Lori Calabrese, MD

Author: Lori Calabrese, M.D.

True Recovery From Trauma and How to Find Restoration

Trauma: Don’t Beat Yourself Up – Allow Your Loved Ones to Lift You UP

Have you been through something traumatic …? Maybe you’re a combat veteran, a first responder, or a victim of severe domestic abuse. It might have been a car wreck, or the unexpected sudden loss of someone you love. Fixed beliefs you form about that traumatic experience can insulate you from working through the scars you feel. If you tell yourself you “shouldn’t” be reacting to the incident, it keeps sitting deep inside you…haunting…but not healing.

Truth be told, you were traumatized. By rape. Infidelity. Fire. Hurricane.

What matters is that it traumatized you.

No one but you knows what has shaken you to your core. And continues to keep you shaken. But no one needs to. This was your experience. And YOU need to heal.

People are individuals and don’t react the same to the same stimulus. One combat veteran finishes his tour and goes back home, gets a job, and proceeds to build his “after-combat life.”

It’s not that he’s not shaken. But his reaction to all that happened may not have shattered him like the next guy. People go through divorce. One ex-wife gets thoroughly angry and surges forward like a steam engine to overcome the heartbreak she feels about her husband’s infidelity. But another one may be so shattered, so disillusioned she can’t work, can’t function, and trembles or vomits when she sees her errant ex-husband or drives by their favorite restaurant.

Sometimes It’s Appropriate to Let Yourself Feel Loss

But then, there’s another reaction. This is you if you’re the abandoned spouse who’s so empathic toward others and their pain that when you’re in pain you just try to ignore your sorrow when you see others who seem to be suffering more.

Sadly, you validate the pain and sorrow of others, and dismiss your own. The result is that you can’t validate your own grief like you would for someone else to help them heal. Sound familiar…?

Hey, Loss is Traumatic: It’s Not a Competition

If a woman loses her husband in a car wreck, and watched him die, she has reason to be heartbroken and deeply shaken. The fact that another woman lost her infant child in a sweeping illness does not trump the widow’s pain.

Both woman have lost a treasured loved one through horrifying circumstances. Both women felt helpless. There is no measuring stick to compare the loss of a husband with loss of a child. Both losses are terrible, and life-altering. In both cases, the women hurt terribly. Both were traumatic.

And both women need support, kindness, a listening ear, and patience. Both may certainly need counseling at some point to help them restore their desire to live and go forward. They’re not in any sort of contest with each other.

In fact, they’re each faced with shock and grief. And people do have to find their way through these very difficult times of life. Often they come through such times as a natural process. Other times it requires treatment.

But either way, the loss is devastating. And each person who suffers terrible loss is justified to feel traumatized…to grieve. To be supported. And to recover.

Let’s look at another perspective.

When a Traumatized Person Who’s Evaluated For PTSD, Is Not Given that Diagnosis…

Does it mean he or she wasn’t traumatized…? Or that the shock or pain of it wasn’t that serious?

NO.

There are certain criteria required for a PTSD diagnosis. Every person is different and responds to painful or traumatic experiences individually. Your pain, loss, grief, and trauma are real and valid.

Don’t let a label or diagnosis invalidate what you’re going through.

Some people, after a deeply traumatic experience, are actually diagnosed with PTSD. Most aren’t. What’s more, there can be other diagnoses after you endure something like this. If it’s not PTSD, it may be depression, or it might be panic disorder, or substance abuse, or an eating disorder.

Or…it might be that you’re sorting through all the complicated effects of grief, shock, and pain that can accompany a traumatic event or experience. To achieve true recovery from trauma requires that you be honest with yourself, as well as patient.

Let’s set labels aside.

If you’re suffering, that’s all anyone needs to know. And your suffering is valid. As time goes by, after a few years, if you’re still suffering the same symptoms you suffered immediately after the event…or even during the event …. then it might be time to see a psychiatrist to find out how to help you move forward.

Because a life-altering event isn’t something you just get over. It’s a part of who you become…every major life event is. But if the way you feel about it is preventing you from living your life and productively contributing to your job or hobbies you enjoy, it may be that an intervention can help you get your life back.

True Recovery From Trauma

Mental and emotional health isn’t defined by a lack of difficulty or upheaval, but by the skills you learn as you live to cope and recover from those challenges and difficulties that happen.

Resilience … takes time to develop.

And…even if your ability to cope needs a little nudge or a leg-up, you’re still learning and building your life skills. And you’ll continue.

The Secret of the Phoenix

There will be fires and wars in life. Betrayals and shocks. But if your goal is to learn to rise from the ashes, you’ll likely gain strength and resilience through the processes you endure, and the storms you weather.

Even so, if you find that the results of trauma in your life have interfered dramatically in your ability to move forward — whether you have PTSD, general anxiety disorder, panic disorder, severe depression, bipolar disorder, substance use disorder, and especially if you have suicidal thoughts — call us.

At Innovative Psychiatry we specialize in helping people who haven’t gotten better with other treatments.

And the most powerful tool we’ve found among the novel, advanced treatments we offer is ketamine treatment. Sometimes in the process of grief, or in processing trauma, you can get sort of stuck, unable to progress forward into a healthier place. Ketamine treatment has proven over 50 years its safety with adults and children.

The extraordinary actions of ketamine treatment can rebuild the structures in your brain that stress and trauma break down. It’s like it restores your tool box so you can rebuild your life. And it can be a huge help in your true recovery from trauma.

Learn about how to choose the best ketamine clinic, or best psychiatrist who offers ketamine treatment, and be your own best advocate. You deserve to live well and enjoy a restored life.

To the restoration of your best self,

Lori Calabrese, MD

July 30, 2018
The Truth About Bipolar II Disorder: How To Get Your Life Back

You Can Know if You Suffer From Bipolar II Disorder

and What You and Your Doctor Can Do About It

Clara is a 27-year-old artist whose talent has opened opportunities for her she never dreamed possible. She’s published books of her original poetry and children’s stories she wrote and illustrated herself. She paints watercolors of children playing amid lovely floral backgrounds … and sells them through a local gallery.

Clara’s light-hearted artistry belies her deeply analytical and moody personality. She says she paints the world the way she wishes it was, rather than the way she sees it.

She experiences long periods of sorrow…self-criticism…shame. Then sometimes, out of the blue, she’ll feel more normal again — and she’ll rush around to buy groceries, clean up her place, and have lunch with friends…until that brief “normal” period is replaced by that all-too-familiar sinking feeling again.

Clara was diagnosed with bipolar II disorder. Most of the time she labors under the leaded blanket of bipolar depression…and occasionally she’ll feel better for a few days. Her “hypomanic” periods are really just about what “normal” would be like for someone who wasn’t ill.

She can’t believe this isn’t just depression.

The Good Times Roll…and Then They Plunge…

Then, there’s Ben. He’s 33 and works in the IT department of a large hardware company. He’s been promoted regularly due to his innate ability to problem-solve software “puzzles.” Ben finds that there are periods when he’s particularly astute, and can work long hours relishing in the challenges before him. At these times, he gets by on little sleep — and feels fine with only 4-5 hours a night.

He loves to get with co-workers for a beer after 16 straight hours of fighting a problem together. He buys drinks for everyone, along with appetizers for the team. Then after a few hours of shut-eye, he’s ready to jump back in again.

However, those times come and go.

After a period of almost spectacular productivity, it’s as if someone blew out the candle. He begins to slow down…really slow down…more and more until it’s hard to rub two thoughts together. During these times he feels heavy, sluggish. He manages to go to work, but once there, he feels dull. And he chows down on chips, cookies, cokes, and pasta. Before long, he can no longer button his pants.

It’s so humiliating. His coworkers – the ones he bought rounds of drinks for 2 weeks ago – poke at him. Tease him. They really like him but don’t understand that he’s powerless to be different right now, and the aggressive ribbing just make his shame more intense.

He just wishes he could go to bed and sleep. He feels overwhelmed at his own failure. He’s convicted of his complete worthlessness.

His boss starts pushing, getting annoyed with his poor performance. Ben feels helpless. Powerless. And ashamed. Worthless.

Then, after a few months, just before his boss is about to lay him off, his energy comes back. Suddenly, he’s brilliant again, and in two weeks makes up for all the down time when he was so depressed.

Ben sees a psychiatrist for his condition, but the treatment hasn’t helped. The doctor diagnosed Ben with bipolar II disorder.

No One Understands: Their Lovable Friend Retreats in Pain

Kelsey is 29 and has a job as a lab tech in the community hospital. She’s fast and efficient in her job and loves it. She has a bright and sparkling personality most of the time. Her coworkers love socializing with her outside of work.

They all want to be her best friend.

But sometimes she withdraws…calls in sick for several days…and avoids answering the phone. She thinks she has the flu from all the aching in her back, arms, and legs. And being home in bed is a welcome relief from the pressures and chaos of the office. She needs rest, she tells herself, and she’ll be ok.

After a week of reprieve, she steels herself to face it all again, and is back at work on Monday morning. But she decides to see her doctor when she realizes she’s still not herself a week later.

After a thorough examination, and lots of questions, her family doctor tells her he believes she’s suffering from Major Depressive Disorder (or unipolar depression, as some call it), and prescribes an antidepressant to help her feel better.

The antidepressant is a SNRI (serotonin norepinephrine reuptake inhibitor) and he expects it to relieve the aching she experiences during these “down” times.

It takes a couple of months, but Kelsey does begin to feel better. She wakes up with more and more hope each day… feels less need to withdraw … and the aches and pains subside. Finally.

The Solution Becomes the Problem

But then something weird happens. About 5 weeks after beginning the SNRI, Kelsey notices herself talking more at work — and at social gatherings, too.

After she goes home she thinks back and realizes she did most of the talking herself…like a veritable Chatty Cathy. It’s embarrassing… what’s wrong with her? She dominated the entire evening! groan…

But she still has the energy for work again and that’s a great relief.

The next week, she deposits her paycheck, and goes shopping. First she decides on new sheets … then she thinks it would be nice to make all her linens match, so she chooses bright cheerful sheets, pillows, duvet cover, towels, bathmats.

The bag is humongous so she takes it to the car then goes back into the department store.

The store is having a sale, and it’s so exciting that she just happens to be there — what great deals! She spots dishes that match her bed and bath linens, then pots and pans.

On her way out she notices those shoes she’d seen in a haute couture magazine…and buys them! She works hard. This is her special reward.

Oh boy! she says to herself, How beautiful and cheerful my whole apartment will be with everything matching. She pulls out her debit card and pays for a full set of dishes complete with matching serving bowls and the matching set of cookware.

The clerk suggests she bring her car to the door so they can help her load it all up.

After loading, she calls a friend to meet her for lunch at the nearby Italian bistro, and off she goes feeling exhilarated.

Following a yummy lunch with her friend and lots of lively chatter, the waiter brings the check. Kelsey pulls out her debit card and offers it to the waiter. In short order the waiter returns.

“Ma’am, this card was declined… do you have another we can try?”

OH NO. In Kelsey’s enthusiasm, she didn’t think to subtract her purchases from her balance. She had spent her entire paycheck without even noticing.

She asks her friend to cover lunch with promises she would pay her right back. What choice did her friend have…? Kelsey knew her friend wouldn’t look at her the same way again. She was devastated…confused… her face flushed and she tried to hide it.

She also knew she should probably return all the stuff she bought. But she just didn’t want to.

What happened…?

Bipolar II Disorder Can Hide For Awhile

Sometimes, a person who’s diagnosed with unipolar depression can take an antidepressant … and manic symptoms emerge.

Kelsey’s relief from depression and physical pain led to a phenomenon that sometimes happens with persons who are depressed and take antidepressants.

Kelsey actually suffers from bipolar disorder, but was mistakenly diagnosed with unipolar depression and treated with an antidepressant because she had not had a manic episode at that point.

The antidepressant either triggered hypomania in Kelsey… or… this was her first hypomanic episode.

Either way, she unwittingly plunged into a crisis.

Bipolar III?

Many doctors call this Bipolar 3 Disorder, which isn’t a real diagnostic term…but more a nickname for the condition when someone with depression who’s never exhibited bipolar symptoms suddenly does upon beginning an antidepressant.

If you’re old enough, you may remember the popular talk show host, Jane Pauley from the Today Show. This was her experience. And in a televised interview, she referred to her condition as “bipolar III.”

Aside from labels, Kelsey needs to be watched carefully by her doctor who’ll cautiously treat the symptoms as they present themselves, evaluating her condition going forward. But that’s another article for another day.

Treatment for all the variations of mood disorders doesn’t line up in black and white categories, but in combinations and shades of gray and it’s important to find the one that best helps you personally.

Bipolar Disorder is a Spectrum Disorder

So, we’ve mentioned three people who share a bipolar diagnosis, but whose symptoms are not that much alike. The point is that bipolar disorder is a spectrum disorder and its diagnosis relies on the patient’s – and their family’s – observations and descriptions of symptoms.

When you suffer from bipolar I, the upswing symptoms tend to be more severe … harder to ignore…and the diagnosis is less difficult.

The distractibility is clear, the recklessness and impulsivity are OBVIOUS, the high energy and lack of sleep and grandiosity can slip quickly down a slippery slope. It’s mania through and through, and it can dig you into a hole, fast.

But bipolar II is more complicated to diagnose because your symptoms land in a variety of places on a symptom spectrum. And sometimes even the symptoms you expect to see aren’t really there… yet. And may never be.

The better you understand your symptoms and recognize them, the more you and your family can help your doctor arrive at the correct diagnosis and the best treatment for you.

How to Understand a Spectrum Disorder

In his book, Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder, Jim Phelps stresses the importance of gauging symptoms on a continuum, rather than checking them off an arbitrary list.

Because we’re human, and everyone has a little of something that can be a symptom in someone else.

You may know someone who has milder insomnia but somewhat pressured speech and …severe irritability. They tell you they have bipolar disorder. So you think that’s what bipolar looks like.

In your case, you may feel confident and clever at times, even at times engaging everyone at a dinner party. Still, behind closed doors you have periods of extreme agitation and impulsivity. Or maybe risky behaviors like spending sprees, speeding, or intense sexual behavior that isn’t your norm…?

It’s tempting to say things like, “Maria doesn’t have bipolar disorder. It must be something else causing her problems. Because my daughter has bipolar disorder, and Maria and my daughter don’t act the same way at all!”

Each Person is Unique – So Psychiatric Disorders Are Unique in Each Person

But the fact is that there aren’t absolutes, but rather varying degrees of various symptoms that interfere with a productive and fulfilling life. And that’s why we seek to treat these symptoms…because they interfere with your life and the way you want to live it.

At Innovative Psychiatry, we see people with bipolar disorder in all its varieties every day. And we work with you to help you feel better. Not to just improve, but to feel so much better you can finally live and enjoy the things that are important to you. You can build and strengthen your relationships. You can focus again to read what you want to read and do things you enjoy. And you can show up when and where you’re needed.

And if you’ve tried other treatments for your bipolar diagnosis that haven’t helped much at all, don’t give up. Chances are that ketamine treatment may be just what you need to feel balanced, motivated, and able to relax and enjoy the moments of your life.

The beauty of it in bipolar disorder is that it lifts depressive episodes quickly — so you can avoid the risks of switching into hypomania or mania that come with using an antidepressant for weeks … or months.

That is so worth it.

The Concept of Spectrum Disorders

We encourage you to read Dr. Phelps’ book to gain insights about your own condition. And some of my blogs. Try to understand the concept of a spectrum illness. Ask your doctor. Get a second opinion.

And if you’d like to see what life is like without phobias, panic attacks, social anxiety, bipolar depression, PTSD, OCD, and… worst of all… those thoughts of death and suicide, call us.

Because every person is different, and responds to medicines differently than every one else, there are no absolute guarantees. But given our success rate, chances are ketamine treatment can turn your life into one you enjoy living.

To the emerging of your best self,

Lori Calabrese, MD

July 23, 2018
Can Inflammation Cause Depression? It All Depends on Your Childhood

Neuro

Neuroscience Discoveries Show Inflammation Can Cause Depression – Especially If You Experienced Severe Stress in Early Childhood

Lillian was in second grade when her mom went to work full-time. For the first time in her life, she would get off the school bus and walk down the street to her house, pull out her key and unlock the door.

Lillian was intelligent and responsible. But when she opened the front door and walked into the dark house, she was scared. She’d creep to the couch, shaking as she turned on a lamp, and sit there until 5:30 when her parents got home.

She often cried during those hours.

Some people could adapt to that just fine. But for some, experiences like this can be traumatic.

Second grade, third grade, fourth grade…. Those long hours in that dark and empty house were a crucible of terror for this sensitive little girl. It didn’t help that her parents weren’t the “sensitive” types. They chuckled about her fear. They just didn’t get it.

A Child Silently Suffers

As little Lillian advanced to middle school and beyond, she suffered for years with undiagnosed depression. Not that her parents were aware. Quite to the contrary, they were proud of their talented and intelligent daughter. As long as she continued to perform, they were happy.

“I see you have an A- on your report card. What happened? Why wasn’t it an A?” Their idea about parenting was to expect the best of their children, and never praise anything short of that. They fully expected their high-achieving daughter to go to medical school, and they had no intention of threatening their bragging rights by supporting what they considered mediocre.

In fact, they expected her to become a pediatrician. That was the plan.

But Lillian, in spite of her high grades, wanted to ride horses, study animal husbandry, and write songs.

Unwitting Parents Tear Down Resilience

This isn’t the first time parents’ dreams for their child remained unrealized. Neither was it the first time a budding teenaged girl felt misunderstood.

When Lillian and her friend dressed to go to an 8th grade dance, before they walked out the door, her mom said, “Lillian, you need to cut your hair. It looks shaggy. And you need to lose weight in your hips. They’re too big!”

The lithe but discouraged girl looked at her shoes… wishing she could be swallowed up by a hole. How could she face the 8th grade boys when she felt so ugly?

Experiences like these accumulated through her teens. Once she was married and gave birth to her first child, the depression grew more severe. It became worse and worse until she stayed in bed most of the days…unable to function to care for her children.

Finally, she was admitted to a community psychiatric hospital. The depression that had plagued her during her formative years escalated to full blown disability. And she improved only marginally from that hospitalization. There would be many to follow.

But why?

Can Inflammation Cause Depression if You Suffered Early Childhood Stress?

An article by Carmine Pariante, MD, PhD published in Psychiatric Times in May, points out some of the ways research is revealing patients with depression have increases in their inflammatory system. Elevated levels of “cytokines” which are substances, like interferon, interleukin, and some of the growth factors, secreted by the immune system indicate inflammatory activity.

Even so, what’s interesting is that not all people who suffer from depression also suffer from inflammation.

They found through a series of studies between 2009 and 2017 that excessive stress early in life, as well as the stress of lower socioeconomic status and cardiovascular risk factors, can lead to inflammation. But of these factors, early life stress was by far the largest correlate to inflammation.

Can Inflammation Cause Depression?

In recent years, we’ve been able to even connect the dots of inflammation in adults who were exposed in the womb to their mothers’ perinatal depression. The link was so significant that researchers were able to make the connection that stress in the womb is linked to inflammation in adults, with or without depression symptoms.

Stress in the womb is a risk factor for inflammation in adults!

Then they took it a step further…

Several studies revealed that certain genetic variations lead to depression symptoms…but only in those who suffered early life stress.

Then things got even more interesting.

Can inflammation cause depression?

Since omega 3 fatty acids fight inflammation, the researchers found that patients with low levels of DHA and EPA had more inflammation. So they speculated that when the levels of DHA and EPA are low, that condition would cause inflammation-induced depression.

DHA is the nutrient added to many infant formulas that’s also found in breast milk. DHA and EPA are long chain omega 3 fatty acids that account for 97% of the omega 3 fatty acids in the brain. They’re vital for optimum brain function and development.

And the researchers were right. They performed a clinical trial with patients who had these low levels…dosed them with EPA and DHA… and found it prevented or delayed onset of this type of depression.

This discovery showed them that patients with low levels of EPA and DHA omega 3’s can be treated with nutrients to restore these reserves and potentially prevent the inevitable depression that can follow.

Personalized Medical Care Means Faster and More Effective Treatment

This innovative discovery empowers us with one way to provide personalized interventions for depressed patients based on their individual cause of depression.

They also found that of those with low omega 3 levels, only those who experienced early life stress became depressed. Others with low omega 3 levels showed inflammation without depression.

What’s more, those who experienced stress in the womb due to their mother’s depression during pregnancy, showed inflammation and depression in adulthood.

Certainly, not everyone who is depressed shows those inflammation markers in their lab work.

But for those who do, we can provide more effective and novel treatments to help them recover.

If they don’t need an antidepressant, but do need dosing of EPA and DHA, and if that intervention will restore their emotional balance, how much better to treat the real fundamental problem.

More Neuroscience Research is Needed

Neuroscience researchers continue to uncover mysteries as they work to find solutions for your suffering. I would like to see studies involving depressed patients who fit these categories treated with IV ketamine infusions.

Is it possible that the patients who don’t seem to readily respond to ketamine treatment are actually those low in EPA and DHA?

On the other hand, would these patients respond to ketamine treatment without doses of EPA and DHA?

So many more studies are needed. In fact, the more we learn, the more we realize what the questions are!

At Innovative Psychiatry, we continually seek novel and effective treatments for you if you suffer from treatment-resistant psychiatric disorders.

Personalized treatment drives us with each patient.

We work hard to find out how to help you get better, based on what factors led to or contributed to your symptoms.

From ketamine treatment to strengthening your microbiome to adding nutrients to your diet and more… we want you well.

Let’s work together to help you get better, so you can enjoy and build a fulfilling and rewarding life. Call us.

To the blooming of your best self,

Lori Calabrese, MD

July 16, 2018
Anxiety and Panic Disorder: Can This Condition Be Quelled?

Anxiety and Panic Disorder – A Tormenting Presence

“Am I going to die? I feel like I’m dying…”

“No, you’re going to get through this. You’re having a panic attack. Just keep looking in my eyes and holding my hand. These feelings are going to pass in a few minutes. Hold on…” The emergency department nurse reassured the shaken young man.

He looked to be in his mid-twenties, a handsome, dark-haired guy with a 5 o’clock shadow getting ahead of itself.

“What’s happening to me? Am I dying …?”

“No. This is fear. It’s a real feeling…but it’s not an accurate assessment of what’s happening. You’re doing fine. This feeling is going to pass. Hold my hand…”

“How do you know I’m not dying…? It feels like I’m dying…”

The nurse ached for him. “I’ve seen this before. This is a feeling you’re experiencing. It’s a panic attack. Do you have a pet at home?”

“Yes, I have a dog.”

“What’s his name…?”

“Barkley. Do you think I’m dying now? Just tell me the truth.”

“No…you aren’t dying. Your pulse is a little faster than usual but it’s regular and your blood pressure is sta-“

He cut her off…

“Are you sure…?? Why am I sweating? Because I feel like I’m dying…”

“I know you do. It’s hard to feel like this. But you’re ok. This feeling is going to pass. Do you have any children?”

“Yes, I have a little boy. Will you please tell him I always loved him very much?”

Panic Attacks Can Take Many Forms

Sometimes you may scream and cry; sometimes you may feel frozen and unable to move, sometimes you might just talk about the feelings of imminent death or impending doom like our friend Tom in the Emergency Department.

If you’ve never had one, here’s how to imagine it:

Think how you’d feel if you came upon a grizzly bear in the woods. You might be frozen with fear or feel overwhelmed with your imminent death… or you might just break into a sweat — or a scream…

“Tom, you’re going to be able to tell him that yourself in just a little while. What grade is he in…?”

“He’s in second grade. Are you sure this is a feeling? Because…it feels like it’s real. I wish I had spent more time just playing with him. He doesn’t deserve this.”

“Tom, just make the decision now that you’ll spend more time with him. You’ll have plenty of opportunities. What would you like to do more with him…?

“Oh anything. Basketball, soccer, playing at the park… He deserves more… I might be feeling a little better…. Is that possible?”

The nurse sighs in relief. “That’s great to hear. I gave you some medicine to help you relax. I’m glad you’re feeling better…it’s going to get better and better now… “

“Oh, I hope you’re right. I thought I was dying…”

Tom has never seen a psychiatrist. No one in his family has. But there’s high blood pressure, heart problems, an uncle with diabetes.

He checks again. “You’re sure I’m not going to die…?”

Anxiety is a bear, but panic attacks are dragons.

Panic attacks come when you least expect them, and in full force. If this happens to you often … even regularly … you may have panic disorder.

Traditionally, anxiety and panic attacks have been treated with anxiolytics, or medicines that cause symptoms of anxiety to diminish.

And also antidepressants – both SRI (serotonin reuptake Inhibitors) and SNRI (serotonin norepinephrine reuptake inhibitors) varieties. And when they work, well…they’re a Godsend.

But far too often they don’t help. Even after trying 2 or 3 different prescriptions, increasing the doses, adding augmentation agents like buspirone.

Sometimes the side effects of the medicines are just too much. Maybe they’ve made you tired all the time, or interrupted your sleep. Maybe you’ve gained weight. Developed chronic GI side effects. Found that your libido is non-existant or that you’ve developed other sexual side effects.

Then what?

Some people are able to get the panic under control with a combination of SRI or SNRI antidepressants combined with Cognitive Behavioral Therapy (CBT).

If your doctor has tried antidepressants, anxiolytics, and even mood stabilizers in an attempt to help you get better, but no combination has worked… then it may be time to consider more novel advanced treatments.

Things like Transcranial Magnetic Stimulation (TMS) or ketamine treatment.

Novel Advanced Treatments To Consider for Anxiety and Panic Disorder

Sound weird?

These treatments aren’t weird…they’re very 21st century.

Transcranial Magnetic Stimulation (TMS)

TMS uses a magnetic coil placed over your head, that sends pulses deep into the brain. These pulses stimulate your brain cells to become healthier and function properly.

As a result, you begin to feel better and better during the 3rd or 4th week. It doesn’t work fast…but it works well in about 70-75% of people. TMS requires appointments five days a week for roughly 4-6 weeks. And there are treatment protocols for anxiety disorders that are quite effective.

Ketamine Treatment for Anxiety and Panic Disorder…?

Ketamine was developed in a laboratory in the 1960’s as an anesthetic. And it’s been used in the operating room for over 50 years. It’s effective and has proven itself as a safe medicine when used for that purpose.

Then, several years ago, ketamine began to be tested for depression. And it’s made a huge difference for many of those who received it. There have been some bumps along the way, as we’ve learned about how to help its benefits last, and which routes allow the most wonderful outcomes.

Now, in 2018, ketamine is receiving increasing respect as the most extraordinary antidepressant neuroscience has seen in the last 50 years.

What’s more, it’s being tested in laboratories and clinical practices, and we’re finding ketamine’s benefits are widely experienced by people who suffer with a host of different psychiatric disorders.

Things like major depression, postpartum depression, treatment-resistant severe depression. Also anxiety…generalized anxiety disorder, social anxiety, and panic disorder.

Add to that PTSD, OCD, and suicidal thoughts.

This medicine is life changing.

But let’s talk about panic disorder and a case study from 2016 that indicates that ketamine might be useful for it. Because right now, panic disorder lacks extensive studies using ketamine. More studies are needed to validate the results some doctors are seeing regularly in the office.

In the case study, Ms. A suffered deeply from panic disorder, agoraphobia, generalized anxiety disorder, and major depressive disorder.

For far too long, she’d been unable to leave the house or use public transportation, and felt unable to learn to drive because of her anxiety. Panic attacks at least every week caused her to believe that she’d never be able to manage the anxiety that ruled her life.

Her psychiatrist prescribed substantial doses of escitalopram and an intense regimen of electroconvulsive therapy treatments. Then she added 400mg of lamotrigine combined with 30 intensive sessions of CBT. In other words, Ms. A was receiving aggressive treatment. And…

All of this helped to reduce her suicidal thinking and mood improved.

But her anxiety didn’t improve. She remained home-bound because of her fear of leaving and having a panic attack.

Then, 6 or 7 months later, she was seen in the emergency department of her local hospital for severe pain in her neck. An MRI showed she had 2 herniated discs in her spine, so in the ER, she got IV ketamine to treat the pain.

One infusion. For pain.

Symptoms of Panic Disorder, Agoraphobia, and Major Depression IMPROVED

And in the weeks following her ER visit, her anxiety symptoms improved. (This is really pretty cool.)

She felt like shopping at the department store, started a business with a friend, volunteered at a market in her community. Her mood was positive and “normal” for at least 10 weeks. Her doctors attributed it to ketamine — although of course there are a dozen other possible factors.

Still.

We see patients who present to us with all kinds of complex symptoms and often panic disorder is just one of the many that bring them to our office. And we see the pit in their stomachs go away. The anxiety lift. The worry diminish. In each case, one at a time. The stories are too complex and too varied to see them as anything more than case reports right now.

So we need to see researchers conduct more studies. When we treat a patient for another disorder, or when a patient is treated with ketamine for severe pain, and their anxiety and panic disorder symptoms fade away at the same time, we’re the first to smile with them. Then they keep smiling all the way home … and all the way back into their day to day lives.

But we need researchers to do their gold standard, double-blind, placebo controlled studies to rule out variables that may enter into the mix in the office, and to verify ketamine is demonstrating effectiveness for this disorder.

There are backup studies for ketamine and social anxiety … another anxiety disorder. We see extensive positive outcomes in treating PTSD with ketamine, an anxiety disorder that often includes panic attacks.

We need to see more studies for ketamine and panic disorder.

At Innovative Psychiatry, we’re seeing patients with anxiety and panic disorder getting better every week and every month. We want to see you get better, too. If you suffer from panic attacks, anxiety, and any other disorders, call us.You can feel so much better. And we want that for you.

To the healing of your best self,

Lori Calabrese, M.D.

July 9, 2018
Ketamine Treatment Enhances Creativity – Lori Calabrese, M.D.

Psychiatric Disorders and Creativity: Is there a link?

Think about it. Vincent Van Gogh. Virginia Woolf. Michelangelo. Beethoven. Robin Williams. Ernest Hemingway. Carrie Fisher. Anthony Bourdain.

Creative Genius.

There are hundreds, probably thousands more, who fit right in with this good company. Maybe you do, too.

Take John Nash, the Nobel prize-winning mathematician whose story is told in A Beautiful Mind.

Hallucinations, delusions, severe depression, fear, phobias, suicide… Psychiatric symptoms are all too familiar. But how often are they accompanied by creative thought, astounding accomplishments, and indescribable beauty…?

The simple answer to that question is probably more often than you think.

So what IS the connection between psychiatric disorders and creativity? Is there a link…?

A meta analysis by Christa L. Taylor, published in Perspectives of Psychological Science September 21, 2017, shows that researchers have used psychological tests, population surveys, and genetics to examine creativity in psychiatric illness, and vice versa. They’ve found measurably higher rates of creativity in people with bipolar disorder, as well as more cases of bipolar disorder in creative people.

Clearly, for every celebrity who’s been diagnosed with a psychiatric illness there are probably dozens who are pretty healthy and stable. (Although some would say that’s a bit hard to believe about Hollywood…!)

But doesn’t it appear so often that the really brilliant ones, spectacular performers in the arts, the math and sciences…seem to battle complicated symptoms …?

When you consider that the links researchers have found in visual arts, performing arts, politics, business, religion, literature, music, and science translate to exceptional people all around you in school, work, and everywhere in between, it’s worth another look.

Still, researchers have often found these connections in individuals with milder forms of bipolar disorder, such as bipolar II and cyclothymia. Their assumption was that the extreme mania of severe bipolar I disorder would interfere with creative thought.

On the other hand, we can’t ignore the great achievements of Beethoven, Winston Churchill, Abraham Lincoln, John Nash, Brian Wilson, Kurt Cobain, who all experienced severe forms of their disorders.

So here’s what’s interesting…

Psychiatric Disorders and Creativity: Clues in Your Genes

Bipolar disorder and schizophrenia actually share genetic origins with creativity. Interestingly enough, there are some symptoms of schizophrenia that are conducive to creative work. Isn’t that a surprise…?

So when someone has psychotic symptoms ….and is afraid to take medication to manage symptoms… you can sort of see where they’re coming from. But, it doesn’t mean we have to take an all-or-nothing perspective.

Burns Woodward, MD, in his article, Creativity and Psychiatric Illness: Finding the Sweet Spot, makes the point that if people who suffer with psychiatric disorders fear treatment because they don’t want to lose their creative thought, it’s important we listen to their perspective.

By listening, and collaborating in working with them, you can support their concerns and still encourage them to participate in a treatment plan that helps them function better and avoid hospitalization.

This is also good advice for families.

When families dig their heels in, convinced their loved one can’t make good decisions for themselves, the resistance on both ends of that battle usually leads to noncompliance.

But when the family finds a way to build harmony with their loved one’s concerns, treatment becomes a possibility. Their loved one can grow closer to cooperating with a treatment plan.

The Case of John Nash

Woodward also makes the point that in the case of John Nash, his fear of loss of creative thought led him to refuse medication. You can only wish he had had the chance to receive IV ketamine for depression. Ketamine treatment enhances creativity and it might have helped his courage with his antipsychotic medicines.

You see, it was only after he had received the Nobel Prize that he began $Psychiatric disorders and creativity seem to be linked, and sufferers worry that treatment will quell their creative thought.$ developing symptoms of schizophrenia.

His distracting delusions and hallucinations prevented him from the intense focus necessary to do more significant work until after he’d been hospitalized a third time. He finally agreed to medication to manage his symptoms. And you know what? John created his only noteworthy mathematical work while he was taking that medication.

True.

But What if Medication Doesn’t Help?

There are currently medications that help some people who suffer from every form of psychiatric disorder. Be it depression, social anxiety, panic disorder, bipolar disorder, PTSD, OCD, schizophrenia, eating disorders…

But there are so many who receive no relief whatsoever from these medications. And those are the ones we focus on at Innovative Psychiatry.

You are someone we want to help.

Innovative Psychiatry dedicates focus and resources to help you experience relief and hope if you suffer from treatment-resistant psychiatric symptoms.

Ketamine Treatment Enhances Creativity

I can tell you straight up that if you do, ketamine treatment doesn’t work for everyone. It just doesn’t, and we don’t know why at this point. We know every brain is different, just like every face is different. Your brain is uniquely yours.

But what I can say is that we’ve seen extraordinary outcomes in the majority of patients we treat. Ketamine treatment is more effective in more cases than any other medicine in our lifetime.

In the case of schizophrenia and schizoaffective disorder, ketamine is not the treatment of choice.

And yet, studies have found it to be very helpful in stopping suicidal thinking and relieving depression in patients with these disorders. Aziz Walid and his team published a case study in the Journal of Addiction Research and Therapy which demonstrated this.

So let’s talk about psychiatric disorders and creativity. If you’re afraid of medicating the disorder you live with because you’re afraid of losing your creative edge, be encouraged. Ketamine brings creativity back to life.

Ketamine treatment enhances creativity.

This is not an old-fashioned antidepressant that dampens your feelings, your emotions, or your creative thought.

Rather it renews, rejuvenates, and replenishes your creative pathways and signaling systems so you can think more, not less. Create new beauty, new prose, new ideas, and feel truly alive again.

So How Hard Is It To Find Ketamine??

Ok, so don’t get me wrong. Ketamine isn’t something you can pick up at the pharmacy. It’s a powerful medicine that should only be administered by a psychiatrist if it’s used to treat a psychiatric disorder.

What’s more, there are countless doctors providing it who really aren’t qualified to do so.

What Difference Does It Make…?

Because ketamine as an anesthetic is a medicine for anesthesiologists to administer to patients for anesthesia or for pain control.

But ketamine as a psychiatric treatment should be provided by seasoned psychiatrists deeply experienced in treating life-threatening psychiatric disorders as well as suicidal inclinations.

Psychiatrists equipped to provide ketamine are still rare. This treatment is best administered by an expert psychiatrist deeply skilled and experienced in treating psychiatric disorders with IV ketamine treatment. And here’s why.

Ketamine for psychiatric disorders is a treatment of delicate brain systems and should be infused with precision and insight physicians of other specialties don’t possess.

Skilled psychopharmacology as well as insight for personalized dose and rate of infusion are vital skills necessary in psychiatrists who provide ketamine treatment.

Physicians from other specialties lack the training to accomplish this well. Sometimes they’re impatient. Outside of their scope of practice. Unsure about coordinating psychiatric care. Or they’re so familiar with the drug itself that they don’t think they need sophisticated equipment to administer it.

A psychiatrist providing ketamine for various psychiatric disorders should utilize a precise infusion pump and monitoring equipment to ensure the most thorough and effective treatment experience.

At Innovative Psychiatry, we’re expressly equipped and proficient to provide you with treatment for your symptoms that other medications and treatments have failed to relieve.

We see a remarkably high remission rate among people who’ve come to believe that their symptoms are treatment-resistant.

If you’ve tried medications for your disorder that haven’t helped, and you’re afraid to try more medication — or sick of their side effects — we can help. Call us and let us help you find the creativity, initiative, motivation, and enjoyment you’ve been missing. Let us help you find the real you that’s been hidden for so long.

To the resurrection of your best self,

Lori Calabrese, M.D.

July 2, 2018
Ketamine Boost Infusions: When You Feel Better-ish, But Not Better Enough

Ketamine Boost Infusions Combined with Infrastructure Changes May Help You Sustain Remission

What do you do when the symptoms return?

You spent years in that condition. The sadness, the hopelessness…the numbness. That terrible shame. Unable to participate. Shut down. Withdrawn.

Or, maybe the symptoms were reactions to sudden noises…smells…darkness… or touch.

They may even have been obsessive thoughts…and compulsive actions that follow.

Or the old dreaded cravings…and relapse close behind.

You even wondered if you could go on much longer.

Then, you heard about ketamine treatment, and you found a way to pay for the treatment series of 6+ infusions. Afterwards, you came alive and felt so much better.

For once, you had hope, motivation, initiative. There was energy to live, invest your effort, build healthy relationships. You enjoyed your job and began to really excel. You actually felt happy. It was exhilarating to not just barely hang on.

Then it happened. …out of nowhere…those old symptoms began to return.

Maybe your job performance led to more responsibility. And the higher level of stress began wearing down your synapses…those connections between the cells in your brain. It’s possible that after awhile those cells in your lateral habenula began bursting too much and too often.

Plus all those G proteins that had slid off the lipid rafts in your cell membranes may have started piling back up on those rafts. The numbness that had gone away, came back.

Why?

Could it be because your wife’s cousin is living with you, taking advantage of your hospitality, rather than trying to find a job or her own place. And you keep stuffing your feelings…you don’t want to upset your wife.

Or maybe your boss takes credit for every innovation your create. But you? You keep working long hours and your husband is fed up that you’re never home.

Stress.

You’re so mad at yourself for not accomplishing more, so you carry your feelings on your sleeve, and jump down the throat of anyone who crosses you. You KNOW they don’t deserve this treatment…but you’re too ashamed to apologize.

Or, perhaps you got a little cocky with your sobriety, and began hanging out with friends who still use the substances you’ve broken away from… ? Any type of hard and stressful situation can make you think back to the old days…

It also might even be that this disorder is in your genes…that your whole family fights depression and it’s like a heavy gray blanket covering everyone around you. It could be to get better you might have to purposefully surround yourself with more positive, uplifting people …?

Or separate yourself from obligatory situations…

Sometimes we can’t see the nose on our proverbial face. We need someone to point it out and help us see specifics like these in our own complicated lives.

And we need to take action.

Tell your spouse what you really feel. Stand up to your boss even at the risk of getting fired. Because your self respect is too important to just silently bow to his abuse and dismissal of your value. That might reduce your stress.

Sometimes it doesn’t take much…just a step… to stand for what’s right. But when you do, the chains fall off.

And your own personal infrastructure – the things that make your life yours – is freed up to support your well-being.

So back to the causes. All of the mechanisms associated with stress can go into play, and undo some of the work the ketamine treatment had accomplished.

This is why it’s important to find ways to improve the “infrastructure” in your life, to reduce stressors that wear down your resilience.

Without making healthy changes in the areas most critical to your wellbeing, the same stressors that caused you to need ketamine treatment in the first place may cause you to need it again.

But…let’s be clear: there are no published studies about “booster” infusions

Can you believe that?

None.

But in all fairness, it can take years to gather data on recurrence of symptoms and how to best treat them.

Still. We need research!

Meanwhile, what do we do? The best we know to do is to use our clinical judgment if symptoms try to creep back in. We collaborate with you, and your treatment team, about the best way to proceed.

Lifestyle changes? Any improvement in the stressors in your life that you can make…well, that can be a big help.

A medication change perhaps? Some people continue their medications while receiving ketamine infusions. A change in medication might help…

Or is an additional ketamine boost infusion what’s called for? Perhaps so. If nothing has ever worked for you before to control your symptoms, you may know that ketamine infusions are your “go-to” solution.

Those of us in clinical practice have learned that additional infusions down the road can help refresh the work ketamine began.

Many patients…and their doctors…take a shortcut straight to ketamine because of their experience that it worked so beautifully after all those failed rounds of antidepressants and other treatments.

But we still don’t have research to show us in those cases how often we should prescribe a booster infusion or whether maintenance is inevitable for the foreseeable future.

My experience says that ongoing maintenance doses really aren’t required in many, if not most, cases. There is no research to guide us at this point. I do wonder why? …and hope that changes soon.

For now, I think it’s premature to make a blanket recommendation for ongoing maintenance “booster” infusions every few months indefinitely.

There are too many cases of patients who only need one or two or three after the initial series… then no more for a year or more. Psychiatrists need to work with their patients and the health care team to guide the best recourse for each individual patient.

But remission is the goal. Helping you feel truly good and able to live productively.

One or two ketamine boost infusions at a time can support and sustain remission. Especially if the patient’s infrastructure is in place and strong.

So…maybe you still feel better than you did before you knew about ketamine…but you don’t feel as good as you did a few weeks ago.

What do you do?

When you feel better, but not better enough, you may need a ketamine boost infusion to get your brain working well again and get you back on track.

Kick It Up a Notch!

Every brain is different, just as every person is different. Dosage and frequency can vary.

Another point… for the purpose of rebuilding and strengthening your personal “infrastructure,” you might benefit from therapy with a skilled therapist after each of your ketamine infusions.

This is when the neuroplasticity in your brain is very high, and it’s easiest to consider new ways of thinking, of reacting, of decisions…that make your life more functional, less stressful, and more rewarding.

Some people don’t need additional infusions at all. When you feel better, really so much better you’re empowered to build the life you want, there’s no need for boosters. And there’s no need to schedule them in advance.

But when you feel better but not better enough, you need to take action and find ways to get completely better. Start with another ketamine infusion. And take an inventory of your daily life. What do you need to change to make it better?

It might be taking action to change something. Or it might be taking action to change your attitude about something. But use those extra ketamine infusions to explore your life, your heart, your attitudes. And with the help of your therapist, make some solid decisions that renew hope in your life.

Renew your wellbeing.

Slash that powerless feeling and remove it…put yourself back in control.

It may require additional infusions every few months for awhile to get your life on track, your infrastructure in line with your purpose, and to create a life you enjoy. But it’s worth the effort.

And by the way, there’s no shame in additional ketamine boost infusions. No one but you knows what’s working for you. This is not a competition.

The goal is for you to live life as your best self, rather than a shadow of that. That you can enjoy your work, your hobbies, your relationships, and your purpose.

At Innovative Psychiatry we work closely with you and your health care team to help you find the most productive and fulfilled you. Call us.

To the emerging of your very best self,

Lori Calabrese, M.D.

June 25, 2018
Remission by Ketamine Treatment: How You Can Hold On to the Benefits

IV Ketamine is a Most Extraordinary Medicine

Here Are Some Ways to Hold On to Its Benefits

This ONE medicine can relieve a wide array of psychiatric disorders. Remission by ketamine treatment is at center stage of the mental health world.

The same medicine that lifts depression and restores creativity, initiative, and hope, also stops suicidal thinking in 4 hours or less and relieves social anxiety.. and, oh yes, OCD. It restores balance in bipolar disorder, and dramatically reduces cravings in substance use disorders…it helps PTSD heal and may also prevent PTSD in first responders.

Ketamine isn’t just an anesthesia medicine any more.

It’s changing lives and taking the world by storm.

It can restore your power to enjoy the beauty of a yellow warbler as it sings among the cherry blossoms. Remember when you felt nothing…? A void. Empty. Isolated. But remission with ketamine treatment changes everything.

You’ve never seen a medicine like this. While pharmaceutical companies are testing other forms of the ketamine molecule, or other molecules similar to ketamine, there is so much more to be learned about ketamine itself!

These other molecules don’t rival ketamine in effectiveness — well, actually, nobody’s doing head to head comparisons.

Because ketamine itself has become the gold standard. Its broad reach and widespread actions relieve suffering in so many different disorders that for so many it has become hope in a jar.

Who could have ever dreamed the day would come when a few infusions could lift a new mother right out of postpartum depression and empower her to bond and enjoy her newborn…? Those heartbreaking stories you hear in the news … can be averted.

Think what ketamine could have done for Vincent Van Gogh if ketamine treatment had been available in his world. Of course, it was unheard of, but it could have saved not only his ear…but his life.

Because it’s saving lives.

Remission by Ketamine Treatment: Antidote for Psychiatric Misery

The terrible anguish that depressed persons suffer has an antidote now. Six treatments (or a couple more) and you can live again, create again, enjoy people again, come out of the terror of darkness again.

You can feel love, hope, initiative, motivation, and creativity. In the morning, you can spring out of bed, and sustain energy and productivity all through the day. Enjoy the taste of a flavorful tomato right off the vine. Tackle long forgotten projects again, complete them, and look at your work with deep satisfaction.

You no longer have to be trapped in a vacuum, unable to connect, lost in the shadows of your mind. You don’t have to fear your own reactions to unexpected noises, or insensitive comments someone drops in your presence.

Feel whole again, find out you can have self-control, and build a life you’re proud of. For many who suffer with depression anxiety that just won’t cut them a break, such a concept is an elusive dream.

But it’s time for us to take a step further, and learn more.

For instance, what factors influence how effective ketamine treatment is for you?

Infrastructure for Optimal Wellbeing

Without question, one factor is simply all those unknowns. Because we’re learning daily about what ketamine can do, as well as the unique genetic, environmental, and other factors that may prevent one brain from responding to ketamine when the next one responds so dramatically. There are factors we just don’t know or understand yet.

We have so much to investigate and learn.

But there are some factors we do recognize.

For instance, it appears that there are environmental factors and personal ones, too, that may determine how long a series of ketamine infusions will benefit you.

Remission is Most Enduring when Your Personal Infrastructure Is in Place

When we speak of infrastructure, we’re referring to all the things in your life that play a part in your outlook and productivity. Things like your attitude, your response to stress or conflict, your nutrition.

To get the most out of ketamine treatment, it helps to do the work to learn and practice healthier reactions and responses, so you don’t pull the same old problems in after you.

It helps if you’ve learned to practice self-love along with respect for others. To manage your anger, and avoid the pitfalls of co-dependency. It helps to feed your microbiome to help maintain your emotional balance.

Because even if ketamine’s wonderful repair work brings you to peace, if you haven’t done repair work in your thinking, your attitude, your outlook, your view of yourself…as well as your view of others… the destructive habits that may have crept in with the misery of your disorder in the first place will slowly tear down the work your ketamine treatment accomplished in your brain.

Not what you want.

You could, then, get a booster infusion to refresh the good repair.

On the other hand, if you’re actively participating in therapy to help you change your attitude and outlook, as well as your responses to the things that happen in your life, you may find your outlook stabilizes after you reach remission… and lasts.

This, of course, is not to say that if remission doesn’t last, it’s your fault. It’s not. There are far too many factors involved in what you’ve experienced to blame your symptoms on any one thing, especially something within your control.

But consider this.

Choices You Make Can Strengthen Remission

If a stressful life has found you reacting and angry in response to small frustrations, or if you’ve been in a toxic relationship where you know you’re being abused and exploited, and stressors like these aren’t changed, you can see why you’d become more and more worn down and stressed…even despondent…all over again.

But let’s say you found the courage to leave that destructive relationship…or you figured out how to change the way you perceive small frustrations so you’re able to be unruffled by them (and ketamine can help you accomplish these things)…you can see how the peace and emotional health in your life would benefit. Don’t you think..?

That’s the thing about ketamine. It can do its part to restore those brain structures that have been worn down and broken by stress, but it can’t force you to get some distance from those factors.

That’s a step you must take … and ketamine treatment can help you get there.

Hard Decisions Lead to Better Living

Here at Innovative Psychiatry we’ve seen this happen in our patients time and again. Sometimes, a patient reaches remission and has a new lease on life. But in a month or two she’s so disappointed because she thinks the ketamine treatment has “worn off.”

However, rather than the treatment wearing off, it’s far more likely that new damage is happening because of her unchanged thinking or environment. When our patient understood the impact of those things, and she entered counseling, her need for booster or refresher infusions seemed to disappear. We have seen this process in many patients.

Many patients have been able to enjoy remission for over 2 years once they learned to make healthy changes in their lives.

There really are things you can do – with ketamine’s help – to maintain the joy of remission by ketamine treatment.

Medical Skill with Ketamine Treatment Can Turn B- Results to A+ Results

Another important factor in achieving and maintaining remission seems to unmistakably be tied to the methods used in administering this medicine. The outstanding and life-saving benefits of ketamine treatment have changed the way the world views depression, social anxiety, bipolar disorder, PTSD, OCD, substance abuse disorders, eating disorders…and suicidal thinking.

But, to get the most out of your ketamine infusion, in addition to building your infrastructure, you need to choose a psychiatrist who is most skilled in administering ketamine to your best advantage.

We use precision infusion pumps, state-of-the-art monitoring equipment, and we’re adept at titrating dose, rate, and frequency to achieve optimal outcomes.

Our goal for you is remission of your symptoms with ketamine treatment.

There’s no question that ketamine treatment can renew your hope if you or your loved one suffers with stubborn symptoms.

Know that you can feel better, live better, and restore what your symptoms have taken from you. You can find your real and best self, and enjoy the world you’re in.

If you suffer from symptoms that medicines and treatments haven’t helped, call us. We can help you turn your emotional and mental chaos into order through ketamine treatment. You can enjoy new hope and purpose for your life.

To the realization of your best self,

Lori Calabrese, MD

June 18, 2018
Ketamine Is Creating a New Wave of Drugs to Treat Depression

Johnson & Johnson and Allergan are now testing new drugs for depression that are based on ketamine. There are still safety concerns.

Ketamine, a powerful anesthetic drug, is inspiring scientists and doctors to rethink how we treat depression.Now, two major pharmaceutical companies, Johnson & Johnson and Allergan, are making strides in developing drugs based on ketamine.“There’s been a vacuum in the treatment of depression for a good 10 to 15 years. There was the development of the SSRI, and then there was a lot of ‘me too’ drugs. No new mechanisms. Just one more antidepressant after another,” Waguih W. Ishak, professor and vice chairman of psychiatry at Cedars-Sinai in Los Angeles, told Healthline.

Johnson & Johnson is currently in phase III trials of esketamine, which is a mirror image of ketamine’s chemical structure. It’s being developed in a nasal spray formulation.

A representative for Johnson & Johnson told Healthline the company is currently seeking approval for the drug to treat people with treatment-resistant depression and those at imminent risk of suicide.

Treatment-resistant depression is a subset of depression that doesn’t respond to at least two different drug interventions.

Allergan is developing the drug rapastinel. It’s chemically different from ketamine but works in a similar way in the brain.

The company has completed phase II trials for the drug and is expecting the results of their phase III trials next year.

“Rapid-acting therapies have the potential to be game-changing in the treatment of depression, an area where patients are in desperate need of new options. Our studies so far demonstrated rapid onset of efficacy within one day, which lasts days after a single dose and a low potential for abuse,” said David Nicholson, PhD, Allergan executive vice president and chief research and development officer, in a statement to Healthline.

Both esketamine and rapastinel have been granted “breakthrough therapy designation” by the U.S. Food and Drug Administration (FDA).

The designation is a fast-track approval process given to drugs intended to treat a serious condition and that demonstrate substantial improvement over currently available therapies.

The ketamine factor

Research into ketamine as a breakthrough treatment for depression has exploded in recent years.

Initially developed to treat pain and approved by the FDA in 1970, the drug was first used by U.S. soldiers during the Vietnam War.

Scientists didn’t discover the drug’s potential to treat depression for almost 30 years. Researchers began to publish reports in the year 2000.

Since then, interest has only continued to grow.

A recurring problem for antidepressants is that they’re slow to act. Most of them take at least two weeks before people feel any of the effects.

Ketamine and similar drugs are fast acting, with some people feeling changes in mood within minutes.

A number of risks

However, using ketamine and similar drugs aren’t without risk.

In fact, for many years, ketamine has garnered a reputation as a powerful narcotic club drug, capable of rendering users incapacitated.

Thus, concerns around ketamine are abundant for both safety, potential misuse, and diversion into the black market.

Even when taken therapeutically, people report dissociative symptoms, which can feel like being disconnected from one’s body or the outside world. The drug can also cause hallucinations.

“There’s been a lot of concern around oral ketamine, which has been prescribed for people for pain. There is a serious concern for abuse there,” Ishak said. “People take it to get high to get those dissociative feelings and hallucinations if they take higher doses. So, I think that’s definitely a serious concern.”

Safety needs to be considered

Ketamine and rapastinel are administered through IV infusion. These and esketamine’s nasal formation are only given under supervision.

People aren’t simply given a prescription and sent home.

The FDA’s final approval of esketamine and rapastinel would have to take serious consideration of the drug’s safety and potential for misuse.

Finally, if an orally administered version of any of these drugs were developed, it would also have to prove that it’s both safe and effective.

“[These drugs] provide a whole new mechanism of action for antidepressants and a whole new way of administering that. Maybe there are ways to have oral administration become much safer so people can take it conveniently rather than under supervision,” Ishak said.

“So, there are a few promising things in it that if they take place, it could easily become a first-line treatment. If this is oral with rapid onset of action, I can tell you this is something I’d prescribe as a first line and not wait until we exhaust two or three trials of other medicines,” he said.

[Read the Original Post]

June 14, 2018
The Heartbreak of Suicide: You and Ketamine Can Help

The Heartbreak of Suicide – What Can We Do?

Each day last week,122 people in the United States took their lives by suicide. We want to talk about Kate Spade … and you. And how the heartbreak of suicide is stealing our loved ones. And what we can do to change that.

By now, most of us have read that Kate Spade died by suicide this past week. This is too important to ignore as if it’s just another news story. Yes, Kate Spade was an icon and many have cherished her distinctive purses, bags, and wallets.

But this isn’t about her products. This is about her.

And others who suffer like she did.

Quietly. In silence… and despair.

All sorts of reports have swept through the news without sensitivity to Kate Spade and her family. A note published publicly by her husband expressed his horror that a note allegedly by Kate to her daughter was published by sensationalistic news media without his consent.

Traditional Depression Treatment Fails Sometimes…Then What?

The bottom line is that when suffering from a psychiatric disorder ends in death by suicide, the public considers that death the business of mankind in general… regardless of the suffering of the family.

It turns out, Kate suffered from depression and anxiety for the last six years before her death. She was engaged in intense psychiatric care regularly. But she wasn’t getting better.

Her family and close friends wanted to help, tried to help, but she probably reached the point that just talking about her struggles wasn’t changing anything… maybe she laughed it off when her best friend expressed concern. Maybe she looked fine. Sounded fine.

Psychiatric Disorders Can Be Hard on Relationships

She and her husband lived in separate apartments the last 10 months, but near each other so their daughter could easily go back and forth between them. The three of them continued to share meals, and vacations.

Kate and her husband Andy had been together for 35 years and the love between them was strong… enduring. But Andy says now they just needed a break to work out their problems…divorce was never considered.

If you’ve known severe depression and anxiety, you know that the depression can be suffocating…the anxiety crippling. And for some, as the depression worsens, the anxiety becomes more intense.

The longer depression goes untreated, the more likely it seems that phobias, panic attacks, and other forms of anxiety can emerge that can leave you feeling unable to function in your life like you used to.

People like to speculate. They’ll tell you maybe it’s not depression. Maybe it’s bipolar disorder.

Kate’s husband has been adamant that she suffered from depression and anxiety for the last six years, and that she’d been in psychiatric treatment for the last five.

And that’s the tragedy.

When you know you’re suffering from a psychiatric disorder, and your doctor provides the best treatment he knows to offer, what if it doesn’t help?

What do you do?

The Heartbreak of Suicide

For decades, this has been the situation with up to 50% of patients suffering with depression. They take medications year in and year out. But they don’t work…or maybe they don’t work well enough. So they try to keep going through their routine until they just can’t anymore. At some point they occasionally mention death… or dying…or funerals…

And they try and try to buck up, keep enduring…until they just can’t anymore.

Their thoughts fill with the idea of relief that would follow the end of life. They resist as long as they can. Sometimes, they succumb.

And someone finds them, after it’s too late to help.

For all of our lifetime, when medications and therapy didn’t make a real difference for a suffering person, doctors have sometimes just said, “I’ve done all I know to do.” It sounds so horrible. Like that’s it. There’s nothing else.

Others suggest trying yet another and another new medication or therapy. When hope just keeps being deferred indefinitely…well, we get heartsick…and can give up.

There’s Hope That Rises Above Traditional Treatment

But here’s the tragedy for Kate Spade, and others like her.

We’ve never had ketamine treatment before the last several years. But we have it now. She suffered for 6 years without relief.

What about you? Untreated depression and anxiety can slowly erode your relationships, your confidence, and your hope.

Does your doctor know about the effectiveness of ketamine treatment, or how to provide it with the best, most effective methods…?

She had made a fortune with her Kate Spade brand in partnership with her husband over the years. So she didn’t miss her chance for effective treatment because of cost. She had the resources to pay for the best treatment.

We see people like her all the time here at Innovative Psychiatry. People at the top of their game who suffer from an array of psychiatric disorders … and need treatment so they can continue contributing to their world, engaging with their families, enjoying their lives.

We can wish Kate had known about ketamine treatment. We can wish her life had been restored, her relationships with family and friends strengthened because she had the energy to invest in and build them again. Because she no longer feared that openness would harm her brand.

But for Kate Spade, sadly it’s too late for that.

Still, stop and think.

So Many Suffer in Silence Until They Can’t Stand It Another Day

How many people across the US died by suicide last week…? 122 each day. One of them happened Friday, when beloved celebrity chef Anthony Bourdain also died this way. How many more…?

We have to ask how many of those deaths could have been prevented if everyone knew about ketamine’s effective treatment that takes the pain away?

How many people in our world still don’t know that treatment actually IS available that can give them their lives back…restore their joy, their motivation, their well-being? That can stop suicidal thinking. Quickly.

We can work together to share this reality with everyone we know so no one else has to die without hope.

We must work together to help people who suffer like Kate suffered find help. And hope. We must talk about psychiatric symptoms without shame. As freely as we talk about back pain, migraines, cancer.

If a friend talks about death…about dying…even off the cuff…even laughing about it…

What do you think?

Oh, weird… wonder why she’s talking about this right now…embarrassing…

I hope not.

But the stigma is right there. Along with shame.

What if I’m overreacting..?

Overreacting to a possible call for help is not life-threatening….but ignoring the situation just may be.

You can reach out. You can confide in your friend about something you’ve been through that was embarrassing. Lower the wall. You can ask if there’s anything you can do. You can share things you’ve read, like this blog for instance.

Brain and Behavior Institute published this statement by Dr. Jeffrey Borenstein on Friday:

“If you are concerned about a loved one, you should express your concern. Some people have the misconception that asking a person about suicide will increase the risk, but in reality asking does not increase the risk of suicide, but can save a life.”

And you can provide your friend with the Suicide Hotline and encourage her to call you or call this number if she ever feels serious about it:

If you or someone you know is in crisis, call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.

Ketamine treatment can stop suicidal thinking in 4 hours or less. Tell your friends and loved ones.

Ketamine Treatment Ends Suicidal Thinking in 4 Hours or Less!

The heartbreak of suicide can be prevented.

It’s true that ketamine treatment isn’t for everyone…but it’s effective for most, and even some of those who seem to not respond at first have a delayed response…and are living their lives with joy several months later. Ketamine is so remarkable, it deserves a chance to show you what it can do.

And you deserve the chance to experience the rapid and robust action of ketamine in your brain, relieving your symptoms.

If you suffer from a psychiatric disorder, or if you know someone who does, read the articles linked to this one and inform yourself. It’s no longer necessary to suffer under the burden of a seemingly untreatable disorder.

At Innovative Psychiatry, we offer a variety of novel, advanced options to reach the source of your disorder and help you get better. We’re not interested in treatment that just takes the edge off…

When you’re in pain, you’re in pain. A little reduction in symptoms really doesn’t help that much. You need to feel good. You need to feel well.

Please call us. Let us help you get better.

May the husband and daughter of Kate Spade, as well as her family and friends, be comforted and find peace. Our hearts weep for you.

And if you find your thoughts filled with images of death and dying…call us. We can help lift this terrible burden from you to help you rebuild a happier, more fulfilling life.

To the healing and restoration of your best self,

Lori Calabrese, MD

June 11, 2018
Post-Traumatic Stress Disorder (PTSD) Can Strike Anyone – A College Kid’s Story

Twenty One Years Old. Enjoying campus life with her friends. Working toward her degree …and her dreams…

Then, a soreness in her mouth… and a trip to the doctor.

CANCER.

“Squamous cell carcinoma of the tongue,” the doctor said.

What??!!?

She’d never heard of such a thing. What could have caused this? How did it happen? Where did it come from…??

When you’re young, with all your hopes and dreams ahead of you, you don’t have the life experience to cope with such a devastating blow. So it’s not really about coping…it’s about taking action.

Fight now.

…process later.

The oncologist promised Nicole, a beautiful, intelligent college student, a full recovery but she would have to endure a horrifically aggressive treatment. There was nothing to do but just close her eyes and dive in.

For starters, she did some quick research. First step was a shocking surgery…removal of 75% of her tongue. Traumatic experience for anyone… But for a college kid? How could she ever feel normal again…?

She also learned that to truly eradicate this invader, she needed to add chemo to the radiation treatment. She wasn’t taking any chances.

Only two weeks to recover from a disfiguring surgery, then radiation and chemotherapy had to begin. A move with her mom into the Ronald McDonald House to be close to treatments, and another surgery to insert a feeding tube into her stomach. Terrible pain like she’d never known.

But it had to be done. The radiation treatments would destroy her ability to swallow, so they had to prepare for nutritional formula to feed her through the treatment process ahead. The pain was excruciating. But then chemo began.

Within 3 weeks, Nicole had lost her ability to swallow, and was hospitalized. She’d lost 35 lbs. of her 130 lb. frame. From the beginning, she had researched to understand the most thorough way to fight this rare cancer, in hopes that she could endure treatments and eventually be completely DONE with it all.

She kept her eye focused on the goal: to SURVIVE…and to get back to normal…and to her life.

After Traumatic Cancer Treatment You Can’t Go Back – Only Forward

When the treatment was finally completed, she was discharged and she moved home again. A 6-hour drive to get home, then a party with her friends that night to celebrate her return to her life.

Finally…it was OVER!!!

…or was it..??

Sometimes, you can be so strong and face the most terrible experiences, the worst life-threatening trauma, and pat yourself on the back for all you’ve endured. But then, out of nowhere, about the time you think you can relax and get back to your life, the other shoe drops.

Not with a thud…but with a crashing, devastating explosion…and ripples that affect every aspect of your life.

Severe Insomnia Sets the Stage for Worse Things to Come

First, came the insomnia. We’ve all heard about insomnia…when someone has trouble sleeping. But, have you ever gone for 5 or 6 days without sleep…? I mean NO SLEEP for day after day and night after night? Unless you’ve experienced this yourself, you can’t imagine what happens in your brain under this type of duress.

It’s used for torture in some third world prisons.

Then, let’s say you finally fall into a sleep but only sleep a couple hours…then it starts again. Day after day after day. You feel like you’ll go off the deep end.

The relentless stress builds and builds.

Tears Give Way to an Eating Disorder

One day, Nicole and her mom went to the mall to buy some clothes for Spring. They were excited about doing something fun and sort of “normal” again. But, when Nicole stepped out of the car, she broke into tears…and tears gave way to sobs. Hard sobbing without relief… She couldn’t breathe. She couldn’t move.

All she could do was sob and sob, wondering even at the time what was happening to her. Eventually, her mom called her dad to come get them and take them home.

That day marked the beginning of 11 years of flashbacks, extreme reactions, embarrassing meltdowns, and crippled emotions. She thought the nightmare was over when she finished her treatments, but a new nightmare was just beginning…

Nicole started back to school in the fall, and everywhere she went people told her how great she looked. (She knew she didn’t look great. She was “scary” skinny…) But more and more she heard it all the time.

Were they just glad to see her back in school…? Or did they really think she looked better than she used to…? She decided to stay ultra thin, to make sure she kept looking “great.”

Before long, she was sneaking out of the house early in the morning to go to the gym, counting calories, and weighing four times a day. After feeling so profoundly out of control with the cancer, she’d found something she could control. And…she liked it.

Working out daily, walking when driving would be more convenient, cutting calories… and hardly sleeping. All of which continued until she graduated with her degree.

Happily, her boyfriend proposed the day of her graduation, and they moved from Pennsylvania to Virginia. She’d been given a clean bill of health by her doctor… she was cancer-free. It seemed everything was going to be ok.

Post-Traumatic Stress Disorder (PTSD) Persists

But it turned out that the cancer was the easier foe to conquer. The fallout afterwards, which in time she was told was PTSD, was a much harder beast to vanquish.

A victim in a hospital scene on TV, the smell of an alcohol swab, or the mention of x-rays or medical procedures would make her freeze. Unable to breathe, choking in terrible panic, screaming for help, time and again… she felt like she was dying.

Her husband urged and even begged her to get help, but she refused. Going to the doctor — any doctor — might start the attacks. If she needed a chest x-ray, she just knew they’d find cancer. If her child needed to see the doctor, it was terrifying for her. Any buzzing noise took her back to that radiation machine years before. A routine scab on her husband’s ear, a swollen lymph node in her daughter’s throat, a sore finger…anything…. would trigger the panic attacks and the fear that she or her loved ones would have cancer and die.

Over the years, she and her husband brought 4 beautiful little girls into the world, two of which were twins. But the routine joys of pediatrician visits as children grow became the war zone for her flashbacks and terrors…

Until she sought treatment… and her life finally began to change.

But let’s get back to that in a bit. First, what is PTSD, and what can you do about it..?

What is Post-Traumatic Stress Disorder (PTSD)?

PTSD sometimes follows a traumatic or life-threatening event, with symptoms typically appearing in the first 3 months after it happened. However, in some cases symptoms may not show up for much longer…even years.

Your symptoms may be repeated, involuntary memories, flashbacks of the event that seem as real as the original incident did, efforts to avoid being reminded of the trauma, feeling detached or estranged from others, in addition to angry outbursts, irritability, and ongoing fear, terror, and shame. You can also become emotionally numb.

In Nicole’s case, she was able to finish her Bachelor’s degree, work at her job, and parent her little girls. But, functioning was really tough for her. In your case, you might be unable to function much at all.

For some people, the symptoms can subside over time, but in others, they can go on for years, or even a lifetime without treatment. The severe distress that’s caused by the horrific trauma may need psychiatric treatment.

Sometimes medicine and therapy help. But for some, it just doesn’t.

Nicole is doing better and better now. In hindsight, she wishes she had sought help sooner. She wishes anyone with these symptoms would go for help as quickly as they can.

But, since the treatment she needed required that she see a psychiatrist, and the thought of seeing a doctor triggered more panic attacks, it was really tough to cross that threshold.

At Innovative Psychiatry, Ketamine Treatment Gives Hope

At Innovative Psychiatry, we specialize in treatment-resistant psychiatric disorders. That means we specialize in helping people get better who didn’t get better with other medicines and treatments before.

We’ve had extraordinary results treating these special patients with ketamine treatment. Ketamine treatment has a way of rebuilding signaling systems in the brain that have been broken down by stress, anxiety, and depression.

When administered expertly, ketamine is even more effective than many people realize in treating depression, anxiety, PTSD, OCD, social anxiety, panic disorder, eating disorders, and suicidal thinking.

By rebuilding broken down synapse connections between the brain cells, enhancing signal transmission from the prefrontal cortex to deep in the brain, and proliferating the structures that provide those pathways, ketamine produces rapid and widespread improvement to the point that many patients declare themselves “well.”

June is National PTSD Month, and this month we want to show some of the types of PTSD, and help get the word out that there is effective and lasting treatment. And that you can have your life back again.

You can enjoy your job again, build your relationships with spouse, family, and friends again. Catch up on neglected projects and enjoy them. Get out and about and relish your days.

If you’re suffering, and nothing has helped, call us. Helping relieve stubborn psychiatric disorders is where we find our deepest fulfillment. We want to see you well. You’re not alone.

To the revitalizing of your best self,

Lori Calabrese, MD

June 4, 2018

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