Be Informed. Be Well. With John Malanca

Ketamine and Depression: A Doctor's Perspective With Paul Bregman, MD

May 10, 2022 John Malanca Season 1 Episode 47
Be Informed. Be Well. With John Malanca
Ketamine and Depression: A Doctor's Perspective With Paul Bregman, MD
Show Notes Transcript

Join John Malanca and his special guest Paul Bregman, MD as they paint an intricate portrait of depression and the uses of ketamine from the unique vantage point of an MD in the field.

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John Malanca  0:00 
Welcome back, John Malanca, United Patients Group Be Informed. Be Well. I have with us a returning special guest Dr. Paul Bregman. Paul, how are you?

Paul Bregman, MD  0:13  
I'm doing fine. It's nice to be back live on camera.

John Malanca  0:15  
I didn't tell you you're live yet. Good to see. So So, Paul, so for our audience members, you know, Paul, credit when credit I started United pacemaker back in 2011, I think you were one of the first people we met at a conference, and we'd always see your face and I, and you spoke and, and I'm like, okay, you know, who's this guy? And, and, you know, it's our paths have always crossed and then I remember we were in our I was in where we patients at a time, and I was emceeing the conference and in New Jersey, and I look out in the audience and, and it was months after Corinne passed, and I was my just get out, get back out there. And, you know, don't give up. And I remember seeing you in the audience. And I was like, You came up to me afterwards and just said, and so it was nice to see a familiar face. And so, you know, you go through a lot, you know, everyone has his book on the outside cover of what we all everyone perceives us. Oh, Dr. Bregman, MD must be successful must be doing this too. It happens with everybody. And what I didn't know is that you've been going through depression for years, but also diagnosed later in life with a type two bipolar. I don't know if you'd call it disorder or not. But and so can you share that because you're, we've done a couple of podcasts. We've done a couple Facebook Lives. And it's amazing on how many people that we talked to I talked on a regular basis. Hey, I just saw that video with with Dr. Bregman that helped me it made me feel that I'm not alone. And so thank you for being open and honest. And I know you're still going through things, but I just want to need you to know that you're not alone. And your story is helping others here too. So let's get on it. Man. I was it's been a, you know, we did we did our first podcast probably about a year and a half, two years ago. And what are you been doing? I know, we talked about, you know, other modalities. Besides cannabis. You've been on antidepressants before you've gone to therapist, you've looked at suicide,

Paul Bregman, MD  2:28  
and categorized. So I've done a number of different things. And I was diagnosed, I went through a diagnostic radiologist and Academy and a cannabis expert. And so I was diagnosed, my father had bipolar type, bipolar, and my mother did as well. So I, genetically I picked it up from then them and it really started at 29 When I started my residency, and then was officially diagnosed at 41 When I was feeling more depressed, and everything and then at 45. I had a retired disabled because of depression and suicidal ideation, and also irritability. And that's bipolar two, I had bipolar, two bipolar one is when people are very manic, and also have depression, but manic where they're really not sleeping and they may have psychosis and voluson. I suffer more bipolar two is more of the Depression, and more of the irritability. And also suicidal is a component of this that has a lot of suicidal ideology. So I think about suicide. I haven't tried to commit suicide. I've been in a gun shop a couple of times, but I've always gotten scared. And the key thing about keeping me from staying alive has been the fear of killing myself. And then I got married and I have young kids and I was fearful of leaving that permanent mark on them. So with the history of bipolar type two and I was working as a radiologist and I finally in 1995 when I was 45 years old, I had to retire disabled because of the depression and the suicidal thinking. And I was working with a psychiatrist there and he gave me Every medicine that was on the market from bibble villified, Seroquel to to anything else. And none of it really worked. I was in that category of being treatment resistant. So with that in mind, I went to get electroshock therapy, a full dose from 1994 to 2002. And there was a mishap in 2002 And it always helped me. And it was a benign procedure. And hope always helped me get out of the depression in the end, so I would recommend that or look into that. And so I had a bad episode. I didn't go back for 18 years. And then I went back. And after the second treatment, it it aggravated a heart flutter, atrial fibrillation. So that has moved me into suffering with my illness with the suicidal ideation and depression. But I've moved into looking at ketamine. Ketamine is out there in clinics now, and it's done to those psychedelics type of thing. So what I've been doing is ketamine. Ketamine infusions, they do it nasal spray, they do it pills, but I get an infusion for like an hour. And it's taking like a small trip out there. But during that hour, when I come back after the hour of the infusion, I feel no more suicidal thinking, no more depression, and no more rumination. But the problem is, it only lasts for about 36 hours, short acting thing for me. So that is incorporated, in my help, and I'm working with the insurance company. But the major thing has been for me, because of the no medicine working from age 45 To really now I'm 72 Is that I've used cannabis along the way. And cannabis has been a lifesaver for me, because it has lifted my mood and helped with my anxiety as well. And so, that came as a lifesaver, that if I didn't have that I would not really have any medicine on the market to use to help me with my mood disorder. This is a mood disorder

John Malanca  7:02  
that worked for you. You know, for our audience members, ketamine, ketamine was just I guess, introduced in Belgium. It's funny, I live in Belgium and but ketamine would use in Belgium for anesthesia for animals, actually, some people would say it was a horse tranquilizer, and that was in the 60s in the 70s. It was used as an anesthetic antiseptic, in the Viet Nam war. And then as time went on in the 70s, and 80s, a lot of paramedics when they're helping someone who is attempting suicide, and there are manic as you're talking about, they were using ketamine, once they saved them, and how they did it out of his a nasal spray or pill or IV, that it would just calm them down, and they'd be able to take them to, I'm assuming the hospital or psych ward, just calm down. And as time went on, even with cannabis, where you're seeing all these studies, like, I'll be darned it works for this, it works for this work. Boy, we might want to start looking at this as as another modality for whatever ailment and they're finding that with ketamine with with patients that we're seeing the benefits with this, let's do some studies. And so now, it has become becoming, I guess, used more often. I don't know if it's legal in all states, I believe it's legal in California, you're in Colorado. And the there's an FDA approved nasal spray, which insurance covers and so for you're talking about doing the you're talking IV correct is what you're doing those those treatment infusion treatments. Yes. And so does insurance cover that. Yeah. So what's the difference between the nasal spray and that is covered by insurance versus an IV infusion? Which is not what why what, why not

Paul Bregman, MD  8:54  
one is FDA, when is FDA approved and what not.

John Malanca  8:59  
Gotcha. So is that like, is that like Marinol? FDA approved and get? Yes, yes.

Paul Bregman, MD  9:06  
And it's not that effective. It's effective for some and they even have a shorter even have a pill now, a ketamine pill as well.

John Malanca  9:14  
Yeah, I knew that and so is it is it and what is the milligram dose? Because I you know, over the years, you know, hearing, you know, through college stuff,

Paul Bregman, MD  9:25  
like, again, varies with with the infusion, it was it's like point five five milligrams per kilogram was a 55 milligram dose. But it was a very trippy dose. I mean, it was very, very powerful in my mind where I wasn't, I mean, I didn't recognize that my shoe feet were connected to my legs, you know, during this, and it was it was that way, but the powerful of it. After an hour it was over. And then I walked out of the office and I just had all of the bad feelings go away. But that's just, that was just the medicine. And I think with the site situation, it really needs not only do you need a psychiatrist handling a medicine, but you need a therapist that you're talking to on a regular basis, you need a case manager that's going to look at your life, you need a vocational rehab person that's going to help you get a new career. And the biggest thing is that came into my life was that I got involved with a conservator, someone to handle the money, because you're sick. And you go to the psychiatrist, and he talks about a lot of different things. But no one is leading you outside of the office to handle the other aspects of your life. And if you're not married to someone who can handle all of those things, or if you're all alone, you need a team around you. That's the key thing.

John Malanca  11:02  
You mentioned type one being manic, you know,

Paul Bregman, MD  11:07  
more Matt Mormon I have hypomania. And type one has real Manik with their noses pressed against the window.

John Malanca  11:15  
Gotcha. Because I remember one of our previous conversations last year or two you're talking about, you know, if you made $1, you spent $5, you know, with managing money is that I remember that correctly, because that happened with my friend's daughter, you know,

Paul Bregman, MD  11:32  
there was no budgeting I had no conception, and I could rationalize away spending money as well, when I should have had somebody in control take, if I was getting $10,000 a month from disability, I should have had that should have gone to someone and take it away. And I should have worked with $7,000 Yeah,

John Malanca  11:53  
yeah. Yeah. So So is this is this working? You know, is it working, because I know, you know, our conversations over the last month, you know, it sounded like it was working. But you know, before jumping on the screen here, it sounds it sounds just like this, it was just a temporary, temporary fix. And if it isn't

Paul Bregman, MD  12:11  
a temporary fix, I have my psychiatrist, and the case manager, Humana, trying to fix this for me and get this approved. So I can have the ketamine aspect of things and go from there. As far as the team approach, being the conservator and the case manager, and Voc Rehab and things like that, that all came into place, as well, and really kept me from becoming homeless.

John Malanca  12:42  
So when you get let me ask you something, because this has happened. First off, my mom says, Hello, she really felt connected with you. And being a great mom. You know, she just wanted to give you a hug on one of our past few past things. And so knowing that we're doing that she's Oh, please don't tell Dr. Bregman. I said hi. And then Beth Das, who's not only a dear friend, personal friend of of mine, but in the United Patients group, she's a nurse. And she's experienced this with some of her patients. And so, you know, she has shared your story numerous times. And when I did share that I was going to be doing this. She's Oh, please tell him I said hi. And so again, that's at the beginning of this of this podcast, I said, you sharing your story, and how easy or how hard it may be for you. You're not alone, and you're helping others. And so I just want to say thank you because, you know, sharing personal stuff. You know, complete strangers, sometimes. Sometimes it's helpful, and sometimes it's, you know, it's you know, it's difficult to do. So I do. Thank you for that. So with you one thing Beth Beth brought up this morning when I was sharing with this, she said ask Paul, because I don't know if it's a family member of her family. Bipolar and the spouse passed away, and that spouse was their safety blanket. And once that spouse passed away, all the manic stuff started coming back. Do you see Did you see more of that not only with one divorce, which, you know, I've not experienced that, you know, I've experienced breakup, and of course, the loss with Corinne, having the loss of that, but also your kids now, in that teenage year where they're moving on, we're like, they don't want anything to do with mom and dad. Does that bring up a lot of stuff that your your daily stuff that's coming up of not having that security blanket anymore? Being alone? Yeah.

Paul Bregman, MD  14:40  
Being I'm glad I left. The person that I was married to, was more of a rescue marriage and we didn't belong together. So it's better for the kids. When I left and they were three and six. And they even had a sense that we didn't belong together. It's been In out of that relationship, I didn't necessarily realize that what I needed as a mental illness patient. And bipolar is really stability, and also this solidness of type thing. But I didn't work on that, to get to move to that point until very recently. So yeah, it's been an alone type of illness. And I didn't know how to deal with with it. But now I have a better idea about how I deal with it. And with the kids going on, I think the kids are developing their own personality. And I think part of them is that they have grown up to a degree afraid of seeing their father's sick.

John Malanca  15:51  
Yeah, who wants to see that? For others that are going through this depression, anxiety, loneliness? Are there support groups that you can share with others? Are there any like, like, you hear people going through AAA, and I think

Paul Bregman, MD  16:06  
they have to look up their local support the Colorado Alliance for the Mentally ill, I think there are ones that could be Googled, you know, as well for for support, because I think support is very key. But I really get back to that team approach of it's not just the psychiatrist. It's not just the therapist, it's the conservator to have the money. It's the voc rehab, it's a case manager, it's all of these other components to plug in to the patient, so that they have these pieces that are filled in, because I would have if I would have had this team at 45, I would have had a couple of million dollars, I would have certainly a job, I would have, you know, I would have had these other aspects of my life that would have been filled in. And so for the psychiatrists never addressed these issues. And therefore, I left his office, but I was still on the outside looking in. I didn't have it under control outside his office. Yeah. So people have to kind of remember that aspect. as well.

John Malanca  17:22  
Gotcha. Let's, let's go back to this ketamine treatment, you know, I really know, know a lot about it. And so I'm assuming our audience, I hear about it. I've heard about it for years as even, it was even at one point. You know, like, a club drug wasn't like, like ecstasy and stuff like that people would call it to prepare Special K, I believe that. But this is not, this is not what you're doing. Can you give us a walkthrough of what a treatment because I know we were supposed to film this last week, he said, John, I have I have a treatment. And so can you share with our audience,

Paul Bregman, MD  18:00  
this is a low, this is a Cisco used in the operating room and still use that those high lows, this is a very low dose, according to your weight, but low dose, and it's given to me in an infusion. And what I'm feeling is a dissociative, lovely experience from my body within the hour, as the IV is running. And that's giving me a rewiring or reset of my neurotransmitters. So that the thoughts that I went in with suicidality, and depression and rumination is all reversed by the effects of the IV ketamine. And during my trip, I'm dissociated from my body, and I'm floating around the room, and it's relatively pleasant. And then after that, they put a new IV and they flush it out of my system. And I'm back to having this type of discussion with you.

John Malanca  19:04  
So, two things, there's a trip the way you describe it, is it the last two hours? Because I know at the beginning, you said some about 30,

Paul Bregman, MD  19:13  
just less than our last, like 40 minutes. And so what was the

John Malanca  19:16  
36 hour thing that you were talking about at the beginning of our conversation?

Paul Bregman, MD  19:21  
36 hours of not, maybe not, not feeling suicidal, not feeling depressed, and not having rumination?

John Malanca  19:30  
Gotcha. So, since you, I'm assuming this is what you go through on a daily basis, weekly basis? I mean, is it constantly here and is Is it safe to do ketamine on a regular basis or is it too because it's not covered by insurance, what you're doing? Is it too expensive and what is what is the cost if that was out of pocket,

Paul Bregman, MD  19:54  
three, transit $75 Sometimes the insurance somebody will pay some Sometimes they won't pay anything, they want you to have at least 5678 treatments. And then hopefully, the effects will spread out and be longer. I had a trip. And so along the way, in each time I had the treatments, it lasted for 12 To 24 to 36 hours, and then it disappeared. So that was my personal case.

John Malanca  20:31  
And is there any, I guess, warnings or side effects that they take to the doctor affect? Brain heart? livers, kidneys, and anything else like that? No, really? And you you being in the medical profession and have been for quite some time? Is this something that you would recommend for? Young I would hot?

Paul Bregman, MD  20:58  
Yeah, I would say those were the medicine, I would say go through the medicine and see if it works and see what side effects you're experiencing, because like Depakote is given out there. But people wind up gaining 5060 pounds of become diabetic. They take what you they give you, you go through that you can also have a genetic test on the swab on your feet. And that can be sent off to the lab. And that can come back to tell you which of the medicine psych medicine you're most prone to have success with. So that's where I would start, okay. And the psychiatrists may say, Oh, we don't want that. We don't need that and stuff like that. That's bullshit. You need that? Because that'll give a good list. So then you go through the medicine. And if that's not working, or you're not getting any better than it's time to talk about AECT.

John Malanca  21:54  
And it's actually a shock. Yes. Because that will

Paul Bregman, MD  21:58  
AECT electroshock therapy. Gotcha. And that will last, you'll have three months to treatment. And that could last for a whole year with you getting maintenance dose along the way. very benign. Very good. Excellent.

John Malanca  22:15  
And and is that something we see, like we've seen Clockwork Orange where they have prongs on you. And whenever they

Paul Bregman, MD  22:23  
just put it in here, it's very sane, it's very safe. In most hospitals around the city or something, there may be three or four hospitals that are doing patients from seven in the morning to three in the afternoon, every half hour, so inpatient, and outpatient.

John Malanca  22:45  
Let me go back to the cannula. And I'm really interested in curious about the ketamine. So when you're on on your treatment, is it a guided treatment with with the therapist talking to you, Paul was talking about this, or are you just sitting there and

Paul Bregman, MD  22:57  
I'm sitting there and they check in and just see how I'm doing. But if it would be nice if it was a guided trip to be because this time around, I would have been able to really get much deeper than I am when I'm not on ketamine talking to my therapist.

John Malanca  23:16  
So so just just to hear you correctly, the therapist is not there. They're just looking in the room making sure that your

Paul Bregman, MD  23:22  
story is the nurses checking in every 15 minutes just to making sure I'm doing okay, now I'm doing and if I'm having a bad day,

John Malanca  23:33  
do you think it'd be more beneficial if the therapist was actually walking you through talking you through like you were,

Paul Bregman, MD  23:37  
at least this time would have been because I was on a different I was on a different plane. And I would have explained to her how, how in depth I was feeling about my suicidal thoughts, and about my depression, and what it all really meant. It would have gone from a level two or three to a level like 789. Like I really feel this way. And I really want you to help me with this. It just would have felt deeper.

John Malanca  24:09  
Yeah. What can you share with anybody else that's going through this doesn't matter what age they are? What can you share? You you've been dealing

Paul Bregman, MD  24:17  
with the fact of what I said about my team being assembled, they shouldn't be alone. They should investigate if they're suicidal, especially or depress them, they should follow and talk to the psychiatrist about what the plan is going to be trying all the medicine, getting the genetic swab, and then if it's not going to be working for them talking about the AECT in a very real way and not be afraid and if they don't want to go that route, then plug in and investigate the ketamine as an alternative as well and whether that's going to be in fusion, the nasal spray For a pill, there are ways to do this to save your life so that they can so that you don't kill yourself. Yeah. I mean, that's what I'm talking about here. I'm talking about trying to work hard and not kill yourself.

John Malanca  25:19  
You is ketamine legal in all 50 states?

Paul Bregman, MD  25:26  
Had it been clinics? I think so. Medical for medical practices? Yes.

John Malanca  25:33  
Yeah. And AECT is that covered by insurance?

Paul Bregman, MD  25:37  
Yeah, that's been around for 50 years, okay. That's very easily. But people, even the doctors have a prejudice against pushing that, if you're not getting well, in six months, and they've tried all different types of medicine and stuff, you need to bring it up to the doctor and say, I want to investigate AECT. And I want to look into this. And if that doesn't work, then you definitely if you're suicidal, are really down, you get, at least if you get one ketamine treatment, and you can pay for it, and you can resubmit the forms, it will give you some relief.

John Malanca  26:17  
Good, good. You know that the reason I asked earlier about doesn't have any side effects, and a lot of these other medications have issues on the gut and liver and other organs in the body as well as, as you mentioned, you know, puffiness. And so it doesn't sound like there are too many. I guess side effects. I don't know. Is it since it's synthetic or what is? Yeah, I

Paul Bregman, MD  26:41  
think ketamine is a synthetic deal. Oh, thing is clean.

John Malanca  26:48  
Gotcha. In all modalities of the spray the pill and the and the IV infusion. Do they all last about the hour?

Paul Bregman, MD  26:57  
No. The Kennedy infusion is the most powerful gotcha II, IV The pill may or may not work for some people. And the spray may or may not be as effective as as anything. But the IBM approving that one? I believe IBM fusion is the is the one you want? In my opinion.

John Malanca  27:23  
Yeah. So you did one last week, when when will you do your next show?

Paul Bregman, MD  27:27  
I'm gonna wait for the insurance company to let me know. And I may book another one that I'll pay for out of pocket because I feel so good. And I liked the anticipation of feeling good, as well. Of course,

John Malanca  27:42  
of course. So what's the next step then? Can it do they recommend? Or do they say not to, you know, I'm a big fan when you're going through something like cancer, you know, patients ask me, Hey, I'm going to try chemo radiation. If that doesn't work, I'll try cannabis or some other modality. And the good thing about cannabis is that you can combine different modalities, and I'm a fan of some battling is something as severe as cancer, you know, having a whole arsenal behind it. Regarding depression, is that the same thing? Or do they not want you to mix and match? I would

Paul Bregman, MD  28:18  
ask the psychiatrists, but I would think if you're in a suicidal place, yeah, depression is one thing and that hurts. And I would ask that question. But if somebody comes in and says, I am in a suicidal place, I would rush to talk and get that align to get you out of that place.

John Malanca  28:40  
Are there more times that these suicidal thoughts come on, like leading up to the weekend where everybody else is doing things? And, you know, are there different times when these thoughts come on?

Paul Bregman, MD  28:52  
Now, the suicidal thoughts, yes, come up at different times. But they also come up as part of the diagnosis for the last 20 or 30 years. Because of just mistakes that have been made. And it's also part of the diagnosis of depression, of what am I doing here? And now I'm getting older. So it's what's the purpose of my life? And if my kids are having problems talking to me, everything seems to just be bigger. And, and you just put the majors thing has been turning 72 and saying, what's the purpose? What has been the purpose of all this? Yeah, well, I have I suffered so much and I continue to suffer on.

John Malanca  29:37  
So there has to be I mean, blimey, you know, when current past I thought the same thing really, you know, what's, what's the purpose, you know, you took the love of my life away from me, and what is the purpose and I think, you know, faith has helped me but also getting up every day and going for a run or a ride. Did you know my bike, rain or shine? And that was, that's what helped me, you know, and I know everyone's different, you know, so you know, but not giving up people say, God, I'm so proud of you for not giving up like, I was, I'm not ready to leave, I believe me, if there was a guarantee that I can go see Corinne, it's a hey, you know, she's, you're not supposed to be here for another 50 years, John, well, I couldn't wait that long, you know, so. So, you know, but if there's a guarantee that I'm going to see here, I would, I you know, but, you know, staying here, and having faith and, you know, my family as your, as you mentioned, you know, family and friends are important. And being able to get outside, I mean, for me, working out, is what helps me, you know, keep grounded. And so with you, you know, you're such a personable guy, you know, what about writing a book? What about doing a podcast, like I have done? What about even being a counselor, you know, going and being, you know, going to these, I guess, support groups, and being that, that that regular spokesperson there to share, you're not alone. You know, guys, I mean, I'm certain, you know, your, your message can really reach a lot of people.

Paul Bregman, MD  31:21  
And so I'm in the process of trying that working with my therapist on that. And, and, and moving, moving forward. This, you know, I really want to live and I just want to figure out, I mean, I know that ketamine can help me, and I know, you know, that can help. And so I have things going on, and just have to absorb the blows and just before it and be there,

John Malanca  31:51  
Does, does working out help at all, walking getting out of the house. I mean, I know it,

Paul Bregman, MD  31:58  
it helps, it helps a little bit. It helps a little bit. But when you've experienced when you've experienced the ketamine, and you've experienced a total white washing of the board, you can't imagine anything else. That firstly, that.

John Malanca  32:18  
So let me ask you can't is like people say, is cannabis addictive? No, I think it's habit forming. Is ketamine addictive?

Paul Bregman, MD  32:26  
Yeah, I think so too. I think so too. I think they give low enough doses, that if you're taking it at home, and you're taking a pill that you have to be aware, John, which is we're dealing with someone's the quality of someone's life. So I hear you saying that you're making a judgment? Yeah, I'm just saying that people have to realize, they, most people have no understanding of what we're talking about. You have to understand that. So when I say that I'm here to survive, and make it through. They they can't conceive of what that addiction may make they cannabis dependence or ketamine dependence. I'm just trying to get by

John Malanca  33:19  
the reason the reason I asked you these questions, and I'm not only asking but I'm asking for the audience, me too, because you know, a lot of times I get the I get emails and messages, and said is this isn't that and so that's why it doesn't matter if I'm talking to you about ketamine, or talking about anxiety in seniors, or whatever. And so that that's, that's why I'm asking these questions for for that reason, just because I want you to be an educational piece for our listeners where they're asked this question asked that question. So that's the reason I I'm

Paul Bregman, MD  33:55  
just saying, I'm more I'm geared more toward the quality of one's life

John Malanca  34:00  
in another. Blimey, I mean, I know a lot of people that live on cannabis 24/7 They said, Listen, you know, you wouldn't like me if I wasn't on cannabis. On cannabis. I feel normal, I feel healthy, I feel alive. And I feel centered, you know, homeostasis balanced. And so, you know, so I'm not here to judge any anyone Well, I

Paul Bregman, MD  34:23  
didn't take it. But I'm gonna think he can Amin is just another important avenue to go as well as the other medicines. I think a lot of people are in mental illness who are taking good medicine that the doctor has prescribed, that's working well, for for that they shouldn't blow off all of those for ketamine or AECT or anything. They should try what the doctor has suggested.

John Malanca  34:50  
So what happened? So like cannabis, you know, because I work with a lot of seniors and their doctors in having my hand. I'm an act like you and asked me that question about cannabis. You know, she's like, given them a doctor for 30 years. So I see what you see on one hand, gotta grab another doctor. So for our audience members that are, may be going through something very similar what you're going through, and they ask their doctors about ketamine or electric shock treatment, and they very denied thinking that that may be, you know, they may think that's my only hope to, to help me get, you know, get my, my mind straight again. So what happened? What can you share with our audience members and, you know, in, maybe they've been,

Paul Bregman, MD  35:30  
you have to ask that doctor for, to give him to give you the name of one or two other doctors that you can talk to.

John Malanca  35:39  
Good, good. You know, and that's the whole purpose of this is sharing your story, and helping others that may be listening, going through the same thing and knowing that they're not alone. And, and you may be that sign like, Oh, my God, I've been hoping and waiting and praying for a sign and you could be that sign, Paul. And that's the part where, you know, you live out your life because I know you're

Paul Bregman, MD  36:04  
great. Well, but suicidality goes to ketamine. If, if you're thinking seriously about suicide, and it's not going away, and you got it. You talk to your doctor quickly, and you sign up for a treatment with suicide on the heels of a recommendation from your doctor, because no one should have to carry that weight.

John Malanca  36:29  
No, not not one thing. And it sounds like over the last 30 plus year period, you tried a lot of things from medications, electric shock to therapy, to meaningly

Paul Bregman, MD  36:39  
electroshock work, and the ketamine works better and quicker. Came the cannabis and the cannabis has worked a great deal as well.

John Malanca  36:48  
Can you do all three? And are you doing all three?

Paul Bregman, MD  36:52  
Yeah, the night before I do the canopy and I don't do any cannabis. You know that type of clear up or two days before that? I don't do

John Malanca  37:00  
that per year personal thing? Or is that their recommendation? That I

Paul Bregman, MD  37:04  
the recommendation? I think they said the day before, don't do any the day before. Electroshock you have to stop a few days before, you know some of the mood stabilizers and things like that. Yeah, and diabetes medicine. But those are the I mean, I had the best benefit for all those years with using electroshock therapy. And I went during the winter, and then I was free of any depression or anything for like eight or nine months.

John Malanca  37:38  
Maybe you need to, you know, like a lot of the snowbirds could get out get out of the you know, with the beginning we I talked about Belgium and Belgium where ketamine was first introduced in the 60s. You know, Belgium is a beautiful country with beautiful people. But when I lived there, it was depressing. It would be pouring rain, like 160.

Paul Bregman, MD  38:01  
Likes Portland, Oregon, or Seattle. Yeah.

John Malanca  38:03  
And so I mean, we had to get out of there. And come April, you when the sun was shining, you're like, Bring it on, bring it out. And you saw everyone was happy. You know, but you know, so it I I'm a big fan of getting sunlight getting out of there. You know, a lot of people in Belgium would would wear glasses like you have on right now. I don't know if there's a special glasses, but they'd go into, you know, sunrooms or have where the special glasses they would, you know, blink lights at them and trick the brain. Hey, this is vitamin D, vitamin D. So well, where do you go from here? What's your next step to

Paul Bregman, MD  38:42  
fighting with the insurance company about getting more ketamine. I'm using my cannabis to have to figure out what's going to happen with my job situation and how that is really going to look. I'm going to continue expressing love and width to my children and just waiting on that. And I'm just mainly just trying to stay, focus and have some quality of life. I met a woman online in Taos, New Mexico. So I'm continuing on with that. And that's where I'm that's what I'm doing.

John Malanca  39:23  
Nothing wrong with that. Nothing wrong with a little touch, you know, and maybe that that could bring in

Paul Bregman, MD  39:28  
that would be that would be joyful. You know, that would be joyful. If

John Malanca  39:32  
anybody's out there. Right now we have Dr. Paul Bregman, single looking looking. We'll do a love connection here. So

Paul Bregman, MD  39:43  
yeah, so Paul Bregman offering cannabis resource. That info is by website cannabis free, MD bregman@gmail.com 303-550-4115 and I'm here to discuss mental illness I'm here to discuss cannabis and just connecting and just letting you know what I think is the right thing to do. I experience always such a good man. Oh man, he's a saint. You know he's a saint.

John Malanca  40:19  
Thank you, my friend. And always, always, always good to see you talk to talk with you. And hopefully we can see each other in public when one of these days.

Paul Bregman, MD  40:28  
Thank you for giving me this opportunity. Always Thank you very much.

John Malanca  40:32  
And right back you and your love my friend and I love that last how you close you said, you know, just put pushing love forward and I just think, as Karina would always say is you're in the trenches, heavy backpack, pouring rain in the mud, and just one step at a time. And so you're doing that and even through the bad and also the good days. You're still doing it and you're not alone, man. And okay. Thank you. And thank you to our audience again for everything you do with the PG family and all the best

Paul Bregman, MD  41:08  
up. Thank you. Love you, John,

John Malanca  41:11  
United pace group being formed to be well and Dr. Paul Bregman. And we'll see you all soon have a blessed Rishi

Paul Bregman, MD  41:17  
and chatty. Thank you very much. Bye