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166. From SSRI's to Psychedelics with Dr. Sam Zand

Nicole: Welcome to Modern Anarchy, the podcast exploring sex, relationships, and liberation. I'm your host, Nicole. On today's episode, we have psychiatrist Dr. Sam Zahn. Join us for a conversation about finding your unique path to healing. Together we talk about building neuroplasticity through play, How community is medicine, and the impact of SSRIs and psychedelics on sexuality.

Hello, dear listener, and welcome back to Modern Anarchy. I am so delighted to have all of you pleasure activists from around the world tuning in for another episode each Wednesday. Hello. Happy you're here. My name is Nicole. I am a sex and relationship psychotherapist with training in psychedelic integration therapy, and I am also the founder of The Pleasure Practice, supporting individuals in building expansive sex lives and intimate relationships.

 Dear listener, I love getting to bring doctors onto the show and asking them very intentional, very direct questions. I think that is the magic of a good therapist, is that the questions that they ask, and how these questions, rather than necessarily providing answers, open up even more questions, open up even more doors for you to walk through to finding your unique, authentic self.

And I just wish that I could have found this sort of conversation years ago when I was put on SSRIs, before I knew anything really about the world of psychedelics, and so I am very honored to be able to have this conversation for all of you dear listeners today. And I just want to underscore that community is medicine.

We know from psychology that relationships form your sense of self, the narrative of who you are, your mental health. And we heal in relationships, okay? So there is no world where psychedelics are going to heal everything. There's not even a world where SSRIs are gonna heal everything. You will heal with these tools.

in community with other loving individuals, right? And so I just want to underscore the importance of community, the importance of integration, and finding the spaces where you can talk about your experiences. And of course, you know, I study relationships. Not just relationships to people, relationships to drugs, to systems, right?

And everything that I did learn in psychology school about drugs is that it's your relationship to the systems and the people that impacts your desire to use, right? I talk about rat park research all the time, and that is an important understanding here. We are always within our social and cultural context.

And so, Taking that broader lens to understand that it is the relationships that you're going to heal in, and I hope that you are having fun learning and exploring in this space as much as I am, dear listener. Mmm. Alright. If you are ready to liberate your pleasure, You can check out my offerings and resources at modernanarchypodcast.

com. And I want to say a big thank you. I am expressing so much gratitude for all of my Patreon supporters. You are supporting the long term sustainability of this podcast, keeping this content alive. free and accessible to all people. And we have a new member, Priya. Thank you for joining the community. It is so exciting to get to connect deeper with you all, to share more insight into my research, into my personal exploration with these things.

And so thank you to Priya. Thank you to all of you members out there that are supporting this movement. It is because of you that I can keep this podcast for free, that I was able book on jealousy and non monogamy for free on my website, right? Thank you. I think it's really important to be able to have these resources free for the collective, so I just have so much gratitude.

And with that, dear listener, please know that I am sending you all of my love, and let's tune into today's episode. So then the first question I like to ask each guest is, how would you introduce yourself to the listeners?

Dr. Sam Zand: Yeah, Dr. Sam Zand, uh, someone who's, uh, of the work of just trying to help us figure out this part of medical science that's just so obscure, um, a psychiatrist and the work that I do is really just helping us find our best self, help us understand ourselves.

It's a journey that I'm on as well, I'm trying to lead others, but also find my own path.

Nicole: Yeah. Well, I'm delighted to have you in the space. Thank you for joining us today.

Dr. Sam Zand: Thank you so much for having me.

Nicole: Yeah. I'd love if you'd be willing to share a little bit about your personal journey coming into this space and why this is a meaningful topic for you.

Dr. Sam Zand: Absolutely. I think in reflection, I used to look at my childhood and upbringing and feel a sense of almost shame. Like I was called so much love growing up and in a space where we talk a lot about trauma and recovery and healing for me. It was hard to both be objective and assess we all do have healing.

There are things that happen in my life, but at the same time, just be open about like, I haven't really had a lot of traumas or anything majorly difficult. I had tremendous love, parents who were very loving towards me, two older sisters. I was guided to be a doctor, didn't want to do it. And then finally found a calling in mental health and psychiatry.

Love it. Recently, as I'm continuing to do my own inner child work and understand my journey and continue to myself actualization, I noticed that it's not major traumas that have happened from the external. Sometimes it's things I've done that were internally inflicting relationships around me that didn't.

Damage me directly, but I was mirroring and seeing and that growth came in latter years. So my journey has been a lot of trying to step into the role of where can I grow and learn from addition to. Having a piece and gratitude for not having a lot of, you know, traumatic conflict that needed to be processed over the years.

It's more just normal human life experience stuff that we all go through. And yeah, that's, that's been thus far in my journey.

Nicole: Yeah. Thank you for sharing. And I, I know a lot of people will probably resonate with that. That in the terms of, you know, if you haven't had these big like capital T traumas, you know, people write it off as, Oh, it's not that bad.

Like I don't have the space to take up for the difficulty, you know, that I've experienced in my life with these pieces. So I appreciate you naming that.

Dr. Sam Zand: Yeah, it's an interesting recognition for self, uh, because I'm in a space where I see so much of the difficulty that people go through, you know, because that's what they bring.

Right? It's the therapeutic conversation of like, I'm, I'm not doing well. And that's part of what we want to reframe. We want to get to preventative health. We want to be there for those who need the support because they're not doing well and get ahead of it.

And help people to find their own path when the external becomes difficult and the internal is, you know, conflicted.

So it's an interesting balance of being present to all that but not taking it for granted as well.

Nicole: Yeah. And I'm curious to how psychedelics come into your work and the things that you're passionate about.

Dr. Sam Zand: Yeah. Yeah. So as a psychiatrist, I almost felt like it was funny in my early medical career, psychiatry had this stigma.

Like it was a, almost a bad word. It's like, Oh, you have to go see a psychiatrist, something wrong with you or like psychiatrists are quacks and they're just up to no good and putting people in all these medicines. And so, you Prominent. Um, day to day work. And I just think because it's a young field when we think of brain health, we are very new.

You know, it's it's only 50 years. We've been practicing with Western psychiatric techniques.

Um, and that's so new and it's evolving. Psychedelics now in this last three to four years, we've noticed have rapidly evolved the way we approach mental health. And the beauty of that is that it's been around for thousands of years.

Although it's new in the Western medicine, it's ancient and cultural and many other societies. So. With that understanding and application clinically, there was a need, there was a void. I felt like in my career, there's just not enough tools. You know, what differentiates me from a therapist is the ability to use medicine and the medicines just weren't working that well, right?

The tools just weren't that sharp yet. And psychedelics just changed the paradigm. Instead of trying to fix an illness, I started to see in my own career around me, this fix it mentality and this, Diabetes state mentality where you have to diagnose people as sick and then fix that problem. And now here's a medication to be the solution.

Instead, psychedelics offers just a different lens, you know, different experiential feeling and perspective. On the same life, right? But unlocking the ability for the mind to just open up and see things differently, that lubricants wasn't a quick fix, but more of a gateway towards self healing, and that has just been a night and day difference.

And now there's like 0 percent shame. I feel about psychiatry or. Our judgment, even if it exists externally, because I'm just so proud of where we are now in this path. And this is now what is becoming mainstream. And I'm just excited to be part of that clinical application for patients, the education for future clinicians and practitioners.

I teach this work at universities, and that's just a really exciting time as well, because we didn't learn this in the last few years. It's brand new. And the textbooks now, it's like not even popped up yet, right? We're just learning. Exactly.

Nicole: Yeah. Yeah. It is an exciting time and why I'm so excited to have you in this space.

I, you know, you had said that the medicines weren't working well. Well, I'd be curious if you could just paint a little bit more of that because as someone who was on an SSRI myself, you know, It was one of those like, Oh, here, I think this will help you try it, see what happens. There wasn't that full discussion about the research on it.

So I found it rather fascinating to go to school, take a, you know, a basic class in psychopharm. We're looking at the research and then, you know, some of the research coming out was saying that SSRIs are not effective for mild depression, right? Just like a level of conversation that was never had in my psychiatrist's office.

So I'm just curious what your takes are on these drugs and, you know, effectiveness.

Dr. Sam Zand: It's a really important topic and also in many ways a sensitive topic because We have this entire industry. What's the statistic somewhere like between 1 7 adults are on an antidepressant. I mean, that's astonishing at the rate, which we're saying 20 percent of us are clinically dealing with depression or anxiety.

It's something that's going on. That's affecting us that we need this medication to solve it. Now, that on its own is. Is looking at this as a problem mentality, like a medical illness, and many people, this is a touchy subject, like it's mental health, a medical illness, or is it just something we're dealing with?

We all experience and we have ups and downs and different fluctuations. And I think when we look at it from a medical standpoint, you have high blood pressure. You have high cholesterol. These are measured. They're objective to a blood test. You can check it. You can track it over. Time, but the language around mental health, it's not as objective.

It's not as structured. It's not as clinically quantified and therefore to apply the same infrastructure in a medical solutions system. It just doesn't fit. It doesn't make sense. And so that's. The first part we have to just really understand is we're trying to make the best of a system that wasn't built for mental health.

It was built for more objective medical decision making. If we look at it through that lens, well, okay, so we came up with the pill solution and the serotonin hypothesis, it's just that it's a hypothesis. We're not sure. Right. And it was developed in the fifties as a result of a side effect. We saw that people who were taking a certain medication for tuberculosis were all of a sudden feeling uplifted in their mood and their spirits.

And they're just kind of, that was the fun TV award, the people who were on those meds. And we connected that quickly to, all right, Well, serotonin must be connected to happiness. And so let's just build medicines that increase serotonin. And so Prozac became really popular and this same company that put out Viagra, same marketing, right?

It's this quick fix. Um, and there's no judgment there, right? Like this is just where medicine and marketing and, and probably good intentions come together in a way of capitalistic endeavors, you know, but it went too far. I think we kept trying to figure out this pill solution. And 50 years later, we're practicing the same thing, which is, I think, the most difficult part to process, right?

Like if we were doing surgery and I'm like, yeah, this, uh, you know, this, this procedure is 50 years old. We haven't updated it, you know, it's like, wait, wait, there's nothing better the last few years. Um, and so finally now we have. A new approach, we're taking the serotonin hypothesis and saying statistics said 30 percent of people got better on this.

And if, if someone is including that population, fantastic. If they don't have side effects and they got better. Great. I'm glad that worked. But 1 in 3 wasn't cutting it for my practice, you know, 30 percent of people getting better even in that scenario. That leaves 66 percent of my patients suffering, right? It's like, uh, a good option. If it was, uh, if I was running a diabetes clinic and the medicine I was giving people only worked one in three times, that would almost be negligent, similar to diabetes is other things we have to do. And we talk about all those holistic measures. And I think in society, we got too focused on the pill fix, fix it, you know, solution.

So antidepressants, do they still work for some? Yes. Do they not work for a third of people? Yep. And for another third, they kind of do this weird in between thing where I'm not sure it's helping a little, but maybe not a lot. And we're continuing to develop better iterations of that. I think we're moving away from a single serotonin boost type of a med.

So Medicines that help improve brain health from a place of fertilizing the brain and tapping into neuroplasticity. And that's the one buzzword that I want to become trendy. Neuroplasticity. It's something we've just learned in the last 10 20 years fully. It's the concept of Our brain's ability to create new pathways, new neurons, new connections.

We used to think brain cell dies and it doesn't regenerate, but that's not true. The brain just needs to be nourished and fertilized in a healthy way. We call that neuroplasticity. And the way to do it is like a child to learn, to play, to be creative, to explore, to experiment. So, um, you know, there's a lot of things that can expose the brain to new things, right?

There's habits that can create a neuroplastic mind. But as adults, we get rigid, we get stuck in our ways. We go to the same job every day and, you know, things become mundane and routine and there are medicines that are opening up neuroplasticity and that's a pretty cool innovation in this space for moving away from just here's a serotonin pill to, here's a pill that can help your brain create better neural connections.

And then what you do with that is up to you.

Nicole: Mm hmm. Which is much of the beauty of psychedelics, right? Yeah. And also things like cocaine, right? I think that's the tricky part, right? We talk about this neuroplasticity, but other drugs, you know, some of the more stigmatized drugs also do the same thing.

Dr. Sam Zand: Yeah. And even a serotonin burst, right? I mean, that that's the mechanism of action that we think psilocybin creates. This neuroplastic change is just a rush of serotonin. Even our antidepressants, we're learning. Enhanced neuroplasticity, but it's a different paradigm now, because before I was saying, take this pill every day.

Right. And, and I still do sometimes, I mean, we still do this work. It still works for some people, but predominantly that was the only option. I was saying, take this pill every day. Two things would happen. One, we're not really assigning any experience show work to that. Right. I mean, we can have a, like do a workbook, but it's not tied to taking the medicine.

Now, when we get someone. Ketamine as the example that's popularly used. There's a whole program around how do I take this? What do I do? And it becomes an experience. It becomes actually a session rather than just, you know, like a vitamin that you pop in and forget about. And then the second thing that happens, You only do this once a week, twice a week, once a month, right?

It's occasional versus the pill that you take every day. It becomes your new normal and your neurochemistry. And so even if it worked for you, what we're seeing is that the data showed after about a year, most people burn out that 30 percent of people that worked for it turned into about 10 to 12. And so that new homeostasis is just I have this felony. It's just this external boost and it's not really solving problems. Whereas with neuroplastic measures that are attached to rewiring reprogramming self work, we're going to see lasting benefit even without taking it.

Nicole: Right, right, right, right. And I'm curious if you could speak a little bit to the ways that an SSRI, these drugs narrow your range compared to psychedelics and the really big opening of the range that you experience.

Dr. Sam Zand: Yeah, I totally understand the question. It's, it's a little bit of a kind of a generality. I mean, again, everywhere else is different, right? For some of us, what we notice is a common, what it, what should be common Labeled as a side effect. And many people feel like it's the intended part of taking an antidepressant or serotonin meds.

It's kind of numbing this kind of, I don't feel as sad, right? I don't feel as anxious, but I also just don't feel as much. Um, and it's that bandaid solution, right? And it's not wrong. Sometimes we need to just turn down that feeling, you know, it just, we gotta, life doesn't stop and we gotta keep going somehow, right?

And that's society and that. And we get it. Sometimes we also need to expand the mind. I mean, to be present to the feeling and we need to go through it. There's a old cultural custom where if somebody lost someone, they say for the next week, they should never feed themselves. There should be somebody there with them, you know, literally like spoon feeding them because they need that support.

It's a different paradigm, right? To say like, okay, well, let me numb myself because I got to go to work tomorrow versus let me take the time to learn more about this experience. What it's teaching me. We don't we all don't have that time. Right? And that's where I think also the psychedelic medicines help us because we structure the time.

You know, the people who need this the most, the people who say, I don't even have time for that, two hours a week. Well, then you definitely need to make the time.

Nicole: Yeah. Let alone 12, you know, or 10 hour trips, you know, the whole experience. Yeah. Well, yeah. And I mean, like you were saying with one in seven people being on, you know, these sorts of drugs, it's kind of, it's just wild to think about, right.

I mean, There's that, uh, quote, it's no sign of health to be well adjusted to a sick society. Right. And so just thinking about that as part of this dilemma of like, you know, not having the space to grieve for a week because we live under the systems of capitalism. Right. And so like how much of our. mental health woes and our pain are not individual focused at all as much as it's this larger system that you know is kind of nebulous and we don't really get a nice arrow to point to but I just, you know, you have to know that so many of it.

Our issues are that larger system, unfortunately. Right.

Dr. Sam Zand: Right. I'm fortunate. I had a background in public health at Johns Hopkins and you see things from a more global perspective. You go through something like a pandemic, you go through something like realizing as a human system as a species now, like plastic is part of our being.

Like it's the microplastics aren't all of us. What does that do? And our mental and emotional makeup.

Nicole: Yep,

Dr. Sam Zand: and so we do have to understand that there are major societal and environmental factors and the education for us to know that and then impact change together. You know, that's maybe 1 of the potential outcomes.

If we all instead of 1 in 6 of us, 1, 7 of us being in an antidepressant, maybe 1 in 2 of us have tried a psychedelic journey. Maybe to open something up collectively.

Nicole: And I think it's fascinating. I've been seeing ads. I won't even name the companies to give them airtime, but like I've seen ads where quite literally it said, get off of your SSRI and try ketamine.

Curious if you have any thoughts in response to that's, that's a movement that's happening too, right? I think actively, but I, I mean, that's sort of advertising I think is scary, but

Dr. Sam Zand: I'm definitely in this world. I'm a psychiatrist who I have a huge advocacy and I'm in the educational space around psychedelic medicine and ketamine therapy.

I have a practice where we practice telemedicine, telepsychiatry and 12 States, we've got 40, 50 clinicians that we train at house and then also, and that's all through insurance. And we're just trying to be, you know, evolving this holistic mental health approach, right? Everyone's super compassionate and caring.

And we're talking about things from the biopsychosocial spiritual model, where it's like all the holistic factors that matter. Then I also co founded a ketamine therapy company that's just primarily targeting self pay clients. And it was an interesting experience because I came from working at the VA and treating homeless patients and, you know, sure, some VIPs and some, you know, big names and this and that, but the whole spectrum, right?

It's just the human experience. There's no like, can you afford this or not? It was a very different feeling as a practitioner, kind of Brought, um, an awareness to if we're really targeting a self pay market, are we doing what's best for outcomes and care, or are we doing what's best for our ROI, you know, for return on investment, for our marketing spend.

It's a huge learning lesson. I think just for me going through it so up close and personal, because the end results is, you know, we want to bring this care in a way that doesn't need to be like marketed so aggressively. It's just, it's just an option that's there because if you market it so aggressively, it almost looks like this panacea and almost just like inauthentic, right?

Like, oh, this is just the next fix. Like, oh, the SSRI Prozac in the 80s was just all the rage. Right? And now it's like, is it just shifting to the next thing? And then we'll lose us. Transcribed I, if that happens of what this is teaching us, it's teaching us to not look for the next quick fix. Let's see, let's look inward.

And that is really the lesson in the practice of ketamine therapy and psychedelic medicine. Being in, you know, communities that language makes sense, but in the normal communities and, you know, Eastern medicine communities, but in Western medicine, we're still kind of displacing this long standing norm.

And so. I agree with you that the marketing to just say, and, and, you know, I've, should I probably talk to 10 different lawyers about this too, right? From healthcare to, um, DEA marketing, FDA marketing.

Nicole: Yeah,

Dr. Sam Zand: cannot say, and. It's really important that those are adhered to because you'll mislead the public, right?

So to just be like, everyone get on this train because it's making money. And like, that's not the way to go, but it's a, it's an interesting intersection of just really trying to help people making sure that the revenue is supporting the team as well, but also not letting the motivation be profit and the motivation be.

Authentic care, compassion and healing,

Nicole: right? Exactly. And I feel like the piece that scares me the most is just the, um, that biomedical model kind of like you were talking about, right? Of like, here, just take this and it will solve it compared to what you were talking about in terms of the biomedical, social, spiritual, right?

Combining all of that, because that's what we know, right? Relationships are connections to one another, right? Are what fuels our mental health. So to have it in this, just like, Oh, take this pill or take this infusion and go home. You'll be fine, right? Like that's missing the holistic. Part of it. So I think, you know, and the, just the complexities that you don't just like switch, right?

So just all of that is so scary to me. And so I hope that there's more space for, you know, what it means to integrate these experiences, which happens. In community, right? Like that's that big piece. I feel like that is really missing.

Dr. Sam Zand: Absolutely. Community is just the key aspect and that's the beauty, especially the stark contrast that we saw post COVID.

We all became so isolated. Mental health became a rampant issue. It became a societal issue. We saw community is the ultimate healer. I love to kind of think about what was mental health like. Prior to a hundred years ago, prior to the advent of Western psychiatry, a thousand years ago, two thousand years ago, if somebody in the community was having prolonged feelings of depression or anxiety, or, you know, just not doing well mentally, emotionally, spiritually, they would go to the community.

They would go to congregation. They would go to the elders. They would go to nature. And one of the downfalls of Western medical marketing is you can't really market those things. You know, it's hard to monetize that in a capitalistic, uh, medical market, which again, I'm not shaming or judging. Like, this is, this is our society economically.

It has a lot of benefit. But who's putting out those campaigns, you know, get off your SSRIs and like, just go join a volunteer group, you know, like let being of service to others heal you. And again, I'm not stigmatizing SSRIs. They work for many people. So I mean, you know, way to get off their SSRIs if it's working fantastic.

But how do we infuse love community and care in that way? Back into a medical model. I think psychedelic medicine is a gateway towards that's another reason that I'm really excited about it.

Nicole: Yeah. And I'm curious, can I ask you about microdosing or does that cross over into maybe a forbidden territory of


Dr. Sam Zand: I can certainly talk about it. I know the limitations of the way in which I can talk about it. I think, uh, updating our education and drug culture in general is so important. And so the caveat that like, some of these things are illegal, right? Like we shouldn't do it as Usually my stance when it is, but the beauty is that in some states they aren't illegal.

So I can talk about that application.

Nicole: Great. Yeah. Well, I'd be curious then. I just feel like this is such an area that there is a huge lack of resources on and research, right? Of what this looks like, how people are using it. And a lot of people are kind of. I, at least I've heard in my communities around, you know, the psychedelic spaces like switching and, and using, you know, psychedelics as micro dosing ways to be able to, you know, and I've worked with some clients on that and trying to at least throw down the, you know, foundation of this is a tool.

Right. This is a tool, not the solution. This is a tool. And so I'm just curious what your perspectives are on it.

Dr. Sam Zand: Yeah. My gut instincts and let's just throw research and science out for a moment. My experience as a practitioner and my gut instinct is saying if we move to the microdose model in general, not saying it works or doesn't work, we're continuing to perpetuate this.

I need to take something every day.

Nicole: Yep.

Dr. Sam Zand: And I think we're still not giving enough reverence and appreciation to this internal body that heals us if we just give it the right conditions. So I'm more of just in my core, a proponent of keeping this medicine sacred, intentional, and actually upping the dose to experience the psychedelic quality of it, but doing it more rarely.

It doesn't mean that it's wrong or bad. It's just like, if I had to pick one or the other. For the way in which this medical treatment was applied, I think there's better application and safety around doing it less often, keeping it sacred, making it very intentional, rather than taking it passively like a vitamin.

I said that, like, I take, you know, vitamin C when I'm saying, you know, we take vitamins that fortify us and help us. And if the research is showing that micro dosing. Causes just a regular neuroplastic shift at a limited cost, and we really understand the side effects of that. And that could be a really interesting path.

And there's tons of studies going on in that in that path, but I also see the protocols where it's like, once every 3 days, and it's kind of sub perceptual ish, you know, you kind of feel it.

Nicole: Sorry, I just like, yeah, what does that mean?

Dr. Sam Zand: You know, so there's a lot of applications in a Western medical model.

It needs to be approved and all these clinical trials and to then be worth the hundreds of dollars to be put into it. It needs to have. Way to make the money back. And so that's usually not once a year in the jungle, right? That's in a pill bottle every day. Um, all these factors really, I think we'll see is all variants of this.

You know, we're going to see those model be more accepted mainstream. We're going to see the underground movement of it. We're going to see the more shamanistic. Kind of community approach that's maybe around others or held intentionally once a month or once a year.

Nicole: Yeah,

Dr. Sam Zand: there's potential benefit, but we need to just safeguard it all as well.

Nicole: Definitely. Definitely. Yeah. I mean, how many people are using coffee in not sacred ways, right? Every single morning to get through that system, you know, chug that. Yeah. I mean, I think there's a lots of questions here and I think it's heartbreaking to think about like, yeah, the huge lack of research that we need on this because it's not as able to build that profit off of it. So then there's, we're going to be lacking that for a while. So that's heartbreaking to say the least, but I'm also thinking, you know, given the focus of the podcast, everything in terms of my work, I'm curious how sexuality plays into this conversation of psychiatry, psychedelics and all of this.

Dr. Sam Zand: Yeah. I would say one of the most Under, uh, utilized modalities of sex therapy. I think if you look at this from a pure Freudian perspective, you know, he was of the belief that the human experience is just trying to manage two emotions. This is our sexual desire and our aggressive desire.

Nicole: That's barbaric.

Dr. Sam Zand: And, you know, evolutionarily that probably makes sense. And I think we've all, if we just look inward, a lot of our shadow. Which carries aggression and maybe some sexual stuff. A lot of our repressed emotion has kind of, is linked to our sexual history and feelings and patterns and beliefs. Um, and doing this work and treating thousands of thousands of people in our communities, I'm still gaining my comfort, not comfort, but I'm still gaining my Kind of rapport building quality to allow people to open up.

It's a really difficult one. When, when they do, I see so much just catharsis and like this, this purge of like repressed feeling that just makes them everything else that had nothing to do with their sexual health. Just seem less charged and when they don't open up and it's like, so, you know, how are things and your sexual health?

And we open that conversation just like all good there next, you know, it's like, Oh, I wish, yeah. How do we open that up further? How do we make that normal? Uh, there's, I think a barrier there that, I don't know, it's societal or just, that's something you just don't talk about. Right. It's taboo. It's even in a confidential.

Session with the therapist where you should just feel super vulnerable and open. I've seen it be very difficult. So I think it's so important, maybe more education from a young, emotional understanding standpoint, where like we don't shy away from the conversations, but also it's a tough one when you really think about it systemically.

Nicole: I know

Dr. Sam Zand: it is so important in our own journeys to hold that space, whether internally or with a professional.

Nicole: Yeah, absolutely. It's such a big piece. I mean, when you think about the roots of our puritanical country, right? We came from some of the more repressive Christians, um, in terms of this stuff. So it makes sense when we look back to our country's roots in that way.

And they're just thinking about, yeah, one of the, you know, biggest pieces of shame is sex. Like it's radical, right? I mean, I guess I do remember before getting into the field, I was in therapy myself and it felt awkward to bring it up to my therapist and it just felt like it wasn't the right space to do that.

Well, you know, so I think it's so important for therapists who are working with clients to just even ask that simple question that you had mentioned, how's your sexual health? The amount of therapists that don't even include that in an intake is. It's wild, wild, right? Like it's at least opening the door so that at any future point, right, that your client could bring it up.

But you know, there's just so much there that I, I truly as an activist, I think about the ways that all those times that we're spinning in our head of like, is this normal? Is this normal? That is so much cognitive energy and space that could be freed up to be dedicated to So many other things, and I am so deeply passionate about the ways that if we think about sexuality as play, right, whether you're playing with one person to a whole community, right, like, whatever it is, your ability to play in those spaces does transfer out.

Right into the world, and they're deeply connected. How do you feel with your ability to communicate your boundaries right here? Transfers out all of these things. So I feel like it's such a crucial component. And I'm thinking about the ways that particularly with your field, right? SSRIs, other sorts of things, I'd love if you could speak to how that sometimes has an impact on sexuality.


Dr. Sam Zand: Because it's a direct connection. We know that the, one of the biggest side effects of SSRIs are sexual side effects and that can be decreased libido, that could be, you know, orgasmia, like an inability to achieve orgasm. Or inability to achieve erection for men, all of those stimulating qualities compromised potentially.

And then what happens? So, you know, we have patients who says this really made me feel better. Like, my depression is improved. My anxiety is improved, but, you know, some of the sexual side effects, like, yeah, they bother me, but that's okay. I'm not really having sex anyways, you know, and then they kind of justify it.

And, you know, it really can open a conversation of what's leading to that repression. What's leading to like, oh, that it doesn't matter feeling. And if we're numbing, but Freud thinks it's just half of our human experience. Right. What are we really what's the. Downstream effect of that. I've seen unprocessed sexual conflict be misdiagnosed as schizophrenia.

Nicole: Wow.

Dr. Sam Zand: I've seen psychosis as a symptom of unprocessed sexual conflict, of repressed sexual, not even trauma, just, you know, inner turmoil, certainly to the spectrum and degree of sexual trauma that was repressed. So many possible difficult outcomes there if we're not holding space around the conflict, but then you brought up also the opposite end of the spectrum, the play, the beauty, the connections, the spiritual elements of connecting and, you know, the education doesn't need to be like, Hey, kids use condoms.

Like, yeah, let's let's do that too. But it's also like, what does sex means to you and want to get spiritual, want to get emotional, want to get scientific. If we thought about things from that perspective of human connection of soulful connection, again, this can't be quantified or talked about very objectively.

Right. Which is why it fits into mental health because nothing in mental health is really objective. It's, it's so subjective. Our perspective, our reality is so unique. So just holding space to share that and talk about it in a way without stigma. Without taboo. Awkwardness is okay. That first step is going to be awkward.

It's okay to work through that. And, you know, when we build rapport with the therapist, for example, sometimes it's just that friendly therapist that stays at that superficial level that everybody likes. Like, yeah, I like that therapist. And then when we're challenged, it's like, oh, I didn't really like that.

Therapy session. And those are the ones we grow from. Those are the ones that really push our boundaries. Um, and so I encourage all of us, myself included to lean into the uncomfortable, awkward conversations in life.

Nicole: Totally. Right. Which is half of what like processing oppression is, right? Is that uncomfortable conversation of, oh, shit, I'm part of the problem.

Right. And not running away from that. So I think that, like, that embrace of the discomfort is such an important piece about this. I'm thinking about, you know, the realities that all those side effects that you're talked about, you know, given what we you had talked about earlier about, you know, after a year, some of the benefits kind of dropping off given another point I'm thinking about that we haven't talked about like placebo effect, right?

How? And then at the same time, you're dealing with The side effects. So we're not really, you know, how much of it do we know is actually working versus a placebo and maybe it dropped off while you're still, you know, dealing with those side effects. But then to actually get off the medication, I think is a quite of a big existential leap.

Am I ready? Am I stable? Am I do that? Can I do this? And then once you get off, it's like every single experience of your life afterwards for an X amount of time, or I'm speaking about my own lived experience here, right? Is like, oh, I'm stressed. Does this mean I need to go back onto this medication? And that's a journey.

So I'm just curious, how do you sit with that when you're trying to figure out whether to get on or off of these medications?

Dr. Sam Zand: Yeah, that's a really powerful question because I, I feel that as a practitioner, like this, this feeling of almost self judgment that may come up or they come to me, like I have the answer, whether or not it's time to get back on and get off.

And I, and I appreciate the vulnerability because it's, it's a tough. Thought to think that, like, we needed this to be what to be whole, to be complete, to be better, to be happy.

Um, and then for someone to say, well, maybe don't. And it's like, well, then what was I tricked or, you know, you talked about the placebo effect.

I think we should stop short of saying like, no, like, you weren't tricked. This was, you know, this is best science right now and brain science. It's just, we're shooting 30 percent from the field. If this was sports, like it wouldn't be very good.

Nicole: Yeah, no.

Dr. Sam Zand: Um, but. The placebo is usually, let's say 10, 20% in, in a different range, right?

So you have to be statistically significant above placebo effect according to the FDA trials. So you can't just be like placebo's 30 and with the meds 30, then it wouldn't actually, you know, the data wouldn't support it. We can get into a wormhole about research and data and how that's just very effective and hard to capture as well.

But, um, so the placebo effect really. It's powerful. It's important. And it's not something I think we should look down upon. It's like you're taking this step to take a leap of faith that this medicine that we don't 100 percent know what it does is going to help you, right? Believe that it will, because if you don't, like it is, it's a, you know, probably a lower chance that it will.

And what does that say about the organ we're trying to treat? What does that say about the brain? That as a belief system that actually governs our ability to get better. And. Yeah. Instead of saying, well, that's just makes all a bit bogus science. Let's lean into that weird science and capitalize on it, right?

Like that's all practice the placebo effect more often. And it's so powerful famous study that people talk about is the one where they give two groups, a stimulant, like an Adderall and a precedent, like a Benzo, like a Xanax. And. Tell the two groups what they got. They record the data. I feel more energized.

Predominantly, if I took the stimulant, I feel more relaxed and down. If I took the Benzo and then they do it again, they tell them that they took the opposite and the higher correlation was, was what they were told they took. We're not talking about sugar pills here anymore. We're talking about the opposite effect, the brain, our belief system as the power to program the brain and body to overcome.

Even the opposite effect, because we were told we were getting the one. So when you think about it that way, it's, it's exciting. It's like, there's this wizardry. How do we lean into that and combine it with Western science? The pill sometimes gives you a momentum boost. It catapults you. But then how do we come off?

And I think we just have to understand that there's that dynamic quality that we can actually spell into existence the way we want to feel as difficult as that, as silly as that may sound. There's a possibility there and science backs it. If that's the case, well, then maybe this medicine that did help us at one point when we needed it, because we lost our job and we were just in a breakup and we were mad at our parents and just 10 different things happened in once.

And it caused this emotional fracture in our life. Well, then we put a cast. That cast that pill helped us in that time and now it's time to take the cast off because we've done the healing. If you haven't done the healing and yeah, maybe the cast needs to stay on longer, but we also need to change the program.

Nicole: Right?

Dr. Sam Zand: Because casts aren't forever. And so that that analogy, I think, really changes the The conversation, this isn't a lifetime disability or handicap. We're dynamic in nature. We're not static. We're not the same person. If you were diagnosed with a quote unquote, mental illness, when you were 21, you're not the same person when you're 30, 40, 50 years old.

In any way, right? I mean, literally your cells have all died and replaced themselves. And so why are we considering that this diagnosis is a life sentence?

Nicole: Right.

Dr. Sam Zand: Why are we labeling and saying, no, this is what you have to be on forever. It's a very momentum builder if we need that, so that the body can heal itself.

And if we want to come off, we can. And if we feel like we can't, like that's okay too. What's the downside? If you're not having side effects and that's helping you, you know, let's, let's continue that path, right? There shouldn't be any shame. Right. Peter path.

Nicole: Totally. Yeah, absolutely. And I think for me, it's just, you know, you were talking about research and the bias and all that sort of stuff.

I think I just shook my brain around for a good amount. And I still do when I found out that the inner radar reliability. Where Alex, I'm sure you understand, but for the listener, right? So if you put a bunch of clinicians in a room and ask them to diagnose this person, we get the inter rater reliability amongst those clinicians and for.

Depression and anxiety, some of the major, you know, disorders that we give people, it was as likely as chance to get that same diagnosis across them. And I was shook. And this is for the DSM five. Um, it was actually a little bit better according in some of the DSM threes, but for the DSM five and our diagnostic criteria, it was as likely as chance.

And so then I'm like, what? The fuck, you know, like we've made this up. So then I'm like looking at other research where it's like, Oh, this is effective for depression and this is effective for that. But I'm like, hold on. If our starting variable is as likely as chance. I don't know if I can read any of the rest.

Oh no. Yeah. Oh no. You know, the whole house crumbles. You're just like, Oh,

Dr. Sam Zand: right. And, and this is the house that we live in. Right. So we have to kind of. Understand it. I understand it has leaks and the piping is needing, you know, replacing everything, but how do we, within that infrastructure, and this is where it's fun for me as practitioner and business owner, both to say, like, within that, we can't just rebel.

Like my first year of residency was full rebellion. I don't want to do this. Um, instead of fighting against the current. Yeah, we're moving with it now. I think psychedelic medicine has opened up a paradigm shift. You look at Johnson and Johnson brought out a ketamine product first, right? And in the world of casting judgment to big pharma, like, which, which I don't, I think our intentions are good.

And there's some bad apples. And, you know, we're just trying to do the best we can collectively. They're probably not the most, you know, favored The company, right? They've had a lot of negative press, but they brought out ketamine therapy for all of us to be able to now utilize and say, it's okay. That was a 40, 50 year hurdle, right?

When we were doing this in the 60s and 70s, and now we're doing it again. So, I think we're on the same team, rather than fighting the system. I think we just have to be swimming in the same current to understand our practitioners who are using these tools the right way. Now we're allowed to use these tools.

Today's ketamine tomorrow's MDMA. Psilocybin. And to the person who still doesn't have trust in medicine or doctors, like, I get it. There's going to be options there as well. You can go to Colorado, you can go to Oregon today and do this work without a clinician, without a doctor. It's just a different government.

Um, so path for everybody, but I think going with the current has really changed my happiness to those rebellious years or weren't the best for my piece.

Nicole: Sure. Yeah, totally. So I'm still there. I don't know if I'll leave anytime soon, though, you know, um, but yeah, I mean, even if the diagnosis and all these things aren't, you know, accurate, the pain is right.

That's the reality is our pain and our suffering is very real. And it's like, we need. You know, uh, companies to be able to do this research and find the drugs and get them out. But it's just like, Jesus, can we just like redistribute the profits? Like, is that a wild concept instead of the organizations?

Like the money goes back to the people cause it's health. I don't know. What an idea. I don't know. Is that too wild?

Dr. Sam Zand: I'll tell you this. I mean, health insurance right now, there's the gap for those who are, um, you know, maybe working and they don't get benefits and they can't really afford their own. But right now.

If someone doesn't, you know, if they're 1. 5 poverty level, like you will get Medicaid and Medicaid covers ketamine therapy. That's crazy. It won't cover, you know, certain things. But this is where I work with better. You was all self pay and, you know, for profit margins. Right? But if we reshift that, we are to allow.

Same service to be utilized under insurance, then we're just leaning on the drug companies to pay. Oh, sorry. The insurance companies to pay us rather than the patient. And there's a system that works within that. And we're adding to the equation as practitioners who are autonomous in their care, trained, learned, get it.

And they can be clinician. They can be therapist. They can be guide on one and you just see your practitioner every week and do your sessions.

Nicole: Yeah. It's an exciting time. I'm really excited to see how. MDMA gets integrated into this with the coming years.

Dr. Sam Zand: MDMA is going to be really interesting. That'll be the location, right?

It'll be tied to similar way to Spravato, that's ketamine nasal spray. You'll have to go to the site. That site will have to be certified and, you know, trained through the FDA protocols. And then you sit and you hold space for somebody, right? You have a therapist, a clinician, someone who's going to be there now.

What we can open up in that time and the therapeutic

Nicole: Six hours, yeah.

Dr. Sam Zand: Yeah. It's a long time too. We have to accommodate for that and figure out that part of the system. But, yeah. Sexual trauma, repressed emotion, relationship conflict, those things are going to be, there will be an accelerated path towards self awareness and transformation.

Nicole: Yeah, I'm really excited because that's my area of specialty, right? Sexual trauma to play that whole journey, right? So even the initial processing of the trauma, but even, you know, The later stages, I think, of that, of like connecting to your body on MDMA and then learning how to play again. I mean, there's just so much I think that you could see with that trajectory of that healing and that medicine and that space.

Dr. Sam Zand: Yeah, it's an exciting time. I'm really. I remember when I graduated medical school, and it was just like the worst students went into psychiatry. It's like, uh, you know, I kind of slacked off in med school. So I'll be a psychiatrist. Like, that was a cliche. And now I'm hearing that it's one of the most coveted fields and it's become very competitive and we're getting really the sharpest.

Students to want to be in this field. And that's just fun. You know, such a one 80 just the last five to 10 years. Um, I think that shame in the industry is going away and now it's just, we have these tools that are really working and let's be proficient in them and let's, let's be able to help people with them.

Nicole: Yeah. Yeah. So exciting. I want to hold a little bit of space to as we come towards the end of our time, I always check in with my guests just to see if there was anything else you wanted to share. Otherwise, I can guide us towards a closing question.

Dr. Sam Zand: I think just reemphasizing point that this work, there doesn't need to be a professional.

It's not gated. It's not like. Because I have a license now, I have unlocked the key to helping people soothe their soul, right? Like, sure. We have experience. This is our profession. This is our practice. The ultimate gift that we're offering is how to do this work yourself. And that I think will do wonders because when we're not relying on the pill, we're not relying on the doctor, the therapist, even we're just relying on our own sensual intuition.

Trusting ourselves, trusting our kind of spirit, that part that we don't really understand, tapping into it. There's so much healing there. And the community around us, of course, can supplement that. But all this conversation about kind of medicine and services and the industry is just, I think the common denominator of what we're learning through psychedelic medicine is that this work doesn't need so much infrastructure, although we have to play through those rules.

The end goal should be just to find your own healing, find your own path. Um, and yeah, that's, that's really what came to me.

Nicole: Yeah. May it be so. Thank you. Yeah.

Dr. Sam Zand: Thank you. Yeah. This was a lot of fun.

Nicole: Good. Good. Well, if it feels good to you, then I'll guide us towards our closing question.

So the one question that I ask every guest on the show is, what is one thing that you wish other people knew was more normal?

Dr. Sam Zand: One of the luxuries of my work, one of the things I love about it is I'm constantly learning. I get this microcosm of society through people's individual journeys, but then kind of juxtaposing all of them together, realizing how how common we all are, right? This human experience and there's normalcy in any demographic.

You know, we all have this kind of part of us, these parts of us that just aren't the kindest, aren't the most polite to ourselves, to others, right? The shadow, normalizing the shadow and recognizing that we all in this human experience show up in ways that maybe we don't like. I think the beauty in that, if we can kind of lift the veil and realize that, like, we What's qualities within us, those unique qualities that we shame I'll do it, but there's someone who is open to seeing that side of you and allowing that person to not feel shame and work through whatever that is.

Um, if we can normalize that we all have a dark shadow that Isn't the prettiest, isn't the happiest, isn't the best, isn't the fill in the word. Um, but it also deserves love and connects us. And then that vulnerability to open that up is what kind of connects two people. That's the beauty I've learned from my work and the normalcy that I think we should bring to the inner shadow.

Nicole: Yeah, exactly. And that's it. Like you said, the beauty of your work and my work that we get to, you know, Be in a space where people trust us to open up about those parts of their existence. And then to us, we're like, Oh yeah, that's just normal. Right. But then that one person in their head is going, no one else struggles with this.

And because we don't talk about it. Right. And so I think that's some of the power of our positionality. So to be able to name that as something that needs to be more normalized, I think is a really important conversation.

Dr. Sam Zand: Yeah. Yeah. And it draws you towards that person too, right? It, it connects people when we.

Open that side of us in the way that isn't the reaction, but through observation through just objective recognition, because the reason we don't like the shadows, it has failed us, right? It is kind of sabotaged us. It has made us. It's embarrassed. It has made us lose relationships, but that's just the side of it.

It usually comes from something that just needed love, needed hurt, needed attention. Allowing that then actually heals it, takes away all of the negative outlets and connotations.

Nicole: And then you get to play with your shadow and you can come talk to me. That's the fun part, but yeah.

Dr. Sam Zand: Yeah. Usually unleashes, you know, superpower, right?

Emotionally, that oppression goes away and getting into it can become a strength.

Nicole: Absolutely. It was such a pleasure to have you on the podcast. Thank you for joining us today.

Dr. Sam Zand: Yeah. Thank you so much for having me. Appreciate the work you do.

Nicole: Thank you. Where would you wanna plug so that people can find you and your work?

Where would you wanna plug them?

Dr. Sam Zand: Yeah. We're currently in about 10 to 12 states, uh, kinda depending on services we're looking for. And you can go to anywhere, and be matched up with a really compassionate, caring, well trained. Mental health professional who can just meet you wherever you are in your journey.

If this is brand new to you, if you've worked with people before we take health insurance in about 10 to 12 States, you can check us out on anywhere. clinic. com.

Nicole: Thank you for joining us today. Thank you. If you enjoyed today's episode, then leave us a five star review wherever you listen to your podcasts.

And head on over to ModernAnarchyPodcast. com to get resources and learn more about all the things we talked about on today's episode. I want to thank you for tuning in and I will see you all next week.


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