Dr. Glen Brooks is the Medical Director of NY Ketamine Infusions and is generally recognized as the nation’s leading practitioner of Ketamine Infusion Therapy for depression and chronic pain. In 2012, Dr. Brooks founded NY Ketamine Infusions in New York City as one of the world’s first therapy centers dedicated exclusively to providing ketamine infusions.
To date, Dr. Brooks has helped more patients than any other provider, having treated over 4,000 patients for major depressive disorder (MDD), generalized anxiety, obsessive-compulsive disorder, post-traumatic stress (PTSD) and neuropathic pain. Building on over two decades of clinical research at major institutions like Yale University and the National Institute of Mental Health (NIMH), Dr. Brooks was at the forefront of introducing this innovative treatment to patients in need.
On April 5th, NY Ketamine Infusions entered into a LOI with Myconic Capital Corp. (CSE:MEDI) to sell 100% of its clinic operations, with Dr. Brooks continuing on as the treating physician and chief medical officer.
What made you personally excited about psychedelics?
I have been interested in any new therapy or development that is safe and predictably effective in treating otherwise treatment resistant mood disorders, including Post Traumatic Stress Disorder, Major Depression, Anxiety, and Obsessive Compulsive Disorders. As such, I have been treating patients with intravenous ketamine infusions for almost a decade.
The emerging field of psychedelics offers interesting and exciting new opportunities for this kind of treatment when traditional psychiatric medications that target “chemical imbalances” have fallen short of the great expectations over the last five decades.
At the moment, we work exclusively with ketamine infusions. While ketamine often has been grouped with true psychedelics, I do not feel that it should be. True, ketamine can act similarly to a “psychedelic” in high doses, but the dissociative experience is not the goal of ketamine infusion therapy. After decades of research at major medical centers and the National Institute of Mental Health the science of the mechanism of repair is now on solid footing. Ketamine achieves a synaptogenic-neuroplastic repair between mood center neurons. This repair is quite independent of any dissociative experience during the infusion.
You were foundational in the early stages of Ketamine as a treatment for depression and other disorders. Why did you first decide to create NY Ketamine Infusions and begin offering these treatments?
As an anesthesiologist I have been administering ketamine as a general anesthetic agent for nearly 50 years in both inpatient and outpatient settings. It is an extremely safe general anesthetic agent with wide application. Ten years ago, I decided to move into the field of addiction medicine, another interest of mine. While effectively getting patients through withdrawal and off opiates, the relapse rates were staggering. The opiates are very effective in treating depression and anxiety, often times much more effective than traditional psychiatric medications. In fact, those patients who relapsed were self- medicating with the only class of drugs that worked for them.
About that same time a psychiatrist at a genetics lab I was using to identify genetic alcoholics asked me if I was aware of the burgeoning literature and research using ketamine to treat treatment-resistant mood disorders. The research was rich in the psychiatric and neuroscience literature, but nowhere in the anesthesia literature. I dove right in, reading every research article I could find and talking to the only two psychiatrists on the East Coast who had already incorporated ketamine into their practices; Dr. Steven Levine in Princeton, and Dr. Keith Ablow in Boston.
It was an easy transition from addiction medicine to establishing a ketamine infusion center. Then, rather than treating the symptom of the mood disorder, i.e. opiate addiction, I was actually treating the underlying cause of the need for self-medicating. Since then, the successes have been nothing short of remarkable.
Today, the vast majority of our patients are diagnosed with Post-Traumatic Stress Disorder resulting from childhood stress or overt trauma. It manifests itself in many ways including Major Depression and Anxiety with suicide ideation, Obsessive Compulsive Disorders, Rumination, and yes, in some patients Alcoholism or other substance abuse as patients try to self-medicate their crippling mental pain.
NY Ketamine Infusions is the largest Ketamine Therapy clinic in North America and has been operating for nearly a decade. In that time, what new things have you learned about the possible therapeutic potential of ketamine?
We are in our ninth year. We have successfully treated patients from 14 years old to 80 years old with very high success rates, exceeding 70%. What we have learned is that patient selection is important, and we are much better able to predict who is likely to benefit from ketamine infusion therapy. We also have learned the importance of proper ketamine dosing, and how varying the speed of infusion can optimize each patient’s infusion experience and outcome. There is no recipe for what we do. One size does not fit all. I cannot overstate the importance of experience in the field, and having a dedicated and well-trained staff that is responsive to each patient’s needs.
NY Ketamine Infusions is working with people suffering from PTSD, OCD, Anxiety, BiPolar Depression, and, of course, depression. Why has NYKI expanded their treatment options to other disorders?
95% of our patients are being treated for mood disorders. However, there is a tremendous need for an effective treatment for Central Neuropathic Pain Syndromes that only respond to ketamine infusion therapy. We fill that need as well. The protocols for mood disorders and pain management are quite different. As an anesthesiologist with pain fellowship training, I am qualified and comfortable taking care of these patients.
Other than ketamine infusion therapy we do not offer any other in-office treatment options for either mood disorders or pain management.
You’ve provided more than 50,000 ketamine treatments to 4,000 patients. What kind of experiences have you seen, in terms of efficacy, safety and impact?
We do have the largest single office ketamine experience in the world. As a result, our statistics do have merit. With careful patient selection and individualized treatment plans our overall success rate is greater than 70%. Following the initial six infusions, 70% of patients will experience what they consider to be significant if not dramatic improvement in both mood and function, allowing them to return to a more regular work and/or home-life. The impact on their lives is often life-changing.
That percentage of improvement does vary with age. Younger adults have success rates that approach 80%, while more senior citizens enjoy efficacy only 60% of the time. The explanation has to do with the brain’s neuroplasticity, which decreases with age.
Ketamine is extremely safe. There have been no instances of in office morbidity or mortality in what is now approaching 60,000 infusions, and we have witnessed no long-term side effects in any of our patients. Doses for depression treatments are quite low, far lower than the doses used for anesthesia.
Why have you decided to focus on intravenous delivery and what does that type of treatment involve for someone who may not be familiar with it?
Intravenous ketamine remains the “gold standard” for racemic ketamine delivery. It is the only delivery model where a clinician is certain of the dose received, and has control over the rate of delivery. With oral and nasal ketamine the absorption is erratic and unpredictable, making any measure of efficacy less certain. With intramuscular ketamine the dose delivered is known, but the speed of uptake cannot be controlled. It is possible for a patient to achieve very rapid and high blood levels of ketamine. Thus, the patient may be thrown into a frightening dissociative experience with no venous access to deliver “rescue” medications. For more information about our view of intravenous versus other delivery methods, you can check out this link on our website.
Can Ketamine affect long-lasting changes to the brain through stimulating synaptic growth? What are some of the things you have learned about ketamine as a therapeutic that many people may not know?
Many patients come into the office with pre-conceived ideas about ketamine based on urban folklore. One of the myths is that ketamine “doesn’t last.” Well…“last” compared to what? Psychiatric meds need to be taken daily, and the efficacy often fades with time. Talk therapy is also ongoing and typically requires weekly sessions.
While not every patient will respond to ketamine therapy, those that do can generally be maintained with periodic boosters that usually begin at monthly intervals, but which often become needed even less frequently until no longer needed.
Remember, ketamine is restoring mood center structure; it’s an anatomic repair, not a fleeting chemical fix as with oral medications requiring daily dosing. Typically, for those responders, an initial course of infusion therapy is six infusions over a two week period. In most cases, patients continue to feel well for four to six weeks before experiencing a mood decline. At that point a booster infusion restores their mood and function for another similar period of time. The need for boosters is usually not for the rest of their lives. Most patients do return for booster infusions on a somewhat regular basis for a year or so, after which the need to come in begins to drop off rapidly with the interval between booster infusions getting longer and longer until they no longer need to continue care.
How does NYKI intend to grow and expand in the future?
In terms of increasing patient numbers, there will eventually be physical plant constraints. We do have the ability to further increase the number of patients we are seeing in our Manhattan office, plus opening a new office in Melville, Long Island has further increased our reach and growth. Given our skills and experience in the field, we also plan to add additional infusion centers in other locations as long as we feel we can provide excellent quality of care. Since I cannot be everywhere all of the time, growth will include the addition of other physicians, and of course, additional medical support and administrative staff. Careful selection of clinicians is critical, and I will always be available to train, consult with and monitor any new physicians.
While ketamine remains the focus of our growth and the mainstay of our revenue stream, NYKI will integrate other therapeutic modalities, including psychedelics, at the appropriate time assuming that these medicines are legalized and current trials continue to prove that they are both safe and effective. Our experience with ketamine puts us in a unique position where we understand how to best administer these medicines for successful patient outcomes.
What do you believe is the most important thing for people to understand about the future of psychedelics as medicine?
While there is tremendous enthusiasm in the world of psychedelics, and we are very enthusiastic about the prospects, we are currently tempering our expectations and trying to be realistic about the near-term applications.
As we know, although we fully believe psychedelics will become a revolutionary new treatment and the trend is moving strongly toward decriminalization, psychedelics like MDMA, psilocybin, ayahuasca and LSD are not yet legal, and legalization will take time. Consider ketamine, a drug that is and has been an important general anesthetic agent for 55 years and is on the World Health Organizations list of top ten most essential drugs. There are now perhaps 400 scientific papers showing ketamine’s efficacy and safety in treating mood disorders yet it is not FDA-approved and needs to be prescribed “off label.” For better or worse, only rarely do insurers pay for ketamine therapy. It could be quite some time before psychedelics receive FDA approval.
Ketamine is also very predictable in terms of the amount of time it takes to interview a patient pre-treatment, and the amount of time that patients will spend in the office. This allows for ease of scheduling and maximizes the number of patients that can be helped in a given day. Intravenous Ketamine is metabolized quickly, and patients can receive treatment and be ready to leave the office within 90 minutes or so.
As psychedelics are introduced, the business model will need to change significantly. Patients will require time with mental health providers prior to treatment to receive counseling, instructions, and to set intentions, and patients will need to be constantly monitored while undergoing their experience. Since the reaction to the psychedelic meds can vary greatly and lasts far longer, often up to six hours, the in-office time is also uncertain and very few patients can be seen in a given day. The strength of the psychedelic experience is also quite profound and will require ongoing post-treatment integration, which requires additional professional staff. With the larger overhead and more limited patient turnover, the business model will have to be refined to make the treatments both successful and affordable, and we remain concerned that it may be difficult to design a profitable way to deliver this type of mental health care to the “masses.” The prospects are exciting and we’re very enthusiastic about the future use of psychedelics for mood disorders, addiction and other intractable problems, but it’ll take some creativity and imagination in dealing with the economics and our current healthcare system to make it work for the many people who can benefit from their use.