Dr. David Feifel, Professor Emeritus of Psychiatry at UC San Diego and founding president of the Kadima Neuropsychiatry Institute, joins the JCP Podcast to kick off the new "Psychedelics in Psychiatry" theme. A pioneer in the field who established the world’s first ketamine infusion program for depression, Dr. Feifel sits down to discuss the paradigm shift currently reshaping mental health care.

In this installment of the Behind the Manuscript series, Dr. Feifel breaks down the findings of his recent JCP paper: “Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Depression”. He explains the significance of the 25mg dose in preventing relapse over 52 weeks and offers a critical look at why traditional SSRIs are no longer enough. Beyond the data, the conversation delves into the nuances of "set and setting," the controversy of microdosing versus "heroic" doses, and the practical challenges clinicians face as the field moves toward interventional psychiatry. Dr. Feifel also challenges the traditional medical view of the placebo effect, arguing that harnessing expectation may be the key to the next generation of healing.

Episode Highlights:

00:00 - Dr. David Feifel and His Breakthrough Career

02:13 - How Early Curiosity Led to Psychiatry Instead of Neurology

07:33 - Balancing Clinical Practice With Research Innovation

11:41 - Psychiatry Entering a Transformational New Era

13:51 - Why SSRIs Fall Short and TRD Demands Better Solutions

17:27 - What Makes Psilocybin the Leading Psychedelic Candidate

20:25 - Why the Psychedelic Renaissance Is Surging Now

25:42 - Microdosing Myths and the Power of Expectancy

33:55 - How Set and Setting Shape Psychedelic Treatment Outcomes

39:51 - Do Psychedelics Really Need Psychotherapy to Work

48:58 - Inside the Phase 2 Study and How TRD Patients Were Enrolled

56:04 - Why 25mg Psilocybin Delivered the Strongest Clinical Results

1:05:39 - What Long-Term Follow Up Reveals About Relapse and Durability

1:11:38 - How Clinicians Can Prepare for Psychedelic Medicine Adoption

1:16:53 - Why the Future of Psychiatry May Rely on Harnessing Placebo Power

Key Takeaways:

"Psychiatry is in the midst of a golden age revolution... I feel like every day I was going to war with Godzilla with a peashooter. Now I feel like we've got some real tools."

"We’re in the midst of what I call the Cambrian explosion of treatments... a massive explosion of life forms after a long time of stagnation."

"The concept of 'one and done' with psychedelics is dead. We aren't going to have patients come in one time and say, 'You're good for life.'"

"Doing ketamine is like doing psychotherapy, but you're both the psychotherapist and the patient at the same time."

Links:

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

Dr. David Feifel: https://www.linkedin.com/in/davidfeifel/

Kadima Neuropsychiatry Institute: https://www.kadimanp.com/

“Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Episode of Major Depressive Disorder”: