The Journal of Clinical Psychiatry Podcast

Dr. Benjamin Brody, an inpatient psychiatrist who built and now directs one of the earliest hospital-based ketamine treatment programs, joins Dr. Ben Everett to unpack the regulatory maze surrounding ketamine and the psychedelics now approaching FDA approval. Dr. Brody traces how he moved generic racemic ketamine from an overlooked anesthetic sitting on the hospital pharmacy shelf to a formally sanctioned inpatient treatment, and explains why esketamine's REMS-regulated pathway looks nothing like the largely unregulated market for take-home ketamine.
As synthetic psilocybin nears a possible FDA decision and the field debates what role psychotherapy should play alongside these treatments, clinicians face fast-moving questions about safety monitoring, staffing, informed consent, and reimbursement. Drawing on his direct experience administering ketamine on the inpatient unit, Dr. Brody discusses self-escalation risk, the paradox reaction his team termed dysphoric dissociation, and what health systems should weigh before building a program of their own.

🎯 KEY EPISODE HIGHLIGHTS:
⚠️ THE NARROW LINE BETWEEN NEUROTROPHIC AND NEUROTOXIC [18:30]
“But at higher doses, it actually becomes neurotoxic and, you know, there's histopathological changes that can be seen.”
At therapeutic doses ketamine is safe and neurotrophic, but Dr. Brody warns that self-escalating doses can quickly cross into neurotoxic and bladder-damaging territory.
🧠 DEFINING DYSPHORIC DISSOCIATION [24:00]
“This is a dysphoric piece or a dysphoric reaction that is layered on top of the dissociative experience for this small minority of patients.”
Dr. Brody explains why his team coined a new clinical term to distinguish ketamine's rare, frightening paradox reaction from a psychedelic “bad trip,” and why naming it matters for informed consent.
🚫 THE CASE AGAINST TAKE-HOME KETAMINE [25:00]
“The unambiguous answer is no, I do not think this is a good idea.”
Citing self-escalation risk, a narrow therapeutic index, and a growing number of ketamine-associated deaths, Dr. Brody explains why he opposes direct-to-consumer telehealth ketamine prescribing.

CHAPTERS:
00:00 – From Creative Writing to the Inpatient Unit
02:30 – A Day in the Life of an Inpatient Psychiatrist
05:30 – How Dr. Brody Came to Believe in Ketamine
12:00 – Ketamine vs. Classical Psychedelics: A Different Mechanism
14:00 – Two Regulatory Worlds: Racemic Ketamine and REMS-Regulated Esketamine
17:30 – Safety Signals: Self-Escalation and Dysphoric Dissociation
24:30 – The Case Against Take-Home Ketamine
29:30 – Psychedelics Enter the Medical Mainstream
33:30 – What to Expect When Psilocybin Gets FDA Approval
39:00 – Staffing and Consent for Hours-Long Sessions
43:00 – Set and Setting: Lessons from Building a Ketamine Program
48:00 – Is This Psychotherapy? Defining the Clinician's Role
54:00 – What Surprised Dr. Brody About Implementation
57:00 – Advice for Health Systems and Reasons for Optimism

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep22-regulatory-maze-ketamine-psychedelics-benjamin-brody/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
How Do We Get Ketamine Safety Right? Three Questions From a Clinical Service
https://www.psychiatrist.com/jcp/how-do-we-get-ketamine-safety-right-3-questions-from-clinical-service/
Dr. Brody's 2025 JCP commentary on self-escalation, paradox reactions, and the regulatory gap between racemic ketamine and esketamine, discussed at length in this episode.
COMPASS Pathways – COMP360 Psilocybin for Treatment-Resistant Depression
https://compasspathways.com/our-work/comp360-psilocybin-treatment-in-trd/
The investigational psilocybin program discussed throughout the episode, including its phase 3 timeline and proposed psychological support model.
Dr. Benjamin Brody – LinkedIn
https://www.linkedin.com/in/benjamin-brody-md-3576bb4/
#Ketamine #Psychedelics #TreatmentResistantDepression #Psychopharmacology #REMS

Dr. Elizabeth Ballard, Director of Psychology and Behavioral Research and Director of Pre-Doctoral Training at the National Institute of Mental Health's Experimental Therapeutics and Pathophysiology Branch, joins the JCP Podcast to trace the full arc of suicide risk assessment and treatment. Dr. Ballard helped develop the Ask Suicide Screening Questionnaire (ASQ) and was first co-author on the individual patient data meta-analysis establishing ketamine's rapid antisuicidal effect.
Suicide risk is assessed in some form during nearly every patient encounter, yet the tools clinicians use and the evidence behind current treatments remain works in progress. Dr. Ballard discusses the sensitivity-specificity trade-offs built into screening instruments, what ketamine research reveals about suicidality as distinct from depression, emerging biomarkers such as nocturnal wakefulness and electrophysiological signatures of hopelessness, and the ethical case for including suicidal patients in clinical research rather than excluding the population clinicians most need evidence for.

🎯 KEY EPISODE HIGHLIGHTS:
🩺 SCREENING IS A LIFE-OR-DEATH TRADE-OFF [11:00]
“This is literally a life or death situation, and so you don't want people slipping through the cracks that aren't getting identified.”
Ballard frames the sensitivity-specificity trade-off built into suicide screening tools like the ASQ as a stakes-defining design choice, not just a statistical one.
🎯 SUICIDE RISK IS MULTIFACTORIAL, SO WHERE DO YOU START [39:00]
“There's so many factors that lead somebody in a moment of crisis to think about ending their lives.”
Ballard argues clinicians can't treat every contributing factor at once, which is why her research isolates modifiable targets like hopelessness rather than suicide risk as a whole.
❤️ WHEN IN DOUBT, ASK [52:30]
“When in doubt, ask. There's no harm in asking.”
Ballard's single most actionable takeaway: approach suicide risk assessment with curiosity rather than treating it as a documentation exercise.

CHAPTERS:
00:00 – Introduction: Dr. Elizabeth Ballard's Path to Suicide Research
05:30 – Building and Calibrating the ASQ Screening Tool
12:30 – The 2018 AJP Ketamine Meta-Analysis: Pooling Individual Patient Data
17:30 – Disentangling Ketamine's Effect on Suicidality from Depression
20:30 – Ketamine's Response Trajectory and IV vs. Esketamine Comparison
25:30 – Nocturnal Wakefulness as a Warning Sign for Suicidal Ideation
31:00 – MEG and Electrophysiological Signatures of Suicide Risk
34:00 – Concordance Across Suicide Risk Assessment Scales
38:00 – Hopelessness as a Distinct, Modifiable Treatment Target
41:00 – Neurofeedback and Episodic Future Thinking at Neu Hope
45:00 – Ethically Including Suicidal Patients in Clinical Research
52:00 – Closing Clinical Takeaway: Asking with Curiosity

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep21-rethinking-suicide-risk-screening-treatment-elizabeth-ballard/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Ask Suicide-Screening Questions (ASQ) Toolkit – NIMH
https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials
Free NIMH toolkit for the screening instrument Dr. Ballard helped develop, discussed at length in this episode.
Dr. Elizabeth Ballard – LinkedIn
https://www.linkedin.com/in/elizabeth-ballard-943245350/
#SuicideRiskAssessment #Ketamine #SuicidePrevention #ClinicalResearchEthics #Hopelessness

Dr. David T. Liebers, MD, MPhil, MPP, a research assistant professor of psychiatry at the NYU Grossman School of Medicine and a research psychiatrist at the Nathan Kline Institute, joins Dr. Ben Everett to explore metabolic psychiatry: the growing evidence linking mitochondrial function, bioenergetics, and whole-body metabolism to psychiatric illness. Building on a previous conversation about GLP-1 receptor agonists, this episode broadens the lens to ketogenic diet interventions, SGLT2 inhibitors, and metformin, tracing how each may support brain energetics in depression, schizophrenia, and bipolar disorder.
This conversation arrives as clinicians increasingly confront the metabolic burden of antipsychotic treatment alongside a widening evidence base for interventions originally developed for diabetes and heart failure. Dr. Liebers discusses recent trial data on ketogenic diets in serious mental illness, the mechanistic case for SGLT2 inhibitors as a psychiatric tool, expanding guidelines for metformin co-prescription, and why brain energetics may represent a legitimate and increasingly tractable therapeutic target, not a replacement for existing models of psychiatric illness, but an additional clinical perspective.

🎯 KEY EPISODE HIGHLIGHTS:
🏛️ THE “ERA OF FOOD AS MEDICINE” ISN’T NEW [12:30]
“We have now entered the era of food as medicine.”
Dr. Liebers traces today's food-as-medicine rhetoric back through nearly two centuries of psychiatric interest in diet's role in mental illness.
🧬 MITOCHONDRIAL DYSFUNCTION AS A TREATMENT TARGET [23:30]
“The big challenge, I think, is identifying those interventions that can reliably improve, metabolic function in a way that can be measured and is suitable for randomized trial designs that let us talk about causation.”
Dr. Liebers frames abnormal brain bioenergetics as a specific, measurable target for a subset of patients underserved by monoamine-based treatments.
⚖️ METFORMIN IS DRAMATICALLY UNDERUSED [55:30]
“I think ten to fifteen percent of the people that should be or would qualify under the new guidelines to get metformin are actually on it.”
Despite expanded 2025 consensus guidelines, Dr. Liebers' EHR data suggest most eligible patients are still not receiving metformin for antipsychotic-associated weight gain.

CHAPTERS:
00:00 – Introduction: Building on the GLP-1 Conversation
02:30 – An Unconventional Path to Metabolic Psychiatry
10:30 – Diet in the Asylum Era: A History of Food as Medicine
18:00 – Why Metabolism Returned to Scientific View
23:30 – Imaging Brain Energetics: Bridging Peripheral and Central Metabolism
28:30 – The Stanford Pilot Trial and the Abrams Follow-On RCT
36:00 – Adherence, Meal Delivery, and the Path to GLP-1s
39:30 – GLP-1 Receptor Agonists in Psychiatric Practice
41:30 – Discovering SGLT2 Inhibitors: A Resident's Chance Encounter
45:00 – The Ketogenic Mechanism Behind SGLT2 Inhibition
49:30 – Trial Emulation and the Empagliflozin Pilot Study
52:00 – Metformin's Expanding Role in Antipsychotic-Associated Weight Gain
56:30 – SGLT2 Inhibitors as a Complement to Ketogenic Therapy
61:30 – Toward a Whole-Person Model: Diet, Drugs, and Exercise
66:00 – Confronting the Treatment Gap: Underused Medications
68:00 – The Future of Metabolic Psychiatry: Integration, Not Revolution
71:30 – Closing Thoughts and Sign-Off

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep20-feeding-mind-metabolism-psychiatry-david-t-liebers/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Dr. David T. Liebers – LinkedIn
https://www.linkedin.com/in/david-liebers-7b9706169/
Metabolic Mind
https://www.metabolicmind.org/
Patient and clinician resource on ketogenic and metabolic therapies for mental illness, recommended by Dr. Liebers in this episode.

The Emerging Role of GLP-1s in Psychiatry with Roger S. McIntyre, MD, FRCPC
Listen to a previous episode from April 21, 2026 covering GLP-1s in Psychiatry

#MetabolicPsychiatry #KetogenicDiet #SGLT2Inhibitors #Metformin #Mitochondria

Dr. Aderonke Pederson, an assistant professor of psychiatry at Harvard Medical School and a psychiatrist in the Depression Clinical and Research Program at Massachusetts General Hospital, joins the JCP Podcast to discuss how contact-based storytelling can function as a clinical intervention for reducing mental illness stigma and medical mistrust.
Stigma and mistrust are measurable barriers that delay care-seeking and worsen outcomes, particularly among Black adults with moderate to severe depression or anxiety who are not currently engaged in mental health services. Dr. Pederson walks through the theoretical foundations of contact-based stigma reduction, her research on religiosity and heterogeneity within Black communities, and a self-administered, video-based mobile intervention now being tested in a randomized controlled trial to help close the engagement gap in primary care.

🎯 KEY EPISODE HIGHLIGHTS:
🧩 STIGMA AS A FUNDAMENTAL CAUSE OF HEALTH INEQUITIES [04:00]
“Stigma has been described as a fundamental cause of health inequities.”
Framing stigma this way means it remains a barrier to care even after every other access issue has been addressed.
🧬 WHY MEDICAL MISTRUST IS AN EXPECTED RESPONSE [05:30]
“We expect mistrust if we have historical factors that have led to that mistrust.”
Clinicians should validate and address the historical roots of mistrust before working to reduce it.
🗣️ NAMING STIGMA TO GET IT OUT OF THE ROOM [53:00]
“It's in the room with you, and the question is, do you acknowledge its presence?”
Recognizing stigma and mistrust as active forces in every clinical encounter is the first step to addressing them with patients.

CHAPTERS:
00:00 – Introduction: When Story Becomes Clinical Intervention
03:30 – Stigma as a Fundamental Cause of Health Inequities
07:30 – From Basic Science to Psychosocial Mechanism: Where Stigma Intervenes
12:00 – The Engagement Gap: Disparities in Depression and Anxiety Care
16:00 – Religiosity and the Limits of Past Contact on Future Stigma
19:30 – Beyond Racial Categories: Heterogeneity and Migration
23:30 – The Power of Story: Why Narrative Changes Behavior
27:30 – Contact Theory: From Allport to the Psychiatric Ward
33:00 – Fisher's Narrative Paradigm and the Neuroscience of Story
36:30 – Shared Identity vs. Story Content
39:00 – Designing the App: A User-Centered Approach
45:00 – Inside the Clinical Trial: Reaching a Hard-to-Enroll Population
49:00 – Primary Endpoints and the Question of Durability
52:30 – Closing Thought: Naming Stigma to Address It

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep19-turning-stigma-into-stories-hope-aderonke-pederson/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Dr. Aderonke Pederson - LinkedIn
https://www.linkedin.com/in/aderonke-bamgbose-pederson-85345315/
#MentalHealthStigma #MedicalMistrust #HealthDisparities #DigitalTherapeutics #BlackMentalHealth

Dr. Crystal T. Clark, Associate Professor of Psychiatry at the University of Toronto and Canadian Research Chair in Reproductive Mental Health, joins the podcast to discuss the evidence-based management of bipolar disorder across pregnancy and the postpartum period. Dr. Clark, recently appointed head of the Department of Psychiatry at Women's College Hospital, has built her research career around closing the pharmacokinetic evidence gap for the mood stabilizers and antipsychotics used during pregnancy.
For decades, clinical practice around perinatal bipolar disorder was shaped by stigma and a lack of data, leaving many women counseled to discontinue effective treatment or avoid pregnancy altogether. Dr. Clark reviews how physiological changes in pregnancy alter the clearance of lamotrigine, lithium, and atypical antipsychotics, why postpartum tapering requires close monitoring, how the Mood Disorder Questionnaire can help distinguish bipolar from unipolar postpartum depression, and what her research reveals about racial disparities in diagnosis among Black women.

🎯 KEY EPISODE HIGHLIGHTS:
🚫 THE STIGMA OF DISCOURAGING PREGNANCY [05:30]
“No, there's no data. This is all stigma.”
Dr. Clark names outright that generations of counseling women with bipolar disorder against having children was never grounded in evidence.
🧪 LAMOTRIGINE CLEARANCE CAN JUMP 300% IN PREGNANCY [16:00]
“Elimination clearance really increases during pregnancy as much as two hundred to three hundred percent.”
This pharmacokinetic shift explains why patients on a stable lamotrigine dose can relapse mid-pregnancy despite full adherence.
📊 HIGHER BIPOLAR PREVALENCE AMONG BLACK POSTPARTUM WOMEN [48:30]
“When you looked at bipolar disorder, there was a higher prevalence amongst Black women.”
This diagnosis-level finding, rare in perinatal mental health research, points to a gap in how bipolar disorder is recognized in Black patients.

CHAPTERS:
00:00 – Introduction: A Career Built on Closing the Evidence Gap in Perinatal Bipolar Disorder
02:30 – The Discontinuation Era and the Stigma of Childbearing with Bipolar Disorder
08:30 – Reweighing the Risk-Benefit Calculus: Untreated Illness as Its Own Danger
13:30 – From Residency to Research: Uncovering the Pharmacokinetic Evidence Gap
18:00 – The Pharmacology of Pregnancy: How Lamotrigine, Lithium, and Antipsychotics Are Metabolized Differently
22:00 – From Algorithm to Practice: Applying and Titrating Lamotrigine Across Pregnancy and Postpartum
28:30 – Lithium in Pregnancy: Monitoring Levels and Revisiting the Ebstein's Anomaly Risk
35:00 – Atypical Antipsychotics: Quetiapine and Risperidone Pharmacokinetics
40:00 – Distinguishing Bipolar from Unipolar Postpartum Depression with the MDQ
45:30 – Racial Disparities in Perinatal Bipolar Disorder Diagnosis
50:00 – Designing a Postpartum Monitoring Plan for High-Risk Patients
54:00 – Future Directions: Formalizing the Lamotrigine Algorithm and Black Maternal Mental Health Research
57:30 – Closing Reflections: The Path Toward Diagnostic Precision

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep18-bipolar-disorder-pregnancy-postpartum-crystal-t-clark/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Dr. Crystal T. Clark – LinkedIn
https://www.linkedin.com/in/crystalclarkmd/
Rates of Major Depressive Disorder and Bipolar Disorder in Black and White Postpartum Women (JCP, 2024)
https://www.psychiatrist.com/jcp/rates-major-depressive-bipolar-disorder-black-white-postpartum-women/
The 2024 study discussed at length in this episode's chapter on racial disparities in perinatal bipolar diagnosis.
A Comparison of Symptoms of Bipolar and Unipolar Depression in Postpartum Women (J Affect Disord, 2022)
https://pubmed.ncbi.nlm.nih.gov/35041868/
The MDQ-based screening study Dr. Clark walks through when discussing how to distinguish bipolar from unipolar postpartum depression.
#BipolarDisorder #PerinatalPsychiatry #Psychopharmacology #PostpartumPsychosis #MaternalMentalHealth