Medicine, Touch Therapy and More with Dr. David Rabin

Bryan Carroll: [00:00:15] Depression, anxiety, PTSD, and mental health conditions in general. We hear all the time about utilizing therapies or medications to help with these conditions. However, when you look at the data, these methods don't have the best success rates in the long-term, which brings up the question about other ways to treat these conditions.

And there are some really neat up and coming treatment options that are in trials currently. And we'll be talking about that later on. What's up everyone. I'm Brian Carroll and I'm here to help people move more, eat well and be adventurous. And today I have Dr. David Rabin on the show and I've thoroughly enjoyed my conversation with Dr.

David because he combines a Western approaches and Eastern approaches to mental health. And we talk about a ton of topics like medications, natural methods to improve mood psychedelics and even touch therapy. He also has a really neat wearable product called the Apollo neuro, which has seven different modes to improve your nervous system.

And I've been using it for a month and a half now. And I really enjoy the recovery mode for after exercise and the sleep mode. And I'll be doing a video talking more about what happened when I use the Apollo Neuro soon, but my weekly average REM sleep has increased by about 30%, which is pretty significant.

And I was able to score you a 10% discount on the Apollo neuro, just go to summit for wellness.com/apollo. To learn more. Also, our huge giveaway is still underway for a chance to win a new Vitamix or a $100 gift card. So head over to summit for wellness.com/giveaway. To learn the details. Now let's jump into my conversation with Dr.

David. Dr. David Rabin is a board certified psychiatrist and neuroscientist is a co-founder and chief innovation officer at Apollo neuroscience. The first scientifically validated wearable system to improve heart rate, variability, focus, relaxation, and access to meditative States by delivering gentle, layered vibrations to the skin.

He is also the co-founder and executive director of the board of medicine. And a psychedelic clinical researcher currently evaluating the mechanism of psychedelic assisted psychotherapy and treatment resistant mental illnesses. Thanks for coming onto the show. Dr. Dave, 

Dr. David Rabin: [00:02:34] thanks so much for having me. It's a pleasure, 

Bryan Carroll: [00:02:36] of course, and I'm super excited cause there's a lot of topics I want to dive into for this episode.

so let's, before we do that, let's dive into your background. Let's learn more about you. what got you into psychiatry and then what got you so interested in all these different avenues? Of psychiatry. 

Dr. David Rabin: [00:02:54] So I think what originally got me interested in psychiatry was that the understanding chronic stress and resilience and the impact that chronic stress has on our lives and, growing up and, and sort of being aware, of this pattern where.

Some people would respond to chronic stress in, in their lives or trauma, multiple one or multiple negative experiences over time. And they would overcome those negative experiences, those challenges, and grow from them into much stronger versions of themselves that were, able to take on bigger and more lofty challenges and goals.

And then there are others of us who often go the opposite path, where we either face challenge and stagnate, or we face challenge. And. Ended up succumbing to the challenge and suffering long-term from the symptoms of chronic stress, which often include physical and mental symptoms and eventually physical and mental illness.

And, this always fascinated me this idea of resilience. And originally I started studying it with respect in my, in my PhD program, and research with respect to aging diseases of blindness and dementia, and then went from there into recognizing that I really enjoyed studying, The whole person and stress of the whole person level and really thinking about ways that we can optimize resilience, building and recovery better on the whole person level.

and then that led me into mental health and psychiatry, where I realized that interestingly, most many of our, of our patients who have mental illnesses, whether they're PTSD, depression, anxiety, OCD, substance use disorders, many of these people sometimes, over 50% of them. Who are given the gold standard evidence-based treatment recommendations from the Western mental health program are not responding adequately to treatment, meaning they're still symptomatic years later.

And this was really discouraging to me and to my colleagues and, and really forced us to think outside the box about. What else could we use to help treat these conditions more effectively? really with a focus on PTSD, because trauma seems to be at the core of a lot of mental illness at some point down the path.

And so, in medical school, actually, I had a really good friend, who was longtime plan to go into psychiatry. I didn't really plan to go into it until later in my training, but she said, you know, Dave, you should really think about going into psychiatry. And I said, well, You know, I don't know. I really like psychiatry, but you know, I'm not really sure about it.

If it's the field for me, if it's far along enough yet and its development, and embracing of other alternative practice approaches, and she started sharing with me all these papers from. Leading research groups and leading who published in leading journals around the world, from Imperial college of London to, you know, folks at Hopkins, NYU, Yale who are publishing groundbreaking work on, psychedelic assisted psychotherapy and how these medicines were helping to take people who had completely failed treatment.

or totally not responded at all to, to treatment, Western treatments for mental illness. And then, ultimately had one to three to six experiences with psychedelic medicines, like psilocybin or MTMA associated with psychotherapy and had radical shifts in their outcomes that lasted for years later.

So that all of a sudden seeing that and reading on the data and reading about the studies and the results they were getting and seeing that these results were continuing over time. Really helped me understand where the field was. And I said, you know, in basically within 24 hours of diving into that literature, I said, Oh yeah, this is definitely the field for me.

I mean this, because this is an opportunity to study cautiousness, which is something that always interested me, and how we perceive meaning from the world and mental health and resilience and chronic stress. And so it really kind of converged everything that I was doing into one place. And then psychiatry became, became my thing.

Bryan Carroll: [00:06:51] Now you were talking about, resilience with people with a stress loads. Does every single person have some level of braking where they take on too much stress and they can't get past it and that's too much for them or are there some people that they can keep piling on stress? And there is no break point.

Dr. David Rabin: [00:07:11] That's a good question. I think that the best way to think about this is that. We only have so much energy that we can put out into the world before we have to replenish our energy stores. Right. So it's kind of like a battery. we have a very extremely efficient battery in us. And as one analogy where we can charge that battery with certain activities, Like recovery activities that are usually triggered by safety.

That can be safety that's induced from the environment or safety that's self-induced through breath, work, yoga movement, meditation ex regular, not overexercise, but regular healthy levels of exercise. Good nutrition, lots of soothing, loving touch from our friends and family, soothing music and things like that.

all of those things said, stimulate the safety system in our bodies. What's called the parasympathetic recovery nervous system. this system is shut down in response to threat and threat often is what triggers these fight or flight States that make us feel like we have to peak perform in a given moment.

So ultimately our society and our community and our civilization is very focused for many, many generations on only really peak performance and not peak recovery. And so I think in short, the best way to understand this is that for all of us, whether you're an animal or a, or a human, if you only focus on peak performance all the time.

Without prioritizing teak recovery to restore the battery in our resiliency stores, then we will, we all have increase our chances of burning out, or succumbing to the effects of chronic stress, which can eventually result in burnout. and that usually starts with. Decreased creativity, decreased sleep and increased irritability.

These are like the first three signs that we all probably have experienced at some time in our lives. Right? Doesn't mean you're suffering from depression. It means you're irritable with your loved ones. You're short with your loved ones because you're not present enough to take and recovered enough to take the time.

To listen to them and be present with them when they're around and you're not, and we're not working. So that's one example, creativity, sleep are two other examples that quickly disappear or get effected when we're under chronic stress or burnout. So, if we focus on prioritizing. Peak recovery. As much as we prioritize peak performance, then we can sustain peak performance for a very long time, potentially indefinitely.

However, if we, you know, if, if we do not prioritize peak recovery, we know what happens. Right. 

Bryan Carroll: [00:09:42] And, another question to go along with resilience is. Does your level of resilience also come about with experience? Like for instance, you know, if let's say you take a TV away from a child that could be the end of the world for them.

And they overreact to that little bit of stress of not having a TV, whereas an adult that might not be a problem at all. So is there like a level of experience in life that can help people to shed certain potential stressors and be more resilient to that type of stress? 

Dr. David Rabin: [00:10:13] Absolutely. So. So w so resilience is a learned thing, right?

It part, it is part of the core of who we are as humans. We have a certain amount of ability to be resilient at baseline it's it's, we're born with it. But, there's also a training component to it. So, which is similar for almost all the skills that we have as humans and we're capable of, there's a certain amount that we're predisposed to be able to do when we're born, or that quarter sort of goes along with being born into the bodies that we were born into.

And there's a certain amount that comes with training. However, almost everything requires at least a little bit of training to optimize. Right. So even if even looking at elite athletes, which I think is a really good example of these folks, many of them are born with, a certain body type that they grow into.

They're born with a certain, innate talent or innate ability to do certain things, physical things, better or faster than other people, but that talent, that skill, those skill sets have to be nurtured properly. To be able to take them to the level of a professional, competitive athlete. Very, very, very few people, if any, are able to take whatever it is they're naturally born with, not practice or do anything and then become a superstar.

Right. So, so it's similar to resilience training, like what you're talking about and the best way that we think about it from a neuroscience perspective is this idea of believe it or not, practice makes perfect. So, this is something that many of our parents taught us as a kid that I know as a kid, I didn't listen to it all.

It was like, ah, you know, it doesn't make sense, whatever, but it's true. I'm actually Eric Kandel who won the Nobel prize in 2004, demonstrating the mechanisms of learning and memory showed without a doubt that this practice makes perfect concept of how we train ourselves to become better, stronger, more resilient, more able to deal with and overcome chronic stress, effectively and grow from it.

Is not just unique to us. It's actually something that dates back. Over 300 million years to ancient sea snails that only have 12,000 neurons. For one as one example, we have like a hundred billion neurons. So we are much more advanced than these ancient sea snails, but even sea snails brains learn and store memories about threatening and safety.

They say things in the same way or similar way that we do. So the practice makes perfect model is very true. And the sooner that we understand that and internalize it as part of this reality that we're facing. every day, then that in and of itself, that understanding helps to guide the way that we become more resilient and prioritize the things we spend time focusing on in our day-to-day lives.

Because if we spend time focusing on things or skills or behaviors that are not serving us, like watching TV every time we're stressed out, clearly that doesn't solve the problem of what's causing the stress, but it might feel good in the moment. So every time we recognize we do that, we're actually retraining our brains to associate the distraction of the TV with stress relief.

But the problem is still there and still needs to be addressed. And so we're the source of our anxiety. Doesn't actually go away. If we learn to address the sources of the anxiety, even though it might be a little more uncomfortable in the present moment, it actually creates much more long-term gains in the law in, over time.

And then over time it actually becomes easier and easier and easier to tap into that state of addressing the problem in the moment, tackling it, and then moving on without thinking about it. 

Bryan Carroll: [00:13:41] So that's like when, you have to look at people's triggers that lead to certain habits. Just like you said, if you're stressed and you sit down and watch TV, that the stress is a trigger and then the habit is you watch TV and in the moment you might feel good from it, but it might not be good.

Dr. David Rabin: [00:13:55] Long-term right. And that's the same as. Every it's everything that goes for everything from, you know, watching TV when we're stressed out or, and binging on Netflix to smoking cigarettes, to using alcohol drugs, video games, work, you know, food. Right. All of these things that we use as either distractions or escapes from anxiety are.

Detrimental because they actually train us to be impulsive. Right. They train, if you train impulsivity and you practice seeking something called instant gratification from distress, which doesn't actually ever really exist. Other than when you get it from a loved one, giving you a hug, there really is no such thing as instant gratification, that's it?

That doesn't have side effects. then we're ignoring the problem at hand. Right? So if there's a problem that comes up. Meaning that we start to feel restless, anxious, worried, et cetera, about something. And we don't necessarily know what it is. The single best thing we can do in the moment is ask ourselves, what is it making me feel this way right now, not thinking about the past much and not thinking about the future much, but really just trying to think about what is it that's right now in this moment, making me feel like crap.

And then usually when you ask, when we ask ourselves that question, the answer will come to us. It'll be pretty clear, not necessarily immediately, but usually pretty quickly. And then. We can make, take the actions to address it, which will result in mid and low long-term gains that hopefully prevent that problem from a rising in the future.

But ultimately the distraction and numbing technique that instant gratification technique doesn't work in the longterm. In the midterm. It only works to PR to prevent some of the iMeet or reduce some of the immediate distress, but ultimately we do become tolerant of it and the effects start to wear off over time, which we see with.

Every single numbing and distracting behavior and every drug known to man. Right. 

Bryan Carroll: [00:15:48] Yup. And I think this is a great time, because earlier you had mentioned that a lot of the Western approach to depression, anxiety, all that type of stuff in the longterm, hasn't been very successful. So now you're starting to look at, you know, more root causes or, different habits that are created from depression, anxiety, et cetera.

And I would love to know what is kind of the Western approach to these issues. 

Dr. David Rabin: [00:16:12] What is the Western approach? well, the Western approach, as it should be practiced is different from the way that it is practiced typically, unfortunately, so maybe I'll start with how it's currently practiced. So typically if you or I am, are suffering from low mood for awhile or anxiety for awhile, say like, Three to six months.

We're feeling like crap. Every day we wake up, we have no energy, we feel tired. we're not getting, we don't feel like we're getting good quality sleep. Our moods down. We're irritable, not feeling our usual creative cells, not passionate about work, not going out. All of those things would fall into a general category of depression or anxiety related disorders.

Right. And there are things in the environment that caused these things. They're not just caused by chance. Right? So the start of this path, the clinical path is to start working with a therapist that can, or talk therapists that can talk to you. About what it is that you're feeling and help you to recognize your feelings, recognize what it is you're experiencing when you're stressed out, not feeling good, et cetera, and then help you understand the origins of those behaviors that you engage in.

Like for example, watching TV, right? When you're stressed out, helping understand why you do that. Maybe you started doing that when you were a kid, because you needed a distraction from. Your parents fighting. And that was the only thing that you could do that you knew was something that worked for you.

Right? And so getting to the core of why we do that, why we engage in the behavior, what the original trauma was, or multiple traumas, the negative, meaningful events over time, what they were, how we reacted to them in the past, and then whether or not that reaction is serving us now. Currently and what we can do about it.

So that is the therapeutic, the therapeutic approach, or a Western perspective is that when it's practiced the right way, however, very few people percentage wise who have these kinds of conditions that we're talking about, depression, anxiety, substance use disorders, PTSD. Very few. If, if any very few of these people ever come into contact with a therapist, Who can regularly on like a weekly basis help to explain to them and walk them through this process.

And the process takes a decent amount of effort. So ultimately what happens is people will get directed to a therapist or an, and they'll not, they'll not, they'll have too hard a time with therapy or the therapist won't know how to work them through these processes. And then they'll. Get sent back to a doctor, psychiatrist, family med, doctor, someone who's a prescriber who will talk to them and say, okay, you've tried therapy.

You've been to six sessions, 12 sessions, whatever. You're still having symptoms. Let's try Zoloft. Let's try Prozac. let's try any number of medications that are listed in the book for what could be used that has evidence for the symptoms you're experiencing right now. And the problem with that is, is that those, not that those medicines are always bad.

They're not. But the problem is that there are a lot of other things that we can try before those medicines, because the medicines, unfortunately train us to seek something outside of ourselves for the healing benefits. And what happens is people are told when they get prescribed the medicines, they have take them every day indefinitely for, you know, who knows how long, sometimes multiple times a day.

And that sometimes they don't even start to work for six weeks. Right. So there's a L and their side effects. So the most common side effect with SSRS, the Zoloft and Prozac is numbing numbing to the point where or numbness to the point where people don't feel, pleasure the same way anymore. Right? So again, it's one thing to explain that to somebody and say, Oh, this medicine you're going to take is going to numb.

The negative stuff. That's the bad stuff you're feeling. But then also explain to them it's going to numb the positive stuff. They're feeling. It's going to bring a whole window in narrow, more narrow, of feeling it reduces the window of feeling. So this is really important to describe to people so that they understand that there are other options before we jump straight from psychotherapy to prescription medicines that you take every day that increase your risk of side effects.

you know, other examples that could fit in the middle, there are things like, you know, herbal and plant medicine and supplements. Exercise is an incredible antidepressant, ketamine assisted psychotherapy, which typically only requires three to 12 doses over the course of three months, rather than, rather than us a dose or Mo one or more doses every day and has less side effects is often.

a more potent option for people that not enough people know how to provide as clinicians, so it doesn't get offered. so there's a lot of options available. There's wearable technology that can be used for this Apollo being one of them that we developed to be able to help, assist in these treatment practices without side-effects.

So there's lots of things that can be used in between. I think the major issue with Western Western approaches to. Psychiatry approaches to mental health right now is that there's a big jump from psychotherapy to daily prescription medicines that have side effects. And we really need to fill that gap with a whole bunch of other natural side effect, free stuff in between.

Does that make sense? 

Bryan Carroll: [00:21:42] Yup. Yeah. So kind of combining the therapy with these other natural options before getting to the medication, 

Dr. David Rabin: [00:21:49] right. Before getting to specifically prescription medicines as the prescription medicines are a little more risky naturally. Like they, they have a little more risk of side effects.

It's just. It's just the facts that have come out of the trials. So, you know, for us, you know, one of the things that we focus on with the board of medicine in particular is the original Hippocratic unders Hippocratic oath and Hippocratic understanding going back to the origins of Western medicine, which were really a hybrid of Eastern Western practices, which started with first do no harm.

Right. So if you're, if you have a medicine that you could take that, like in like a Prozac, for instance, cause you're not feeling good. And I was to tell you, Hey, this medicine could help you, but it's just as likely to give you side effects of no longer being able to have orgasms or, you know, you might make a different decision about the drug before you tried it versus something else.

So to me, to me, that's like real informed consent. You know, that's really like informing the patient transparently about. What they can do before they, you know, go that big, take that big step, 

Bryan Carroll: [00:22:54] right? Yeah. Because that's like you said, if you're getting rid of that feeling on both ends of the spectrum, I've heard people feel like they're, they're kind of like a zombie.

They don't really have that emotional connection to anything anymore when they're on the medication. 

Dr. David Rabin: [00:23:08] Right. And that's, and that's that, that's that numbness that, that we believe comes from, and this is not a hundred percent known yet, but we believe that that numbness comes from flooding. The serotonin receptor.

One of the serotonin receptors it's called the five HT two, a receptor with the Swift serotonin from the brain that is flooded because of the selective serotonin re-uptake inhibitor, which prevents. The serotonin claim back into the brain cell. So normally serotonin's released as a burst to stimulate meaning in association with, or to S to, to convey and communicate meaning between neurons.

With respect to an event, an event happens, you get a giant burst of serotonin, and it seems like the more meaningful that event is. Likely directly correlates with how much serotonin is released in the binding capacity and all that stuff. And then after the event, the serotonin is quickly taken back up into the cells so that another meaningful event can come and then stimulate that, that cell again.

But when you flood that receptor site and there's serotonin around all the time, you get what we perceive to be the effect that you just described as feelings like a zombie or feeling numb where you not only. You're not only decrease our ability to feel negative feelings, but also the peak of positive feelings as well.

And you kind of wind up in this more neutral middle ground, which is fine for some people, but typically not ideal for most. 

Bryan Carroll: [00:24:37] so the serotonin receptor sites, are they similar to like an incident, insulin resistant type state, the more that it experiences a more resistant it can become to it? 

Dr. David Rabin: [00:24:48] Yes and no.

I think that. The simple way to answer that question is that with respect to receptor physiology, neuro neurotransmitter receptor physiology, whether it's insulin or I'll focus on the similarities here, because I think that's the most important. So, so to answer your question simply the answer is mostly yes, in that the more that we flood a receptor site in our brains, In, or in our bodies than, more than our bodies and our brains.

And basically the cells that make that receptor decrease the sensitivity of that receptor and the amount of that receptors presence. Right? So if, if, if the body sees Hey, all the time, I am getting activated at this one spot by this one, neurotransmitter called serotonin, then the serotonin receptors. In that spot, the cells that make the receptors will start to say, Oh, well, I don't need as much receptor mate because there's so much activation going on all the time.

So it starts to decrease the amount of receptors made and starts to decrease the sensitivity of those receptors, which is also thought to possibly be related to that feeling of numbness that you were describing earlier. 

Bryan Carroll: [00:26:03] That makes sense. So you had talked about some of the middle ground between, You know, therapy and, clinical medication.

And you mentioned a plant medicine and herbs. Can you talk about some of the herbs that you would use? to help people with depression and anxiety. 

Dr. David Rabin: [00:26:20] Yeah, absolutely. I mean, I think some of the most interesting herbs that, and supplements that are available have to do with regulating our circadian rhythms more effectively, which is our sleep and wake cycles.

So when we focus on our sleep and wake cycles and getting them more. more scheduled, more routine, our bodies and our minds tend to really like that. That's like, especially when they're, when our sleep and wake cycles are, are consistent with nature, they're like aligned with what's going on in the environment around us, in terms of when the sun comes up, when the sun comes down, when the temperature changes around us, what the animals are doing, all of that is kind of our natural state.

And so a lot of the supplements that we use that I use and that many of my colleagues use tend to focus on giving a boost to the structure of those circadian rhythms. And that's also what a lot of people, most of our Apollo users use. Apollo four is basically when we want to wake up in the morning and we're feeling tired or sluggish or unmotivated turning on your Apollo or taking a little bit.

Of, CBD a, which is the raw form of CBD. For instance, that's not psychoactive, or taking a little bit of like reishi mushroom or Shaka mushroom. Some of these things can be really helpful cordyceps, or using some, and any number of this. So many other ones, ashwagandha is a good one. but by using some of these herbal supplements plan plants, then you can.

Induce wakefulness, Yerba Mata is another favorite that I like. It's an alternative to coffee that can induce wakefulness and induce a state of feeling more energized and motivated to go about your day without actually having to take a hardcore stimulant or even take anything that has a significant amount of caffeine in it, which might ultimately disrupt our sleep at the end of the day.

Right. So if we can avoid taking things that have a really long half-life. That, can disrupt our sleep. Then we're likely to feel better the next day as a result. And then that continues over time. So, the wakeful stuff I just mentioned to you for sleep, when people have trouble sleeping, I recommend things like, valerian root, Melatonin, low dose melatonin.

Most people overdose. Melatonin. Melatonin is an interesting one because it actually tends to work better for most people in lower doses. So somewhere between 1.5 to two milligrams, not more and taking somewhere between half an hour and an hour and a half before bed, rather than right before bed. These are great, great supplements that work really well to help regulate sleep cycles.

Five HTP, which is a precursor for serotonin is a really great one. I think I mentioned valerian root, there's another, a number of other routes and, and things that could be used. Tumeric curcumin is a really great antioxidant. that is also a, you know, a great root herbal supplement and there's tons of other stuff out there, but many of those things, those are the ones that I use most commonly in my practice.

Bryan Carroll: [00:29:23] Yeah. That's a lot of really good stuff in there. And I love that you brought up the circadian rhythm because I know a lot about people. Sleep seems to be one of the first things that people just kind of toss out the window, right? When you have kids you're not sleeping. When the kids themselves, even though you tell them they need sleep, they're staying up till two, am doing tech talk or whatever else on social media.

And then people wake up tired. They're tired all day, and then they wonder why. You know, they start having anxiety, depression, et cetera. So I love that you brought that up. 

Dr. David Rabin: [00:29:55] Oh yeah. It's so important. And I, and that was one of the most important findings that we saw out of Apollo. You know, when we made the technology.

as a wearable, we put it out into the world. We, we first studied in the lab, but then we put it out into the world and we said, Hey, people tell us how you use this. and people were most were almost where we track their usage, obviously through the device because it's a wearable digital device. And over time, what we found is people use it mostly to wake up and energize them in the morning.

instead of using caffeine and stimulants and then use it at night to calm down and wind down before bed, instead of using alcohol and sedatives. and that in and of itself was probably one of the biggest benefits that they, that they found in their lives was just getting that circadian rhythm motor control ends up, setting us up for success, much more of the time.

Right. 

Bryan Carroll: [00:30:41] Yeah. And there's a, there's a lot of questions I have about the Apollo that I want to ask after we talk a little bit more about psychedelics, because I know there's a lot of good stuff coming out about psychedelics and, there's also still a lot of legality issues. So can you talk about the legalities?

Dr. David Rabin: [00:30:56] Sure. and, and they're all very related. Really. I'm also a ketamine assisted psychotherapy provider. and I'm trained in MTMA assisted psychotherapy as well. we. But use MTMA and psilocybin in clinical trials only right now. They're not legal for use except for a certain few small exceptions, like Oregon just legalized and decriminalized psilocybin just recently.

you know, some cities in California did it. Colorado is moving in that direction. Many cities have done it there. if not the whole state. so there's a lot moving in this direction, but as far as medical practitioners can go, who are board certified, we're only legally able to provide ketamine in, for general practice at this point.

Ketamine, however is really interesting because ketamine is legal in every state and it's legal in every, almost every country in the world. And what's. Yeah, and it's been around for like 70 years and it's a very short acting psychedelic medicine that was originally discovered as an anesthetic agent and a, a pain reliever, I think roughly 70 years ago or something like that.

And then anesthesiologist found that it had antidepressant benefits. And so ultimately I think it was about 10 years ago, a new Academy was off patent, so it was a generic and couldn't be patented, but then a new. Pharmaceutical company came out and patented one form of ketamine, one variety, and then ended up putting that through the FDA and got approval for treatment resistant depression, using ketamine as a nasal spray.

But, the more common forms that we use are oral oral, dissolving rapid dissolving tablets or injection. I am in the muscle or in the shoulder or IV. in, in, in the vein and that medicine we can deliver in-person we can, and there's probably like a thousand ketamine clinics in the country right now that deliver it in person.

but a lot of psychiatrists, which I think is really the, one of the most exciting areas of psychiatry, a lot of psychiatrists are now delivering ketamine remotely. we have a big remote ketamine practice where I work with a number of providers, but where we see clients over the internet, And then we, across different States and then we have the pharmacy mail, the clinical grade medicine to your home, and then walk you through how to do it at home.

on your own time with us, and then on your own time thereafter, which saves everyone a lot of time and everyone, a lot of money down the road and increases accessibility to the medicine dramatically. So as, as we look ahead, you know, legal wise, legal legality wise, MTMA and psilocybin are ketamine. It's going to be legal.

It's legal now, and it will continue to be legal. And right now I think that's the major focus for. how we can provide psychedelic assisted psychotherapy to people for treatment resistant, mental illnesses, for which the results have been literally tremendous, MGMA and psilocybin have great results, but they're not going to be legal through the FDA, meaning not in a study, for legal use, not in a study, like in a regular practice.

We'll probably be end of 2022 beginning of 2023, and then others will follow. but, that's kind of where we're at right now. the results from these medicines, which we haven't really talked about that much are really impressive from the clinical trials. And just to give you an idea, people who have had treatment resistant depression or PTSD for 10 plus years can get just one to three doses of psilocybin or MTMA, and within, And within just one to three doses of medicine with associated psychotherapy for anywhere from six to 12 weeks, we'll have well over 67% of these people are no longer meeting diagnostic criteria for their mental illness at one to five years out.

So you think about how, how incredible that is. We haven't gotten anything close to that kind of findings. Those kinds of findings from our SSRI Western medicines, like Prozac, Zoloft, you know, Selectsa Lexapro, any of those other ones. We don't see that. We see that people have to take the medicine every day continuously to continue to get benefit with psychedelic medicines.

We see something different. We see that we can provide the medicine and. Somewhere between one to three doses. In the case of ketamine, it's more like 12 doses, but you provide it in a very set, rigid amount of doses and number of doses. And then that is provided in association with psychotherapy. The psychotherapy with the medicine combined helps the client remember their own.

Inner innate skills of how to heal themselves and how to recover. And then they do the work themselves, and then they sustain the work over time, which is what we call integration. And then that results in these long-term benefits years later, that we don't see with other mainstream 

Bryan Carroll: [00:35:49] medicines. Yeah.

That's amazing. Amazing. So with the dosing, are people actually going on psychedelic trips or is it not quite that strong so that they are present in the moment? 

Dr. David Rabin: [00:36:00] Well in these studies, they're, the dosing is pretty high. So for the psilocybin studies, the doses have been three and a half to five, five grams.

So that's like a, you know, a full, fully psychedelic dose, fully altered state of consciousness dose. with MTMA obviously the experience with MGMA is different. It's a very clear, clear experience that, isn't. You don't really like have things like you don't see things or hear things that you normally wouldn't hear or see necessarily with MGMA.

but you do have profound clarity into your life, into, others around you. The way you've been thinking about yourself, the way you would think about yourself and others, and the world. So with both, and with respect to MGMA, they do use a full dose as well. Ketamine is also used in a psychedelic dose.

So these doses are on the order of. Obviously everyone's different, but with ketamine it's somewhere between 50 and 100 milligrams, usually of active medicine. 

Bryan Carroll: [00:37:02] So what's the actual mechanism that's going on with the psychedelics in the brain. Like w how is it that they can go on a psychedelic experience and be able to recover from depression and anxiety with that going on?

Dr. David Rabin: [00:37:16] That's a great question. So I can't tell you that we know the exact mechanism yet. I think we're working on it. I'm working on it with some, some research groups, and, and working with maps on this. We're also have there's lots of other groups doing incredible work around the world on this. One of my favorites actually.

Is, the work is the work of Franz Vollenweider, who has sends some the best, research into psilocybin and LSD in Switzerland. and he's one of the old guard in this department, but doing this for a very long time and he's found some fascinating. Results that really linked psychedelic medicine back to this serotonin receptor that we were talking about earlier, the five HT two, a receptor in that.

it appears for instance, and I, again, I can't tell you how they all work because they all work differently and we don't know exactly how they work. but in terms of reducing their effect. But what I can tell you is that it appears that there is a very common mechanism between all of them. And that common mechanism is this five HT two, a receptor that is a serotonin receptor that is particularly highly concentrated in the emotional cortex of our brains.

And interestingly, again, this receptor is flooded when we're exposed to SSRI, but when you block that receptor and that receptor is also, I should say, bound by serotonin under normal conditions. And when we, and when we, And when we take psilocybin or when we take LSD, psilocybin and LSD bind directly to this five HT two, a receptor, which was found by Franceville wider in colleagues that this binding occurs.

So what's really interesting that front that Vollenweider showed is that if you give somebody a placebo or active group, and he did this in a double blind, placebo controlled fashion, where he gave a bunch of people, LSD and psilocybin, And then healthy people and then gave them a drug that blocks activity at the five HT two, a receptor, specifically an oral drug.

And some people got a sugar pill and some people got the actual blocking drug. And interestingly enough, all the people who got the drug that blocks activity at this one receptor basically had no. Altered state of consciousness of facts and no shift in their perceptual, meaningful meaning of the experience with the psilocybin or the LSD, which is really interesting because we've never, ever known that there was really one receptor that was sort of sitting at the top of the cascade.

Right. We always thought that there were tons of stuff going on, which there is, there's still dopamine going on. There's still oxytocin. There's still serotonin and other places. There's still lots of stuff happening, but there is one receptor. Interestingly enough in that emotional cortex, that's also very common in other parts of the brain, but really focusing on emotional cortex where we know drugs like psilocybin MTMA and LST, act that that receptor is particularly important at governing the rest of the cascade.

So interestingly enough, the reason why I brought this up is because if you, if you saturate that receptor, if you fill it with stuff, Then, like with the Prozac Zoloft, these Sri's, you create numbness. If you create a burst experience, which is what LSD psilocybin and MTMA do at the receptor site, they create this giant burst of activity of serotonin that doesn't last a long time.

It lasts like four to six hours, not weeks, then that burst results in this radical transformative experience that allows us to change the way we perceive meaning from our lives. Right. So in some ways, this five HT two, a serotonin receptor is really interesting to think about as almost the meaning receptor.

It's like the receptor that we activate naturally when we perceive meaning from the environment and that receptor can also be influenced by different. Chemicals in the environment and different experiences from the environment and from our past, that changed the way we perceive meaning and change the way that we have these experiences.

So to answer your question, I think that I know that wasn't a short answer, but I think a lot of the, the. Central pathway of how these medicines work is that they focus on binding this receptor, this specific  serotonin receptor, creating bursts of activity, which is not that different from the way that we would create natural bursts of activity when we have a spiritual, profound, meaningful experience naturally.

and then that time limited bursts activity that allows for us to shift our meaning, our sense of meaning allows us to literally change the way that we see ourselves in our lives and see the way. That we can heal ourselves. And then that over time as the, as we, that, that experience isn't enough over time, we have to integrate what we learned from that experience into our day to day practice that literally reinforces new behavior along this practice makes perfect model of making sure that we are still, still reinforcing what we've learned from the experience.

Does that make sense? 

Bryan Carroll: [00:42:27] Yeah, it does. And that brings up a interesting question is when you get that burst and you have all these narrow transmitters that are flooding the system, and then you come way off of that, do you dip into a low at all? Do you like over because there's, you know, you know what I'm trying to say?

Dr. David Rabin: [00:42:45] Yeah, yeah, yeah. So, so people, so most people don't, most psychedelic medicines don't. Don't get people into a low, if the, if they're used properly, which means that the set and setting of the environment is curated properly and safely. So if the person is in a really safe environment, then they typically do not experience that kind of drug come down.

A fact that people describe, however, there are cases where people have had very severe PTSD for many years, where they will experience a comedown after the MGMA wears off. that definitely does happen. and, but it's something that's, it's not like it's it's yes or no. It happens. It's, there's, there's a gray area where we can work with people to avoid that from really making them feel miserable and sticking, rather keeping the positive stuff at the forefront.

but I think it's important to note that. If you're someone who typically bounces up and down between, I feel really great. I feel really crappy. I feel really great. I feel really crappy, meaning that you probably don't have a very good balance of serotonin in your body or in your mind. And it's not like you're born with that.

It's just that your behavior pattern or your life pattern has resulted in you not having a good balance of serotonin necessarily. It's probably more likely that if you don't. Take proper precautions for a psychedelic experience with your therapist or clinician or whoever it is that you will feel a little thrown off afterwards, coming back into your regular self, particularly your day-to-day self, particularly after your first experience.

So it's really important to take that into account when you're, when we're thinking about this stuff and how to, how to make sure we have a good experience for our, with our, with our clients. 

Bryan Carroll: [00:44:29] Yeah, the psychedelic information is super I'm fascinated by it. And I, like you said, there's going to be a lot more information coming out in the future.

especially ones more and more things become legalized, nationwide. So I'm super excited to see that. And then you've mentioned multiple times, your Apollo neuro device. Do you want to talk. A little bit about what's going on with that. What is it first off? I have it on my ankle right now and I have it in the focus mode.

and then tell us what the purpose is. 

Dr. David Rabin: [00:44:58] So, so Apollo is a wearable that delivers a gentle vibration to the skin that help, that feels like, it feels like someone giving you a hug on a bad day or feels like someone holds or feels like when you hold a pet or a purring cat, or the ocean waves washing over us, which is instantly calming.

And the reason how we are, the way we came up with this was actually very heavily influenced by my research into chronic stress and resilience and, and, people who have veterans who had treatment resistant PTSD, and also it was heavily influenced by my training and DMA assisted psychotherapy because MTMA assisted psychotherapy.

Like most current modern practices of psychotherapy are all based on safety practices. So me. And when I, when I say that, I mean, making sure that when the client comes into our office, that for them to have a good experience in the office, they have to feel safe. Emotionally, physically, mentally safe around us, legally safe, knowing that if they tell us something, we're not going to report them to the cops, knowing that we're not going to judge them when they tell us something.

Right. And so being, having that safety that we curate for them, which is what people pay us for when they come into the office is absolutely critical. And, and in the MTMA experience, That safety is, is highlighted as the most important part of the experience for curation. So when I started thinking about this from the standpoint of the importance of safety or, and why it meant why it creates or facilitates these really powerful healing experiences for people, I realized that this is not unique.

And the reason why the safety so important is because safety is literally the trigger. For our parasympathetic recovery nervous system to turn on. And that system governs and directs resources to our reproductive system, our digestive system, our immune system, our sleep and recovery system, our metabolic system and our creativity, part of our brains, our empathy, parts of our brains, all the parts of our brains and bodies that we want to be active when we're not actively running from a bear or a lion in that moment.

Right. When we're running from a barrel line in that moment, and we're actually in a survival threat, we don't want resources going to those systems, but when we are safe, we want resources going to those systems, that those systems, reproduction, creativity, empathy, et cetera, they all make our lives so much better.

And so understanding that what we realized was looking back at all the literature that had been. You know, this, this is research that I did mostly between 2014 and 2018 at the university of Pittsburgh doing the literature review of what had already been done. We found out that it was very clear that certain, certain things boost activity in the recovery system, much more than others and touch was one of those things.

And, music was one of those things. So effectively we researched in-depth all the neuroscience of touching music. And then figured out how to rep and, and, the States that the body gets into when we reached States of, of calm and flow. And then we basically customized music. That's written for the touch receptors on our skin, rather than for our ears that allows us to, feel the vibrations from the wearable.

And then our emotional brain automatically interprets those signals as safety. And that allows us to either enter into a. Calm clear focus, state more easily, or a, or a calm, sleepy state, more easily, or a relaxed state or a meditative state or a wakeful high energy state, whatever it might be that we're trying to transition to and helps us access our goals more effectively, just like we can do with deep breathing or just like we can do with music or soothing touch from a loved one, but we don't always have those, those people with us, or always have the, the clarity of mind to tap into a breathing exercise in the middle of a board meeting or at any given moment.

Right. So that, so Apollo really came out of that research and then turned into a wearable that delivers these gentle, soothing vibration to the skin, that has no side effects, which is really great. So we can use it on kids and, and, and, elderly adults and vulnerable populations. And we did, testing on thousands of people in the lab and real world, and then release that into the wild in January of 2020.

And now we have about, I want to say 15,000 devices out there in the world. we're having great results that are consistent with our lab trials, which is really promising and so rare to see. Yeah. 

Bryan Carroll: [00:49:32] when I got the device, I was, you know, I'm always slightly skeptical about things and I'm like, is it psychosomatic that it works?

Or is it actually doing something? And so, that first night that I put it on, like, usually it takes me a little while to kind of calm down before I go to sleep. I hit the, the sleep mode and then within like two minutes, boom. I was out. And so I've been monitoring with my, I have my Garmin Phoenix watch, so it does a lot of different, health markers as well.

And I've been monitoring just the last month, the different sleep levels that it tracks and my REM sleep has been increasing. and it's, I'm in a deeper state of sleep and I feel so much better. It's actually, I, I. I'm very impressed with it. And then I also use it like right now, when I'm doing podcasts interviews or anything that I have to be more focused on, I use it then.

And then, one of the things I really like too is the recovery mode and I have some questions with that. So, like when I do a lot of recovery for myself, I'm using different tools, such as percussion, massagers, like a hyper bolt and all that type of stuff. If you're using the recovery mode, on the Apollo.

While also doing like a percussion massage or anything like that, would that interrupt what the Apollo is trying to do? 

Dr. David Rabin: [00:50:49] It shouldn't, we don't have any evidence to say that it would, at this point, most people combine the Apollo with other things. I think the main goal is just make sure the main, the main, thing to make sure of is that your goals are aligned.

Right. So don't drink a cup of coffee and then put the Apollo on sleep mode. Cause that's probably not going to work very well. Right. So however, I do know a lot of people who will drink coffee in the morning and then feel like they are over-caffeinated and put it on a meditation mode for the day because they're, they want to slow down, slow, slow their roll a little bit, you know?

Bryan Carroll: [00:51:22] Oh, that's a good idea. 

Dr. David Rabin: [00:51:24] Yeah. The over-caffeinated of caffeine did adjustment. but I think as long as your goals are aligned, So you're using you're, you're trying to recover. Post-stress whether it's physical, mental, or emotional. I mostly use the recovery mode after long travel and after I work out.

but if you use it in, in alignment with the goal of recovering post stress, whether it's physical, mental, or emotional, what have you, then it will work fine with whatever it is you're doing, but if you're doing something else, that is the opposite has the opposite outcome. Then it's going to conflict.

Does that make sense? So, can 

Bryan Carroll: [00:52:00] you, train your nervous system in the wrong way? Just like you said, if you're taking caffeine and trying to go to bed, can you screw up your nervous system in that way? 

Dr. David Rabin: [00:52:08] Yeah. I mean, you could train your nervous system the wrong way, doing any number of things. I think, I mean, that's that's, to me like that's like the brilliance of era of candles work more than anything is, is that practice makes perfect, is not respective of just good things.

Right? It's bad things too. It's impulsive. It applies to impulsivity. It applies to instant gratification. It applies to. To feeding that compulsive part of ourselves. Right. And more we do something, even if like drinking, drinking coffee in the morning, many of us do it, even though it doesn't actually serve us very well.

You know, the more we do it though, the more we rely on it. And that's, that's just how we train our bodies and our brains. That's, that's how the, that's how the core parts of our nervous system works. Biologically speaking. So taking that into account is really important so that we, at least at the, at the very least make sure that we're training ourselves in alignment with our goals.

Perfect. 

Bryan Carroll: [00:53:01] And then, my final question about the Apollo is, you know, I've just used the preset modes. That's on the app. I haven't played with any of the intensity adjustments or anything like that. So with the intensity adjustments, what. Is there a certain guidelines to follow for that? Like, do you want to just barely be feeling the vibrations or do you want the vibrations to be strong?

Dr. David Rabin: [00:53:24] That's a great question. And some of the stuff is included in with the device, but, and I'm really glad actually to hear that you've been having such great results with the factory settings that we sent you. because those are interestingly enough, those are just what we put in there because that's what tends to work for most people.

so it's really interesting that you were having such good results with that. I'll send you another document that you can share around to two people who connect with you through summit for wellness that, has more details, but ultimately the main idea here is that the different. Modes there's seven different modes.

So there's energy and wake up, which is the most energizing. It's kind of like a cup of, kind of like a cup of espresso, like a double shot of espresso. Then there's a social and open, which is like a social clear, focused creative flow state. Great grime. I use that one mostly for public presentations and running meetings.

And. going out when I'm tired and when I'm hanging out with folks, then there's clear and focus, which is another one that, that I use a lot too, which is great for focus. Great for presentations. And gray for podcasting and that kind of thing. and then the rebuild and recover is kind of the balanced one that's right in the middle.

It's not really that stimulating. It's not really that calming. It's kind of like balanced right in the middle of that is great for post-stress of any kind. even if you just use it for two minutes and then below over build and recover, are there much more, calming patterns? So meditation, mindfulness, relaxing, unwind, and sleep and renew.

Each setting has its own intensity bar that you can adjust to your comfort. what we typically recommend is that you adjust the intensity to level where you can just start to feel it. It's kind of like the recommendations we use for people who ask us about microdosing. Like you were asking earlier, you adjust the level of the dose of Apollo to where you can just barely feel it, but it's not distracting.

So when people ask us about microdosing, again, microdosing of psychedelic medicines in particular is not necessarily legal, depending on the medicine, but we, we're effective. But when people ask us, we tell them, you know, the best, best choices to choose a dose that is one 10th to 100th of the dose active high dose peak dose.

And that you do that and dose yourself a level where you just barely notice that there's something different. And that's really where people have to tend to have the best effects. the nice thing about Apollo in this regard is that Apollo doesn't have any side effects. Cause it's just sound waves and you can wear it all the time.

So what we were really thinking at the university was, Hey, psychedelics are amazing. They are really, truly at the forefront of where mental health is going. However, most of them are illegal. Most of them won't be available for use in the mainstream until 2022, 2023. Ketamine is the only one we have right now.

And there's very few people trained to administer it properly. So what can we do for, for people we could create, if we understand how psychedelic medicines work based on the safety pathway I talked to you about earlier, then we can maybe make a technology that can activate the safety pathway in a similar manner as psychedelics, but without.

Having the side effects of psychedelics. So it can be used in kids. It can be used in adults. It could be an elderly adults and people who wouldn't necessarily be good candidates for medicine. So that was a big focus for us going into this. And the intensity is the main way that you can customize your experience with Apollo right now in the future, there will be more software releases coming out that allow more customization over time.

Bryan Carroll: [00:56:46] Awesome. Well, I'm loving it. I'm so glad that you have it available and I'm I'm. I'm really enjoying playing around with it. So if people want to learn more about Apollo, they can go to summit for wellness.com/apollo. And then if people want to see more that you're doing as well. Dr. dave.io is where they can find you.

Is there any final thoughts that you want to share with us? 

Dr. David Rabin: [00:57:09] no, I mean, I think we covered it. I I'll say if anybody wants to check out. Yeah. my nonprofit work, with respect to helping to provide more education and guidance for the clinical use of plant medicines and minimally and noninvasive treatments for hard to treat illnesses.

please check out the board of medicine.org. It's a five Oh one C3 non-profit medical board of expert leading experts who support this cause of restoring Western medicine back to the original Hippocratic vision, and also uniting Western medicine with Eastern and tribal and alternative practices that are safe, with safety as a priority.

And, you can also find me on social. Is that on Twitter at, Dr. Dave Raven and on Instagram at Dr. David Raven. 

Bryan Carroll: [00:57:51] Awesome. Thank you so much, Dr. Dave, I appreciate the conversation and I'm super stoked to see what's going to be coming out of all the psychedelic research that you're involved in.

Dr. David Rabin: [00:58:01] Likewise, thanks so much for having me, Brian. I really appreciate it 

Bryan Carroll: [00:58:04] to say this episode has the potential to be in the top three episodes for next year. And I loved how much information Dr. David shared with us. If you want to learn more about the Apollo neuro. Head over to summit for wellness.com/apollo.

To get your 10% off coupon, also make sure to register for the Vitamix and $100 gift card giveaway that giveaway ends on Christmas. So make sure you enter as soon as possible. There are daily ways to get more entries. So the earlier you sign up, the more chances you have at winning. So go to summit for wellness.com/giveaway to get going.

And this is our last full episode of the year. We are winding down, I'm prepping for next year's show lineup. So stay tuned for that. And at the end of the month, we'll have our top five countdown episode. So until then keep climbing to the peak of your health.