Lori Calabrese, MD

Author: Lori Calabrese, M.D.

  • How to Start Today to Build Christmas Cheer and Hanukkah Happiness… in Time for December 2018

    How to Start Today to Build Christmas Cheer and Hanukkah Happiness… in Time for December 2018

    Christmas cheer, hanukkah happiness you can start now to build for next year.Christmas Holidays…Hanukkah

    …. a season of Joy?

    The song says this is the most wonderful time of the year, and for so many children, it is…but for others, not so much. It’s also a treasured time for many adults…but not all. And while there’s no magic way to go through some step-by-step plan to snap from sorrow to happiness, there are some purposeful things you really can do to get your brain in a happier mode over time.

    Because although it feels like happiness and sadness come from your heart, they’re actually manufactured in your brain. And neuroscientists have done some remarkable work to get to the bottom of what makes or breaks our feelings of contentment, happiness, emotional warmth, and feeling loved. 

    There really are things you can do! 

    We have a tendency in our society to just let the way we feel “happen” to us. Some of us are naturally upbeat…others of us lean toward the grumpier side. Still others are downright melancholy.

    But if being happy doesn’t come naturally, you can regularly take some simple steps to train your brain into a happier, more upbeat outlook. And it’s like going to the gym.  If you go once a year…the results aren’t so impressive, right? On the other hand, if you go every day all year long … you’ll have a toned, well-developed body that responds instantly to any demand.

    Emotions are like that, too. If you’re a 97-pound weakling in the emotional part of yourself, every wind that comes along can knock you down. But, build your emotional strength and resilience, and you can stand and command in the face of all kinds of adversity with grace, patience, and confidence.

    Weight-lifting for emotional resilience

    A book by Alex Korb, neuroscience researcher at UCLA, entitled The Upward Spiral, reveals all sorts of eye-opening activity that happens in the brain in response to sadness, guilt, and rejection…and shows how you can turn those negative feelings on their ear by simple emotional strength-building actions.

    You know what it’s like to feel guilty or ashamed…these are terrible feelings and makeChristmas cheer, Hanukkah happiness to build up for next year it seem impossible to be happy again. Pride is an emotion you may use to try to overwhelm the feelings of guilt and shame, but interestingly, they all stimulate activity in specific parts of the brain: the dorsomedial prefrontal cortex, the amygdala, insula and the nucleus accumbens.

    There’s a lot of scientific jargon there, but these structures are as important to your emotional life as your heart, kidneys, and lungs are for your physical life.

    Turns out that worrying, which is a natural reaction to guilt and shame, actually decreases activity in the amygdala, and is calming.  (You’re tricking your brain into thinking you’re at least doing something about the problem.) Sounds crazy, because worrying does other things like stir up ulcers, so it’s not really a good solution.

    Play the Glad Game

    However, there is something that is:

    When you feel down, ashamed, guilty, or fearful, when you’re worrying a hole in it…Stop.

    Play Pollyanna’s Glad Game. Remember the old Walt Disney movie Pollyanna?  A child whose missionary parents had died was sent to her aunt’s to live. She had a way of turning frowns to smiles by following the principles her parents had taught her. Like counting her blessings when she was down.

    Ask yourself what you’re grateful for. Think hard. Just because you’re down, or maybe even devastated by one of life’s worst losses, there is always something to be grateful for. What’s important is that you search for it. It could be that you have a warm place to live…or if you don’t, it might be a friend you have, or that you’re healthy.

    Or if you’re sick … it might be that you have good care, or that you simply have a beating heart.

    But think about it, and search for it. Because gratitude increases neurotransmitters in your brain like serotonin and dopamine. And those neurotransmitters help signals move through your brain, to lighten your mood and to help you feel more sociable.

    And here’s another thing… expressing gratitude to others in your life, helps them feel grateful to you, too.  And that stimulates more mutual gratitude … and those relationships slowly become stronger. 

    So, bottom line, the search for things you can be grateful for actually helps your brain spiral upwards, as the title of Korb’s book Christmas cheer and Hanukkah Happiness is hard to hold onto at times.describes. Do it, everyday and often, to train your brain to be happier and stronger.

    But I’m just too angry…

    Now, let’s be realistic. Sometimes you feel so beaten down, so hopeless, so angry, or so scared, that you can’t – just can’t – think of something you’re grateful for.  The best thing to do when that happens?  Just name names.

    If you feel angry…?  Say, “I’m angry.” If you’re scared or worried…?  Say so. Best to not go into a diatribe about it, as that can backfire.  But if you just call it what it is, simply expressing the emotion you’re feeling reduces the activity in your amygdala and actually helps you feel some relief.

    So call it what it is.  Then move on.

    Another stab at the gratitude exercise might also be more effective right about now.  And remember…this is an exercise regimen to build a brain that’s better at happiness so keep up the good work!

    Get off the fence and MAKE that decision

    Now, let’s talk about those times when something is eating at you in the back of your mind. You know that gnawing… and it’s so subtle but unsettling….  You have to consciously stop and ask yourself, “what’s bugging me??”

    It just could be a decision you NEED to face and MAKE.  Staying on the fence about it is building anxiety, and anxiety creates all sorts of havoc in your emotions.  It can make you irritable, withdrawn, distracted.

    But making the decision does good things in your prefrontal cortex. And that calms down worry and anxiety, helping you to feel more relaxed wellbeing.

    So you need to get that decision settled.

    Here’s a clue that might help you get there. Decisions are sometimes choices that aren’t easy. Maybe there’s no perfect choice. At Christmas cheer and hanukkah happiness is hard sometimes.those times, neuroscientists say that a “good enough” decision is better than no decision.  Far better.

    When you accept that a good enough decision is acceptable, you release yourself from the stress of striving for perfection, and avoid activating the ventromedial segment of your brain which heightens your stress.

    Instead, accepting good enough switches on the dorsolateral prefrontal cortex regions, and you feel more in control…which is far more comfortable.

    And…you know what?  Good enough is almost always good enough. Things have a way of just working out, especially if you’re at peace and not tormented.

    Neuroscience says that actively choosing…or making the decision…increases the feelings of reward from dopamine activity. 

    Just do it.

    You deserve the break.

    Now, you’ve established some great habits:

    • like making a list of all the things you’re grateful for, building an attitude of gratitude
    • Naming names, calling out those emotions that feel awful, and taking the wraps off ‘em
    • Make that decision, and get out of limbo

    And you know what…?  People who are naturally upbeat and happy tend to do all these things instinctively.  Ever noticed that?

    Hugs for Christmas cheer and Hanukkah happiness

    And now the best of all, and my personal favorite, is to give and receive love with touch. Hand holding, shaking hands, hugs and squeezes, and pats on the back.

    In fact, research shows that 5 hugs/day for 4 weeks builds happiness in a measurable way. 

    Physical touch releases oxytocin, which is a neurotransmitter that gives a sense of wellbeing. This is the same neurotransmitter that’s released in the mother when she’s nursing her baby. It gives the mother a sense of wellbeing along with a stronger bond to her infant.

    Holding hands and hugging are some of the most therapeutic methods of touch, because that oxytocin reduces reactivity in the amygdala. 

    So get out there and hug, dear friend. Do it for science. And do it for your own happiness. And do it all year round for next year’s Christmas cheer and Hanukkah happiness. The more the better and for as long as possible!

    Take the findings of neuroscience researchers…and use them to YOUR advantage

    “[Optimism] is not about providing a recipe for self-deception. The world can be a horrible, cruel place, and at the same time it can be wonderful and abundant. These are both truths. There is not a halfway point; there is only choosing which truth to put in your personal foreground.”
    ― Sonja Lyubomirsky, The How of Happiness: A Scientific Approach to Getting the Life You Want

    And if you’ve been suffering from symptoms of severe major depression, panic attacks, bipolar disorder, OCD, or PTSD, and Christmas cheer and hanukkah happiness for grandma and grandchild togetheryou’ve tried at least two forms of medication or other therapy, call us. Innovative Psychiatry specializes in advanced treatment options that can be provided in cooperation with your current psychiatrist.

    Help us help you by calling us for an appointment. We can determine if you’re a candidate for IV ketamine treatment or Transcranial Magnetic Stimulation (TMS). Here at Innovative Psychiatry we’ve consistently seen 80% positive results in our most treatment-resistant patients. We’ve also seen 75% positive response in our treatment-resistant patients to TMS.

    2018 can be your best year to date.  There are outstanding alternatives available now to help you if nothing has helped before.

    To the year of your best self yet,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Ketamine Treats Social Anxiety Disorder…Seriously…?

    Ketamine Treats Social Anxiety Disorder…Seriously…?

     

    ketamine treats social anxiety disorder so attending a party is much easier.

    Yes. Let’s be really clear.

    Because nothing seems really clear if you’re someone who just doesn’t want to go …

    Go?

    Yes, who doesn’t want to … or can’t just easily … go. To work. To class. A meeting. That job interview. Even out for coffee. Or Shopping. 

    There are a thousand reasons you might not be able to go. You might be too tired, too busy, not interested … or too stressed, or depressed.

    You may be too introverted or shy or …  just too worried about what others will think of you, about how you seem to them, about whether or not you’ll do or say something embarrassing, or worse, yet, humiliating.

    Humiliating is the worst

    Ketamine treats social anxiety disorder. You can stop the humiliation.

    It’s a dread and a fear that you can’t shake if you have social anxiety disorder. Reassurance doesn’t help. Self-talk falls flat.

    And it’s different than being introverted or shy. Social phobias and anxiety are often mislabeled “introversion”… but they’re not the same. We’re pretty complex — sensitive to the number of people around us, whether we know them, how they perceive us.

    If you’re an introvert, you draw your energy from quiet time with your own company. 

    If you don’t know the people around you and feel uncomfortable, you may be shy — but once you get acquainted, you may be someone who comes out of your shell and chats them right up.

    But if you have social anxiety, it means a sense of vague, but intense, fear rises inside you in social settings where you feel you will be observed, or noticed, or scrutinized. It could be by people you know or … by people you don’t know.  You may believe that everyone is talking about you, criticizing you, even ridiculing you. 

    It can be so difficult that you find it hard to speak at all.  Your palms may grow sweaty, your voice may crack …you may blush deeply over and over…where they can see it. 

    You wish you could control it, because the reaction you experience and the fear that you’ll make a fool out of yourself … and that others will notice and not want to interact with you is far worse than just getting acquainted with someone
    Social phobia and anxiety -study shows ketamine works.
    . It’s crippling. You’re frozen. Wishing for an escape.

    You feel like such a jerk.

    How to Escape from Social Anxiety??

    If you talk to a friend or counselor about it, they may ask, “so… what is it exactly that you’re afraid of?” 

    Well…how do you answer that..? Is the anxiety you feel something that just happens that you can’t prevent? 

    I’ve met lots of people who don’t even realize they have social anxiety. They never had a name for it. They believe it’s just the way they are, and they try to live with all the “can’ts.”

    But I know others who dread entering an elevator with someone of the opposite sex, or who die a thousand deaths before walking into a classroom of students they haven’t met before, or who will cancel plans rather than experience the misery they feel when attending a gathering.

    Social anxiety just makes life so difficult.

    Ketamine treats social anxiety disorder. Man seeking refuse in alley could enjoy himself in a gathering...with treatment.

    It holds you back in so many ways — from your own family, from making friends, from raising your hand in school to being able to sign up for classes, or talk to a professor. From entering an elevator with people in it.

    Fast forward and you see it holding you back from using your native intelligence –to express your ideas, talk to a coworker, or to your boss … or the mortgage loan people or your server at a restaurant. If you can get to the restaurant.

    It can ruin your life.

    And put you at risk for developing other things that can ruin your life … like depression, alcoholism, and cardiovascular disease.  Geez!

    Most people who labor under the pain of social anxiety would get rid of it in a New York minute…if they could.

    Treatment for social anxiety has been along the same lines as treatment for any anxiety-producing condition. Antidepressants and anxiolytics  – medications that reduce anxiety — along with therapy have been the treatments used for the last 50 years or so. But, unfortunately, these have been only partially helpful.

    Why isn’t treatment more helpful…?

    About 1/3 to 1/2 of all people with social anxiety disorder don’t respond to the treatments that are out there for it –SSRI’s, venlafaxine and cognitive behavioral therapy.  Even when you wait for 8 to 12 weeks to get the full benefits.  All evidence-based treatments, for sure, but with inadequate relief for most.

    That’s why it’s so exciting to see innovative treatment available for social anxiety disorder with impressive results from the absolute gold standard of clinical trials:  a double-blind, randomized, placebo-controlled crossover trial — recently published in the journal Neuropsychopharmacology.  IV ketamine treatment has novel actions in the brain that reduce anxiety and fear fast.

    Ketamine Treats Social Anxiety Disorder

    Ketamine switches on mRNA to switch on DNA to turbo boost BDNF, as you can read here. And it works rapidly to slide the G proteins off their lipid rafts in the cell membranes, as described here. Those G proteins have to be off the lipid rafts to do their job improving signaling between the synapses and neurons.

    And…ketamine also blocks NMDA receptors AND improves glutamate levels, which you can learn more about here.

    So far, we know about these four actions of ketamine in the brain. And ketamine is kicking bootie and taking names across the anxiety spectrum: PTSD, OCD, phobias, and now social anxiety disorder,

    ketamine treats social anxiety disorder.

    Jerome Taylor and his colleagues set up an elegant proof of concept study with just enough patients to give it power. Eighteen adults with social anxiety disorder, as described in the DSM-5, were given either a ketamine infusion or placebo infusion…and their responses were measured 3 hours after the infusion, and multiple times over the next 14 days. A great sample of real-world, complex people, some on and some off meds — just like in real life.

    Then, 28 days after their first infusion, they came back in and got the other infusion; if they had a ketamine infusion first, they got a saline placebo the second time, and vice versa. Turns out that 17/18 patients knew when they got ketamine instead of saline, so the blinding wasn’t perfect. But there are always limitations to studies, and opportunities for refining the questions we ask and the methods we use the next time around.

    Still.

    Ketamine treats social anxiety. Ketamine was safe, generally well-tolerated, and worked.  People responded to ketamine, and they had significantly greater reduction in anxiety that lasted up to 28 days, compared to when they were treated with placebo. Fear, avoidance, social anxiety, and social avoidance all fell significantly.

    Of course, study results are often reported in the most conservative terms. We always need and want to know more. But this trial provided fine evidence that ketamine is effective in reducing social anxiety.  Hopefully, this kind of anxiety reduction can lead to more social activities and opportunities for people who so suffer so terribly.  Hopefully, this study will open the doors to more inquiry.

    Isn’t that outstanding??

    We always love to see clinical trials and studies that put ketamine through its paces. We love to hear of others who find ketamine to be effective in treating mood disorders.

    Because here at Innovative Psychiatry, we see it every day. In fact, within our practice we see a strong 80% positive response to ketamine even in people who’ve failed everything. 

    We like to say that they didn’t fail — everything failed them. If you feel like what you’re doing isn’t working, you’re not alone.  You may have one thing — depression, maybe, or bipolar disorder — or you may have a lot of things — PTSD, anxiety, and OCD. 

    But we have one of the 6 Best Medical Achievements of 2017 to offer you: IV Ketamine Treatment.  We’ve used it for years … before anyone knew it was going to become one of the 6 Best.

    …We’ve always been on the cutting edge.

    We’re not a pop-up clinic.  We’re not a johnny-come-lately.

    We’ve developed our approach over the past 20 years to help those who suffer the most…and are desperate to find relief. We stay up at night to find solutions that are novel and innovative, that will allow you to function again and find joy in your life with the advanced treatment options that we offer. 

    We’re the only psychiatry practice in Connecticut that’s daring enough and forward-thinking enough to bring you a menu of advanced treatments in a beautiful outpatient office with its own library of research articles that supports everything we do: IV ketamine treatment, TMS, reducing inflammatory factors, improving nutrition and enhancing the gut microbiome.

    We have advanced treatment options for you

    Social phobia and anxiety - study shows ketamine works.

    If you’ve been suffering with a treatment-resistant mood disorder like depression, social anxiety, phobias, panic attacks, PTSD, bipolar disorder, and OCD, please call us. Let’s set up an appointment to figure out if IV ketamine or another innovative approach is right for you. 

    We don’t take over your medication management or therapy — we offer advanced solutions to enhance what you’re already doing — with the doctors you’re already working with. So you can finally leave social anxiety, depression, bipolar disorder, PTSD, and OCD behind.

    We want you to feel better… and we believe we can help.

    We’re closed for the holiday but we’ll be back to schedule appointments right after the New Year. Put us on your calendar.

    To the new emergence of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • 6 Best Medical Achievements of 2017 that Everyone Should Know About!

    6 Best Medical Achievements of 2017 that Everyone Should Know About!

    2017 Has Changed the Way We Could Treat Depression, Alzheimer’s, Cancer and AIDS

    Sandhya Raghavan  | Updated: December 15, 2017 5:51 am
    Like its predecessor, 2017 has also been blamed for being the worst year ever, collectively by the internet. But when you look at some of the medical milestones of the year 2017, you’d be forced to reconsider. Researchers in 2017 have worked tirelessly to make our lives a little better and a lot healthier in the years to come. These include breakthroughs in Alzheimer’s, Parkinson’s, cancer and HIV treatment.

    Here are some of the greatest medical achievements of 2017 that will make each of us proud.

    1.  Oxygen therapy for Alzheimer’s disease

    Among the latest breakthroughs is the use of hyperbaric oxygen for the treatment of Alzheimer’s disease. A progressive disease, Alzheimer’s is known for its resistance to treatment. But discovery is hailed as a milestone in Alzheimer’s treatment because it is said to improve the pathology of the disease and correct some of the behavioural problems in patients. Here how oxygen therapy can reduce symptoms of Alzheimer’s.

    2.  PaxVax’s vaccine that can stop outbreaks quickly

    Cholera is a gastrointestinal disease that affects the small intestines. One of the hallmarks of the disease is that it can assume epidemic proportions. And as of 2010, cholera has been classified as a pandemic. To counter this problem, the vaccine company PaxVax has developed a cholera vaccine, a single dose of which can stop the epidemic in its tracks, controlling big outbreaks more quickly. PaxVax vaccine can stop cholera epidemic from spreading.

    3.  Using one’s immune system to fight cancer in children

    CAT T-cell Therapy is one of the latest and the most effective breakthrough in cancer treatment. According to a study conducted by Memorial Sloan Kettering Cancer Center in New York City, researchers have found a way to treat acute lymphoblastic leukaemia in children by using the immune system to attack and kill cancer cells. This helps children afflicted by the dreaded disease to achieve remission quicker and live a normal childhood.

    4.  Kicking and killing HIV virus

    HIV has the ability to resist medication and treatment by lying dormant in CD4- T cells. So when the patient stops the medication, this dormant virus awakens again and starts attacking the body again. So the scientists from UCLA, Stanford and National Institute of Health have been trying to find a way to smoke the virus out of its hiding places and attack them when it activates. The team of scientists have aptly named the technique “kick and kill.”

    5.  Animal tests for head transplantation

    Till recently, head transplantation as a possibility existed only in science fiction. But a recent experiment conducted by a group of Chinese doctors brought this fantasy a step closer to reality. The doctors severed the spinal cord of 15 rats and tried to reattach them in 9 of them. Except for one, all the rats survived for close to a month after the experiment. A Russian man suffering from muscular spinal atrophy has volunteered for the spinal transection surgery.

    6.  Ketamine as a treatment for depression  

    In a revolutionary discovery, ketamine, an infamous date-rape drug, found redemption in 2017 as a possible treatment option for depression, PTSD and suicidal ideation. Research has revealed that ketamine, an anaesthetic drug, could be able to tackle depression like no other drug has done so in the past. If studies are to be believed, ketamine will be able to reduce depression within hours after injecting it intravenously.

    [Read the Original Article Here]

  • Medscape: Ketamine Rapidly Reduces Suicidal Ideation

    Medscape: Ketamine Rapidly Reduces Suicidal Ideation

    Megan Brooks

    December 13, 2017

    A subanesthetic intravenous infusion of ketamine can rapidly reduce suicidal ideation in patients with major depression, and the clinical improvement is maintained 6 weeks later, results of a randomized controlled study suggest.

    This study is “the most definitive demonstration so far of a clinically meaningful reduction in suicidal ideation within 24 hours after ketamine treatment,” first author Michael Grunebaum, MD, from New York State Psychiatric Institute, Columbia University Medical Center, New York City, told Medscape Medical News.

    The study was published online December 5 in the American Journal of Psychiatry.

    Largest Study to Date

    The study included 80 patients who were admitted voluntarily to an inpatient research unit at New York State Psychiatric Institute with major depressive disorder and clinically significant suicidal ideation (Scale for Suicidal Ideation [SSI] score ≥4).

    Forty patients were randomly allocated to receive intravenous racemic ketamine hydrochloride 0.5 mg/kg, and 40 patients were allocated to receive midazolam 0.02 mg/kg in 100-mL normal saline infused over 40 minutes. Midazolam was chosen as the comparator because it is a psychoactive anesthetic with a similar half-life to ketamine and has no established antidepressant or antisuicidal effects.

    Baseline characteristics were similar in the two groups, including the SSI score. The mean SSI score was 14.3 in the ketamine group and 15.7 in the midazolam group.

    The average SSI score 24 hours after infusion (primary outcome) was 4.96 points lower in the ketamine group than in the midazolam group (95% confidence interval [CI], 2.33 – 7.59; P < .001). Cohen’s d for the difference in mean group change was 0.75, which is a medium effect size.

    Treatment response was defined as a reduction of ≥50% in SSI score. The proportion of patients who experienced a treatment response at day 1 was greater in the ketamine arm than in the midazolam arm (55% vs 30%; odds ratio, 2.85; 95% CI, 1.14 – 7.15; P = .024). The number needed to treat was 4.

    Notably, the investigators report, the improvement in suicidal ideation largely persisted during the 6-week period of uncontrolled observation. This may be partly explained by the fact that patients continued prior psychotropic medication, which was optimized after ketamine infusion.

    There were greater reductions in overall mood disturbance, depression, and fatigue, as assessed with the Profile of Mood States, on day 1 after ketamine vs midazolam infusion. Results of a mediation model suggest that ketamine’s effects on depression and suicidal thoughts are at least partially independent, the researchers note.

    Adverse effects (mainly an increase in blood pressure and dissociative symptoms) were similar to those reported in other ketamine studies. The adverse effects were mostly mild to moderate and transient, typically resolving within minutes to hours after infusion, they note.

    “This is the largest study to date in suicidal, depressed patients, using a randomized, midazolam-controlled design, and also addressed various prior research limitations, which have included measurement of suicidal ideation with a single questionnaire item and patient samples with low levels of suicidal ideation or mixed diagnoses,” Dr Grunebaum told Medscape Medical News.

    “We think the most noteworthy results of this study are that it shows, using a rigorous clinical trial design, that ketamine treatment was associated with a clinically meaningful reduction of suicidal thoughts in suicidal, depressed patients within 24 hours and that with optimized, clinical pharmacotherapy in an uncontrolled follow-up observation, this reduction appeared to last for at least 6 weeks,” said Dr Grunebaum.

    Potential Lifesaver

    Reached for comment, Seth A. Mandel, MD, chairman of psychiatry at Northwell Health’s Huntington Hospital, New York, said, “There has been a cottage industry of nonpsychiatrists performing ketamine infusions for treatment-refractory depressed patients. My concern in these cases has been, what happens if it fails for someone who has put their last hope in this treatment?

    “This study points to a more positive and practical use for ketamine infusions,” said Dr Mandel, who was not involved in the study.

    “It could be a very useful and even lifesaving temporary maneuver performed in ERs or outpatient ambulatory settings, buying valuable time until treatment can be optimized over the ensuing weeks. It may not only be useful in preventing suicides but also in avoiding costly hospitalizations for acutely suicidal patients,” he noted.

    Dr Mandel cautioned that it’s “unclear from the study what happens with these patients beyond 6 weeks. Does suicidal ideation return, and if so, should the treatments be repeated, and for how long? What are the long-term effects of repeated infusions? Further studies are needed to answer these questions.”

    The study was supported by the National Institute of Mental Health. Several authors have disclosed financial relationships with various companies, as listed with the original article.

    Am J Psychiatry. Published online December 5, 2017. Abstract

    For more Medscape Psychiatry news, join us on Facebook and Twitter.

    Medscape Medical News © 2017

    This is a re-post from: Ketamine Rapidly Reduces Suicidal Ideation – Medscape – Dec 13, 2017.

  • What Your Friend With OCD Needs from You

    What Your Friend With OCD Needs from You

    Boy locks door repeatedly so what your friend with OCD needs from you?Wonder how to help someone with OCD? 

    Think about what your friend with OCD needs from you…

    Obsessive Compulsive Disorder, or OCD, is a condition where intrusive thoughts occur in your mind over and over again. You don’t want to have these thoughts or ideas…but you can’t stop them by sheer will.

    To make it worse, they’re often disturbing or upsetting.

    Compulsions follow the disturbing and repetitive thoughts…and you feel driven to act them out over and over again. When you actvigorous handwashing is hard to stop so what do your friend with OCD need from you. out these compulsions, your hope is that they’ll drive away the obsessions.

    Unfortunately, as hard as you try to drive away those obsessive thoughts with your compulsive and repetitive behaviors…they just don’t go away. In fact, they become stronger.  More compelling… even overwhelming.

    Eventually the overwhelming and compulsive behaviors become so demanding and cause such anxiety and are so time consuming…

    Well, it all becomes a vicious cycle.

    Some people with obsessive compulsive disorder are driven only by obsessions.  Others by only compulsions.  But most are driven by the obsessive – compulsive cycle of both. And it can occur as often in men as in women, and in children as often as adults.

    People with OCD weren’t born with these symptoms. In spite of extensive research, the cause is still pretty much unknown…although there seems to be a genetic connection in families for the tendency. And it may begin following a severe strep infection in children, or an accumulation of stressors in adults.

    Regardless of the cause, what’s important is the role you play, as someone who cares about anyone who seems to suffer with OCD.

    What Does Your Friend with OCD Need From You?

    Let’s talk about some ways you can support her. If you’re not alert to the behaviors you see, and what’s causing them, it may be Latching and unlatching the door may help but what does your friend with OCD need from you?easy to fall into criticism and judgment, teasing or ridiculing, which honestly, just makes things worse for them.

    For instance, you may begin noticing behaviors or habits that are frustrating to you, but are actually “signals” of OCD.  Things like spending way too long in the bathroom, continually showing up late, or constantly asking questions about themselves that are steeped in self-judgment, and needing continual reassurance.

    Long blocks of time doing anything… with no explanation for what was going on… simple chores that turn into prolonged undertakings… and doing the same thing over and over and over…

    If you see behaviors like these, coupled with irritability and an unwillingness to talk about it, be assured this isn’t about you or your friendship.

    Something painful is happening with your friend. While it may appear to you initially that she’s being weird, or that she has a wacko personality…she may be suffering from OCD.

    And if she is, she needs support and acceptance from you. If she feels you blame her … or you’re critical of her…anxiety will just skyrocket and her symptoms will likely get worse.

    What Symptoms Look Like

    She may have obsessions that center around a common theme…like fear of contamination or dirt, or maybe about everything around her being orderly and symmetrical … or maybe fear of harming herself or others.

    Those obsessions are likely to result in compulsive acts such as not wanting to touch things that have been touched by others. Maybe she wonders if she forgot to lock the door or turn off the iron…

    And she may feel mounting pressure to return to the house and check that the door’s locked and the iron unplugged. “Would you stop it?? We’re late already…!” isn’t the response that will calm things down and get you back on schedule. Instead, reassuring her that the schedule can be adjusted and it’s time together that matters is a much more productive response.

    Easy Tasks are Tougher for Her

    Taking a shower and dressing for a quick brunch may involve 5-6 hours, while you wait for her to emerge. Remind yourself that what does your friend with OCD need from you?she’s not treating you disrespectfully nor is she intending to be inconsiderate.

    She may or may not even realize what’s happening that takes her so much time …and she may not realize so much time has passed either.

    Also know that any change, even what seems like a good change, can stir up anxiety for her. And if you’re counting on her to carry her weight, such as in a move or cleaning the house, you’ll both end up miserable.

    More important than her equal share, is that she feels accepted, understood, and reassured. She’s likely already beating herself up. She probably has NO idea why each task takes her so long. Your friend with OCD needs your reassurance at times like this.

    She needs your help to cut herself some slack. “It’s no surprise you’re feeling stressed, or that your symptoms are worse right now…you’re going through a lot of change. Be patient with yourself, and give yourself time. This will subside — like it always does.”

    Give Her Credit for Improvement

    For anyone who doesn’t suffer from OCD, small tasks seem rather insignificant. But for your friend, shortening the length of her Two friends cook together so what think about what your friend with OCD needs from you?shower time by 5 minutes, or washing her hands one less time, can require an enormous amount of work, and fighting through gargantuan anxiety.

    Resist the temptation to compare her to you…but instead applaud her efforts and results. The gratification of those small victories can be so motivating to continue making progress.

    You’re Friends First

    In the midst of all the OCD centered interaction, remember your friendship comes first. You are individuals first.

    If you had thin hair, and she helped you with products to thicken it, that would not become the center of your friendship. But just one of many ways you connect and support each other.

    And just as she wouldn’t focus every conversation around your hair, you mustn’t allow too many conversations to be focused around her OCD symptoms. Just as you wouldn’t play “mother hen” to any other friend, this friend also needs time to herself and respect as an individual. And you need the same.

    What your friend with OCD needs from you is recognition of her best traits, as well as support for her struggles.  After all, that’s howEven friends with OCD need to be friends first, so what does your ocd friend need from you? friendship works, isn’t it?

    OCD is often treated with antidepressants and medications that reduce anxiety, but the results haven’t been stellar. However, an advanced treatment option is yielding some bright hope for those who suffer with this disorder.

    IV ketamine treatment treats OCD symptoms by rebuilding synapses and strengthening signaling throughout the brain. It also reduces anxiety, depression, suicidal thoughts, and relieves PTSD.

    At Innovative Psychiatry, we consistently see 80% recovery in treatment-resistant cases of depression, anxiety, PTSD, and obsessive-compulsive disorder.

    If you or someone you care about is someone who suffers from OCD symptoms, call us. We’re here to help you with advanced treatment options like IV ketamine treatment and Transcranial Magnetic Stimulation.

    Even though our practice is closed to new patients seeking medication management or therapy…we’re just too full…we are scheduling patients who want to see if advanced treatment options like ketamine treatment might be right for them.

    We look forward to working with you for the better.

    To the release of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Holidays with Depressed Family…How’s It Going for You?

    Holidays with Depressed Family…How’s It Going for You?

    This baby sleeping in a box at Christmas is peaceful. But holidays with depressed family can be hard on everyone.Holidays with Depressed Family … Not Easy

    Are you enjoying this holiday season…? This time of shopping, music, winter hats and gloves… hot chocolate and marshmallows. Sounds like a Christmas carol, doesn’t it…?

    On the other hand, there’s another side to the holidays, isn’t there?

    Is setting up the tree, and unwrapping all your ornaments, something you make time for, and do with quiet joy…?

    Or is it something you cram into the 45 minutes between work and the holiday chorus concert while the kids scarf down McDonald’s and fight over who gets the last cookie…?

    The traffic to go anywhere is jammed in gridlock…so driving home from work… well there’s no way you’ll ever get This Norman Rockwell picture is heartwarming, but holidays with depressed family can be hard.home.

    That “Christmas Card” Family Holiday

    Wouldn’t we all love to have that dreamy kind of holiday…?

    Yes, maybe.

    But I’d like to suggest that a “perfect Christmas card holiday” wouldn’t be as perfect as it sounds. And here’s why.

    Because it isn’t reeeeally sitting inside a Norman Rockwall painting on the wall that scratches that itch we all have for meaning in life.

    And because it really isn’t silent perfection that fills our hearts — no matter how pretty the picture.

    But isn’t it the people…?

    Isn’t it being with Aunt Sue who talks a lot, and Grandma Jansen and her raucous humor, and the wild and wooly cousins we grew up with…the crazies and the noise….?

    Life is messy. It’s not a pretty little picture, and we aren’t images on a holiday card. And you could even have a fault or two yourself … right?

    Holidays with Depressed Family Members Can Be Messy

    But you love them.  And they love you. You have history together. You’re family.

    If you have some people in your family who are a bit out there, eccentric and even occasionally annoying, that’s part of the patchwork quilt that makes you who you are and gives your family uniqueness.

    And…If you have family members or friends who have the challenge of managing bipolar disorder, depression, anxiety, PTSD … this may be a particularly taxing time for you and for them.

    You know those stresses that turn your holiday moment into a chaotic nightmare…? As much as you feel the stress, This warm scene of Christmas tree and presents doesn't reveal that holidays with depressed family can be taxing and hard.they are possibly more distressed than you are. When you have all you can handle, and someone in the room makes a scene…or explodes into an outburst… or leaves and no one knows where he is…you want to pull your hair out.

    Nothing wrong with that. You’re human.

    In Family Gatherings, Stronger Ones Carry the Load

    But, as you know, it’s also true that you may be a little more predictable. Your emotions may be a little more reliable. And you may be a little more skilled at managing them. These loved ones of yours probably do the very best they can. And they want meaning and love just like you do.

    Of course, this isn’t news to you. You know all about all this, because these are your family members. You’ve been there…and done that. Still, it doesn’t hurt to get a little encouragement from others who also understand your situation. Sharing the holidays with depressed family members can be challenging at best…and sometimes downright traumatic for everyone.

    Holidays Can Breed Crisis

    Caleb was a young man in his twenties, who had been diagnosed with bipolar disorder when he was a young teenager. He’d had bouts in psych hospitals. He’d also had bouts in jail. And bouts in rehabs. By this point in time, his confidence in himself was pretty much shot.

    He had such a gifted personality… you couldn’t sit in the room with him and not laugh your head off at his incredible humor. When he was good, he was your favorite person in the world.

    But far too often, he was sick. Nosediving into depression and crippling anxiety. You could tell when his fun self was transitioning to his tormented self. And that could happen at any time. Sometimes there was a trigger that set him off. Other times it just happened with no warning.

    Holidays were tough for him. His hopes were high and his anxiety that he’d fall apart were higher. You probably This young man sits alone in an isolated woody area because holidays with depressed family is so hard.already can guess that the anxiety can lead to a panic attack.

    So it was Thanksgiving, and the memories and interactions got to be too much and he left. Just walked out. He walked to a bridge in his community. He sat on the bridge and watched the traffic underneath, contemplating what he was going to do.

    Thankfully, his family drove up soon enough. They’d been looking. And they held him…reassured him…and he agreed to get in the car and go home.

    That Thanksgiving wasn’t a flawless Christmas card experience for the family…but isn’t it all about the people you love anyway? The family’s memory of that Thanksgiving was about safely returning home with him.

    Depressed People Have So Much to Bear

    Cherri was 16. She had been depressed so long she couldn’t remember what “happy” was like. She looked mad and sullen to those around her. But it wasn’t that. She was so numb. So silent. So hopeless. So paralyzed.

    She thought about death. About relief. She had self-medicated with various substances in the past then spent 18 months in rehab. After she came home, she was white knuckling sobriety, but was still miserable.

    Then her grandmother died a week before Christmas. She’d been so close to her. At times it seemed Grandma was the only one who understood her. At least it felt that way. Cherri couldn’t bear the pain.

    The day of the funeral she ran away. She just couldn’t face everyone. She needed to be alone with her memories of Grandma as she knew her.

    When the family arrived at the funeral home, they mumbled among themselves about Cherri’s selfishness to turn all Depressed teenage girl finds a quiet place to calm herself. Holidays with depressed family are hard.the attention to herself. In their own pain and loss, they didn’t really realize it wasn’t about Cherri being selfish.

    It was that she was so sensitive, and she could feel the feelings of the people around her. And she wanted to protect her private feelings about her grandma.

    When the family returned home after the funeral, Cherri was alone in her room…looking at pictures of Grandma with the family.

    People with Depression, Anxiety, Bipolar Disorder, and PTSD Need Extra Support This Time of Year

    Holidays are complicated. The next few Christmases for Cherri may be tumultuous, too. That’s the way it goes. Everyone grieves in their own way.

    For those of us who love vulnerable hearts who themselves suffer from anxiety, depression, bipolar disorder.…PTSD… may we be patient with our families, and with ourselves.

    And accept life at this time of year as it happens.

    Because it’s all about love … after all.

    If you have a family member who is suffering, where treatment hasn’t  helped, please call us.  We’d love to help you and help your family. That’s what we do. We offer advanced treatment options, like IV ketamine treatment and TMS. We offer hope.

    May your holidays be warm and heartfelt, and may you feel loved by those around you …

    To the emerging of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Anxiety Treatment That Doesn’t Make You Sleepy

    Anxiety Treatment That Doesn’t Make You Sleepy

    Anxiety treatment that doesn't make you sleepy? Ketamine gives this young woman resilience.
    What Is Anxiety, and How Do You Treat It?

    People talk about depression, talk about PTSD, and about bipolar disorder. But how do you talk about anxiety? How do you know if you have anxiety, and how do you find anxiety treatment that won’t make you sleepy so you can do things without being tired…or without being overwhelmed?

    What is it, really?

    Anxiety Shatters Innocent Trust

    Seven-year-old Chrissy climbed the stairs to take her bath…. It was dark upstairs. She wondered what could be lurking in the shadows. Surely there was nothing to be afraid of.  She tried to convince herself that this is home, and her parents kept the doors locked, so no one could have crept in to wait for her upstairs in the dark.

    There was nothing to be afraid of!

    But her reasoning didn’t seem very convincing. As she reached the top stair step, and turned past the landing, groping in the darkness to find the bathroom doorway so she could flip on the light, her eyes tried to adjust.

    Out of nowhere, two hands grabbed her in a sudden burst and she screamed in terror. Her 12-year-old brother burst into laughter and fell to the floor rolling around in glee.

    “That’s not funny, Ben!!”

    Anxiety Builds Obstacles to Moving Forward

    …Eleven years later, Chrissy hugged her mom and dad goodbye, after they’d unloaded the car of all her boxes. They were about to drive back home and leave her to unpack and set up her dorm room. She would register tomorrow for classes. This was her first time living away from home.

    She climbed the stairs of the dorm, walked down the long lonely hall, and stood before the door to her room.

    Chrissy froze.

    Her throat went dry, her stomach cramped, her palms sweaty.

    She couldn’t open the door.   

    Insomnia caused by anxiety. Anxiety treatment that doesn't make you sleepy.

    The key was in her hand but she couldn’t bring herself to push the key into the lock. A nightmare of some kind awaited her … she just knew it. What if her roommate didn’t like her?  What if she wasn’t welcome…?  Or worse, what if there were people inside who made fun of her?? This would have to be her home now, and what if she couldn’t relax here?

    Why did she come? She wasn’t ready for this. She was too insecure, too shy. This was never going to work. 

    What had she been thinking????

    Chrissy continued to stand in the hall.  Looking at that closed door. Off behind her, she could hear voices. Chatter. Laughing….

    She knew they were laughing at her. NO ONE goes to college without the maturity to walk into a dorm room.

    She was going to be the laughingstock of the entire campus.

    Minutes passed.

    Finally, in one big moment of resolve, she wiped her wet palms on her jeans, shoved the key into the lock, opened the door, and walked in.

    Anxiety Can Erode the Foundations of a Solid and Resilient Life

    Nine years have passed since that day in the dorm hallway.  Chrissy thinks sometimes she’ll never be able to manage her own life. She’s been to college, completed her degree, although there were some shaky times.

    She’s held a couple jobs, but something always seems to go wrong. She keeps thinking she needs to build a career … but hardly knows where to begin. 

    Her self-confidence isn’t great, and she tries to hide it behind flashy clothes and makeup. She tries to appear to “have it all together,”  but deep inside she wishes she could hide from the world.

    Gripping chest from anxiety. Anxiety treatment that doesn't make you sleepy.

    Her live-in boyfriend works hard and works out, but with abuse in his childhood and PTSD from combat in Afghanistan, there isn’t much peace at home. His hyper-vigilance and flashbacks make the nights like a terror movie. She never knows when he’ll fly into a rage … or come at her. It’s a living nightmare, but she doesn’t want anyone to know what goes on…so she keeps it all to herself.

    Over time, it seems to get harder and harder to just leave the house. One day last week she was at work and panic rose up inside her.  She was shaking, trembling, and just couldn’t see much besides bright lights.  She grabbed her purse and walked out. Got in her car and drove home.  She hasn’t left the house since.

    Not that she hasn’t tried. This morning she even put her things in a bag to go see a friend. Got into her car. And sat there. Why was this so hard?  She reached into her purse to get the key.  But couldn’t get it into the ignition. Just …couldn’t.

    So she sat there. And cried…and cried….

    Severe Anxiety Can Prevent You From Finding Your Place in This World …and Flourishing

    Anxiety comes in lots of forms. It can be a nagging dread about entering a public place, or about joining a group of people. Sometimes the dread is worse than other times.

    Sometimes it’s a sickening feeling that interferes with your good intentions. 

    Other times it’s a crippling terror that plants your feet – as if they’re concrete – bolted to the sidewalk.

    Sometimes anxiety turns on faucets of sweat that run down your face and sides while you ride an elevator. Or makes your mind go blank when you stand up to give a presentation you’ve worked on for weeks.

    A date with a someone new can lead to abdominal cramps, headache, and diarrhea. 

    But anxiety symptoms can get much, much worse.  A rapid heartbeat and sweaty hands, face, and torso, along with severe chest
    Man with chest pain caused by anxiety. Anxiety treatment that doesn't make you sleepy.
    pain and shortness of breath can mimic a heart attack. Many people wind up in the emergency room — and they’re shocked when they’re told they’re having a panic attack, not a heart attack.

    How Can You Get Ahead of Anxiety…???

    The traditional treatment for anxiety has been antidepressants, anxiolytics, and therapy. 

    But.  Unfortunately, only about one third of people who suffer with depression, anxiety, or both, get better with antidepressants or therapy, or both. Another third are believed to be helped with a second medication or combination of medications.

    So about a third of all people with anxiety continue to suffer, lose their jobs, and sabotage their relationships with symptoms they can’t control.

    Is There An Anxiety Treatment that Doesn’t Make You Sleepy?

    Because IV ketamine works on different parts of the brain than traditional antidepressants, ketamine treatment can now make the difference for 80% of those people who’ve been left untreated. And un-helped.

    And it yields extraordinary results in people who suffer from mood disorders by:

    All in all, ketamine helps rebuild brain structures that support communication through the prefrontal cortex and deep into the brain.

    Ketamine Brings Your Brain to Life

    Ketamine doesn’t make you sleepy.  In fact, ketamine wakes up your brain. As the synapses are restored, signals travel faster and
    Dread of anxiety follows man everywhere. Anxiety treatment that doesn't make you sleepy.
    faster deep into the brain, bringing a sense of well-being along with initiative, creativity, and order.

    Your brain will function at a much more effective and efficient level. You’ll feel like your best self. Your sleep will improve when you’re sleeping, and your alertness will improve when you’re awake.  It’s pretty extraordinary.

    This is anxiety treatment that doesn’t leave you sleepy. There’s no fatigue, no weight gain, no sexual dysfunction, no constipation or diarrhea, and none of the other side effects you can see with other medications used to treat anxiety.

    Ketamine is an anesthesia medicine that’s been used in emergency and surgical settings for 50 years, and has been found to be safe and reliable. It’s only been in the last several years that it has emerged as a remarkable treatment for depression, anxiety, and other mood disorders.

    Ketamine’s rapid and robust antidepressant action is restoring the lives of those who’ve suffered with treatment-resistant psychiatric mood disorders.

    At Innovative Psychiatry, we’re seeing a consistent response rate of 80% to IV ketamine treatment. So, while ketamine isn’t for everyone, chances are pretty good that it can really help you.

    Message on the beach says HELP... anxiety treatment that doesn't make you sleepy.

    If you suffer from anxiety disorders that haven’t responded to other traditional treatments, call us for an appointment.

    We’re not able to take on new patients who need medication management. That arm of our practice is just too full. However, we are accepting patients who want to see if they can benefit from ketamine for severe depression, crippling anxiety, and other serious mood disorders.

    Let’s work together to help you get better.

    To the restoration of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Considering Ketamine for Depression? Here’s How to Screen a Ketamine Clinic

    Considering Ketamine for Depression? Here’s How to Screen a Ketamine Clinic

    Screen a ketamine clinic before receiving treatment. Your brain is complex with delicate systems.

    Maybe you’ve heard the buzz.

    Ketamine for depression is in the headlines, the journals, and the chatter at Starbucks. If you or someone you love wrestles with the exhausting symptoms of depression, you’ve likely heard about it.

    Or maybe you haven’t.

    Either way, it’s the biggest news in psychiatry these days, and seems to be high on the list for some entrepreneurs looking to make a profit. The result is clinics that have popped up all over the country — almost overnight– run by businessmen, anesthesiologists, psychiatrists, ER docs, ICU docs, and nurses.

    If you’re considering ketamine for depression, maybe you’ve looked for someone in your area who offers ketamine treatment?

    There may be more places to get treatment than you think. Or there may be fewer than you wish. Either way, your health, your brain, and your mind ought to be treated with care, caution, and best practices, for best outcomes as well as safety.

    Let’s talk about the ins and outs of these clinics and practices, so that you can be your own advocate. Scrutinize … and screen a ketamine clinic before you agree to treatment.

    Psychiatric Treatment as a Business..?

    Healthcare should not incorporate high pressure sales techniques. But there has been an explosion of ketamine clinics … pop-up clinics … and non-MD CEO-types setting up ketamine clinic franchises and making a nice profit from them. They work with anesthesiologists, emergency department physicians, family medicine docs, and other non-psychiatrists to run these clinics, and pocket a lot of the money.

    They operate as call centers or use centralized calling services to funnel and schedule appointments, collect your money … and bend over backwards to get you in the door. Some of the call centers or clinics are pretty aggressive in encouraging you to schedule followups for maintenance dosing or buy clinic “memberships”  so that you can get maintenance ketamine on a regular schedule.  Even though the whole question of maintenance hasn’t been well-studied. 

    This is a business model. Not a wellness model.

    And in our experience, most patients don’t need maintenance ketamine on a regular schedule.  (We need much more research to determine that.) 

    One Size Never Fits All in Psychiatric Treatment

    Just like the degree of response, the need for maintenance doses of ketamine is purely individual, and should be handled on a case by case basis. In short, ketamine treatment for mood and anxiety disorders should be given by psychiatrists who can evaluate each patient for their response to treatment, its effectiveness, and durability.

    So … if ketamine infusions are $500-800 each, you can see the business model in that — and the profits — in making sure everyone comes in once every month or two. Whether they need it or not…?  

    But psychiatric care, like all health care, demands personalized care.  Expect to be treated with what you need, not what someone’s wanting to sell.

    Screen a Ketamine Clinic Before Treatment

    There are lots of options for ketamine treatment. Lots of places all of a sudden. 

    Major academic and teaching centers which offer ketamine treatment during a study… if you qualify for one of their studies.

    Dedicated ketamine clinics which offer only ketamine treatment … for depression, or pain, or both.

    And individual psychiatrists in established practices on the forefront of medicine who offer ketamine treatment because they’re on the forefront of medicine … and as one of many treatment options they offer for their patients.

    If you have a severe mood or anxiety disorder, you need psychiatric care.  Not anesthesia care –  Not critical care – Not part-time care – And certainly not a business-type CEO or “closer” trying to get you to book a series of treatments before you know if they’re even appropriate for you.

    When your suffering comes from a mood disorder, you need a mood specialist.

    If you’re really sick, you want to go to the best person to figure it out. You’re probably already seeing an expert … or you’ve seen a lot of them.  And if the treatment you’ve had hasn’t helped and you’re considering ketamine, it’s crucial that your psychiatric care is individualized and personalized to fit you, your symptoms, your Seek a psychiatrist who carefully supervises each patient's ketamine treatment when you screen a ketamine clinic.responses, and your personal needs.

    For that to happen, you should be evaluated by a psychiatrist who will work with you — and everyone involved in your treatment — to determine if you’re a candidate for IV ketamine treatment, or if you would be better served by something else.

    You need a psychiatrist who has deep experience with ketamine treatment and its effects on psychiatric symptoms, disorders, and patients …. who is comfortable with medicine, on top of the technology, and knowledgable, skilled and responsive throughout the infusion experience to manage every aspect of it.

    And who is willing to coordinate this aspect of your psychiatric care with everyone else caring for you.

    And so, of course, it’s not the same for everyone. It’s personal. You’re unique. Your story could be filled with dashed hopes, trauma, and a lot of misery. Your history could be sprinkled with substance abuse and infused with shame.  Where you go with it, whom you trust … is critical. Sometimes, it’s a matter of life and death.

    Inferior Standard of Care?

    The early published studies using IV ketamine in treatment-resistant depression used a very small dose — called a subanesthetic dose — administered through an IV pump over a set amount of time.

    Many doctors use this protocol widely.  It’s a strong standard. This delivers a dose of ketamine at a speed that’s fast enough to elicit the therapeutic response we want to see — during the infusion itself and afterwards — but slow enough to keep any unpleasant side effects at a manageable level.

    A full course of treatment is considered to be 6 infusions typically given 3 times a week for two weeks.  Again, based on the early studies that dosed ketamine kind of like ECT is scheduled– every other day.

    Now, for many patients, this regimen is remarkably effective, but with real-world patients, with complex symptoms and complex histories … varied and complex medical issues … or because of a host of other medications they need, their genetic profiles, history of drug reactions medications, severe anxiety … the research-based infusion protocols need to be modified. 

    We can tell this even during the infusion itself based on how you respond during the infusion. Some need a different schedule of administration — and let’s be real — sometimes that’s just due to practical reasons like travel, work schedules, or the inability to get a ride home. We’ve used a variety of intervals between infusions. Just as an example, for patients traveling from out of state, we’ve modified the protocol and used 3 daily infusions and then another 3 the following week, and the results were remission. Sometimes we add additional infusion treatments beyond just 6 to get the best possible outcome.

    The researchers among you could say:  What?  It doesn’t follow the protocol.

    Life doesn’t follow a protocol.

    Neither does real-world psychiatric treatment.

    And the best psychiatrists among us are constantly evaluating and precisely adjusting medication as we work with the biologic, genetic, individual, and psychological factors for each of our patients.

    Especially when we work with IV ketamine as a medical treatment for severe depression and anxiety disorders.

    You should expect nothing less.

    Precision, by the way, is a big deal.  It’s best to use an infusion pump.  Infusion should be by infusion pump not a bag on a hook when you screen a ketamine clinic.Ketamine for depression is a safe drug but it’s a powerful drug for fragile patients with anxiety and mood disorders, and it should be administered with precision using a sophisticated infusion pump.  

    However, many clinics offer ketamine infusions from a bag that hangs on a hook with a little manual roller that adjusts the flow.

    The problem with this is the varying rate of the infusion. If it runs in too fast, you can have scary traumatic reactions or a scary spike in pulse and blood pressure — and if it’s too slow, it may not produce the therapeutic response during the infusion itself or the ultimate outcome we want to see.

    We can control the flow rate with an infusion pump — but without one, the flow rate could be adjusted or altered by anyone in the room. Not good.

    Routes of Administration

    If you suffer from treatment-resistant depression, ketamine treatment is the most advanced and effective treatment available. And it’s amazing to see ketamine at work in someone failed by traditional antidepressants.

    IV – Intravenous Precision

    But not all modes of administration are equal. IV delivery is the only route that allows you to receive exactly 100% of the dose you’re given. The only route.

    For ketamine to create the changes in the brain that relieve depression, you need to get the right dose, and your psychiatrist needs to know exactly how much ketamine your brain has seen in order to get that dose right … for you, for your next infusion, and for your overall treatment. Right dose, right rate, right length of time.

    IM – Intramuscular Gamble

    With IM administration of ketamine, you absorb about 93% of your dose … but not all the time, not every time, and not over the same period of time. What you get is a gamble. When you inject ketamine into muscle, you’re stuck. Literally. You can’t slow it down, you can’t turn it off, and you can’t decide to stop. Your right to discontinue treatment evaporates right there. If you suffer a reaction to ketamine, in the office (or hours later depending on how you absorb it), you have no recourse but to endure until it dissipates and the reaction ends.

    In fact, there’s nothing you can do but let it work its way through the tissues until the reaction subsides. “No” doesn’t work here.  “Um, I changed my mind” doesn’t work here. However, the psychiatrist can slow or stop IV ketamine immediately if you have an unexpected response … or if you just change your mind and say stop. Your psychiatrist can control the speed and intensity of the treatment. It’s just so much safer.   

    IN – Intranasal Roughshod and Random

    On top of that, if ketamine is given intranasally, it’s really poorly absorbed. You receive roughly 45% of the amount you spray. But, you only get that much if you’re lucky — if it doesn’t run down the back of your throat, or get trapped for a while in boggy sinuses. And since the right dose needs to reach your brain in order to work, what you’re doing with intranasal is just sort of sloppy. How could anyone really figure out what the right dose is for you, or what you actually got or absorbed, with all these variables?

    We’re not talking about treating allergies.

    We’re talking about suicide, trauma, severe intractable depression … anxiety that feels unbearable.

    And we’re dealing the brain and with structures — like neuronal dendrites — that have been altered physically and actually pruned, because of those experiences and symptoms … and the complex and delicate systems that operate there. Precise medication doses and rates can carefully change those systems and delicate balances for the better. And can get those dendrites to branch out again and connect.

    Intravenous infusion is the only way to be exact. Precise. Accurate.

    Checklist: What to Look For When You Screen a Ketamine Clinic

    Considering ketamine for depression?  Get a pen, or copy and paste this list.

    Satisfy yourself that all of your questions have been answered.  You want to know that if you undertake this treatment, it will be provided in the safest, most therapeutic and most effective way possible. You should know if your treatment is based on research protocols. Whether it’s standardized. If it’s personalized.

    1. Who is actually evaluating you and determining if this treatment is appropriate for you? Is it within their scope of practice to do the kind of comprehensive psychiatric evaluation you need? What do they base their evaluation on? How much time do they spend? Who do they talk to? How much information do they gather? How do they handle substance abuse?

    2. Is the doctor who does the evaluation the same one who provides treatment?

    3. Is the doctor who provides ketamine treatment specialized to be able to treat your condition itself? In other words, is your ketamine doctor a psychiatrist who specializes in treating severe mood and anxiety disorders?  You don’t need a technician here, you need a specialist.

    4. What is the extent of his or her ketamine infusion experience? Ask about numbers, outcomes, whether they keep a registry of their own patient data and results, how they follow outcomes both during a treatment course and afterwards, how they coordinate your care with everyone else who’s treating you.

    5. Is the route for administration of ketamine specifically IV?

    Infusion pump delivers precise dose of ketamine so screen a ketamine clinic if they use one.

    6. Is ketamine given with a computerized infusion pump? Is the dose adjusted during infusions or throughout the treatment course? How often? Is the adjustment standardized or does it vary?

    7. Is there a recommended frequency? What is their experience with the number of days between infusions? And with extending a course of treatment for a patient?

    8. How are you monitored psychologically during and after your treatment … or how is the treatment experience processed or integrated? Is there continuous monitoring of your vital signs?

    9. How do they work with the set and setting (your mindset and the treatment setting) to help you have the best possible outcome?

    10. What happens when it’s over?

    Delayed Response Doesn’t Mean Un-Responsive

    With all this said, the fact remains that ketamine doesn’t help everyone.  Or at least it doesn’t seem to help everyone. At least not within the typical infusion course. But … we’re learning more about these non-responders all the time and we’re learning about them in our offices … probably because we’re in the trenches.

    For instance, if you didn’t show a definite improvement within the first couple of infusions, we used to assume that ketamine was just not going to work for you.

    However, over time and with experience we’ve learned that some patients actually have a slow, delayed response to ketamine treatment. It may be weeks before they begin to experience the benefits of the ketamine treatment, but once it starts, it builds, and you can enjoy the same extraordinary benefits as patients who felt better after the first day.

    There are extraordinary individual stories where this has occurred (after they’ve left devastated that they didn’t respond!) … and we definitely need to learn much more about these treatment outliers and what turns the corner for them in the weeks or months following their treatment.

    For this reason, it’s important to stay in touch with your ketamine doctor and let them know how you are doing over time.

    Ketamine’s Not for Everyone…But It Could Be Just What You Need

    Ketamine isn’t for everyone, but 8 out of every 10 profoundly depressed patients we see whose previous treatment has failed them experience transformation from IV ketamine treatment.

    It’s fast and it’s powerful. For the sake of the rest of your life, your relationships, and your joy, give yourself the opportunity to turn your depression, suicidal thoughts, PTSD, severe anxiety, phobias, or OCD on its ear.

    Let’s talk and see if you’re a candidate for ketamine treatment. You can be free from the terrible weight and despair of depression, anxiety, and serious and compelling suicidal thoughts.

    At Innovative Psychiatry we’re available to offer you this extraordinary, life-changing medical treatment.

    Call us for an appointment to determine if you’re a candidate for ketamine treatment.

    You can feel good again. You can live a fulfilling life.

    To the emerging of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Can Inflammation Cause Suicide? What Can We Do to Stop It?

    Can Inflammation Cause Suicide? What Can We Do to Stop It?

    Can inflammation cause suicide?

    Really?? Can Inflammation Cause Suicide…?  Or Suicidal Thoughts?

    Maybe you’ve just reached the end of your rope. The long dark days, the despair of watching everything always go wrong, the deterioration of your relationships, the exhaustion and inability to think well enough to do your job…and that feeling that you despise yourself. Loss of self-respect was the final straw.

    It all culminates in a dark, rumbling thunder cloud in your mind. And every day you wake up you feel angry that you’re still alive. You prayed last night that you wouldn’t wake up, that you’d finally be released from this horrid existence.

    Depression can come for lots of reasons, or it can come for no reason at all.  If you’ve endured the long dark halls of major depression, tried one medication after another and have never gotten better … if you’ve worked with more than one psychiatrist without any benefit…

    Maybe you’ve just reached the end of your rope.

    Where Does Suicidal Thinking Come From?

    Do you ever wonder why you sometimes feel like you want to stop living when you’re depressed?  Why some people never have a thought like that…but you do?  What causes suicidal thinking anyway? 
    Can inflammation cause suicide? Young man sits on train tracks.

    We’ve all assumed it was just the way one person responds to terrible, heart-breaking depression versus another. That people are different and respond to things differently.

    New Discovery About Suicidal Thinking

    But, there’s some new information about major depression, and especially the suicidal thinking that sometimes goes with it. Researchers in the UK have discovered a link between inflammation in the brain and the presence of suicidal thinking and intent.

    Dr. Peter Talbot and his team at the University of Manchester found that there is a marker that’s increased in the brain of depressed patients who were contemplating suicide. It turns out this microglial activation marker is a sign of inflammation, and was only elevated  in depressed patients with suicidal thoughts — not in depressed patients who weren’t suicidal.

    They found the most dramatic elevation in the anterior cingulate cortex through brain imaging. This part of the brain is where mood regulation happens, and many of us think it could be the focal point where depression starts.

    In the past, the closest researchers had come to detecting this connection was by studying tissue samples from deceased patients. But this is Can inflammation cause suicide?the first time that elevations of this microglial marker have been identified in severely depressed patients who were alive and able to talk about the severity and the torment of their suicidal thoughts.  And this inflammatory marker is specifically a marker for suicidal thinking in depression — not for depression itself.

    So Now What?

    Now, you may wonder … so what? What we can do with this information??

    Well, for one thing it helps a lot to think that in some cases, specifically those depressed patients who are thinking about suicide, we might be able to find anti-inflammatory treatments that may actually help their suicidal thinking.

    Does this mean we’ll start prescribing two Advil for suicidal patients, with instructions to call us in the morning….?

    No. Of course not.

    Still, this is a first step along the path of research to help us provide more individualized and personalized care for our patients.

    … It may turn out that … targeting inflammatory pathways and the release of inflammatory factors in the brain — on the other side of the blood-brain barrier — may help to manage suicidal thoughts in depressed patients … It may turn out that bioavailable curcumin, a potent natural anti-inflammatory that easily crosses into the brain, will become an even more critical supplement for us to study and to offer to our patients who are depressed … and suicidal.

    Long story short, the human brain is medicine’s last frontier.

    The complexities of the neurons, their connections, the vast array of chemical reactions that lead to signals that zoom around to create your feelings of love, joy, anger, sorrow – and depression – and the physical structures that determine your cognition and your mood, are the focus of extensive research among neuroscientists around the world.

    The more we learn through the research of neuroscientists, the clearer our path can become treating certain patients. Because it all comes down to the fact that no two brains are alike. We’re each unique, and the response of our brains and personalities to our individual circumstances and genetic makeup varies.

    So, for those patients who are deeply depressed and are thinking about ending their lives … following the path of investigating their level of brain cell Can inflammation cause suicide? Standing on ledge about to jump.inflammation may soon be a viable part of an overall treatment plan.

    At the same time, as a result of explosive research, we’ve found that ketamine treatment has an extraordinary effect on suicidal thinking. And… we can treat that in those with treatment-resistant depression right now.

    We know, and have seen in hundreds of cases, that IV ketamine stops suicidal thinking in 80% of treatment-resistant suicidal patients. And it can do it within 4 hours — and often in just the first hour. For most people who suffer from severe depression and torturous suicidal thinking, IV ketamine is a treatment that can give them emergency relief. It will allow them to just go home … have dinner … go to bed like anyone else … and wake up refreshed. And alive.

    And for many, it will continue to help them feel better, think more clearly, and process their emotions. In fact, process them so well that they can invest in therapy to change the way they respond to life’s events and build a healthy, better life for the long term.

    For that 20% who aren’t helped by ketamine, it’s great news that research is breaking through more mysteries. Because treating suicidal struggles in depressed patients is a life or death matter.

    If you can relate to this concept of suicidal thinking, and if your thoughts head in this direction at times, call us. We can arrange an appointment to discuss whether you’re a candidate for ketamine treatment.

    We can help you get your life on the path you want it to be.

    To the restoration and health of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Ketamine: PTSD and Depression Treatment For Veterans …and For You, Too

    Ketamine: PTSD and Depression Treatment For Veterans …and For You, Too

    PTSD and depression treatment - ketamine.There’s No PTSD and Depression Treatment Like This Treatment: IV Ketamine

    Do sudden noises make you jump and feel like your heart just stopped?  If someone pats you on the back while saying hello, does it take everything inside you to keep from beating them to the ground?  Do you find yourself on edge, feeling more and more tense and vigilant as the sun goes down…? 

    If this sounds familiar, you may be suffering from Post Traumatic Stress Disorder, or PTSD.

    PTSD is cruel, and happens as a result of severe traumatic experiences that live on in your head even after the event is over.

    Military men and women who’ve seen active combat sometimes suffer from PTSD. As time passes, the symptoms are more likely to become worse than better.

    PTSD Caused By More Than Combat

    But, it’s not only the combat zone that causes it. It can be caused by a dangerous event, like a car crash, or domestic violence, or a major natural event.

    Whatever the original cause, PTSD has a way of creating a life of its own. You tend to reach a point where you separate the past from the present based on date of that event. Life before the trauma, and life after the trauma.

    That particular battle where you were ambushed, and your friends were maimed or killed.

    That specific day when the beating was so vicious, his rage so terrifying, that you dream about it every night and wake up in a cold sweat.PTSD and depression treatment are needed for domestic abuse.

    That storm of storms that ripped your house apart while you trembled in the bathtub with your children…

    As painful and terrifying as these memories are, many people just don’t know what to do but try to white-knuckle the nights of terror, then pull themselves together and muscle through the days.

    The trouble is, “just muscle-ing through” doesn’t improve the symptoms. At least most of the time.

    Instinctive Responses to PTSD Symptoms Don’t Help You Get Better

    People tend to respond to the horrific symptoms of PTSD in either of two ways.  Either they avoid thinking about the event, the traumatic memories, and anything associated with it, or they become extremely alert and on edge.

    If you’re trying to avoid thinking about the painful and terrifying memory, it might look something like this:

    • You’d probably avoid going places, or seeing people that reminded you of what happened. 
    • You’d also likely avoid discussing it with anyone, or talking about anything that might stir up the memory
    • As a result, you’d likely not want to be around other people, since you can’t know when someone might talk about something that conjures that pain
    • And you’d probably feel safer just not going out, and not making plans to do much of anything in the future, because you just feel safer at home.

    PTSD and depression treatment ketamine is the only fast acting treatment available.On the other hand, if you’re one to respond to this trauma with extreme alertness, you might have these reactions:

    • You can’t go to sleep or even if you can, it doesn’t last.  Sleep becomes almost impossible to maintain.
    • Emotional outbursts are frequent, out of proportion to the circumstances, and leave others shaken and you embarrassed.
    • Concentration is tough. Focus almost impossible.
    • Irrational reactions to common everyday things like a barking dog, a ringing doorbell or honking car, or even someone patting you on the back…

    These are part of your daily life.

    PTSD and Depression Treatment

    As widespread as PTSD is, you’d think treatment would have been figured out long ago.  But that’s not the case. Until now, PTSD and depression treatment have been limited to certain SRI’s that have been prescribed like Zoloft and Paxil, with limited results. These are the only two medications approved by the FDA for PTSD. But they aren’t always effective.

    PTSD has a long-standing reputation for being really hard to treat. And that’s been especially true among those who are serving and have served in active duty military settings. In real English: Combat.

    Combat PTSD Conference

    On October 18 of this year, Dr. John Krystal, Chair of the Psychiatry Department at Yale University, spoke to a group of researchers at the PTSD and depression treatment ketamineSan Antonio Combat PTSD Conference.

    Dr. Krystal studies ketamine, and how it affects the brain. As he spoke, he expressed that ketamine works rapidly relieving symptoms of depression in trials, and some patients showed a reversal of symptoms after just one intravenous dose.

    With excitement in his voice, he spoke about the astonishment of working with people who suffer from treatment-resistant depression, and seeing their response to a single dose of ketamine. He said, “it’s the most remarkable thing I’ve seen in my career…!”

    When he spoke about ketamine’s impact on men and women with PTSD, he noted that while not all achieve complete remission from symptoms, the average achieve 50-75% reduction in symptoms. Since traditional antidepressants only provide about 10% reduction in symptoms, this is clearly a remarkable relief for these patients.

    And, he added, ketamine’s dramatic improvement over symptoms isn’t the only reason for its promise for PTSD patients.

    Its rapid onset makes it the one medication that can reverse the suicidal thinking fast in these people.

    Ketamine Does More Than Anesthetize Symptoms – It Restores Brain Structures

    As we’ve talked about here before, PTSD and depression can cause the synaptic structures in the brain to break down. Dr. Krystal refers to this as “loss of synaptic connectivity.” When these breakdown, certain mental functions are impaired. Things like memory, planning ability, andPTSD and depression treatment is most effective with ketamine. emotional control are greatly affected – as seen in patients with PTSD.

    The beauty of ketamine is its action in restoring those structures, replenishing them, and doing it very fast.

    A 4 week study is underway on ketamine and its use in PTSD. The study takes place in San Antonio, TX and West Haven, CT, involving nearly 200 military personnel. The aim of the study is to test various ways of dosing ketamine, and its effectiveness.

    We welcome studies conducted to learn more about ketamine. My professional reaction to the impact of this remarkable drug on those who suffer from PTSD, depression, and other psychiatric mood disorders is similar to Dr. Krystal’s: “It’s one of the most remarkable things I’ve seen in my career.”

    Ketamine: Most Remarkable PTSD and Depression Treatment Out There

    At Innovative Psychiatry, we’ve consistently seen 80% of cases of PTSD, depression, anxiety, and other mood disorders achieve a strong response to ketamine treatment. We offer a variety of innovative treatments, but ketamine is hands-down the most extraordinary PTSD and depression treatment we offer.

    If you suffer from PTSD, you know that this condition can wreck your life and relationships. You know the helplessness and shame you feel after flashbacks, irritable over-reactions, and night terrors.

    I’ve heard PTSD patients who endured traumatic combat experiences say they refuse to see anyone who hasn’t been in the military. And I PTSD and depression treatment ketamine brings relief. understand why.

    But, this medication is not like the others. Patients with PTSD emerge from ketamine treatment feeling as if a weight has been lifted off, feeling more at ease, less vigilant, and more able to process their trauma.  They feel more resilient, more able to contribute to healthy relationships. They feel safer in their own skin.

    After treatment, we encourage you to work with your own psychiatrist or therapist to continue to rebuild your life. You’ll most likely find your ketamine treatment has dramatically transformed your ability to process the trauma you’ve experienced, your outlook, and your desire to move forward in your life.

    To the restoration of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

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