5HT: 5 Healthyish Things, including psychedelics and a migraine hack

Trump signed an executive order (EO) last week to fast-track psychedelics for serious mental illness.

Joe Rogan, R.F.K. Jr., and former Navy SEAL Marcus Luttrell were all standing behind him. Rogan told the room he texted Trump about Ibogaine and the impact it could have on the country’s opiate problem. Apparently, the president responded, “Sounds great. Do you want FDA approval? Let's do it.” Then, during the signing, Trump whispered, “Can I have some, please?” I don’t… love that? But this is where we are, so yeah. 

Now, what does the order do? Basically, four things:

1️⃣ Directs the FDA to issue Commissioner’s National Priority Vouchers to qualifying psychedelic treatments with Breakthrough Therapy designation, potentially shortening review from 6–10 months to 1–2 months.

2️⃣ Creates a “Right to Try” pathway for eligible patients to access investigational psychedelics like ibogaine under the federal Right to Try Act.

3️⃣ Puts at least $50M through ARPA-H behind state psychedelic research programs. My home state Texas has already put up $50M for ibogaine clinical trials.

4️⃣ Pushes faster rescheduling reviews after successful Phase 3 trials.

To be clear: no psychedelics are being rescheduled—yet. This isn’t “legal shrooms 🍄for all.” (Yet.) It’s more like a shove to move psychedelics through the system faster.

I’m largely pro this direction. Mental health in this country is a crisis, and it’s not getting better. Roughly 14.6M U.S. adults experienced serious mental illness in 2024, and more than 60M experienced any mental illness. Antidepressants and talk therapy help some, but pretty obviously aren’t moving the needle. 

Psychedelics have the potential to do that (see more on why below.) My take is if this EO can help people with serious mental illness get access to promising treatment, that's amazing 🙌. Buuuut if this order ends up as only a press release or, worse, “my podcast is a fast-track to clinical trials-based decisions,” I'm out on that 👎. 

To sanity check my reaction, I texted Owen Muir, Chief Medical Officer at Radial, where I’m currently acting Chief Marketing Officer. Owen is one of the sharpest psychiatrists I know on this stuff and among the most published researchers in the field.

He’s pro-psychedelic. He’s a senior author on an eight-part systematic review in the American Journal of Therapeutics. He also recently dropped the paywall on it because of the EO. And he has PTSD himself.

His take: this order is “a truth nuke with a very long fuse.” He points out that—even with this EO—anything real is likely still 12–18 months away from making it through an actual regulatory process. He also pointed out that it's kind of wild to issue this kind of statement while doing very little with the psychedelic-adjacent treatment we already have (again, more on that below).

Because, whether you know it or not, psychedelic medicine is actually already here.

Have you heard of SPRAVATO®?

Well, you probably have heard of ketamine. And SPRAVATO®, which is “esketamine” (essentially a similar drug derived from the same compound as ketamine) is a prescription nasal spray for adults with treatment-resistant depression. It’s a glutamate-acting, dissociative drug administered in a certified clinic under REMS guardrails, including supervised dosing and two hours of monitoring. 

Unlike traditional antidepressants, which can take weeks to work, SPRAVATO® can relieve symptoms within 24 hours (!!). The FDA first approved it in 2019 as an add-on treatment, and expanded the label last year as a standalone option. If you need it, it’s probably covered by your insurance.

At Radial, it’s the second most-accessed depression treatment in their Brain Medicine program after TMS. (Side note: TMS isn’t psychedelic, but it matters here because it’s another example of brain medicine already helping people today. If you missed my write-up, new data on sustained improvement and remission just continues to be bananas.)

Basically, any approved psychedelic treatment—like those in Trump’s EO—should follow the SPRAVATO® playbook. Two of the big ones to watch are psilocybin and, yes, ibogaine.

Psilocybin, aka magic mushrooms, is a naturally occurring psychedelic being studied for depression, including treatment-resistant depression. So far, the data is promising, but not proven. Two studies (here and here) found that a single 25mg dose was associated with meaningful reductions in depressive symptoms. Buuut a more recent, more tightly blinded trial showed mixed results.

Ibogaine comes from a West African shrub and has been used for centuries in Bwiti ceremonial rites. It prompts a long, intense, dreamlike psychedelic experience and is being studied for addiction, PTSD, depression, and traumatic brain injury. Mark Hyman talked about his experience earlier this year. (And yes, it’s also the most Joe Rogan-coded drug name ever—looking for iboGAINs anyone??!!)

Recently, Stanford Medicine researchers studied ibogaine-assisted therapy in 30 special ops veterans in a clinic in Mexico, administering it alongside magnesium to reduce cardiac risk. Participants of the study showed major improvements in PTSD symptoms, anxiety, depression, cognition, and functioning. That’s a big deal (even though the study was small, self-selecting, and had no placebo). 

I’m not just bullish on the potential of psychedelics but also sold on their effectiveness already. I’m also very pro taking them out of the underground and into the clinic. Buuut I also think if the administration really cared about the mental health crisis—and not just midterm optics—it should also focus on expanding access to treatments we already know can help today, like TMS and SPRAVATO®. 

My hope is Owen is right (and he usually is). As long as the fuse on this “truth nuke” actually burns, this trip may actually lead somewhere.

Someone please try this “garage sale” hack and tell me if it works!

Now, let’s talk about ezetimibe.

Yes, this edition is full of big, sciencey names, and, yes, there will be a pop quiz next week! 😆 

I first learned about ezetimibe in this viral thread of doctors sharing what they actually take themselves. 

Apparently, many (like a shocking amount) of doctors say they take ezetimibe. And they’re not taking it instead of statins (also popular). They’re taking it on top of them. As I’ve learned, that’s because statins and ezetimibe pull different levers: statins reduce how much cholesterol your body makes…while ezetimibe reduces how much cholesterol your body absorbs.

I take a 5mg statin daily, and heart health has obviously been top of mind. My numbers are pretty strong, buuut in my latest labs, I had elevated beta-sitosterol, a plant sterol often used as a marker of cholesterol absorption. That suggests I mayyyy be an “overabsorber.” 

Most of us think of cholesterol as a production problem—I know I mostly have. But for some people, it may also be an absorption problem. I already know I have a genetic predisposition to absorb more iron (which is one of my favorite Scrabble words—hemachromatosis—and will also be on next week’s quiz). So maybe I’m also a little too good at absorbing cholesterol? Congrats to my gut for being an overachiever! 😂

If true, lowering production may only be part of the equation. That’s where ezetimibe comes in—to lower absorption. It may be the missing piece for me and, apparently, for the doctors who say they’re taking it too.

This is another great example of the increasing shift from reactive to proactive health. It used to be: your numbers look good, you’re fine. Now it’s more: what can I do to lower risk and keep getting healthier?

So, fast-forward to last week, I brought this all up with my PCP. I didn’t want to just stack another pill, so we weighed the pros and cons and decided it was an optimization worth trying. I plan to start taking it and will share an update.

Plus, I think more doctors should share what they personally take and why. What better signal is there than that? If you’re a physician reading 5HT (I know there are many of you!), reply back and tell me what you’re personally bullish on enough to add to your routine, I’m curious (and I may share it in a future edition).

Apparently, there's a new personality label making the rounds: otrovert. 👀

The term comes from a book called The Gift of Not Belonging: How Outsiders Thrive in a World of Joiners by Dr. Rami Kaminski, a New York City psychiatrist. According to Kaminski, otroverts exist outside of the “extrovert-introvert spectrum.”

They’re not antisocial. They’re not awkward loners. They can be warm, friendly, and well-liked. They just don’t love belonging to groups. You probably won’t find them rushing a sorority, joining a book club, or leading the local kickball league. But they’re very down for one-on-one coffee and deep conversations at a party. And, yes, this is trending on TikTok, and, yes, there's a quiz. (Of course.) 

Is this hard science? Probably not. But it also doesn’t need to be, imo. The introvert/extrovert binary has always felt too small. (How many people do you know who say they’re both?) Giving people another option—and a name for it—could help explain something they couldn’t articulate before. And ultimately, there’s a ton of value in feeling seen.

Ambivert tried to solve for the middle. Now, otroverts is describing something else specific: being social, but not tribal. Independent but not isolated. Friendly, but not join-y. And, personally, I’m not losing sleep over whether this passes peer review.

Am I an otrovert 🤷‍♂️? IDKID. I’ve always felt extroverted and genuinely love being around people, but I also need serious alone time to recharge. FWIW, “social outsider” resonates more than other labels. Buuut let me take the quiz and get back to you. 😆

Directions: Copy, paste, and fill in the prompt below to get your palm read ✋. Yup, you read that right 😆. This week’s Neural Hack is inspired by this tweet annnd my readout is unreal. So, yeah, prepare to be woo’d 🪄.

👋 Who are you again? I’m Derek Flanzraich—founder of two venture-backed startups in Greatist (👍) and Ness (👎). I’ve worked with brands like GoodRx, Parsley, Midi, Ro, NOCD, and Peloton. I now run Healthyish Content, a premium health content & SEO agency (among other things).

Every Thursday, I share 5 health things I feel strongly about so you can live healthyish. (Disclaimer: I’m more your friend with health benefits. None of this is medical advice.) Also some links are affiliate links, but they influence my decisions zero.

Oh, you also feel strongly about some health things? Hit reply—I’d love to hear it.