Not Boring Founders: Dylan Beynon, Mindbloom

0:00The predominant form of treatment would work for about 54 % of patients versus 40 % for SSRIs. By using at-home ketamine therapy and combining it into the psychedelic therapy modality, we have gotten people a clinically significant response rate 63 % of the time. So that's 40 % more frequently than SSRIs. But it also works immediately versus 16 weeks for giving SSRI. And 10x fewer patients have side effects from ketamine therapy than they do from SSRIs. This story is about working hard even when it seems silly. and for the people trying to make crazy things happen.

0:41Not boring is for the optimist. Take a little shot of optimist. Take a little shot of optimist.

0:57Let's just zoom out and take a little shot of optimist. Dylan, welcome to Not Boring Founders. Thanks, Paki. Super fired up to jam with you. So tell me what you do. Mindbloom's mission is to transform lives today, to transform the world tomorrow through psychedelic medicine. What does that mean? What does Mindbloom do? Mindbloom is the nation's largest provider of psychedelic therapy. We do at-home ketamine therapy for people with anxiety and depression. We've done over 250 ,000 psychedelic therapy sessions since launching in 2019. And there are two big things that we have aimed to accomplish and made a lot of progress in.

1:39One is we've radically increased access to psychedelic therapy, started with ketamine therapy by creating a telemedicine model that has driven the cost of treatment down 80 % from the average in-person provider when I started the company, as well as bringing treatment to many Americans who didn't previously have access to an in-person clinic. About 160 million Americans don't have access to in-person behavioral healthcare. And so we're in 38 states, reaching about 90 % of Americans today. And the second is we've built a comprehensive solution that just starts with ketamine, the medicine, in order to get people better outcomes, or we call ketamine therapy 2.0.

2:18So this combines the ketamine along with specialized coaching from psychedelic guides, along with a lot of different therapeutic content and programs for different mental health care issues like grief, alcohol use disorder, anxiety, depression, to help people prepare for, get the most out of, and integrate their experiences. And as a result, just last summer, we published, along with researchers and physicians from UCSF, NYU, Cleveland Clinic, MAPS, who does the MDMA clinical trials in Houston Methodist, the largest ever clinical study in 70 years of psychedelic therapy and 20 years of ketamine therapy history, demonstrating that this program is literally the best treatment for anxiety and depression that's ever existed.

3:01That's unbelievable. So can you dig a little bit more into the findings from the research? What makes you say that it's the best for anxiety and depression in history? So zooming out, I started MindBloom, which is my third company for two big reasons. One is that mental health care is largely considered the number one public health crisis in the U.S. today. So to put the problem into perspective, nearly a quarter of Americans have a diagnosable mental illness in the United States. We've seen suicide and overdoses become the top two causes of death for adults under the age of 45. And the problem is just getting worse for a couple of reasons.

3:39One is that a lot of Americans, like I mentioned, don't even have access to treatment. About 160 60 million Americans don't have access to providers. There's massive stigma and mental illness, and it's very expensive. Psychiatry is the least insured specialty of all medical specialties. The other reason, the more insidious reason that we're losing the fight to the mental health crisis is that existing treatment options or legacy treatment options just really don't work for most people. So SSRIs like Lexapro and Prozac, what we think of as antidepressants, are effective for about 40 to 45 % of people.

4:13So less than half. They take six day weeks to work and like 40 to 50 % of people have severe side effects from them. They can't tolerate weight gain, sexual dysfunction, insomnia, severe anxiety, sometimes suicidality. And the clinical outcomes from talk therapy are even worse than that. Ketamine therapy over the last 20 years has quickly become one of the most promising, exciting treatments in behavioral health because the clinical outcomes are just better. So there've been over a hundred clinical studies published on ketamine therapy and in-person ketamine therapy, which is before my balloon took a lot of protocols that other providers were using and brought them into the mainstream.

4:50The predominant form of treatment would work for about 54 % of patients versus 40 % for SSRIs. By using at-home ketamine therapy and combining it into the psychedelic therapy modality, we have gotten people a clinically significant response rate 63 % of the time. So that's 40 % more frequently than SSRIs, but it also works immediately versus 16 weeks for giving SSRI and 10X fewer patients have side effects from ketamine therapy than they do from SSRIs. I was going to ask next about the trade-off. Telemedicine obviously seems like a better business model. You don't have to spend the money on locations and all that, but you're saying that actually the telemedicine approach, the way that you're doing it beats in-person ketamine therapy as well.

5:37That's right. And I think there are a couple of reasons for that. So the first reason is that when I started MindBlend, I became an ketamine therapy patient myself, and it was incredibly transformational. Just as transformational is a lot of different psychedelic therapies that I've used personally over the past 16 years, but it was extremely expensive, hard to access. You have to have someone take you to a clinic, sit with you for a couple hours and take you back every single time. That experience isn't great because what you do before a psychedelic therapy experience, during and after dramatically affects the quality and the outcomes.

6:12And traveling to a clinic, sitting in an unfamiliar medical clinic, traveling back from a clinic is not very conducive to your mindset going in, your ability to process afterwards, and the physical setting is often uncomfortable and foreign. In addition, ketamine therapy 1.0 was generally just an injection of ketamine, often delivered by an anesthesiologist or ER doctor, even a mental health care provider, and then you're sent on your way. still had these incredible outcomes, but we saw an opportunity to create a more comprehensive and complete psychedelic therapy solution that didn't just give you the medication, but gave you specialized coaching to help you prepare for each experience, get the most out of each experience with custom and developed audio and programs and guidance, and help you integrate each experience both directly afterwards and between each session.

7:04In addition, I think a lot of people here at home and they think maybe that would lead to worse outcomes. But because with psychedelic medicine, your mindset going in the physical setting that you do it in is really important. Doing it at home allows you to prepare a calm, expansive mindset, allows you to be in a safe, comfortable setting, and allows you that time immediately after to actually journal and integrate and process the experience and relax from it versus being shuttled around to and from a medical clinic. So I think those are a few of the reasons that despite telemedicine feeling like it would be cutting corners.

7:37It actually enables for psychedelic therapy, I think a superior experience, which has shown up in the largest clinical study in psychedelic therapy history. It was amazing. And of almost 1300. Yeah. Amazing when it works out like that. The thing that's better for the business is also better for the patient, which means the business can get bigger and reach more people and all those types of things. I've looked into psilocybin treatment a bunch. And one of the things that from a business model perspective seems tricky, Like SSRI is the benefit if you're a pharmaceutical company is that you have a customer for life.

8:08Once they're on there, psilocybin can work in a couple of sessions and you're done and you're fixed. On that spectrum, where does ketamine fall in? And if it is a fix more than a lifelong thing, what do you do from the business model perspective there? Yeah. So first and foremost, there's currently a dearth of clinical data, both lab data and real-world evidence for clinical data on the durability of effects. We're actually right now running a clinical study that'll be like 8x larger than our last clinical study. So we'll have an end of almost 10 ,000 patients trying to look at the durability of effects, not just how do people's behavioral health conditions improve immediately after treatment, but in the months and years after it.

8:55I think we could only be so lucky to solve the number one public health crisis eternally. I think the reality is that mental health is very dynamic. People have different issues that come up for them throughout their life. And so they'll dip in and out of different mental health states. For example, one of the big reasons I started Mindbloom is because that mental health crisis we talked about earlier is really personal and meaningful to me because I grew up in a family that was obliterated by the mental health crisis. My mother and my sister were both severely mentally ill, schizophrenic, bipolar, addiction.

9:31We tried all the traditional treatments for them, SSRIs, anti-anxiety meds, anti-psychotics, talk therapy, group therapy, inpatient rehab. And unfortunately, none of those traditional treatments worked for either of them. My mother spent 15 years homeless before dying of a fentanyl overdose a couple of years ago. And my sister died of a fentanyl overdose about six months ago, right after getting out of rehab. I'm sorry. Thanks. I appreciate saying that. It was very challenging. And one of the big reasons our mission and Mindbloom is to transform lives, to transform the world, is that I saw through that experience myself and some of the traumatic experiences I experienced growing up in a very turbulent household, that mental illness doesn't just affect the individual who's suffering, which it does.

10:13tragic for them, but has these ripple effects to their friends, family, community, and the work they can't do in the world. But on a more positive note, after my sister passed away, my father, who was already depressed, was cast into suicidal depression because of his grief from it. And we were able to get him on MyMalume's treatment programs, and he's done a few now, and he's absolutely transformed, full remission from not just suicidality, but depression. he sounds 30 years younger he's exercising meditating which if you knew him would be stunning he's a he's a working class guy mailman city bus driver and and i think we just see that people have all these different things that come up during their life traumatic events with divorce happens a lot with our clients heartbreak is a common theme grief is a common theme loneliness or aging, social anxiety.

11:08During COVID, we saw it's 20 % of Americans are clinical hypochondriacs. You have a pandemic, massive mental health issues there, OCD, PTSD, different substance issues, even things like smoking or nicotine can be persistent behavioral disorders for people. So I think even if we are able to get people durability for any given issue that they're facing with a neuroplastic drug, whether that's ketamine or psilocybin or LSD or MDMA, there'll still be issues that come up for people. But hopefully we can live in a world where companies like Mindbloom and providers can all put themselves out of business because we come up with a panacea for anguish and can move on to higher order problems for human flourishing.

11:49For sure. I want to get back to that part because I think there's probably, if everybody's cured, awesome, and then still probably a ton of great uses for all of those treatments. But what does a program look like today? Let's say I think that I might be a candidate it, I go to the Mindbloom's website. Take me from day one through all the way. So Mindbloom is a six-session treatment program. You meet with a psychiatric clinician, just like you would in person if you're meeting a psychiatrist, but through Zoom. I think a lot of people when they hear telemedicine, ketamine therapy, they think it might feel a little bit like drive-through medicine where you text a doc and get a script.

12:30But whereas some direct-to-consumer companies look more like online pharmacies where you might text a doctor for seven minutes to get a treatment, and that's appropriate for those treatments and treatment plans, at Mindbloom, patients are spending on average seven plus hours with their care team throughout that succession treatment program. So that's a couple hours of psychiatric consultation and medication management and titration up to the right dose with your psychiatric clinician. And then several hours of one-on-one messaging and group integration therapy with your coach or your psychedelic guide that you're connecting to through the platform.

13:06In addition, we have a mobile app that's Headspace or Com, but for psychedelic therapy with an entire suite of different content and programs and services to help people prepare for, go through, and integrate their experiences. The sessions themselves are taken sublingually. So it's a little flavored tablet that you dissolve under your tongue and in your cheeks. The experience itself lasts about one hour. And during that one hour, patients have on an eye shade and headphones, or they're able to select from a library of different guided programs and tracks that take them through with different types of music, spoken word to simulate what it would be like doing a guided experience in person remotely.

13:50That's very cool. And for those in the audience, myself included, actually, have not done ketamine before, what's the trip like? How would you compare it if people have done psilocybin or something like, how would you put it on the spectrum of other different experiences? That's the classic indescribable experience question. So I think the way you framed it's a really good way. If you've done a serotonogenic psychedelic medicine like psilocybin or LSD, or even ayahuasca. I think the way to think about that is that it really enhances a lot of your senses to the point of distortion in the foreground.

14:27You have hallucinations that are visual, they're auditory, they're even like olfactory and obviously cognitively and emotionally. Ketamine therapy works on a different set of neurotransmitters, your glutamate system, and it's much more in the background. So for a lot of people, it can feel very trance or dreamlike. The visualizations that people have are a lot less crisp, but they can often feel like memories coming up or dreams coming up. Oftentimes people have a very warm, positive, emotional uplifting that can feel a little like MDMA, not nearly as empathogenic or euphoric, but it can definitely, for a lot of people, they can feel this positive, creative sense of calm and well-being that if you're someone who's suffered for anxiety or depression for 5, 10, 20, 30 years, it might be the first time that you felt that way in that time period.

15:24In addition, people have a lot of different creative thinking that comes up during the experience, a lot of different cognitive insights. So ketamine, similar to psilocybin and LSD, is shown to cause the brain to secrete BDNF or brain-derived neurotrophic factor, which is like HGH for the brain or fertilizer for the brain. And so functionally what that feels like for people is a sense of sort of creativity and insight. And oftentimes if they're doing in a psychedelic therapy modality where they came in having written intentions, prime their subconscious and are exploring for them what changes they want to make in their life or what's holding them back, those cognitive insights are into them and how they want to or need to change to accomplish their emotional or psychological objectives.

16:14That neuroplastic state for people where they're more easily able to create connections in the brain and rewire their neural pathways and their behavioral emotional patterns is also shown to persist for three to 14 days afterwards. So even after the experience, the medicine is still working for people where they're a lot more easily able to change their behavior and get more insights and really solidify changes in ways of feeling and being. And that's why it's this six session program that sort of compounds on itself as people do it over the one to two months. And I know it might be tough to answer some questions because you're not a doctor and you have a company to run, but would it be better if the session just lasted forever?

16:57If I came in not depressed or feeling anxiety, but just wanted to get more creative. I'm stuck writing or I want to take Not Born to the next level. Could I just be on a program for the rest of my life and let neuroplasticity and creativity persist or what changes over time? Yeah. Putting on my personal psychedelic medicine enthusiast hat, clearly subjectively, people report a sense of improved wellbeing, like lateral thinking, creativity, cognitive insight that drives towards enhanced state of mental wellbeing and just like wellness. And so I think as the medical system, I think we're undergoing a transformation evolution from what I think of as old medicine versus new medicine.

17:46And so old medicine is like very reactive. It's very focused on treating the symptoms of disease states, and it's very paternalistic and topped out. You go to a doctor, they tell you what to do. New medicine, on the other hand, is very proactive. It's very personalized. It's not focused on just the disease states as it is in getting you to the optimal state of physical, emotional, and mental well-being. And it's a little bit more peer-based. So it gives patients more autonomy and responsibility to take charge of their own health and use providers as trusted advisors. Today, we're undergoing that shift in the medical system.

18:24I think we have a long ways to go. And so where ketamine therapy is today is it can only be prescribed for clinical indications of anxiety, depression, chronic pain, other mood disorders. And so today, if you came to Mindbloom and you said, I'm just looking to enhance creativity or explore my consciousness, you would not be eligible for treatment. But if you have symptoms of anxiety or depression, many people in modernity have symptoms of anxiety, but they think it's normal. Actually, it's normalized, right? I don't sleep that well. I'm restless. I'm fixated on the future. I'm normal. Can you fix my sleep?

18:56If you could fix my sleep, I would be forever grateful. Do you have onset insomnia or maintenance insomnia? I don't know the difference between those terms, but I just - Trouble falling asleep or staying asleep? It's really waking up to pee, I think at three in the morning, four in the morning, and then not being able to get back to sleep. That's the top part. Have you tried just a catheter? I did not try the catheter. I should try a catheter. Ketamine sounds a lot less painful than a catheter though. What's your caffeine consumption look like? I grappled with maintenance insomnia for years and it wasn't until I made the really challenging commitment, which took a long time and a lot of false starts to titrate my caffeine intake down like 70%.

19:40And then I also started watching television before bed, which interestingly enough, people would say is would be bad for your sleep, deleterious for your sleep. I found that even if I read, it tends to activate my mind. But if I'm watching television, then I'm completely vegging out. And so those two have improved my sleep like 80 % over the past two years. It's been pretty life-changing for me. Yeah, I would say probably. And I hate watching TV. It feels like a waste of time. But it's where, yeah, if you feel better the whole next day, it's worth it. I would say probably the caffeine is the main culprit, probably in three cups of Cometeer and maybe sometimes a lunchtime Celsius.

20:22I feel good about it because I cut myself off at lunchtime, but that's probably the culprit. Yeah. Have you done genetic testing to discern whether or not you're a fast or slow metabolizer? I have not. So I think if you've even done 23andMe, you can check the SNP. if you go into your raw genetic code, you can use like self-decode, I think it's called to look this up, to see if you're a fast or slow metabolizer. For me, I came to terms that I'm a slow metabolizer. And so even if I had all my caffeine early in the day, given the half-life you still have in your system like the next day. And so if you're metabolizing it slowly, like you still have caffeine in your system.

21:00And so I think it was just ramping up my sympathetic nervous system. And it wasn't until I stopped jacking myself up with stimulants to be productive all the time that I started sleeping better. It makes sense. It's switching back. You don't describe Mindbloom as a ketamine company. It's a psychedelic medicine company. What's the roadmap from where you are today to what the world looks like in the next five years, decade? How do more treatments come on, broader uses? When you look at all that, what do you see and what needs to happen? So today we have essentially one SKU for two customer segments.

21:37We do at-home sublingual ketamine therapy with our whole complete solution for patients with anxiety and or depression. Looking at the roadmap, if I had to break it apart into a few different milestones, I would say over the next 18 months, we have two big initiatives. One is what I call vertical expansion. So taking our one SKU, at-home sublingual ketamine therapy, and expanding into about a dozen other mental health care patient populations. So these are both mental health care indications and also just mental health issues. Alcohol use disorder, grief, smoking cessation, OCD, PTSD, behavioral change around some big things that affect people's health, like weight loss and exercise, social anxiety, loneliness, heartbreak.

22:28These are all, whether or not they're a clinical indication or just a mental health issue, key drivers of people's mental health and things that there are for a lot of these, a lot of clinical research that's ketamine therapy can really help for people. The second one over the next 18 months is our research uncovered that around 75 % of behavioral health patients will only consider a treatment that they learn about from a medical provider. So if we want to propel ketamine therapy and then other psychedelic therapies into the mainstream and really make it a big three treatment alongside talk therapy and traditional medications, which it should be when you look at the clinical outcomes, it should be number one, really, then we're going to need to not just get patients to adopt and consider it, but also to get providers to adopt and consider it.

23:15So one of the things we're doing on the back of this clinical study that we published last summer is we've begun partnering with providers who've been asking us to help them add on ketamine therapy to their practice because it's the most exciting treatments in behavioral health today, whereby they're able to add on telemedicine prescribing of ketamine therapy. We wrap around them. So it's not our affiliated providers prescribing it, just the provider you'd work with, but they'd work with our coaches, our program, our platform, our pharmacy partners. But that's just ketamine therapy. And there's a reason it's called Mindbloom and not Ketabloom.

23:51And that's because ketamine therapy is just the first legally prescribable psychedelic therapy in the US today. It wouldn't even be the one I would start with, or I think our clinical leaders would start with if all of them were available. MDMA therapy just completed fairly recently the last part of clinical trials and is preparing for a new drug approval by the FDA. And so we anticipate probably close to the end of next year, beginning to provide MDMA-assisted therapy to patients as well. Well, Cybin-assisted therapy just began phase three clinical trials. And so there'll probably be a couple of years after that.

24:27And then there's an entire pipeline of other neuroplastic drugs, things like LSD, mescaline, 2CB, ayahuasca, DMT, 5-MeO-DMT that are also coming down the pipeline. for a variety of mental health care issues and addiction treatments. From there, I still think that even these neuroplastic drugs are just the beginning of new technologies to help us improve our brain health and change our behavioral patterns. And so I think any technology that's developed, we will want to help either increase access to it and or help people get the best outcomes possible for it as a care delivery platform. And that could include non-psychedelic medicines.

25:12For instance, just the other day, there was a peer-reviewed study published in, I believe it was Science, around molecules that are being developed to essentially do that BDNF action that we talked about earlier, brain-derived neurotrophic factor, without the hallucinogenic effect. So this would essentially create a state of neuroplasticity in your brain that you get from things like high-intensity interval training, exercise, just a smidge of it, or fasting. Psychedelics do something like 10X what antidepressants do in terms of BDNF, or no, sorry, 10 ,000X what SSRIs do in terms of BDNF. But if we could subtract the hallucinogenic effect and even some like neurotoxicity of things you get from MDMA, you could have a true limitless drug on your hand that enhances creativity and orthogonal thinking and help people reshape their neural pathways in healthier ways.

26:05I was going to ask, that was one of my next questions about the importance of the hallucinogenic effects. Are there some things where it's actually super useful to hallucinate and others where cutting that out is better? Is it just a matter of the fact that more people are going to take something that doesn't make them hallucinate? What's that spectrum look like? I mean, there certainly seems to be something around the depth of hallucination or ketamine dissociation, we've seen the data is correlated to clinical outcomes. So people who go deeper in a way that's safe and effective tend to get better outcomes.

26:41We've also seen people who don't even get to a dissociative state can still have those, have great clinical outcomes and argue that because of the BDNF action that's occurring. So oftentimes clients will be underwhelmed by their first couple sessions because our clinicians start people to really low dose and titrate them up over multiple sessions to get them to the ideal range for them. So oftentimes patients are disappointed over the first couple sessions, but then still report feeling these incredible antidepressant effects in the days after. And that's likely because of the BDNF action that's occurring.