Lori Calabrese, MD

Author: Lori Calabrese, M.D.

  • Spravato: Esketamine Nasal Spray Controversy Storms Ahead

    Spravato: Esketamine Nasal Spray Controversy Storms Ahead

    This man is happy following treatment in spite of esketamine nasal spray controversy.

    Have you tried Spravato?

    Periodically, we’ve added our two cents to the discussion. Since its approval by the FDA in March of last year, we’ve seen a variety of protests from psychiatrists about its value for treating treatment resistant and severe depression. A recent article published in The Lancet provides an overview of the back and forth discussion. A group of physicians wrote a series of editorials published in The Lancet in October 2019, challenging Spravato’s value when weighed against its dangers and modest effectiveness. And the esketamine nasal spray controversy surges forward.

    A significant benefit for Spravato is supposed to be that because the FDA approved it, some insurances cover the cost of the medication and the cost of the doctor’s 2-hour office visit to administer it. (Stay with us–more on this later!) That’s a substantial benefit in the eyes of some patients.

    There have not yet been head-to-head controlled trials comparing racemic ketamine infusions to Spravato. But there are plenty of physicians around the country who have used both in their offices with patients. And when you compare Spravato with the effectiveness of IV ketamine treatment, Spravato’s benefit is less dramatic, and rather than occurring rapidly and robustly — it seems much milder and more gradual.

    Spravato esketamine nasal spray controversy is hot on The Lancet.

    In addition,  FDA approval requires the use of an antidepressant at the same time as Spravato.

    (It’s like Spravato is an adjunctive treatment to an antidepressant you’re starting at the same time, or an add-on to an antidepressant that’s on board but not completely effective.) Hmm. When you think about it, it may be harder and harder to know what the FDA trials really showed.

    So let’s look at the objections of these doctors, and the response from a team led by Ella Daly, M.D., associated with Janssen, the maker of Spravato.

    A Former FDA Recruiter Expresses Misgivings about Spravato’s Trials

    One of the critics of Spravato’s FDA approval was a former FDA reviewer himself. Erik Turner, MD, of Oregon Health and Science University in Portland, OR, made a point in his editorial.

    He said that some physicians who had heard that Spravato was a “game-changer” were likely to feel disappointed when they found out that  81% of the response to this medicine was experienced by those who were given the placebo!  

    Dr. Erik Turner challenges FDA approval of Spravato esketamine nasal spray.
    Erik Turner, M.D.

    As a former reviewer himself, he expressed his concern that esketamine nasal spray was basically approved on only two positive trials, in spite of the failed ones. 

    In a short-term trial to show effectiveness, the response of reduced symptoms was not maintained for even 24 hours. It’s not hard to see why that wasn’t satisfactory. 

    In the FDA trials, Janssen used the Montgomery-Asberg Depression Rating Scale (MADRS) to rate change in mood in the subjects who were taking esketamine spray. Surprisingly, there was only a mean 4 point improvement on that scale which has a possible score of 60. 

    It’s only fair to note that 69% of subjects who were taking the active drug vs. placebo technically responded. However, when we consider that they deemed only 2 points on the MADRS as “clinically significant,” practicing psychiatrists might not see it the same way when evaluating their own patients.

    Still, 52% of the placebo group scored 50% or higher improvement on their MADRS rating. So research team labeled them “responders,” (meaning the nasal spray they were testing had made them feel 50% better). But…the nasal spray that the placebo group was using was a placebo….

    You can see why Dr. Turner had some misgivings about the accuracy of the conclusions.

    Maintenance Trial Findings Distorted..?

    Dr. Turner also challenged whether the maintenance trial’s findings were up to par because a single site in Poland was the basis for those results. Trouble was that 100% of participants in the placebo group there relapsed. Which most researchers consider a red flag.

    The Janssen team defended their findings, and pointed out that the FDA didn’t see the need to eliminate data from the Polish site. In this recent response published by Dr. Daly and her colleagues, they produced another analysis which eliminated the Polish data. They used updated estimates and concluded they maintained the statistical significance.

    Dr. Turner came up with his own calculation based on information openly accessible to the public. His conclusion was that there was a “non-significant difference.” So he made the appeal “in the spirit of open science” that Janssen would provide an unbiased researcher with the patient-level data to hopefully resolve this conflict and try to replicate Janssen’s findings.

    Then …there is the issue that 6 people died during FDA trials. Of the six, 3 were suicides. The suicides occurred on the 4th day, the 12th day, and the 20th day after the last dose of esketamine.

    Esketamine nasal spray controversy is about Spravato not helping people like the FDA implied it would.
    There were no deaths with the placebo.

    Again …troubling. And confusing for a lot of people.

    Right now, the FDA says that Spravato can only be administered in offices, clinics, or hospitals registered with the Spravato Risk Evaluation and Mitigation Strategy  (Spravato REMS). Patients must remain in the office for monitoring for 2 hours after each dose.

    Another Editorial by Two Experts Fuels the Esketamine Nasal Spray Controversy

    Ioana Cristea, Ph.D., of the University of Pavia in Italy, also published one of the editorials in October in The Lancet with Florian Naudet, M.D., Ph.D., of Universitaire de Rennes in France.

    Dr. Cristea pointed out that the mild benefits of Spravato should be weighed against its potential for harm.

    She also holds that since Spravato is so expensive, has high potential for abuse, and has a troublesome history for safety, the bar for FDA approval for antidepressants should be raised.

    And she has a point.

    In the real world, our patients suffer severe and complex disorders, and the need for robust and rapid solutions for them has been gaping for 30 years. 

    Mild benefits that build gradually are only effective in select patients. 

    At Innovative Psychiatry we do use Spravato for select patients — but we use IV ketamine much more often. 

    Why?

    Because IV ketamine treatment can yield such rapid and robust benefits. And many patients need a treatment that’s both rapid and robust. It’s often life-saving. And we’ve published our results using IV ketamine infusions to stop suicidal thinking in real-world patients and presented our ongoing data at several conferences.

    For some patients, the insurance coverage that makes Spravato more accessible to them is well worth the risk of a less robust outcome. And we’re pleased to help them access the treatment best suited to them.

    With that said, since Spravato is made with the left-side enantiomer of the racemic ketamine molecule, it’s lacking the attributes of the right-side enantiomer. This is a subject that’s been side-stepped. We need more data about the right-side enantiomer.

    Esketamine Nasal Spray Controversy – Was Spravato the Only Alternative to IV Ketamine?

    And another thought. Janssen’s stance in developing the esketamine nasal spray was that ketamine was only available in IV form. But was that a real concern? Long before Spravato was approved, compounding pharmacies were already creating nasal sprays for ketamine, so it’s clear that a nasal spray using the full racemic ketamine molecule was a viable consideration. Some doctors have been prescribing that, and oral lozenges (called troches).

    Spravato esketamine nasal spray provides only a mild and gradual benefit in some people.

    So was it really because ketamine was only available in IV form? Or was it because ketamine’s patent had expired? (Hint: The big money is in the patent.)

    Is it possible that safety and effectiveness were sacrificed in lieu of monster profits?

    There is no pharmaceutical company sponsoring controlled studies of racemic ketamine.

    But there are real-world physicians with complicated patients around the country willing to carefully and diligently report what they see in their day-to-day offices. These are retrospective studies of their protocols, their patients, and their patients’ responses. Submitted for peer-review. And published.

    We know because we’re one of them. (We’re actually the first one of them. With the largest numbers, and with extraordinary responses to treatment.)

    Why do we do this?

    Because we know that once insurance companies realize that IV ketamine treatment in the office can rapidly stop suicidal thoughts and plans in patients with treatment-resistant depression — even those who’ve made attempts before, been hospitalized, been failed by ECT, failed by TMS — those insurance companies are going to be pressured to stand up and listen.

    If we can turn these patients around (you? someone you love? someone you know?) so that they don’t have to go to the ER, and don’t have to be psychiatrically hospitalized…. WOW! What insurance company wouldn’t jump at paying for IV ketamine infusions instead of ambulances, ERs, and hospital days??

    That’s what I advocate for. Every day. Safe, effective, rapid treatment. Hope. Better lives for my patients.

    Imagine that.

    Imagine the goodwill gesture — such a small gesture, and such a small cost –for your insurance company to just simply approve payment for the codes we use everyday for office-based IV ketamine infusions for depression.

    What a concept. Radical. Life-saving.

    Read the paper. See for yourself.

    IV ketamine treatment stands as the most rapid, effective treatment against severe and treatment-resistant depression, as well as suicidal thinking, that we’ve ever seen. In the office, in an evening. In less than an hour.

    Which insurance company will step up and pay for IV ketamine to save a life?

    A girl can dream …and that goes for psychiatrists and their patients, too.

    If you believe Spravato can work for you, call us. We’re happy to provide this treatment for you. Don’t let the esketamine nasal spray controversy discourage you. In some people it works very well.

    Esketamine nasal spray controversy didn't stop this man from responding to treatment.

    If you’ve tried Spravato and you were disappointed with the results, call us and let’s talk about what IV ketamine might do that Spravato can’t.

    We’ll help you understand the differences in the fixed doses available with Spravato and compare them to what is available when ketamine is used IV.

    And if you suffer from severe depression or bipolar depression, PTSD, social anxiety, alcohol use disorder, or another substance use disorder, and have been failed by other treatments, call us, too.

    Because you can feel good again.

    You can rebuild your life with the motivation, initiative, and energy that’s been missing with restored hope … and joy. What’s more, creativity can return and grow as you invest in your career, your relationships, and your hobbies.

    We’re all about seeing you restored, fulfilled, rewarded.

    Give yourself the opportunity to live well again.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Student Need for Psychiatric Care on Campus Quadrupled

    Student Need for Psychiatric Care on Campus Quadrupled

    Mason walked to the student union and plopped down to drink his coffee.

    Man, he just wasn’t feeling it. He went to class, but the studying and note taking, and researching all year was getting to him. He just wanted to go to bed and stay there. Just another example of student need for psychiatric care on campus. I’m a statistic, he thought to himself. Great.

    It was that time in the semester for another round of exams, and he was worried he couldn’t pass them. He tried to study but it just didn’t stick. He’d go over it and over it…but couldn’t seem to retain much at all. 

    It’s not like he was partying or anything…he wasn’t doing much of anything social. He didn’t feel like seeing anybody. Just wanted to be alone.  So he’d try to study then just lay his book down and turn over and go back to sleep. 

    Spiring Break was 3 weeks away.  Maybe that would help.  But he had to pass all his exams before then. What was he going to do?  His self-confidence was fading, and he was feeling more and more like a real loser. What was wrong with him?

    “Hey Mase! What’s up? Are you going to the campus movie night tonight?”

    “No man.  I’ve gotta study…”  Mason felt like he was lying, because he knew studying wouldn’t help anything. His brain was a lump of cold oatmeal.  Useless.

    “Oh really? You know we’ve got a study group going for Chemistry, right?  You wanna join us?”

    “Maybe, man.  Where do you meet…? “  He knew he wouldn’t go.  He couldn’t handle being around people right now…

    “We meet in Greg’s dorm room. At Stratton Hall.  327 Tomorrow after lunch.”

    “Thanks man. Maybe I will…”

    Depressed or Anxious Students Seek Solitude to Avoid Embarrassment

    Mason trudged off toward his dorm before someone else came along to strike up more conversation.  He felt like he was dumb as a rock. What had happened to him?  It used to be easy to learn. Mason’s self doubts were common for students suffering from disorders. Student need for psychiatric care was weighing down the healthcare system on campus.

    Once in his dorm, he sat at his desk and opened his economics book…determined to get something out of it. He opened to the page he was supposed to be reading and started reading.

    Then his mind wandered off to an online game he had played last year…  the action was really good in it. And it was challenging.  He had to really work at making points. There were some cool guys who played… Wonder why they…

    Aaackkk!!! Mason realized his mind was wondering again.  He put his eyes back on the beginning of that page and started reading again.  He read the first half of that page 4 times…and couldn’t recall what it said.  

    He slammed his book shut and dove into his bed and covered his head with his pillow. And that’s when his roommate walked in talking out loud. Mason pulled another pillow over his head.

    If only he could sleep. I mean really sleep. When was the last time he’d actually slept all night?  Laying there in the dark, his mind wandering…his worry about school choking him… listening to his roommate snore.  How does he do that??  He’s over there sleeping like he doesn’t have a care in the world. 
    Student need for psychiatric care is tripled what it used to be on campus and this young man needs treatment.

    He knew his parents would disown him if he didn’t make the grades. He was so tired…

    Student Need for Psychiatric Care on Campus Soars

    It’s true. Mason isn’t alone. The Center for Collegiate Mental Health (CCMH) at Pennsylvania State University released an annual report in 2018 that showed that student demand for mental health care on 550 university campuses increased by 30-40% between 2009-2015. The increase in enrollment was only 5%. 

    The primary complaints have been much the same as they’ve always been as students seek counseling for depression, anxiety, and relationship struggles. 

    And there’s a difference between relationship counseling and student need for psychiatric care due to depression, bipolar disorder, anxiety disorders, and PTSD.

    But, a recent article in Psychiatric News, a publication of the American Psychiatric Association, indicated that students carry more distress than they used to, and it’s more upsetting and worrisome to them.

    So they tend to take things harder, and if they never struggled before, they still are more likely to struggle in college.

    Social Media is Again at Fault

    Students now are also tormented by the belief that everyone else around them has a perfect life, and that they’re the only one struggling.

    This is largely related to the facade they see on social media. As they internalize these false beliefs, some students succumb to self-doubt and self-hatred, because of these comparisons.

    Suicide May Be a Consideration..?

    On top of that, suicide has become less implausible…more common place—at least from some students’ perspectives.  Obviously, this is a grave concern for campus counseling services. Through surveys, the CCMH has found that suicidal thoughts have increased among students every year for the 8th year in a row.

    Student need for psychiatric care on campus is overwhelming, and some students slip through the cracks.

    The reality of it has burdened these organizations to not only train their own staff for suicidal thoughts in students.

    They also must train everyone on campus to recognize signs and symptoms and take action… including campus police, professors, residential advisors, librarians, and anyone else whose job includes student contact.

    Some campuses focus on meeting the need in more minorities and male students, who tend to avoid mental health services. Other campus are including a counseling office in the campus clinic to make counseling more accessible with less stigma. 

    At any rate, while all these campuses scramble to provide services their students’ needs, the demand has risen so fast that they remain limited in resources for what they can do.

    Meanwhile, more intervention is needed. The demand overwhelms the system.

    Many of These Suffering Students Can Achieve Remission Off Campus

    Many of these students are diagnosed for the first time with depressive or anxiety disorders in college. But many more were diagnosed years earlier, and have been undergoing treatment before college. The increased pressure and demands of college often push them into more severe symptoms.

    For these who’re being treated before they enter college, or for whom treatment has become inadequate, a very real option can be IV ketamine treatment. When medicines are no longer helping, or never did, IV ketamine infusions can relieve symptoms dramatically. 

    The lack of energy, the struggle to learn, the despair, can be replaced by motivation, initiative, and the creativity to study and perform once again. 

    The restoration of brain circuitry, and proliferation of structures in the brain can rapidly build the resilience to embrace school again.

    On top of that, suicidal thoughts or behaviors can be eradicated in an afternoon with IV ketamine treatment. It’s a remarkable way to reverse suicidal thoughts, so a student can focus on getting better.

    IV Ketamine Can Transform Students and Reduce Student Need for Psychiatric Care on Campus

    At Innovative Psychiatry, we see students like this regain their joy and hope after IV ketamine treatment and walk out with confidence. IV ketamine treatment can lift your student’s outlook and energy. Despair can become hope, and listlessness can turn into purpose-driven initiative.

    These students are resilient and happily studying together because of IV ketamine treatment.

    That sullen student can wake up with new ideas, energy to socialize, and a song he’s singing. 

    This treatment can be transformative. And the more ill your child is, the more powerfully it seems to work.

    If your child sounds like Mason, or if his symptoms are even worse, call us. 

    And if you can relate to Mason’s story, and don’t know where to turn for help, call us… we want to help you rediscover your creativity, energy for work, relationships, and fun. We want to see your hope restored.

    Don’t let something like your education or your future fall by the wayside. You don’t have to because you do have options. 

    Let us help you live again with joy.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Relieve the Heartbreak of Elderly Depression with IV Ketamine

    Relieve the Heartbreak of Elderly Depression with IV Ketamine

    Ruby’s daughter let herself in with her key at the back door.

    When she walked in, the house was dark. Strange…she thought. Her mom was usually home on Saturdays.  She quietly stepped through the house looking for some sign of her mom.  A grave sense of dread came over her as the house continued to be silent…what was she going to find…? She stepped into her mom’s bedroom, and saw her form lying in bed. Joan stopped and caught her breath. Joan had been worried about her mom lately, and the heartbreak of elderly depression, since her husband died 11 months ago.

    Then a weak voice said, “Hi honey…”

    Joan exhaled. What a relief.

    “Hi Mom! The house was dark and quiet…  I was concerned.  You rarely leave the house on Saturday…”

    Joan stopped short of voicing what she’d feared.

    “Are you feeling ok? Why are you in bed..? It’s really dark in here…”

    “What day is it?” Ruby quietly asked.

    “It’s Saturday, Mom. How long have you been in bed..?”

    “Well, I remember watching the weather on Tuesday…I was wondering if I needed to wrap the pipes.”

    “Ok.  That was Tuesday…  Do you remember what happened Wednesday?”

    “I guess I’ve just been sleeping…”

    “Mom?  Since Tuesday?”

    “I don’t know…maybe? I got up and went to the bathroom at times then just felt tired and went back to bed…”

    “Do you remember if you ate anything..?”

    “No…not really.”

    Joan was alarmed.  Her mom hadn’t eaten since Tuesday.  No wonder she was weak. And she’d gone four days without her medicines. 

    Four Days without Her Medication

    Joan headed to the kitchen to make her mom some soup.  She wanted to go easy and see how she digested soup before solid food.  After opening the can of soup and dumping it in the pan, she looked at her mom’s medicines.

    Well, that confirmed it. The pills were still in the Wednesday, Thursday, and Friday compartments.

    Joan was shaken to think if she hadn’t dropped by, and another week had gone by, what could have happened.

    Joan brought her mom the bowl of soup with some crackers and a glass of milk on a tray.  She helped her 84 year-old mom sit up and propped her with pillows, then set the tray in front of her.  Slowly, her mom nibbled on a cracker, sipped the milk and finally scooped a spoonful of hot chicken noodle soup.  She closed her eyes as she swallowed.

    “Ok mom?”

    “ Yes, it tastes good.”

    Joan talked about trivial things to try to lighten the mood. Ruby had looked after everyone all her life, but since Joan’s dad, her mom had seemed less and less engaged in her own life.

    Maybe listless was the word. 

    She’d withdrawn from her bridge friends. She’d said it didn’t seem as fun anymore. Her grandkids were all grown with families of their own. Cleaning house and cooking was a chore without Charles to do it for.

    She just got tired of the struggle. What was the point?

    She felt tired all the time, and found herself taking more and more naps.  

    How do you find purpose in life after the companion who’s been there for 62 years is suddenly gone?

    The Heartbreak of Elderly Depression

    The more questions Joan asked, the clearer it became that her mom wasn’t fighting the flu, she was depressed. At least she seemed to be.

    Joan wondered how long she’d been depressed. And whether she’d thought about ending her life… It had really shaken her to walk through that dark silent house.

    She asked her mom more questions. Ruby was matter-of-fact. “Yes, the doctor told me I was depressed a couple years before your dad died. He prescribed some pills for me, and I took them, but they didn’t do anything. I think they must have been those sugar pills you hear people talk about. I finally stopped taking them.  There was no point.”

    “Joan,” Ruby said, “I miss your dad. Charles and I talked about everything. Without him, life is flat. It’s just so empty. I have you and your sister, and I love you both, and all the grandkids and their families. But I feel so empty.”

    “Mom, I can only try to imagine how much loss you feel with Dad gone. We all miss him, but he was your constant companion and love for 62 years. I ache for you… and I can’t help but feel that even though grief has made you feel empty, that does’t mean your time on earth is finished. Maybe something can be done to help you feel better, you know? Would you be ok with me making an appointment to see Dr. McShane? We can go together.. Ok?”

    The Heartbreak of Elderly Depression – How Can We Help?

    Here’s the thing. Our parents (and grandparents) do look after everyone else all their lives. Then, they slow down, and the the rest of the family can easily forget to touch base. Why? Because life is busy. We all live with packed schedules, and a week can go by without our even noticing it.

    Our elderly loved ones can find themselves withdrawing, slowing down, and feeling somewhat useless. It’s not that unusual for depression to follow. 

    In many cases, prescribed antidepressants help. But in some, they don’t help in spite of trying more than one. When the disorder doesn’t respond to multiple treatments, something more advanced is needed.

    IV Ketamine Treatment Can Reverse Elderly Depression

    IV ketamine for treatment resistant depression may just be the treatment of choice, to restore your parent’s brain circuity. By turning on mRNA which switches DNA to “ON” your brain-derived-neurotrophic-factor (BDNF) turbo boosts the prolific and rapid production of dendrites and dendritic spines to sweep through the important parts of the brain with connections to send signals at the speed of light.

    Depression lifts, joy surges, creative thought grows, and Grandma gets that sparkle back in her eye,  and has the energy to play bridge with the girls again… and make cookies for children in the neighborhood.

    At Innovative Psychiatry we love treating grandparents and watching them get a new lease on life. Of course, if they’re grieving losses, they can grieve while still enjoying life. 

    Ketamine treatment doesn’t prevent grief, which is a part of life.  But ketamine can help them think through the grief in a healthy, healing way. And meanwhile, they can also enjoy their friends, family, and grandchildren.

    Your Loved One Can Recover from the Heartbreak of Elderly Depression, and So Can You

    Do you have a parent or grandparent who seems to have lost their joy for living? Maybe they’ve tried antidepressants but still seem serious, irritable, edgy… or bland, shut down, and without energy. Maybe you notice they don’t bathe very often anymore, and have lost interest in their appearance, or in things they normally love to do. 

    If this sounds familiar, and you have loved ones you hope can be helped by IV ketamine treatment, call us. 

    In fact, if this describes you, please call us and let us help you find your joy again.

    IV ketamine treatment rapidly proliferates your brain circuits with an abundance of new synapse connections that make the way for restored creativity, emotion like joy, happiness, love…and hope. You want to do things you enjoy again.

    Amazingly, this proliferation also increases emotional energy that can translate to more physical energy, too. Initiative and motivation increase, and joie de vivre abounds. Few phrases express what ketamine can do like this French phrase, which means “a cheerful enjoyment of life and exultation of spirit.” 

    If you have lost the song in your heart, you can have that restored. Some of our patients report waking up in the mornings singing. 

    How about you?  Have you lost your song? IV ketamine treatment can restore it, and give you that, “Oh what a beautiful morning!” feeling. 

    It’s amazing to realize that people with joy and a song in their heart are that way because they have a LOT more synapses than others, isn’t it? 

    Let us help you and your mom find your songs again.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Depression in Pregnant Mom Can Affect Baby Before and After Birth

    Depression in Pregnant Mom Can Affect Baby Before and After Birth

    Depression in pregnant mom can affect her baby's brain development.

    Sarah Driscoll had looked forward to her first pregnancy for years.

    She had to complete her graduate degree first, so she could relax and enjoy every moment. Now she was pregnant, and it was going well. Every visit to the doctor revealed more growth in her baby. It was an exciting time. But as her delivery date approached, something seemed off. She’d heard of depression in pregnant moms but she had no reason to be depressed!

    Still, rather than feeling excited about her baby’s birth, she found herself with mixed feelings. The idea of the work ahead, the sleepless nights, the exhaustion… began to weigh on her. Each day she felt more nervous about it than the day before.

    She mentioned her fears to her husband who reassured her that it would probably all fall into place once she saw her beautiful baby’s face. She secretly hoped so, but was skeptical.

    One day she asked her mom if she felt the same way before her first baby, and her mom told her no, she was so excited about having the baby in her arms, she didn’t care what it required of her.

    That just made her feel more selfish and guilty.

    Her best friend chimed in with a similar perspective, except admitted she was worried whether she would be able to handle everything after her third baby was born. But she reassured Sarah that it turned out to not be a problem. Caring for her 3 children was not so hard to take in stride.

    Sarah’s anxiety rose higher and higher, and by the time she began having labor contractions, she felt exhausted about the whole thing.

    After 9 hours of labor, her baby boy was born healthy, looking around the room with big bright eyes. And he quickly began to nurse when the doctor placed him on her chest.

    Postpartum isn’t always a fairy tale

    Sarah felt she should feel happier. Pangs of guilt shot through her that she felt so little for this beautiful baby boy. Her lack of emotion seemed to confirm she just wasn’t fit to be a mother.  And now this poor child was stuck with her.  What should she do?

    The first 2 weeks after he was born seemed like a test of endurance. How long can you live without sleep, she wondered. She went through the motions of changing diapers, feeding, and holding this baby. But she felt like a robot. And she was consumed with guilt.

    Help Arrived: Her Sister Came to Visit

    When her sister came to visit, Sarah tried to be a hostess in her exhausted, bedraggled state. Her sister sensed she wasn’t doing well and finally asked. 

    “How are you feeling emotionally..?”

    Sarah’s chin quivered. “I feel like a terrible mom. I love my baby but I don’t feel it. I’m so tired. I thought this would be a happy time….”

    Her sister arrives to help new mom with depression.

    Her sister wrapped her arms around her. 

    “Sarah. You’re NOT a terrible mom. But you do need some rest and a chance to see the doctor.  Tell you what.  Go to bed.  Let me take over with Jake.  I’ll love every minute of it and you need rest. Then we can talk more.”

    No surprise, the nap helped Sarah feel revived, but it didn’t help the empty, blank, nervous feeling go away. So she Said that to her sister… who told her she had a friend who was diagnosed with postpartum depression and had described feelings kind of like Sarah did.

    She suggested they make an appointment to see the doctor, who then referred Sarah to his trusted psychiatrist friend. That psychiatrist explained that depression in pregnant moms happens sometimes. She recommended a special treatment that could give Sarah rejuvenation in her emotions, her bond with little Jake, and hope for the future.

    She called it IV ketamine treatment.  Sarah had never heard of it, and her only concern was whether it would hurt her baby through her breastmilk.

    The doctor explained how it worked, how quickly it’s eliminated, and how infusions are usually scheduled, but if she liked she could pump her breast milk for the next 2-3 weeks then resume breastfeeding afterwards. Sarah was fine with that, and frankly was game to try anything at that point…

    We don’t talk about depression in pregnant moms very often, do we? 

    In fact, at this point it’s been nearly 2 years since the last time. But treating depression is important. And when it comes to bringing a child into the world, that depression may have a reach beyond just you.  It may impact your baby as well.

    A study published in the American Journal of Psychiatry this past September authored by Zou, Tiemeier, et al, showed that maternal depressive symptoms during the time before and after childbirth actually can affect the development of the baby’s brain. 

    For the study, researchers collected data from 3469 mothers and their babies related to whether the mother experienced depression symptoms during pregnancy and afterward, through the baby’s childhood up to age 10. They measured behavioral and emotional problems in these children, at the end when the children were ten years old. 

    Children were assessed at age 2 months, 3 years, and 10 years. The timing of the mother’s depressive symptoms were charted as they pertained to these age points.

    What they found out was that at the age of 2 months, babies whose mothers had been depressed had less gray matter — meaning the volume of their brain was smaller. They also had less white matter, which is the areas of the brain where brain cell connections happen. The color is the result of the myelin that covers and protects these circuits. 

    This was not the case in older children, but was significant at the 2 month mark after birth.

    However, those children who had these changes at two months were more likely to have attention deficit problems at 10 years. Depression in pregnant moms can have a lasting effect in their children.

    Preparing for Your Child’s Best Future

    Seems pretty important, doesn’t it?

    Especially as you plan and prepare for conception. If you’ve been depressed, and medicines haven’t helped, consider IV ketamine treatment before you get pregnant. 

    On the other hand, we all know that not all pregnancies are carefully planned. So what happens if you find out you’re pregnant and you’re also depressed?

    The FDA classifies ketamine as a Category B drug, meaning it is believed to be relatively safe during pregnancy, but it really hasn’t been adequately studied during pregnancy yet.

    You Have Options

    The good news is that you can wait until the baby is born, then receive ketamine treatment to hopefully relieve the depression symptoms right after your baby is born. 

    As always, remember that ketamine isn’t for everyone. But those who’ve been severely depressed and not helped by traditional medications are usually dramatically improved with IV ketamine treatment, even to achieving remission.

    With that said, the best hope for you to have the well-being to bond with your baby, and to enjoy your life and motherhood, may lie in ketamine treatment.

    And just as important as your wellbeing, is your baby’s brain health and development during infancy and childhood. If your wellbeing could protect your baby from attention deficit problems later.. well, that’s a no-brainer. Right??

    We think about prenatal vitamins, exercise, and childbirth classes. But the idea of IV ketamine treatment before pregnancy hasn’t really been on the list, you know? 

    That’s because we didn’t have the info we have now about the effect of depression in pregnant moms on the developing baby.

    The more we learn, the more we can do to give our babies the best possible start in life. And the beauty of it is, taking care of baby this way will help you enjoy life, too.

    Moms, Dads, and Babies All Live Better

    At Innovative Psychiatry, we like to see moms come in for IV ketamine treatment because they deserve to feel good, to have the joy, energy, and initiative to give their families what they need, while enjoying their lives themselves. 

    This mom's depression is in remission and she's enjoying her baby and her life.

    But we’re especially happy for women who’d like to achieve remission from their life-long depression before they start their family.

    What a wonderful beginning. But you know what?  It’s not just about moms, either.  It’s also about dads.

    And when a dad realizes he wants a child but is depressed, this may be the ideal time to reach out for treatment and the potential of remission. Because if he hasn’t benefitted from other medicines, he may be a great candidate for IV ketamine treatment. It can help him be the best dad he can be…and enjoy his life and family to the fullest.

    Wouldn’t you love to have the zest for life to enjoy your children, camping with the family, coaching your kids’ soccer team …dancing with your spouse? IV ketamine treatment can give you your life back, and give you the freedom and stamina to do things you love to do, the initiative to invest in your career and hobbies, and to build strong, lasting relationships. 

    If you’ve suffered from symptoms of disorders that hold you back from moving forward in your life, call us.

    We want to help you plug in to a life that really matters to you.  

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Fighting Meanness, Hatred, and Cyberbullying in Schools

    Fighting Meanness, Hatred, and Cyberbullying in Schools

    Social media use can be good or destructive to teen users.

    We recently talked about the prominence of depression in teen girls.

    And the fact that it’s rising at a faster rate than depression in teen boys. We also talked about the impact of social media on growing and developing preteens and teens. But let’s talk a little more about the meanness and bullying that is perpetrated over social media. Where it comes from… and what can be done about fighting meanness, hatred, and cyberbullying among our youth.

    Meanness is often a symptom of unresolved emotional issues. At least, that’s what psychotherapist Peter Michaelson says, and I agree with him. He describes meanness as a repetitive behavior that can be difficult to remedy without deeper insight. 

    The meanness may be a one-time remark that’s hurtful. Or it may be habitual, purposeful criticism and intimidation. Either way, it can cause damage that keeps on delivering for many years to come.

    It’s true that thoughtless comments may not necessarily be fueled by meanness. They may be unfiltered observations made by one child to another, without realizing the painful sting the words cause. 

    “Your teeth look like a rabbit,” a fifth grader might say to another. The speaker, because of age, may not realize the recipient actually feels painfully self-conscious about her teeth. Comments like this can reverberate for a lifetime, but they don’t usually cause despair and depression.  

    However, if the same comment were made over and over by friends and classmates online and in person, it would hurt. And if it was passed around on Instagram or Snapchat with photoshopped pictures of the child, it could even be traumatic. Then, if the photos compared him to a rabbit eating a slice of cabbage, the hurt, ridicule, and betrayal he might feel could trigger something worse. 

    Teaching the Difference in Thoughtlessness and Meanness

    We want to help our children learn to be sensitive and considerate of the feelings of others — and also help them cope with thoughtless remarks of others that aren’t intended to offend.

    We live in a world where things like this happen. But this is simpler than fighting the meanness, hatred, and cyberbullying our older children contend with every day.

    Instagram and Snapchat – For Good or Evil

    The increase in the hostile culture that has grown up around our teens seems to have erupted in cadence with social media platforms. From MySpace, to Facebook, to Instagram, Snapchat, and scores of others, people of all ages have increased their use of these platforms to stay up to date with family and friends. 

    While some studies reveal that many people feel these digital platforms improve their relationships by giving them more context about the lives of those they care about, other studies show that use of them reduces face to face contact with the people in their lives who matter.

    But for teens, social media is perceived as being a necessary part of their social life, and school life, as well.

    Revealing Study about Social Media

    Kasperksy Lab conducted a global study measuring the impact of social media use on our personal lives and relationships. It revealed that about 1/3 of social media users communicate less with their parents, their partners, their children, and their friends because they follow them on social media and just keep up by reading.

    Since social media profiles and posts tend to show those things people want the world to see, their profiles seem ideal, often generating negative feelings like jealousy and resentment in their followers.

    Fighting meanness, hatred and cyberbullying is painful, so this girl chooses to spend time alone in the woods.

    Nearly 60% of respondents in the study (which included 16,750!) admitted that they believed their friends lived better lives than they did, based on their posts. 59% felt hurt or angry when someone posted a critical comment on their profile. And almost half expressed their pain after seeing their friend’s holiday photos online.

    And only 31% said they weren’t bothered by the number of likes they receive.

    Teens Feel the Impact of Instagram and Snapchat Most Deeply

    Nowhere is this more true than among preteens and teens, whose developing views of others and the world are being molded by interaction on digital platforms.

    And while some teens feel more closely connected to their friends and their friends’ feelings through these platforms, many more feel trapped by them.

    Once they’ve been bullied, they report that they’re afraid to close out their account because they know others will continue to talk about them …. and they want to know what they’re saying.

    Fighting meanness, hatred, and cyberbullying in our teens’ social culture is vital, though daunting.

    Because of the impact this distorted social environment is having on kids today, it’s important to think outside the box to find strategies that can serve as rudders to change the course and help our children choose healthier and safer methods of relationship building.

    Small Rural School Set Out to Find Solutions

    One school in a rural community in New Hampshire has set out to find ways to guide their students in developing a healthier social environment. Their story was published in The Atlantic early in 2017.

    Pittsfield, NH is a community of around 4600 residents and a school for both middle school and high school in one building, about 260 students in all.

    Fighting meanness, hatred, and cyberbullying can leave a young girl like this lost, isolated, and hopeless.

    One 14 year-old we’ll call Tori, received a snapchat (or Snap, as they say now) of a picture of her from behind taking notes in class. The caption read, “I literally hate you. You’re a round cereal box.” 

    The screenshot circulated, and soon everyone was calling her Cereal Box.  She’s a petite girl with neat braids, and rarely drew this type of meanness. Plus, knowing who sat behind her in that class made the task of figuring out who sent the message pretty simple.

    Public Attacks Hurt

    But, even though the name-calling (what’s a round cereal box anyway?) didn’t seem to target anything she was insecure about, the fact that someone told her, “I literally hate you” stung. And why? She had had no interaction with this girl to speak of…certainly nothing negative. 

    She wondered why the girl didn’t just tell her she hated her, rather than broadcasting it to the whole world.  

    And it made her so uncomfortable that she realized how much attacks like this must hurt those who were often targets of meanness and hatred.

    When she told her parents about it, they encouraged her to go straight to this girl and confront her directly without texting or social media retaliation. Wise parents. Brave girl.

    When she did, the girl looked at her with a look that said, Sooo? What did I do?

    And herein lies the problem.

    This distortion in social interaction hasn’t taught kids productive ways to cope with the feelings they have. Instead, lashing out on social media has just become an accepted method …no matter who it hurts.

    Student-Directed Programs Prove the Most Successful In Fighting Meanness, Hatred, and Cyberbullying

    One teacher at Pittsfield sponsored a group known as Drop the Drama, a name coined by the students. It started out with 5, and soon grew to 20. Students work together to look for more productive ways of interacting than social media, and  more positive responses geared at inclusiveness as opposed to exclusion. 

    Their belief is that a small group of students with a passion for change can impact the entire student body far better than any lecture or workbook presented by adults. 

    The administration plays an important role here: they take a survey among the students at the beginning of each year to find out how happy, how content, and how safe the students feel in the learning environment.  They were disappointed to see a sharp decline in recent years.

    The rising use of social media on cell phones has resulted in depression and suicide in teens.

    But they’re hoping to see the surveys report improvements at the beginning of next year as these new programs have time to improve the social environment.

    Tori, our friend they called a Cereal Box, decided to be proactive, rather than letting the hurt of the experience continue to torment her.  She went with her dad to the grocery store, and posed with a box of Fruity Pebbles. Her dad snapped a photo of her which she in turn posted on Instagram. 

    The caption read: “Cuz I’m a box of cereal. LOL”

    By owning the name, the original offense lost its power to hurt her. And she didn’t need to hurt anyone else to make herself feel better.  The teacher who sponsored Drop the Drama was so proud of her.

    And Tori is determined to help so many other wounded students to recover. She believes through Drop the Drama she can help them turn the negatives into positives on campus.

    ADULTS Provide the Support When Teens Work to Change Their Culture

    In our busy world of packed schedules, we listen to our teens talk about their crises. (Car talks are a good place for this.) And we feel helpless to change the culture.

    But, the meanness our children are faced with every day is desperately in need of intervention. Dramatic change is needed in every city and township, and in every middle school and high school. 

    In every one. And in everyone.

    In Pittsfield, the administration developed a program to begin in elementary school with training for responding to uncomfortable feelings like jealousy and anger, and to do so without hurting others in the process.

    There are as many ways to fight meanness, hatred, and cyberbullying as there are people to think of them!

    To prepare them to view social media in a mature way, and to protect themselves from inappropriate “drama.” To help each other, and to rise above those who lash out with hurt. And to defend each other.

    Teachers help with academic classes and also with fighting meanness, hatred, and cyberbullying.

    The program continues into middle and high school. 

    In addition, the Drop the Drama group is reaching out to the student body to support change. They’re encouraging them to use kindness, promote inclusiveness, and face-to-face interaction.

    We talked about a school in an earlier post, where students were moved by a string of 6 suicides. They developed a program to befriend anyone who seemed to be isolated, depressed, or lonely.

    This new perspective quickly spread through the student body fighting meanness, hatred, and cyberbullying.

    This student-promoted policy has created a social atmosphere that has become more warm, inviting, and safe for students overall. As a result the students bounce back from offenses and embarrassment more easily because of the supportive environment.

    What ideas do you have for your child’s school?

    Innovative Psychiatry Provides IV Ketamine for Teen Crises

    Sometimes students who’ve been traumatized by meanness and bullying become depressed. In fact, sometimes they see no way to go on with their lives and they even want to die.

    IV ketamine treatment can end suicidal thoughts very quickly so those teens can be helped with ongoing treatment — sometimes psychotherapy, sometimes medication. And in those cases where medications don’t seem to help, we offer novel and advanced treatments like IV ketamine treatment in a beautiful and relaxing office setting.

    A worthwhile mission is fighting meanness, hatred, and cyberbullying in schools.

    Our teens and our children need the opportunity to develop in healthy ways. To be immersed in balanced and friendly environments to learn healthy interaction skills.

    And so, we want to see an environment develop where kids and teens learn to lead by EXAMPLE rather than dysfunction. Where they can join forces to forge an inviting world … to bond, interact, collaborate, and reach out to those in pain.

    An environment where they can learn to be caring, compassionate, and responsible as they mature to adulthood.

    Life Can Be Joyful. You Can Have Hope…

    If you continue to suffer after taking traditional medications that haven’t helped, call us. If you have a teenager who seems to continue to suffer in spite of trials with medications, do call us. We want to help.

    The medicines available to help patients with severe depression, bipolar depression, PTSD, social anxiety, substance use disorders, or suicidal thoughts, only help some people some of the time.

    Fighting meanness, hatred, and cyberbullying is worth the work so teen girls like this one can be happy.

    IV ketamine treatment is more rapid — and for many, much more effective. Even when other medicines fail, when words can’t reach you, when TMS doesn’t work, when you’ve done ECT. (Our own published research shows that.)

    Not perfectly, not always. But it can help a lot more people a lot more often than the other treatments we’ve had available. It works in a variety of ways in your brain so you can feel dramatically better. And it’s fast.

    If you or someone you love needs a more effective treatment, IV ketamine treatment can restore your joy. And your relationships, your creativity, and your hope can be rejuvenated. It can give you the energy to invest in things you’d lost interest in.

    Let us help you find your best self, and your best life again. It’s your turn.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Why is Depression in Teen Girls Increasing So Fast??

    Why is Depression in Teen Girls Increasing So Fast??

    Depression in teen girls might be reduced by less social media and more involvement pets.

    Juliette stopped in her tracks.

    She could see from halfway down the hall that her locker had been trashed. Covered with photos, markings, and fake blood, it looked like a crime scene. As she got closer, she could see printed photos someone had taken of her while she was dressing in P.E. She ran to the locker and yanked off and crumpled the photos as fast as she could. (With friends like this, it’s no wonder there’s a rise in depression in teen girls.)

    As she stood staring at her locker frozen, her face burning with humiliation, she couldn’t think… Then, in one sweeping motion, she pulled all the trash off her locker door and wadded it up. 

    Only then did she look up and see the bystanders, the sidelong glances, and hear the snickering muffled giggles of her “friends” gathered around watching.

    She grabbed her books, slammed her locker door and shot off to class.

    Juliette sank into her seat, head down, heart-broken, and wondered why??  Who did this and why?  

    She felt betrayed, angry, heartsick. And abandoned.

    She didn’t say a word for the rest of the day, just kept her head down and shot out the front door when the bell rang to go home.

    Her mom was waiting outside, and Juliette jumped in the car, put her face on her lap and said, “Drive!”

    “What’s the matter, Jules?”  Her mom was alarmed.  She’d never seen her 13 year-old like this. 

    “Just drive.”  

    So her mom put the car in gear and did.

    Teen Trauma Triggered by Ridicule and Humiliation

    Once home, Juliette flew upstairs, slammed her door, and locked it. She dug her phone out of her purse for the first time since she saw the locker. Two hundred and thirteen messages. She wondered if there might be apologies… so she opened one …then another.

    NO apologies. Total strangers making jokes, rows of laughing faces, some even calling her crude names. The photos she saw on her locker had gone viral. All over Instagram, Pinterest, facebook…

    Her friends were silent.

    She thought she would die. How could she ever show her face in that school again? She could never leave her room again. She covered her head and sobbed.

    “Jules..?  Honey, are you OK?  Did something happen?”

    “Mom, I just want to be alone.”

    This isn’t something my parents can help with. I’m alone with this nightmare, she thought.

    So a traumatic experience begins to fester…

    Scenes like this aren’t uncommon if you have kids. You got her into ballet at 3, then gymnastics at 5, then soccer at 7. Always hoping to help her gain confidence in herself, to help make the transitions of childhood to adolescence, and adolescence to adulthood advance more smoothly. To help her develop an anchor within herself that would see her though the storms, and the things that others did.

    And your happy, socially-balanced child does great with her activities, her friends, slumber parties, and sports events.

    Until the day she’s publicly humiliated.

    The humiliation can happen on Snapchat, Facebook, Instagram, and other social media sites. It can happen in text messaging. Or it can happen at school and at slumber parties.

    And, while the cruel embarrassments and humiliations children and teens impose on each other are terrible — and seem almost insurmountable for some students– it’s what follows if they can’t get past it that can be life-threatening. 

    Believe it.

    Depression in Teen Girls Can Be Deadly

    Sometimes, what we parents see is a child, preteen, or adolescent, who is acting differently.  Who won’t talk to us. Since we don’t know what they’ve faced at school, we may be clueless about the trauma they’re experiencing. We may think they’re just being moody teenagers.

    Sadly, the trauma may cause such a deep pain that they can’t find words to “get it off their chest…” So they may isolate, huddle, and try to figure out how to cope on their own.

    An experience like Juliette endured isn’t usually a single event. There’s the aftermath. Someone in her shoes may skip school for a few days until she can muster the courage to step out and go again. But even when they do go, there are whispers, snickers, more text messages. 

    And sometimes even more incidents that go from bad to worse. 

    The stress continues, long after we parents think it should be over.

    Or we may never know it happened in the first place.

    And as we often talk about, prolonged severe stress can result in that pruning of the dendrites and dendritic spines that destroys synaptic connections between brain cells. And depending on how severe the pruning is, and how long it continues… the outcome is often depression.

    “But she’s a kid…” you may think. “She doesn’t have severe stress. How could she?”

    It’s an unfortunate miscalculation to think that a child can’t experience severe stress. Her world is her reality. And she’s been building that world since she can remember. If everything that makes her world a warm and inviting place of support, caring, and acceptance is disassembled and left in shambles, then her world is shattered. 

    And as her parents, you can’t fix it. 

    That’s not to say you can’t be a comfort and a support. But no one can fix her world for her but herself.  A pretty daunting task for a devastated 13 year-old.

    It turns out that teen depression rates have been increasing for years, but the rate of depression in girls is rising faster than it is in boys.

    Teen Depression is Threatening Our Children

    Girls and boys. But is there difference in how much and how often it strikes? Why are teen girls becoming depressed more often than boys?

    For one thing, by the age of 15, girls are actually twice as likely to become depressed as boys. It’s surprising, isn’t it?  …but there are reasons. 

    The smart phone, for instance. By the mid 90’s, both boys and girls were using them. And those babies born by then were the first generation to live out their entire lives in the age of smart phones. Those babies are 25 this year. 

    Let’s hear from those young women, shall we?

    A team of researchers analyzed 3 surveys that included 200,000 females in the US and the UK.  And…they learned some things.

    For example:

    Fill a classroom with 25 teens, and give them the freedom to use their smart phones. Then, walk up and down the aisles and glance at their screens. You know what you’ll see, first thing?

    They’re not doing the same things.

    The boys are playing games… on their smart phones, or talking about sports, and texting each other about the games.

    The girls?  They’re texting, and on social media.  What are they texting about ?  Their appearance, their clothes, their hair…and someone else’s appearance, clothes, and hair. 

    And when one sends off a text, she’s reassured that she’s accepted when she receives a response right back. No pauses.

    If there’s a pause before she receives a response…because maybe the other girl is in the restroom, or is carrying too much in her arms to text easily,  the first girl begins to feel dismissed.

    Anxiety rises.

    And that knee-jerk reaction happens over and over and over, day and night, month after month…year after year.

    Hurt Feelings, Misunderstandings, Feeling Left Out

    Now, add to that the pecking order on social media platforms. The girl with 8 likes is shamed when compared to the girls with 500 likes and shares. And don’t kid yourself. Those comparisons are made. Ruthlessly. 

    Images that create a fantasy of one girl’s life lead to others feeling ashamed of their “plain” homes, clothes, and activities. None of this is grounded in the real world. But then smart phones and social media have little to do with the real world.

    The pressure is intense enough that one study found that girls who compare themselves to other girls on social media were more likely to be depressed.  

    And get this: in 2017, a full one-fifth of teen girls said they’re suffering from major depression. One Fifth!

    Then, there are the cruel “jokes” some girls play on others, where messages, videos taken without permission, and compromising  photos are sent out and go viral.  And young girls become convinced there is no remedy to restore their lives after such exposure, and at the tender age of 10, or 12, or 14… they end their lives.

    So is it all social media?  No.

    Don’t boys use social media? Yes, they do.

    But these researchers also found that social media and the interactions there have a stronger effect on girls than boys. 

    They found that 15% of girls who were on social media only 30 minutes a day, due to other activities, family rules, etc, were unhappy. But 26% of girls who were on social media 6 hours a day were unhappy.

    Now let’s look at the boys. Only 11% of the boys who were on social media 30 minutes a day were unhappy.  And those boys who were on social media 6 hours a day? Only 18% of them were unhappy.  

    So what is it about girls that more of them seem to succumb to depression from social media? 

    Researchers found it was that being popular, and having positive interactions with others is tied to their sense of satisfaction, happiness, and confidence.

    Social media can either build up the social ties a teen girl enjoys, or it can destroy them through bullying, shame, and conflict.

    And we can’t forget that pressures about image and appearance continue to increase at this age…

    Now… what can parents do?

    One obvious step might be to postpone your child’s access to social media. That message is being disseminated by experts on adolescent mental health far and wide.  

    While it’s illegal for a child to have a social media profile before the age of 13, parents might consider extending a moratorium on social media use longer than that. 

    The social pressure among teens to excel on social media is not aimed at their growth, self-confidence, or character, but is actually designed to pull them into an addictive activity.

    We all know Mark Zuckerberg as co-founder of facebook. But do you know Sean Parker? He joined Zuckerberg 5 months after Facebook was launched as a student directory, and Zuckerberg credits him with the phenomenal growth it enjoyed. Which made him a billionaire.

    Referring to facebook, Parker said,“It’s a social-validation feedback loop … exactly the kind of thing that a hacker like myself would come up with, because you’re exploiting a vulnerability in human psychology.”

    He went on to say that social media like Facebook “…literally changes your relationship with society, with each other. It probably interferes with productivity in weird ways. God only knows what it’s doing to our children’s brains,” he said.

    Children aren’t equipped with the life experience or brain development to see these sites for what they are. Rather, they’re swept up in the tidal wave that is adolescence and the need for social acceptance at probably the most vulnerable time of their lives.

    As parents, they need us to be proactive, to give them time to develop the life skills to keep such activities in their place. 

    They need time to just grow, physically, mentally, emotionally, and socially. To develop healthy relationships with their peers, and to survive their preteens, teens, and early adulthood so they can go on to become the best they can be. 

    Depression in Teen Girls Needs to Slow Down. Let’s Do Something.

    Would this approach prevent depression in girls?

    No, no, of course not. But it just might protect your daughter from depression. And maybe her friends. And maybe some of their friends.

    By finding opportunities to get your daughters talking with their friends about the dangers and risks of social media, and using text messaging less… and in more responsible ways… perhaps we can open their eyes. And a lot of others.

    Maybe that could go viral.

    Maybe a new culture could emerge where our daughters lived well, and survived their own adolescence… and could go on to have daughters of their own.

    After all, that’s what we want for them, right?

    Ketamine For Treatment Resistant Disorders

    If your daughter — or son — has developed depression, and medicines aren’t helping, call us. Let’s talk about IV ketamine treatment — which shows a much higher response rate than antidepressants.

    The sooner your teen’s disorder is treated and relieved, the sooner her resilience is restored, the better equipped she (or he) will be to tackle the life issues she faces as she grows to adulthood.

    Depression in teen girls is increasing, but we’re not powerless to fight it. Let’s work together to turn the tide on disorders that result from things like the intense stress of social media.

    And if your teen is struggling without relief, learn about IV ketamine treatment. It’s saving lives.

    To the restoration of your best self…and your teen’s,

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Can Use of Opioids Lead to PTSD? And If So, What Can You Do?

    Can Use of Opioids Lead to PTSD? And If So, What Can You Do?

    You know how a disorder – like bipolar disorder or PTSD – can make you so miserable…even make you want to self-medicate?  

    Doing so is rarely a good idea, though it may seem at the time that it helps.  But that’s for another post. Anyway, you know how self-medicating often accompanies these disorders, and we’ve assumed that the self-medicating is driven by the symptoms of the disorder: the ups, the downs, the agitation and rage, the misery… If the symptoms were to go away, there would be no need for self-medicating. Right? Doesn’t that seem logical? Well, a recent study says no…in fact, self-medicating with opioids… or even using prescribed opioids may lead to PTSD!

    Mood Swings in Bipolar Disorder Make You Want to Self-Medicate

    Take bipolar disorder, for example. You feel yourself swinging up, up, up until you’re confident, then agitated, shooting words like a machine gun, and feeling more energy than you can manage… you just want to feel normal, you know?  So you start drinking beers as fast as you can to slow down… and…well, it’s not an exact science.

    You end up drinking way too many until you’re frankly drunk…but there’s still energy you have to manage, somehow. You may want to jump in a car and head down the freeway… but thankfully, you can’t find your keys.

    OR… your mood starts plunging and plunging.  Way too fast… and before too long you want to scream and cry. You feel so hopeless, and disgust and self hatred take over your mind… and it feels like you have fire ants on your brain. 

    You need something to help you feel better. So you reach for something that helps you feel like you’re at a party. Then, after awhile, you’re a mixed up ball of horrific and frustrating feelings…and you decide to go for something different that will help you chill.

    This is a dangerous and destructive path, but it’s tragically common. This is self-medicating.

    And, unfortunately, you may not even realize that use of opioids may lead to PTSD.

    =============

    Meet Zach. He served two tours in Afghanistan. He wanted to go back for a third, but his family needed him at home. (At least that’s what he told himself.)

    Zach never talked about it, but he’d gotten high with friends off and on in high school. He had joined the Marines for the hard work and discipline, to get himself back on track.

    Now this.

    Anyway, he had rehab. Who was he kidding? There was no way he could go back. He figured he was nervous about going home after all that happened…

    The truth is, Zach got through the first tour fine. Then, on the second tour, he and some fellow marines were helping some children carry water to their homes.

    He and Rex were heading in the same direction when a little girl approached them with eyes as big as saucers. Rex naturally reached for the child and at that moment she detonated. The child had been wrapped in home-made explosives under her clothing.

    Rex blew apart, as did both children. Zach lost his right arm and his ear. Such an inhuman thing to do. The scene was tattooed in Zach’s memory and he couldn’t escape from it. Children’s body parts, his friend and marine brother’s hands, leg, organs, everywhere.

    Rage Begins… and Panic

    Rage burned within him that anyone would stoop to the evil of murdering children that way just to get rid of a marine or two.

    When he got home, he wasn’t the help to his family he wanted to be. He had trouble holding a job… any sudden startle stirred up the fight in him and sent him into a cold sweat at the same time. Like the wait staff dropping a dish. The clatter sounded like that explosion inside his head. His only thought in moments like that was to tear apart the reprobate who did this to these little kids. And stole his friend.

    Zach was seething all the time. Going through surgeries for his arm stump and ear reconstruction. Jumpy, easily provoked, irritable…and at times terrified. His marriage was deteriorating. His children afraid of him.

    He talked to a buddy about getting his hands on something to calm him down… he hated being like this.

    Something had to give…then his wife learned about a “new” treatment for PTSD…

    ============

    Researchers Asked, Can Use of Opioids Lead to PTSD?

    So…  it turns out this self-medicating road goes both ways. A new study released in December 2019 demonstrated that heavy opioid use over time before a traumatic event influences us to be traumatized by the event… basically it alerts us to be so fearful of that experience that we can develop PTSD as a result.

    We’re talking about Post Traumatic Stress Disorder, or PTSD. And like bipolar disorder, PTSD has an established reputation as a disorder that is quite often co-morbid (meaning you have more than one illness at the same time) with substance use disorder.

    In fact, 40% of people diagnosed with PTSD also struggle with substance use disorder (SUD) …meaning they may have addictions, or they may regularly use a substance that masks or combats the way they feel…until it doesn’t. 

    Now get this: almost 35% of people who struggle with an opioid use disorder also suffer from PTSD. Sound familiar?  

    PTSD <=> SUD

      40% <=> 35%

    A bit of a coincidence you think..? Maybe, but more likely this two way street of comorbidity with PTSD and substance use disorder does cause us to stop and think….can opioid use play a role in the development of PTSD?

    Laboratory Animals Develop PTSD after Opioid Use

    This study I mentioned was just published in Neuropsychopharmacology last month, by a team at UCLA led by Zachary T. Pennington. Their carefully planned study involved laboratory animals and demonstrated how the use of opioids during a time that preceded a trauma increased fear learning.  Or, to be more clear… use of opioids may lead to PTSD.  

    Interestingly, in cases where the opioid use occurred after the traumatic experience, there was no lasting fear or PTSD reaction.

    The team used an upsetting/frightening stimulus to create a traumatic experience for the animals and noted their reaction to it. Then after creating the condition of “withdrawal” from opioids using morphine and naltrexone (a medicine used to block the effects of opioids) they placed the animals in an environment where only a mild stimulus was used, and saw that the animals reacted strongly in fear — basically they froze in place — as though it was the original severe experience.

    Sounds a lot like PTSD, doesn’t it?

    Remember Zach? The guy who is a combat veteran with PTSD freezes when someone pats him cheerfully on the back to greet him. It’s all he can do to avoid turning and fighting that person to the ground. Why? Because it feels like he’s being assaulted, and all those horrific memories flood him as if they’re happening right now.

    Researchers also gave control animals (the ones who don’t receive opioids so they can be compared to the ones who do) saline injections instead of morphine, and then followed with the traumatic experience. Those animals experienced far less fear and anxiety reactions compared to the ones who had been given morphine prior to the traumatic experience.

    Stress Enhanced Fear Learning (SEFL)

    They call this approach “stress-enhanced-fear-learning” (SEFL) and it’s a model for us of PTSD and how it ca develop. 

    And this demonstration shows us that people who’ve used opioids, whether they were prescribed — or obtained illegally — could be vulnerable to PTSD from traumatic experiences in the future. The resilience necessary to quickly recover from trauma seems to be drastically reduced in those who are exposed to opioids.

    The media is full of the dangers of the opioid crisis, but this is one we didn’t see coming. Use of opioids at a particularly vulnerable time can lead to PTSD …or at least that’s what this study seems to tell us.

    Still, the researchers emphasize that there’s a difference between fear learning and fear expression. Fear learning is the process we go through where we’re frightened by something unpleasant that we don’t want to experience again…and by it we learn to be cautious and recognize danger.  (This is a good thing.) The amygdala is the primary place in the brain where fear is processed and stored. Some types of fears are then sent to the hippocampus for further storing.  But that’s not the point.

    Fear expression is what we do and how we look when we feel fear. Fighting or running are expressions of fear. Freezing can be an expression of fear, too.

    Fear expression is our response to the fear we feel.

    The way we express fear has nothing to do with the learning process we go through to establish a fearful memory. But the process we go through to learn the fear has a lot to do with whether we quickly recover from it, or whether it turns into a fearful memory that becomes traumatic every time we think of it…and that’s the story of PTSD.

    What we didn’t know before this study, is that using opioids may make you really vulnerable to PTSD, so avoiding them if you can is better for your overall wellbeing going forward. 

    Because use of opioids may lead to PTSD…

    Of course, since this is the first study that has identified the role opioids may play in the development of PTSD, there are lots more studies needed. We’d like to see studies that test the development of PTSD if the opioids were used 6 months ago, a year ago, 2 years ago…?  

    In this laboratory setting, with lab animals — not human beings — it had only been a week.

    And because this study focused on the reactions of lab animals, we don’t yet know how the results would look in human subjects. In addition, we can’t know without more research, what this means for people who already take opiates for pain.

    It’s certainly true that none of us knows when we might experience something traumatic. It can happen to anyone… at any time. An assault, a vehicle collision, a catastrophic illness, a vicious divorce.

    The study demonstrated this phenomenon only in cases where the animal had previously had the opioid before experiencing the trauma. When the opioid was administered after the trauma there was no PTSD reaction.

    So… of course we’d like to avoid opioids as much as possible for unexpected surgeries, accidents, and injuries just in case of trauma in the future…? At the same time, we don’t know enough yet to be alarmed.

    This is how it works with new discoveries. Tiny pieces of information eek out…one bit at a time. And so we look forward to what else can be learned about this PTSD – Opioid connection.

    Still, we’re excited about an effective treatment for PTSD if it does develop, and for certain substance use disorders, as well.

    IV ketamine treatment has demonstrated what it can do for both of those, both in studies and in real world practice.

    At Innovative Psychiatry, we use novel and advanced treatments for disorders that haven’t responded to traditional medicines and treatments. IV ketamine treatment reigns proudly at the top of that list. 

    And we’re always thrilled and amazed to see how effective ketamine can be in reversing a cluster of disorders all at once. By treating PTSD and depression with IV ketamine, we often see phobias disappear, too. By treating suicidal thoughts with ketamine, which can be utterly life-saving…we often see depression lift, and PTSD with it.

    There’s nothing magical about ketamine. It’s just a man-made molecule that happens to work in a surprising number of ways. But when you’ve been tormented by the traumatic flashbacks of PTSD, disrupting your life and your family, and then those terrifying visuals and experiences subside with ketamine infusions, it sure can seem like it’s magic. And it thrills your family just as much as it does you…when they see your new-found peace and resilience.
    If use of opioids leads to PTSD for you, IV ketamine treatment can help you achieve remission like this relaxed guy on the beach.

    If you suffer from fear and the fearful memories that disrupt you life, your career, and your relationships — or if you’ve been diagnosed with PTSD but treatments haven’t helped, you owe it to yourself and the people you love to reach out for the freedom you can enjoy after IV ketamine treatment.

    Your life can change through the extraordinary effects of IV ketamine treatment. 

    Expect around 6 -8 infusions or so… and be patient if you don’t immediately feel better after the first one. Give it a little time and a few more infusions…

    On average, it’s common for people to experience ketamine’s benefits after the 3rd infusion. But that’s an average and individual experiences vary.

    You do your part, we’ll do our part…and we’ll also eagerly embrace collaboration with the healthcare team who knows you well.

    You can have a better life. You really can. Find out how you can enjoy the resilience to snap back after something goes wrong. Reach out for help to get better with IV ketamine treatment. We’re here to walk you through it, and to help it go smoothly. You’ll be in a quiet, comfortable room, with lights turned low for your infusions. And you can bring soft music to play, if you like. A blanket to keep you warm and secure.

    This is your chance to emerge better, balanced, and joyful. This is your opportunity to restore hope.

    We look forward to talking with you. Call us.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Reach Out for Ketamine… to Get Better… and Make 2020 Your Best Year Yet

    Reach Out for Ketamine… to Get Better… and Make 2020 Your Best Year Yet

    This is the first Monday of the New Year…so how do you start a new year?

    With resolutions? A diet?  Maybe more exercise? Lots of people do. But what about you? What if you don’t have an appetite…?  Might be hard to stick to a diet more than a couple days… and what if you haven’t slept in days…and you’re exhausted… who cares about the new year and any good intentions? When you feel crummy, the beginning of the year seems like just more of the same ol’ misery. Maybe you wonder, why try? You’ve been so depressed, with so much anxiety, and have felt so alone, so vacant, for so looong, it seems futile to try something new…  BUT. What if there really IS an answer that could sweep away your misery and you could finally feel like the best you you’ve ever been…?  I know, you probably think that sounds impossible. But wait a sec…this is the 21st century, my friend. Treatments have improved. Or a better way to put it, there’s now a treatment that’s a game changer. But it won’t come to you.  You’ll have to reach out for ketamine so you can get better now. You’ll have to do something…because this treatment won’t magically show up in your living room. So why not do it now?

    IV Ketamine Treatment – The Game Changer for Psychiatric Disorders

    Of course, I’m talking about the treatment that came out of the woodwork the last decade. The one that started as a trusted anesthesia medicine listed on the World Health Organization (WHO) List of Essential Medicines. The one that’s been so safe for 50 years that it’s been used in surgical settings for people of all ages across the globe, and also in surgical settings for pets of all sizes. 

    Like most exceptional medicines that are designed for sedation and/or pain relief, it’s been abused by people on the street and in the club scene for its dissociative side effects. As a result, it’s sometimes been misunderstood as a result.

    But under psychiatric supervision, it’s nothing less than extraordinary in its effect on people whose disorder has not responded to traditional medications. Which is one of its many endearing charms.

    Why wait any longer? Why not reach out for ketamine now and start this new decade on far better footing..? Stick your neck out and make the call for treatment now because you deserve the chance to live a fulfilling life, free of symptoms that keep your life shackled.

    Ketamine Treatment Relieves a Broad Variety of Disorder Symptoms

    It happened last week, and it shocked me. Someone asked me about the best treatments for depression, anxiety, and PTSD. As I began to talk about treatments, I saw a blank look on his face when I mentioned ketamine infusions. He’d never heard about them…! And I realized that though this medicine is always in my radar, there are countless people who know nothing about what it can do.

    Someone who suffers from unrelenting and severe depression, bipolar depression, PTSD, OCD, social anxiety, substance use disorder, alcohol use disorders – and sometimes eating disorders like Anorexia Nervosa – can achieve remission with IV ketamine treatment.

    IV ketamine treatment can be a bit tepid in relieving symptoms for those with milder cases. But, let me quickly say that when you feel bad, it doesn’t feel mild. And that’s why we have criteria to help us measure the severity of each case.

    Just knowing how severe it is – or not – can guide us in how to treat it. When we see someone who has suffered with symptoms for years in spite of multiple medication trials, in spite of other treatments, who has also been hospitalized for symptoms, and may have attempted suicide multiple times, we realize this patient has suffered severely for a very long time. And patients like this usually experience a dramatic remission after IV ketamine treatment.

    Not always. But usually…

    IV ketamine treatment doesn’t work like this for everyone… sadly, not even for everyone who’s severely ill. But it has a remarkably fast and vigorously thorough effect on a very high percentage of patients… higher than any other office treatment for these disorders.

    And that’s not all.

    Freedom from the Doldrums

    You know how it is with depression that hangs over you…month after month and year after year… even if you have a few days that are a bit better…and you can actually smile some…as soon as someone says something that hits a nerve – you plunge again…back into the pits. It’s like you have nothing to fight with, like a tightrope performer with no net. So even a lighter feeling for a few days is temporary and you know it. You can feel how fragile it is.

    But with IV ketamine treatment, that fragile-ness seems to evaporate. You get offended by the guy at the party who ALWAYS has his foot in his mouth, and it burns you up. But the nosedive you expect floats away, as you think through that guy’s words and realize your peace is too important to jeopardize… and ::::poof!:::: you move on. And it’s forgotten.

    One reason may be the resilience ketamine builds. You’re able to adapt and quickly recover from the offenses that happen and you have the power to just snap back and be ok. It’s amazing…in fact, it’s priceless.

    So, reaching out may require that you talk to yourself. Maybe you’ll need to “psych yourself up,” but when you do whatever you need to do, and reach out for ketamine treatment, you’ll find yourself surprised at all that happens for you.

    Neuroplasticity + Psychotherapy = Peace & Joy in life

    Then, to point out yet another talent of this treatment, researchers and therapists have learned that because of the neuroplasticity ketamine creates in your brain circuitry, psychotherapy can be much more effective about 24 hours after an infusion.

    At Innovative Psychiatry, we love working with your psychiatrist and therapist to help make that benefit available to you with scheduled infusions coordinated with your therapy appointment 24 hours later.

    But, the fact is, that none of this can be available to you unless you reach out. It requires that you call us. Let us coordinate with your healthcare team.

    You’re probably thinking, How Can I Do THAT?  I Can’t Seem to Get Out of Bed??!!

    And there’s the rub.

    There is more help available for your tormentous symptoms than has ever been seen by your parents or grandparents or great grandparents… 

    But the biggest obstacle between you and having a healthy, balanced, rewarding life is actually a characteristic of your illness. To get to that rewarding life (you may have all but given up on,) you have to do something you may not think you can do. And here it is…

    PUSH through.

    …and make the call.

    And you know how you can do that..? 

    By grabbing on to HOPE. 

    The drowning man has to take hold of the rope. If he’s passive and tries nothing, he’ll drown.

    The mountain climber who loses his footing and careens over the cliff has to reach out and GRAB – something. A rock…a rope…a bush…?

    Once you reach out, it gets easier. We step in. You’ll still have to show up, but each time it will probably get easier and easier. And as ketamine goes to work in your brain cells – the systems and circuits and structures – surging hope and strength and resilience will billow from within you.  

    It doesn’t happen all at once the very first minute…

    Maybe it just trickles at first, but then the trickles become waves, and the joy and initiative surges, and you find you’re CAPABLE of doing things you want to do, that you’d all but forgotten about.

    For some it’s during the first infusion…for some it’s after the second one. For others it’s after the third… and in some cases it’s even after the fourth.

    Your family may notice the changes in you before you do. You may show unexpected initiative before you FEEL all that much better. (Miranda, are you actually folding clothes? Unbelievable!)

    Reach Out for Ketamine!

    More than likely, you’ve heard of ketamine treatment. Maybe you dismissed it, because you’ve heard of it as “Special K” or thought it was just a horse tranquilizer. You think it all sounds bizarre, or the creepy kind of experimental treatment that happens in somebody’s garage.

    If so, maybe it’s time you do your own homework? The National Institute of Health funds extensive research about ketamine treatment because it’s so extraordinary.

    Esteemed neuroscience researchers around the world submit their research to peer-reviewed medical journals. Conferences of psychiatrists, neurologists, neuroscientists, and physicians in other fields are hosted in major cities like Oxford (UK), NYC, Austin, San Francisco, and more. And this has been going on for years.

    IV ketamine treatment is the most effective medicine for psychiatric disorders we’ve ever seen. It’s not FDA approved because no one wants to pay for FDA trials if they can’t make a profit off a patent. And..ketamine is too old…there’s no patent to be had.

    So, we lobby for it to be covered by insurance companies, anyway. And until then, you have to pay for this treatment out-of-pocket. However, there is medical financing available everywhere. And your resurrected life, your ability to pursue your dreams, build strong, healthy relationships, and enjoy your hobbies on your terms…isn’t all that worth a small loan?  To be able to live again?

    Reach Out for Ketamine and Get Better for 2020

    This is a new year, and a new decade. Right now, this week, is the perfect time to turn the tables on misery, take hold of your hope, and reach out to get better.

    Tell yourself that it’s your turn to get better. And that you’re not going to give in to excuses. That you want to live better, healthier, and more balanced. That you want your life to BE better. Give Hope the benefit of the doubt.

    This step can turn your entire life around for the better. But you’re the one who has to take it.

    Because it’s not right for everyone. We need to be sure you’re a candidate. And we’ll evaluate that first. 

    So…you may say, What if it doesn’t work for me?

    This young woman chose to reach out for ketamine and it changed everything about her life.

    Well…we say, What if it does??

    The likelihood it will transform your life is much stronger than the likelihood it won’t work for you.  Much stronger.

    Do you really want another decade to crawl by while you’re trapped in the misery and despair of this disorder?

    Reach out for Hope and for a better life in 2020 and beyond. 

    We’ll walk you through the process, answer your questions, and make it as easy for you as we possibly can. We’re here waiting for you to call us because we want to see you enjoying a full life.

    Reach out for ketamine and grab onto HOPE.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Ketamine and Other Breakthroughs in Psychiatry for 2019

    Ketamine and Other Breakthroughs in Psychiatry for 2019

    Man on a cell phone demonstrates one of the breakthroughs in Psychiatry of 2019.

    Tomorrow is the last day of 2019…and the day before a new year – and a new decade – begins.

    Let’s jump in and look back. Let’s celebrate our progress over the last year and consider the impact of new breakthroughs this year. Some of these breakthroughs in psychiatry for 2019 may surprise you.

    The World Health Organization says that depression is the leading cause of disability worldwide. (This is not a breakthrough–it’s one of the sad facts of our time.) And for at least 1/3 of those who suffer with it, traditional brand name and generic antidepressants on the market don’t work.

    In the early 2000’s, researchers discovered that IV ketamine caused a rapid and  robust response in people with major depression.

    Now, 10 years later, a ketamine derivative is one of our biggest breakthroughs this year. So let’s talk about that, and other breakthroughs in psychiatry for 2019, as well.

    Breakthroughs in Psychiatry for 2019

    1. Esketamine (Spravato)

    Spravato is one of the breakthroughs in psychiatry for 2019, because it won FDA approval this year.

    In March of this year, the FDA approved a derivative of ketamine, the left enantiomer of the molecule, in a specially designed nasal spray for treatment resistant depression under medical supervision in approved clinics. However, the FDA approved this to be used only in conjunction with another andtidepressant at the same tije.Use of esketamine requires the initiation of a new antidepressant at the same time. 

    After years of promising outcomes with IV and IM ketamine in treating depression and other disorders as an off-label treatment, FDA approval of esketamine presented a milestone — it’s a novel form of treatment as a nasal spray and it uses a derivative of a medication that we’ve been using successfully and safely for years. PTSD, cocaine use disorder, alcohol use disorder, bipolar depression, social anxiety, and suicidal thinking can all respond to IV ketamine.

    While esketamine hasn’t been studied for most of these conditions, it can create a robust add-on response to an antidepressant in some patients who benefit from low doses. And the beauty of it is that because of its FDA approval, esketamine as a medication is covered by many insurance programs.

    Although there are tons of hoops to jump through, red tape, paperwork, REMS monitoring (the risk mitigation program that the FDA requires that all doctors and patients participate in).

    So… FDA approval marked a new breakthrough in psychiatry for 2019, and a milestone in ketamine’s journey. The quest for wider acceptance as a remarkable treatment for people who’ve remained depressed in spite of traditional medicines.

    This 21st century novel and advanced treatment for psychiatric disorders is changing the face of disability.

    Growing numbers of people are experiencing not only improvement, but remission from their symptoms, and are recovering to build fulfilling and rewarding lives, relationships, and futures.

    Here at Innovative Psychiatry, we offer both IV ketamine treatment and esketamine nasal spray for those patients who are candidates for these treatments.

    2. Telemental Health Support

    Healthcare services provided by online video or telephone has been growing for a number of years. It has improved medical care for shut-ins  and the elderly who have difficulty accessing it in the office. Psychiatric patients in remote areas have received better psychiatric coverage through this means of communication.

    By combining technology with new policies, telemental health has advanced in its effectiveness again. Sometimes using a method of treatment reveals new opportunities for improvement as challenges reveal themselves.  

    So, The National Center for Performance Health in Florida recently established ecare4kids. This tele-counseling program serves public school children in Florida with online tele-counseling. All 50 states provide some amount of tele-health services through Medicaid.

    Then in February 2019, Congress introduced the Mental Health Telemedicine Expansion Act. The Ways and Means Committe approved it in June of this year to ensure more psychiatric health care in remote areas throughout the US.

    3. Gene-guided medicine

    The Human Genome Project completed mapping the genome in 2003.

    So what’s a genome? 

    Good question. It’s the complete set of DNA, or the genetic material, found in a microorganism or the cell of any living thing. In this case, we’re specifically talking about human DNA.

    To clarify, DNA is made of a pair of twisting or spiraling strands that consist of four chemical units which we call nucleotide bases. And the bases are made of adenine (A), thymine (T), guanine (G), and cytosine (C). These bases are paired in specific patterns, i.e., an A is paired with a T, and a G is paired with a C.

    This woman is bursting with excitement from the treatment she's gotten listed in psychiatry breakthrougs for 2019.
    Now imagine this: there are 3 billion of these base pairs in your DNA, which are held within 23 pairs of chromosomes…in the nucleus of every cell of your body.

    You can see how ambitious it was for this team to take on the project of mapping all this out.

    Well, now that we have that mapping, the obvious next step follows the reduction in price of mapping your own individual genome. The initial mapping project was estimated to cost 30 million dollars. 

    But the more they use this process, the more the process reduces in cost. The next steps can feasibly include things like getting your own map so your medical and health needs, and even the medicines you take, can be so specifically customized to your genetic profile as well as your environment and lifestyle, that the effectiveness of treatments you need can soar.

    Which brings us to the point that the disorders we talk about and treat are, in most cases, inherited to some degree. So you see multiple family members suffering from psychiatric illnesses at the same time…and all too often — severe illnesses.

    Imagine if we could better fit a medication or treatment specifically to your DNA profile. And the same for your family members. So much suffering from side effects could be eliminated.

    We have important information already available to us about the cytochrome P450 enzyme system (the enzyme system in the liver responsible for the oxidative metabolism of many of our medications) …and at Innovative Psychiatry we use evidence-based genetic information as we have available to help explain your responses and guide your treatment.

    4. Genetic Editing

    You feel like dancing like these friends from the psychiatry breakthroughs of 2019.

     …Say what?? It hasn’t been that long since we figured out what the genome looks like.  Now we’re talking about editing it? Like editing a paper?  

    Well, sort of.

    It turns out that this year genetic scientists broke through in a major way with a possible method for potentially removing genetic links to disorders and diseases like Alzheimer’s, ADHD, and autism, and replacing those links in the individual’s DNA with healthy links.

    So…scientists at Harvard and MIT took the wraps off a new approach to what they coined, “prime editing.” The chemist/biologist who led the unveiling described its usefulness as a metaphor of Word processing.

    A total WOW.

    He said these little prime editors search for certain DNA sequences and precisely remove them, then replace them with sequences that don’t produce disease. He says that 89% of disease-causing defects can be resolved by this method…eventually.

    Such astounding breakthroughs in psychiatry for 2019 – what can they imagine next?

    The potential here goes without saying. What would happen if we would eventually do a little primed editing and edit out suffering? Like the kind associated with severe depression? With bipolar disorder? With alcohol dependence? With anxiety? We get breathless just thinking about it!

    5. Psychiatric Healthcare with Cell Phones

    Man on a cell phone demonstrates one of the breakthroughs in Psychiatry of 2019.

    A technical/data science/healthcare company (Mindstrong) has secured a handful of patents to develop an innovative method of providing mental healthcare services over cellphones.

    By partnering with your health insurance company, services can be provided to you free of charge, including evaluations, psychotherapy, psychiatrist visits, medication evaluations, and support when things unexpectedly come up between doctor visits. Their psychiatrist will work with yours to provide smoother and continuing care. And because it’s designed to be free (for you), more people can receive care for their disorders.

    Using a mobile app, text therapy can be provided as Cognitive Behavioral Therapy (CBT), Coping and Emotion Regulation, Psycho-education, Crisis Management, Reflective Listening, and Empathy.  

    Since 75% of Americans own a cell phone, finding a way to reach a broader audience with mental healthcare is evolving to naturally involve mobile phones. Hmmmm…..

    Digital phenotyping collects data from the smartphone to provide measures of cognition and emotion. They say that the way you use your cell phone tells them a lot about your mood and state of mind. They can’t see you but they collect data. 

    They’re not covering every cellphone in the US yet, but they’re growing…and it won’t be long. 

    What do you think about this idea? I’d love to hear your comments below.

    With all these psychiatry breakthroughs in 2019, it’s easy to get caught up in the sci-fi talk and forget what we have NOW.

    We’re living in a new world, and IV ketamine treatment IS sci-fi. 

    We could not have imagined in the past century that a medicine originally designed for anesthesia would come out of the woodwork and actually provide a solution to major depression, alcohol overconsumption, opiate dependency, anxiety disorders, PTSD, OCD, bipolar depression, and suicidal inclinations. Ever.

    Let’s not miss what’s right in front of us. 

    IV ketamine treatment can resolve depression symptoms. 

    This is the jarring news we take with us into the new decade. 

    Depression, PTSD, OCD, social anxiety, bipolar depression, substance use disorders, and suicidal thoughts no longer have to be a final sentence. You can get better. Your life can transform to a new, meaningful, rewarding source of joy…and hope.

    If you wonder whether IV ketamine treatment could work for you, call us to schedule an appointment and come in. We invite contact from your health team, and we’d love to collaborate with them to help your life transform.

    We look forward to the opportunities to meet you and discuss options in the new year.

    Have a Happy and Healthy New Year in 2020 – full of  hope, purpose, and joy.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Your Generosity’s Impact on Depression

    Your Generosity’s Impact on Depression

    Your generosity's impact on depression is remarkable.

    This is a time of year when we do lots of giving, don’t we? 

    And for the most part, we receive the giving of others, too. While it’s fun to receive and get stuff, receiving doesn’t have the impact on our brain, our outlook, our health and immunity, as well as our sense of well-being, that giving does. In fact, when we really give of ourselves, give a piece of ourselves, hoping it will truly help or benefit the person we give to, something wonderful begins to happen. I guess most of us feel a certain amount of obligation this time of year to make sure we have a gift for each person in our world… family, co-workers, neighbors, friends and those in all our other circles. But there’s an important distinction between obligated giving and true generosity from the heart. So let’s talk about one of the most important results: your generosity’s impact on depression.

    It turns out that when you give out of obligation, it doesn’t really trigger any magical benefits in your brain. You still feel bad and you suffer a smaller balance in your checkbook. Plus you know…you still don’t know how to make things better.  

    Giving the Best of Yourself

    But when you give of yourself – from your heart – something amazing happens. It can be a check you write from the money you’ve worked hard for. It can be giving your time and support to someone who needs something you specifically can provide.  

    No matter what you give, when you really want that person to deeply benefit from it, that’s when it helps you, too. Well, at that point things start clicking in your brain in a way that turns up the heat in your immunity protection. It also turns up the connections in the signals moving in your brain, and – no small thing – it turns your attention from yourself and how bad you feel to someone else and how you helped them feel great. You may have even given them hope.

    Generosity is so Good for Your Depression

    So why is giving so valuable, and your generosity’s impact on depression so life changing?

    Good question!!

    Generosity's Impact on depression helps to release joy during the holidays.

    It starts in the mesolimbic pathway in the brain. Weird word, I know. But this strange phrase refers to a circuit in the brain that takes advantage of the neurotransmitter dopamine to link your behavior with a feeling of pleasure. You may have heard it called the “reward pathway.” 

    (It probably won’t surprise you to know that because of that, this area is studied by researchers seeking understanding and solutions for addiction.)

    So, when you’re a giver, a series of events takes place triggered by a special set of chemicals like dopamine and its mesolimbic activity, endorphins that give you almost a sense of euphoria, and oxytocin.

    Oxytocin is associated with tranquility and inner peace, as well as a sense of belonging, cuddliness, and connection. It’s the same hormone secreted when a mother nurses her baby….it causes the bonding between mother and child.

    Stress is a Destroyer

    Now when you’re spread too thin, or disasters are happening around you, both natural and figurative, that stress prunes and breaks down the synaptic connections in your brain. 

    Stress tells your body to prepare to fight or take flight. When your body keeps going into this state, believing you’re facing life or death, it wears it down. It depletes neurotransmitters, prunes the synapse structures and connections that allow for signals to be delivered, and increases cortisol. And when cortisol increases, these neurotransmitters stop producing.

    But, it turns out, that even if you do experience a lot of stress, something as simple as giving of yourself, volunteering, and helping and supporting others can combat the destructive effects of stress… and prolong your life.

    Generosity’s Impact on Depression and Mortality

    A study led by Michael Poulin published in the American Journal of Public Health, 2013, found that a stressful life did not predict the mortality rate in those who provided help to others. However, in those who did not provide help to others, stress did predict their mortality.

    Generosity's impact on depression is increased by the mutual support and fresh air and exercise of these volunteers as they give of themselves.

    A study published in the Journal of Health Psychology that focused on volunteering found that volunteering reduced mortality rates in a group of 2000 people more than exercising 4 times a week and regularly attending church. 

    Get this: it found that of the 2000, those who volunteered for 2 or more causes enjoyed a 63% reduction in mortality in contrast to those who didn’t volunteer at all.

    Volunteering is a Category All Its Own

    One thing about volunteering is that you have to really give of yourself. Your time, your energy, your comfort zone.  And you probably believe in the cause and truly want to help the recipients. So with volunteering, you’re probably meeting the criteria for health benefits. And yet…that’s not why you do it, is it?  

    You do it because you really do want to help, to make a difference.

    And it’s that heartfelt commitment to make a difference for someone and that deep desire to help, that triggers this cascade of neurotransmitter reward. Someone called it the “giver’s glow.” 

    It’s your generosity’s impact on depression in your life. It can help you go from shutdown…to glowing…!

    What it does do is to reduce the effects of stress in your life and improve your immunity, while flooding you with a warm sense of connection, and belonging, and soul satisfaction.

    These studies found that when someone is helpful regularly for a prolonged period of time, the benefits to their health and outlook compound, and carry on for a prolonged period of time.

    Which is why it’s not only better for the organization to know they can rely on you every Tuesday for a year, but it’s much better for your wellbeing and longevity.

    May Your Giving Season Be Your New Beginning of a Generosity Approach to Life

    And, so here we are. It’s the Giving Season. We’ve had Giving Tuesday which helped to organize donations all around, and… which helps you with a tax write-off. But let that be only the start. Because if you donated for the tax write-off, that’s your benefit. 

    Still, if you make this the beginning of a new year of reading to the elderly, or teaching English as a second language, or literacy support, or anything that can help make another life or many lives better, healthier, and with more hope, then you may very well be on your way to a ripe and healthy old age.

    Giving from the heart…giving unselfishly, giving of yourself in your own creative way, and giving your hard earned money to make life better for someone… can improve your outlook, your energy, and your sense of purpose. It can increase the neurotransmitters that move signals around in your brain, and improve your immunity.

    This man offers another a helping hand because generosity's impact on depression is unmistakeable when you help someone outside yourself.

    What a truckload of benefits for you from giving of yourself.

    And, if we at Innovative Psychiatry can help you with symptoms you can’t resolve yourself, please call us. IV ketamine treatment can give you the transformative restoration so you really can give your best self to others.

    We want to help you find the power to live, and give, and bloom. To be satisfied and fulfilled with your life, your work, your relationships…all of it.

    Have a Wonderful and Fulfilling Holiday Season!

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

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