The Ketamine StartUp Podcast

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Oct 2026

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Welcome to the Ketamine StartUp Podcast! This is the FIRST podcast dedicated to entrepreneurial medical professionals who want to learn more about providing ketamine therapy, run a business, marketing, and more. We are Sam and Kim Ko, two board certified physicians who have ventured into the ketamine therapy world. We’ve learned a lot of lessons, taught many clinicians like yourself, and luckily made a few friends along the way. In this podcast we share our experience and knowledge, plus that of the ketamine industry pioneers and leaders in our interviews. If you’re ready to boldly go where a few medical professionals have gone before, download and listen to our podcast today

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October 28, 2026Episode 681 hr 1 min

Episode 68 – Ketamine Therapy, Integration, and Durability: What Happens After the Session with Dr. Scott Shannon

Most conversations about ketamine therapy focus on the session itself. Dr. Scott Shannon is more interested in what comes after. In his view, ketamine can be a powerful way to help someone get out of a rut, but the real question is what that person does with the opening it creates. This conversation gets into why he sees the weeks following a session as a critical window, and what integration and psychotherapy may add to the picture. Dr. Shannon is a psychiatrist who decided in high school that he wanted to study consciousness. He completed his psychiatry residency at Columbia and a child and adolescent psychiatry fellowship at the University of New Mexico, and he has taken part in psychedelic research, including Phase III trials of MDMA-assisted psychotherapy. In 2010, he co-founded Wholeness Center in Fort Collins, Colorado, an integrative mental health clinic that describes itself as the largest of its kind in the United States. His team has offered ketamine therapy for about a decade, using multiple routes of administration over the years. This conversation is wide-ranging and candid about where opinion ends and evidence begins. Dr. Shannon describes two things he sees working together, the experience itself and neuroplasticity. He shares why he believes durability improved at his clinic when more psychotherapy was built in, and why he thinks the field needs a large, well-designed study comparing ketamine with and without psychotherapy. He also makes the case that clinicians should experience the “terrain” before guiding others, while acknowledging the limits of that idea. For clinicians building or growing a practice, he offers perspective on choosing business partners and developing a philosophy of care that can carry a clinic through uncertainty, including the possibility that ketamine access changes. What You’ll Gain · A clinician’s framework for thinking about why ketamine therapy can help someone out of a rut, and why lasting change may depend on what happens next · Dr. Shannon’s perspective on integration and psychotherapy, and why he believes the field needs a large, well-designed study comparing ketamine with and without psychotherapy · Why he encourages clinicians to experience the “terrain” before guiding others, and where he acknowledges the limits of that, such as contraindications · How his clinic’s approach to routes of administration has evolved over a decade of ketamine therapy · Questions to ask yourself about your philosophy of care before building or growing a practice Episode 68 show notes: 00:00:00 Teaser - The Tow Truck Question 00:00:28 Welcome and Meet Dr. Scott Shannon 00:02:21 From a High School Psychology Class to a Question About Consciousness 00:07:36 Advice From His Father and the Path to Psychiatry 00:09:16 Early MDMA Couples Therapy and the Scheduling That Followed 00:11:43 Research With 5-MeO-DMT and LSD, and the Challenge of Recruitment 00:14:33 How Dr. Shannon Got Into Ketamine Therapy 00:17:34 Learning Ketamine Therapy From a Clinician Study Group 00:20:08 What Creates Lasting Change After Ketamine Therapy? 00:23:01 The Tow Truck Analogy and the Weeks After a Session 00:24:40 Ketamine-Assisted Psychotherapy: What Do We Know? 00:28:56 Why His Clinic Added More Psychotherapy 00:31:24 Should Clinicians Experience the Medicine Before Guiding Others? 00:35:00 A Group Ketamine Process for Healthcare Providers 00:37:06 How His Personal Journey Shaped His Care for Patients 00:41:16 Advice for Starting a Private Practice: Partners and Philosophy of Care 00:44:47 What Wholeness Means and Why He Chose the Name 00:47:20 Love, Defenses, and the Healing Relationship 00:52:28 Why He Moved Away From the "Expert" Role 00:56:15 Power Outage and Rapid-Fire Questions Begin 00:59:15 Where to Find Dr. Shannon 01:00:22 Episode Ending Thanks for listening Connect with Dr. Shannon at: The Wholeness Center 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-068 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist .

October 14, 2026Episode 671 hr 5 min

Episode 67 - Ketamine, Pain, and Private Practice: Inside the Multimodal Clinic Model with Dr. Zach Fisk

Dr. Zach Fisk runs a pain medicine practice. That is how he would describe it, and that framing matters. Acute Pain Therapies in Bellevue, Washington offers a genuinely broad range of interventions including stellate ganglion blocks, regenerative medicine, peripheral nerve stimulation, spinal cord stimulators, PRP, and radiofrequency ablation. Ketamine sits within that model as one of many tools, not the headline, but arguably the one that changes lives most dramatically when it is the right fit for the right patient. This conversation gets into how that practice was built, what drives the clinical decisions behind it, and what it actually takes to sustain something like this over nearly a decade. Dr. Fisk is a board-certified anesthesiologist with fellowship training in acute pain management and an MBA from Tufts. He opened Acute and Chronic Pain Therapies in Bellevue, Washington in 2016 after leaving a stable position at the VA, where the chief of anesthesia told him his idea for an outpatient perioperative pain service was dead in the water. Eight years later, he is still going. This conversation is wide-ranging and genuinely honest. Dr. Fisk talks about his dosing philosophy and why he does not find body weight to be the most useful guide, his experience billing insurance for ketamine and why he eventually went fully cash pay, the role of outpatient sublingual ketamine in his practice, and how he thinks about patient selection after nearly a decade of doing this work. He also shares what he would tell an anesthesiologist or pain physician who is considering opening their own clinic, and it is not the answer most people expect. What You'll Gain: • How Dr. Fisk built one of the most comprehensive multimodal pain and ketamine practices in the Pacific Northwest, and why he believes ketamine works best as part of a broader clinical model rather than a standalone offering • His honest account of the early days, including seeing two patients in his first month, the VA chief who called his idea dead in the water, and what kept him going through the uncertain early period • A detailed look at his dosing philosophy for ketamine infusions, including why he does not rely primarily on body weight, how he structures dose titration over one hour, and how he tailors protocols to individual patient profiles • The insurance journey that started with unexpected coverage, moved through clawbacks and audits, and ultimately led him to go fully cash pay, including his candid take on why insurance covers Spravato but not IV ketamine • How he thinks about outpatient sublingual ketamine prescribing, when he uses it, when he does not, and why he draws a boundary around prescribing it purely for psychiatric indications given his anesthesiology background • His straightforward advice for anesthesiologists and pain physicians considering opening their own clinic, including why he says this path is not for most people and what you genuinely need to be prepared for Episode 67 show notes: 00:00:00 Teaser: Risk, Stability, and Building Something of Your Own 00:00:17 Welcome and Meet Dr. Zach Fisk 00:01:43 Dr. Fisk’s Path: Tufts, Anesthesia, and Acute Pain Fellowship 00:02:35 The Idea for an Outpatient Perioperative Pain Clinic 00:03:56 Why Ketamine Became a Primary Service, Not a Background One 00:06:19 The MD/MBA Path and How Business Training Shaped the Practice 00:09:18 From Fellowship to the VA: Building an Acute Pain Service 00:10:21 Leaving a Stable Job When You Want to Build Something 00:11:31 “We’ve Never Been Trained in Business, So I Just Went for It” 00:13:21 Year One Reality: Two Patients in the First Month 00:14:00 Early Hiring Mistakes and Why a Startup Consultant Made the Difference 00:15:32 What Medical Training Never Teaches: HR, Finance, and Practical Skills 00:20:00 The VA Chief Who Called It “Dead in the Water” 00:22:08 The 80-Year-Old Test: Taking Risks While You Still Can 00:26:00 Inpatient vs. Outpatient Ketamine: Dosing, Duration, and Monitoring 00:31:34 One-Hour Infusions and a Two-Titration Protocol 00:33:05 Why Body Weight Is Not the Best Guide to Dosing 00:36:50 Building a Multimodal Practice: Services Beyond Ketamine and SGB 00:41:47 Patient Stories: When Ketamine Changes and Saves Lives 00:43:10 Red Flags, Patient Selection, and Honest Conversations About Success Rates 00:44:40 Outpatient Sublingual Ketamine and the Lucinda Grande Protocol 00:47:52 The Insurance Journey: From Clawbacks to Cash Pay 00:51:40 The Spravato vs. IV Ketamine Insurance Mystery 00:55:03 Advice for Anesthesiologists Considering Private Practice 00:57:31 Rapid-Fire Questions Begin 01:02:42 Where to Find Dr. Fisk and a Tip on Naming Your Business 01:04:33 Episode Ending Thanks for listening Connect with Dr. Fisk at: Acute Pain Therapies Website https://acutepaintherapies.com/ Instagram https://www.instagram.com/acutepaintherapies/ 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-067 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist .

September 29, 2026Episode 6641 min

Episode 66 - She Left the ER to Help People Heal. This Is Why. with Dr. Glareh Imani (Episodes from the Vault)

This week we are reaching back to our very first season to resurface a conversation that has stayed with us. And there is a reason we keep coming back to it. There are a lot of conversations about the mechanics of opening a ketamine clinic. This one is about the why behind it. Dr. Glareh Imani is a board-certified emergency physician who opened Nameen Infusion and Wellness in Goodyear, Arizona after more than eight years in emergency medicine. Her background in neuroscience, her personal experience with ketamine, and a deep sense of gratitude shaped the kind of clinic she built and the way she shows up for her patients every day. What makes this conversation stand out is how honest and human it is. Dr. Imani talks about the unexpected challenges of opening a clinic, the patient transformations that confirmed she had made the right choice, and the personal evolution that came with doing this work. She also reflects on autonomy, on what it means to finally be the one making the decisions, from clinical protocols to the waterfall in her reception area. Recorded at the ASKP3 conference in Austin, Texas during our first season, this episode holds up beautifully. If you are considering the pivot from your current position, or if you are early in building your practice and need a reminder of why you started, this one is for you. What You'll Gain: · Dr. Imani's honest account of what it took to go from the idea of opening a ketamine clinic to actually delivering on it, including what surprised her most along the way · How her background in neuroscience and her personal experience with ketamine shaped both her decision to open a clinic and her approach to patient care · What set and setting actually means in the outpatient clinic context, and how Dr. Imani thinks about the environment she has created for her patients · Two patient stories that capture what ketamine therapy can do when it is delivered with intention and individualized care · What the transition from corporate emergency medicine to clinic ownership actually feels like, including the autonomy, the trade-offs, and the parts you cannot put a price on · How Dr. Imani balances running a clinic, working emergency medicine shifts, and family life, including what she says makes it all possible Episode 66 show notes: 00:00:00 Teaser: "I'm Happier Now Because I Know I Can Help in a Different Way" 00:00:18 Episode Introduction 00:02:03 Background: From Neuroscience to Emergency Medicine to Ketamine Therapy 00:06:13 Her Personal Ketamine Experience and the Decision to Open a Clinic 00:08:19 Unexpected Challenges and the Backup for Everything Rule 00:09:00 Ketamine in the Hospital vs. the Outpatient Clinic: Set and Setting 00:10:33 Safety Standards and Why EM Training Is an Advantage 00:13:00 Patient-Centered Care, Setting Expectations, and the Tools She Relies On 00:15:08 Advice to Her Past Self: Start Sooner and Do Not Do It for the Money 00:18:02 The Power of Autonomy and What Clinic Ownership Actually Feels Like 00:19:40 Personal Evolution: Mindfulness, Journaling, and Resetting Yourself First 00:23:21 Patient Stories: Transformation That Confirms the Decision 00:26:24 Balancing a Clinic, ER Shifts, Family Life, and Why Community Matters 00:28:40 Rapid-Fire Questions Begin 00:37:00 Time Travel: Being a Teenager in Vienna as a Refugee 00:38:22 Gratitude, Resilience, and the Gift of Helping Others 00:40:10 Final Thoughts and Where to Find Dr. Imani 00:40:54 Episode Ending Connect with Dr. Imani at: Nameen Infusion & Wellness website Nameen Infusion & Wellness Instagram 📝 Complete show notes with resources and links, please visit www.ketaminestartup.com/podcast

September 14, 2026Episode 6515 min

Episode 65 – From Shift Work to Ketamine Clinic: What Actually Changes with Dr. Nico Grundmann (Soundbites from the Vault)

This Soundbite from the Vault packs three genuinely useful sections into one digestible clip, and each one stands on its own. It opens with something most emergency medicine physicians quietly wonder about before making the pivot: what does it actually feel like to work in a ketamine clinic after years of shift work? Dr. Nico Grundmann, founder of Ember Health in New York and an emergency physician with an MBA from Stanford, gives a refreshingly honest answer. The schedule changes. The mental model changes. The relationships you build with patients are unlike anything the ER allows. And for the right person, all of that is exactly the point. The middle section pulls back the curtain on what patient care can actually look like. From the first call to the four-visit induction series to long-term maintenance care, Dr. Grundmann walks through the full patient journey at Ember, including their 84 percent real-world treatment response rate and why they believe the care coordination model is what drives it. It closes with the three things Dr. Grundmann would tell anyone opening their own ketamine practice. Not generic advice. Specific, hard-won pillars that have shaped how Ember operates across five New York City locations and more than 2,200 patients treated. What You'll Gain: · An honest account of what actually changes when you move from emergency medicine to a ketamine clinic, including the parts most people do not talk about before making the leap · Why care coordination takes up 30 to 40 percent of the day at Ember and what that means for EM physicians who are used to handing off at the end of a shift · A clear picture of what the patient journey looks like inside a well-run ketamine practice, from first consultation through long-term maintenance care · Why Ember's real-world treatment response rate of 84 percent outperforms the published academic data of 75 percent and what Dr. Grundmann believes is driving that difference · The three pillars Dr. Grundmann would share with any provider opening their own ketamine clinic, built from years of operational experience across multiple sites Episode 65 show notes: 00:00:00 Teaser: "This isn't a role where you clock out and you're done." 00:00:13 Episode Introduction 00:01:25 What Is It Actually Like to Work in a Ketamine Clinic After Years of Shift Work? 00:03:20 Who Is a Good Fit: Longitudinal Care, Fixed Schedule, and Panel Management 00:05:00 For the Right Person It Checks Every Box: What the Fulfilling Version of This Work Looks Like 00:07:58 What Does the Patient Journey Actually Look Like from First Call to Treatment? 00:10:30 Real-World Treatment Response Data: 84 Percent at Ember vs. 75 Percent in Published Literature 00:12:33 Three Pieces of Advice for Anyone Opening Their Own Ketamine Clinic 00:14:36 Episode Ending Thanks for listening Selected Links From the Episode: Want to go deeper? This soundbite comes from Episode 040 – Episode 40 - Scaling Ketamine Clinics: From Pilot to Five Locations with Dr. Nico Grundmann , where we cover the full conversation including how Nico built Ember from a one-room pilot site to five locations in New York City and the systems thinking behind all of it. Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist .

September 1, 2026Episode 6431 min

Episode 64 - What the Research Says About Ketamine for Postpartum Depression

Clinical Disclaimer: This episode is for educational purposes for licensed healthcare professionals and is not individual medical advice. Ketamine and esketamine are not FDA‑approved for preventing or treating postpartum depression; any use in this population is off‑label and should be considered investigational and undertaken only with appropriate training, collaboration, and adherence to current standards of care. Postpartum depression affects roughly 10 to 20 percent of mothers and remains one of the most undertreated conditions in medicine. As public awareness of maternal mental health grows, providers in the ketamine and psychedelic therapy space are increasingly asking: is there a role for ketamine or esketamine here? This episode is our evidence-based answer to that question. We walk through the current clinical literature on ketamine and esketamine for perinatal depression, drawing on randomized controlled trials, meta-analyses, and expert commentary from institutions including the Center for Women's Mental Health at Massachusetts General Hospital. The research landscape is more nuanced than most providers realize, and understanding it clearly matters both for patient conversations and for how you think about your practice's scope. One distinction shapes everything that follows in this episode, and it's an important one: virtually all of the existing trial data involves perioperative prevention in cesarean delivery populations, not outpatient treatment of established postpartum depression . Knowing what the evidence actually supports and where the gaps remain is essential context for any provider working in this space. What You’ll Gain · A clear breakdown of what current ketamine and esketamine trials actually show for postpartum depression prevention , and what limited data exist for treatment . · An understanding of why racemic ketamine and esketamine tell different stories in the peripartum literature. · The key ethical and practical considerations for any provider thinking about this population. · An honest framework for how to talk with patients who ask about ketamine for postpartum depression. · Context on what the research gaps mean for where this field is heading. Review the research behind this episode, including full citations for every study discussed, in the Clinical References and Further Reading . 📖 Prefer to read? We turned this episode into a full blog post with structured tables comparing the racemic ketamine and esketamine evidence side by side, plus a research gaps summary you can reference and share with your team: Read the Blog Post Episode 64 show notes: 00:00:06 Episode Introduction 00:02:02 Clinical Context: Defining PPD, Postpartum Psychosis, and Perinatal Depression 00:03:34 Prevalence, Public Health Burden, and Why Cesarean Delivery Matters Here 00:04:40 Why Ketamine and Esketamine Are Conceptually Interesting in This Population 00:05:38 Prevention vs. Treatment: A Critical Framing Point Before the Research 00:06:32 Racemic Ketamine in the Peripartum Setting: Mixed and Conflicting Signals 00:09:22 What the Meta-Analyses Tell Us: Darwish et al. 2025 and Li et al. 2024 00:11:18 Bottom Line on Racemic Ketamine in the Peripartum Setting 00:12:05 Esketamine: Why It May Outperform Racemic and Why This Is Not About Spravato 00:13:32 The Esketamine Trials: From Early Signals to the 2024 BMJ Landmark Study 00:18:51 Treatment vs. Prevention: What About Established PPD? 00:21:29 Ethical and Practical Considerations 00:21:40 Lactation and Infant Exposure 00:22:14 Neurodevelopment Data: The Long-Term Unknown 00:22:35 Informed Consent in the Peripartum Period 00:23:04 The Tension Between Rapid Relief and Premature Clinical Adoption 00:24:10 Clinical Takeaways, Research Gaps, and What Cautious Optimism Looks Like in Practice 00:24:27 What the Evidence Supports: Esketamine Summary 00:25:23 What the Evidence Does Not Yet Support: Outpatient PPD Use 00:25:41 Bottom Line on Racemic Ketamine: Summary 00:26:07 Five Research Gaps the Field Needs to Address 00:27:56 What This Data Means for Ketamine Therapy Providers Right Now 00:30:03 Closing Remarks Thanks for Listening 📝 For Complete show notes along with the the research behind this episode, including full citations for every study discussed, please visit http://www.ketaminestartup.com/podcast/episode-064

August 17, 2026Episode 6321 min

Episode 63 - Opening a Ketamine Clinic: An Unconventional Path for Emergency Physicians (Episode From The Vault)

In this episode from the vault, we’re going back to when Sam gave a presentation at the American College of Emergency Physicians (ACEP) Scientific Assembly, making the case for why emergency physicians and clinicians are uniquely positioned to successfully practice in the ketamine therapy space. This is not a generic overview of ketamine. It is a frank, evidence-based conversation directed at clinicians who are feeling the weight of burnout, decreased autonomy, and a healthcare system that is asking more while giving less in return. Sam walks through the science, the mechanism, the financial realities, and the deeper question of purpose that every provider should sit with before taking the leap. If you have ever wondered whether your emergency medicine training could translate into something more fulfilling, this episode makes a compelling and well-researched argument that it can. What You'll Gain: • A clear picture of the mental health and chronic pain crisis driving demand for ketamine therapy, and why the current standard of care is falling short for so many patients • A walk through the key clinical studies supporting IV ketamine for depression, anxiety, PTSD, and chronic pain, including the landmark 2023 New England Journal of Medicine trial comparing ketamine to ECT • An honest look at the mechanism of action behind ketamine therapy, from NMDA receptor antagonism to neuroplasticity and BDNF, explained in language that makes clinical sense • Why emergency physicians bring a uniquely transferable skill set to the ketamine therapy space, and how that advantage plays out in practice • The financial and emotional realities of running a ketamine clinic, including what Sam wishes more providers understood before they opened their doors • Why knowing your why is the single most important thing you can do before starting a ketamine practice, and how it will carry you through the inevitable hard moments Episode 63 show notes: 00:00:00 Teaser: "This is the why, the purpose, the motivation." 00:00:34 Episode Introduction and Overview 00:01:45 The Mental Health Crisis: Why This Work Matters Now 00:03:48 Burnout and the Changing Landscape of Emergency Medicine 00:04:43 Why EM Physicians Are Uniquely Positioned for Ketamine Therapy 00:05:02 The Clinical Evidence for Depression: From the Berman 2000 Study to the 2023 NEJM Trial 00:07:25 The Clinical Evidence for Anxiety: Dr. Paul Glue's Escalating Dose Study 00:08:20 The Clinical Evidence for PTSD: Single and Multiple Infusion Data 00:09:41 The Clinical Evidence for Chronic Pain: What Works and What Doesn't 00:10:55 Mid-Episode Ad: Free Ketamine Startup Checklist 00:11:44 How Ketamine Works: NMDA Receptor Antagonism and Glutamate 00:12:19 Multi-Receptor Action, Neuroplasticity, and BDNF 00:13:30 Beyond the Mechanism: The Experiential Dimension of Ketamine 00:14:40 The EM Skill Set Advantage: Clinical Experience, Procedures, and Scheduling Flexibility 00:15:24 Emergency Medicine Is a Mindset, Not a Location 00:15:53 Before the How, There Is the Why 00:16:39 The Toxic Waste Pool: A Story About Purpose and Motivation 00:17:23 The Financial Reality: Don't Open a Clinic for the Money 00:18:14 Why You Should Open a Ketamine Clinic: Purpose, Autonomy, and Saving Lives 00:18:55 Patient Testimonials: In Their Own Words 00:20:17 Outro Thanks for listening 🎥 Prefer to watch? This episode was originally a live conference presentation with slides covering the clinical studies, mechanisms of action, and other helpful visuals. The YouTube version brings all of that to life: Watch Episode 063 on YouTube 📖 More of a reader? We turned this presentation into a full blog post covering the clinical evidence, why your EM training is an unfair advantage, the financial reality nobody talks about enough, and what patients say when the treatment works: Read the Blog Post 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-063 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist .

August 3, 2026Episode 621 hr 5 min

Episode 62 - What It Takes to Be the First: Building a Ketamine Practice in a Resistant Healthcare System with Dr. Lowan Stewart

Dr. Lowan Stewart is not just someone who opened a ketamine clinic. He is someone who built the infrastructure for an entire country to access it. In this conversation, Sam sits down with Dr. Stewart, an emergency physician who co-founded the first ketamine clinic in New Mexico in 2016, brought ketamine therapy to Norway two years later, established the first public ketamine treatment unit in Scandinavia, and played a central role in Norway becoming the first country in the world to approve national public reimbursement for off-label ketamine in treatment-resistant depression. What makes Dr. Stewart's story particularly resonant for our audience is how familiar the starting point will feel. An EM physician who loved his work but felt the limits of what emergency medicine could do for the river of suffering flowing through the department. A side project that became a calling. An uphill battle against institutional skepticism that most providers in this space will recognize immediately. He also brings a perspective on the future of psychedelic medicine that is worth hearing. His argument is straightforward: ketamine is not just a treatment. It is the infrastructure that will make everything else, psilocybin, MDMA, and what comes after, possible in clinical and public health settings. Getting ketamine right now is how the field prepares for what is coming next. This is a wide-ranging conversation covering career pivots, pioneering in resistant systems, the mechanics of moving a national healthcare system, and the daily reality of doing work that genuinely transforms lives. What you’ll gain: • The full arc of Dr. Stewart's career pivot from emergency medicine to ketamine therapy, including what pushed him toward something with more systemic and sustainable impact than the ER could offer • A firsthand account of what it actually looks like to be the first mover in a resistant healthcare system, from opening the first ketamine clinic in New Mexico to fighting a formal complaint from the Norwegian Psychiatric Association • How Dr. Stewart built the first public ketamine treatment unit in Scandinavia and the strategy behind getting ten major Norwegian hospitals to implement ketamine therapy simultaneously through a multi-site clinical trial • What Norway's landmark decision to become the first country in the world to approve national public reimbursement for off-label ketamine in treatment-resistant depression means for the global field and what other countries can learn from it • Why Dr. Stewart believes ketamine is not just a treatment but the infrastructure that will determine how ready clinical and public health systems are when psilocybin, MDMA, and other psychedelic medicines arrive • His honest reflection on why this work is worth it, including what it feels like to shift from focusing on the quantity of life in the ER to focusing on the quality of life in ketamine therapy Episode 62 show notes: 00:00:00 Teaser: "Once somebody says, 'I'm alive today because of this treatment,' you can't not do it." 00:00:24 Episode Introduction 00:02:19 Sam Welcomes Dr. Lowan Stewart 00:02:53 Background Overview: Emergency Medicine, Norway, and the Journey to Ketamine 00:08:56 Why Neuroscience: Starting an MD-PhD and the Rat Brains Advice 00:10:09 From Space Medicine Dreams to Emergency Medicine Reality 00:12:14 The Decision Point: Going Away from EM or Toward Something New? 00:15:37 Opening the First Ketamine Clinic in New Mexico: What the Ketamine World Looked Like in 2016 00:17:55 Bringing Ketamine to Norway: Opening Axon Clinic in 2018 00:20:06 Approaching the Norwegian Psychiatric Association and Health Department with the Data 00:26:40 Psychiatrist Skepticism: "I Don't Know What to Do with These Patients If They're Fine" 00:28:29 The Formal Complaint from the Norwegian Psychiatric Association 00:31:23 Establishing the First Public Ketamine Treatment Unit in Scandinavia 00:34:34 Axon Clinic's Acquisition by Awaken Life Sciences and the Ukraine War Impact 00:40:18 Norway's Landmark Approval: National Public Reimbursement for Off-Label Ketamine 00:44:20 The Multi-Site RCT Strategy: Implementing Ketamine Across Ten Major Norwegian Hospitals 00:50:17 Why Ketamine Gets Overlooked at Psychedelic Conferences and Why That Needs to Change 00:55:14 One Piece of Advice for Any EM Physician or Clinician Considering This Pivot 00:58:34 Rapid-Fire Questions 00:59:07 How Dr. Stewart De-Stresses: Cold Ocean Swims and Sauna in Norway 01:02:17 How to Connect with Dr. Lowan Stewart 01:04:03 Episode Ending Thanks for listening Connect with Dr. Stewart at: Clinic Website - Axonklinikken http://axon.no/ Email: lowan@axon.no Linkedin: https://www.linkedin.com/in/lowan-stewart-27349616/ 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-062

July 21, 2026Episode 6114 min

Episode 61 – Is Your Clinic Asystolic? The Marketing Framework Every Ketamine Provider Needs (Soundbites from the Vault)

In this Soundbite from the Vault, we're revisiting a carefully selected segment from a live conference presentation we gave to a room full of ketamine therapy specialists, walking through the exact marketing framework we've built and refined over the years. Not familiar with our Soundbites from the Vault? These are shorter, standalone segments from earlier episodes that we think are worth revisiting: easy to digest and immediately relevant to your practice. This one is a little different from our typical guest interviews. It's practical, visual, and built for providers who are doing their own marketing, outsourcing it, or using AI tools to help, and who want to understand the thinking behind it all. Because the framework matters regardless of who's doing the work. We cover the full ACC model: awareness, consideration, and conversion, breaking down exactly where every marketing effort you're making fits inside it. Then we get into organic content, what it actually is, how to create it sustainably without burning out, and our Venn diagram approach to figuring out what to talk about in the first place. And if you stay to the end, you'll hear why your clinic's online presence may be one of its most important vital signs. If your marketing has ever felt scattered, reactive, or disconnected from any real goal, this framework gives you the language and the structure to change that. What You'll Gain: · A clear understanding of the medical marketing funnel and how every marketing effort you make maps to one of its three layers: awareness, consideration, or conversion · The ACC framework explained through a relatable analogy that makes the patient journey easy to visualize and remember · A practical Venn diagram approach for figuring out what content to actually create, where what your patients want to know meets what is authentic to you · A simple content creation system that turns one video into a blog, social media posts, and micro content across platforms · Why your clinic's online presence is one of its most telling vital signs, and what asystole, bradycardia, and atrial fibrillation have to do with your Instagram account Episode 61 show notes: 00:00:00 Teaser: "What you want to be is in normal sinus rhythm…" 00:00:19 Episode Introduction 00:01:43 What Is the Medical Marketing Funnel and Why Should You Care? 00:02:08 The ACC Framework: Awareness, Consideration, and Conversion Explained 00:02:35 Awareness: How Patients First Discover You and What Content Helps Them Find You 00:03:45 Consideration: Why Patients Compare Their Options and How to Stand Out 00:04:24 Conversion: Making It Easy and Frictionless for Patients to Say Yes 00:05:13 Want More Patients? Start by Growing the Top of the Funnel 00:06:34 What Is Organic Content and How Is It Different from Paid Advertising? 00:07:58 The Venn Diagram: Finding the Sweet Spot Between What Patients Want and What's Authentic to You 00:08:14 What Your Patients Actually Want to Know 00:08:29 Why Authenticity Is What Turns Generic Content Into Content That Connects 00:10:00 From One Video to a Blog, Social Posts, and Micro Content: The Content Creation System 00:12:02 Is Your Clinic Asystolic? Why Organic Content Is One of Your Most Important Vital Signs 00:13:41 Episode Ending and Resources Thanks for listening Selected Links From the Episode: Want to go deeper? This soundbite comes from Episode 035 – The Medical Marketing Funnel for Ketamine Clinics , where we cover the full conversation including a deep dive into the newsletter as a standalone marketing tool for your practice. 🎥 The marketing funnel, the Venn diagram, and the organic content framework are all significantly easier to follow when you can see the slides. Check out the full Episode 035 on YouTube to watch the original presentation with all the visuals included: Watch Episode 035 on YouTube 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-061 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀 Want to fast track launching your ketamine clinic? If so, download our free checklist .

July 7, 2026Episode 6016 min

Episode 60 – Why Music Is More Than Background Noise in Ketamine Therapy (Soundbites from the Vault)

We're taking it a little easy in July, and in the spirit of that, we're launching something new: Soundbites from the Vault. These are shorter, standalone segments from earlier episodes that we think are worth revisiting, easy to digest, and immediately relevant to your practice. For our first soundbite, we're revisiting one of our favorite conversations from Episode 32 with Steve Gelberg, author of Tuning In: Experiencing Music in Psychedelic States. Steve spent years researching the intersection of music and psychedelic-assisted therapy, and what he shares here has direct practical implications for how you're running your ketamine sessions. This segment gets into something most providers haven't thought deeply about: music isn't just filling the silence. It's doing active therapeutic work, from calming a patient's first fear response as ketamine comes on, to opening access to the subconscious material that makes treatment meaningful. Steve also covers the practical side, including what types of music to use, why lyrics are generally a problem, and how to think about the classical versus ambient debate without getting dogmatic about it. If you've been using the same playlist since you opened, this one is worth 15 minutes of your time. What You'll Gain: · Why music and psychedelics share a unique therapeutic synergy rooted in how both interact with emotional and subconscious experience · How the right music can calm the ego's fear response during the onset of a ketamine session and support deeper therapeutic outcomes · Why lyrics are generally avoided during psychedelic-assisted therapy and what instrumental genres tend to work best · The case for neoclassical music as a middle ground between classical and ambient for ketamine sessions · How to think about patient-chosen music versus therapist-curated playlists, and why avoiding dogma matters more than finding the perfect answer Episode 60 show notes: 00:00:00 Teaser: "The right kind of music…” 00:00:33 Episode Introduction and Soundbites from the Vault Launch 00:01:32 The Shared Ontology of Music and Psychedelics 00:03:37 How Psychedelics Open the Emotional Sphere of Consciousness 00:04:41 The Unique Therapeutic Synergy Between Music and Ketamine 00:05:08 What Music Is Actually Doing at the Onset of a Ketamine Session 00:05:55 How Music Helps Surface the Root of Depression, Phobias, and Trauma 00:07:01 Music as an Ancient and Primal Human Tool: Lullabies and Soothing 00:08:25 The Case for Healing Female Voices in Psychedelic-Assisted Therapy 00:09:41 How to Choose Music for Ketamine Sessions: A Provider's Guide 00:10:23 The Classical vs. Ambient Debate: Origins and Context 00:11:36 Why Lyrics Are Generally Avoided During Ketamine Therapy 00:12:39 Neoclassical Music: The Best of Both Classical and Ambient 00:13:39 Avoiding Agitating or Overly Dramatic Music in Sessions 00:14:11 Patient-Chosen vs. Therapist-Curated Playlists 00:15:12 Why There Should Be No Dogma Around Music Selection 00:15:48 Episode Ending and Resources Thanks for listening 📝 Want Steve's exact playlists and a link to his book? Everything is in the show notes at https://www.ketaminestartup.com/podcast/episode-060#links

June 23, 2026Episode 5959 min

Episode 59 - Rethinking Set and Setting: Dr. Roberto Malinow's Revolutionary Hypothesis on How Ketamine Actually Works

This week, host Sam Ko goes upstream from our usual clinical and business topics to sit down with Dr. Roberto Malinow, emeritus professor at UC San Diego, member of both the National Academy of Sciences and the National Academy of Medicine, and one of the world's leading researchers on synaptic plasticity and NMDA receptor biology. His work has been cited more than 30,000 times, and his recent perspective piece takes a very different view of what's actually happening during a ketamine infusion. The core of this conversation is his hypothesis that ketamine works by selectively weakening hyperactive brain circuits, but only the ones actively firing while the drug is on board. It's a finding that raises some genuinely uncomfortable questions about the standard set and setting approach, and points to chronic pain treatment as a practical place to start testing these ideas clinically. You'll also hear about the brain's "disappointment center," the lateral habenula, and why it may be hyperactive in depression, the Stanford anesthesia study and what it suggests about brain activity during treatment, and a wide ranging look at consciousness, optogenetics, the gut-brain connection, and what basic science still doesn't fully understand about how psychiatric drugs work. What You'll Learn in This Episode · Revolutionary ketamine mechanism - How Dr. Malinow's hypothesis suggests ketamine works by weakening hyperactive brain circuits, but only when those specific circuits are actively firing during treatment · The disappointment center concept - Understanding the lateral habenula as the brain's disappointment center that inhibits dopamine and may be hyperactive in depression, serving an evolutionary purpose in reinforcement learning · Challenge to set and setting orthodoxy - How activating negative thoughts or painful experiences could possibly enhance therapeutic outcomes · Neuroplasticity fundamentals - How synapses can be rapidly modified and why NMDA receptors are crucial for both strengthening and weakening neural pathways, forming the basis for learning and memory · Rapid vs. delayed therapeutic effects - Why ketamine can work almost immediately while traditional antidepressants take weeks, and what this reveals about different mechanisms of action · Chronic pain treatment implications - How activating pain circuits during ketamine infusions might be more effective than current protocols, and why chronic pain could be the ideal testing ground for this hypothesis · Basic science translation - How laboratory findings about synaptic plasticity and NMDA receptors connect to real-world therapeutic applications in depression, PTSD, and pain management · Optogenetics technology - How scientists can now deliver light-sensitive proteins to specific neurons, allowing precise activation or inactivation of brain circuits to study behavior and memory · Memory manipulation research - Fascinating studies showing how specific memories can be turned on and off using targeted brain stimulation, with implications for trauma and addiction treatment · Consciousness and synaptic function - Exploring the complex relationship between individual neurons and higher-order brain functions, and why bridging these levels remains challenging Episode 59 show notes: 00:00:00 Teaser: Those hyperactive circuits… 00:00:24 Episode Introduction and Guest Overview 00:01:12 Sam Introduces and Welcomes Dr. Roberto Malinow 00:02:41 Background: From Reed College to The MD/PhD Path 00:05:17 Why Basic Science Won Out Over Clinical Medicine 00:06:06 The Lecture That Started It All: Professor Rodolfo Llinás and Synapses 00:06:51 How Ketamine Interacts with the NMDA Receptor 00:07:47 The "Disappointment Center": What the Lateral Habenula Does and Why It Matters in Depression 00:09:16 The Standard Set and Setting Approach in Outpatient Ketamine Clinics 00:10:12 The Three-Part Hypothesis: Neuroplasticity, Hyperactive Circuits, and Negative Thoughts 00:11:49 Written Exposure Therapy and PTSD: Priming Circuits Before the Infusion 00:12:53 Chronic Pain as the Easier Testing Ground for the Hypothesis 00:14:20 Activating the Pain Pathways During a Ketamine Infusion 00:17:23 The Anesthesia Study (Heifets/Stanford): Why the Brain Needs to Be Active 00:18:48 What Would a Human Study Design Actually Look Like? 00:20:41 Animal Study Evidence Supporting the Active-Stimulus Hypothesis 00:21:33 Zooming Out: Synapses, Consciousness, and the Shakespeare Analogy 00:23:18 Optogenetics Explained: Using Light to Control Specific Neurons 00:27:31 What Don't We Understand About Depression? 00:28:29 Lateral Habenula in Animal Depression Models and Dr. Malinow's Own Experiments 00:29:13 The Dystopian Scenario: Using Ketamine-Like Drugs to Wipe Out Ideas 00:31:31 Common Misconceptions Clinicians Have About Synapses 00:32:47 What Surprised Dr. Malinow Most About Studying Synapses 00:35:15 Why Ketamine Works Rapidly While SSRIs Take Weeks 00:37:30 The "Party Trick": Learning Is Neuroplasticity in Real Time 00:39:13 NMDA Receptors and Their Role in Learning and Memory 00:39:47 Optogenetics Research: Turning Fear Memories On and Off in Animals 00:42:08 Glutamate: 90% of Synaptic Transmission Explained 00:43:55 Synapses in the Gut: The Enteric Nervous System 00:45:58 The Gut-Brain Connection and Future Research 00:46:23 Papers Worth Reading in the Ketamine Space 00:47:50 The Psychedelic Renaissance: Psilocybin, the Disappointment Center, and What's Next 00:50:20 Could the Activation Hypothesis Apply to Psilocybin and MDMA as Well? 00:52:57 Rapid-Fire Questions Begin 00:53:19 Time Travel 00:54:19 Hidden Talent 00:54:48 Alternate Career 00:55:42 Advice to 18-Year-Old Roberto 00:56:29 Final Thoughts and Call to Action for Clinicians 00:57:00 Where to Find Dr. Malinow's Research (UCSD Website) 00:57:40 Sam's Closing Remarks 00:58:32 Episode Ending Thanks for listening Connect with Dr. Malinow: Website: https://biology.ucsd.edu/research/faculty/rmalinow Email: rmalinow@ucsd.edu 📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-059 Follow us on Linkedin Ketamine StartUp Website YouTube 🚀Want to fast track launching your ketamine clinic? If so, download our free checklist .

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