Lori Calabrese, MD

Author: Lori Calabrese, M.D.

There’s More Proof That Ketamine Works for Depression

Ketamine Makes Time Magazine!

Jun 21, 2017

TIME Health

For more, visit TIME Health.

For decades, scientists have searched for a new type of antidepressant, one that works differently from the 20-plus drugs already on the market. Finding a new option is crucial, since a third of people don’t respond to available depression treatments.

They haven’t had much luck — except for the discovery that IV infusions of ketamine hydrochloride, an FDA-approved anesthetic, can cause rapid antidepressant effects in many people with stubborn depression.

Figuring out exactly how ketamine has these effects has been a researcher’s dream, since ketamine is too problematic a drug to currently be considered a mainstream depression treatment. It’s illicitly used — and abused — as a psychedelic club drug and can cause hallucinations. Ketamine can also have negative side effects when used off-label to treat depression, including unexpected changes in heart functioning, cognition and respiration. Its antidepressant effects fade, so it typically has to be given over and over again, and it’s not yet clear how safe or effective it is when taken long-term. Developing a drug that works like ketamine, but without all the baggage, is the holy grail — but scientists haven’t known quite what to target.

[Read the Full Article Here]

June 23, 2017
Joie de Vivre with IV Ketamine Can Replace Last Resort Treatments

When Depression Doesn’t Get Better

When you’re sick of one more trial. One more dose increase. A new augmentation agent. Another cross taper…reducing dosage on one drug while increasing it with another… When you’re sick of just feeling so sick and tired and miserable. When you can’t stand the thought of gaining more weight. What then?

With the rising use of IV ketamine infusions for treatment-resistant mood disorders, more and more people who are sick of their symptoms are seriously stopping and thinking about their best course of action. Since oral antidepressants can take weeks – if not months – for their full benefits, people are looking at brain-targeted treatments that have faster results.

Life Threatening Symptoms

One reason is that the suicidal thinking that can occur with depression can be life-threatening. If you have thoughts that it would be a relief to be dead, or thoughts of killing yourself, waiting 2-3 months for oral medication to kick in and relieve these thoughts can be dangerous.

Another reason is that once you reach the point that you’re looking for alternatives to oral antidepressants, you’ve probably been depressed for months or years. And the longer it goes on, the more life-robbing it becomes.

Then, there are studies that show the longer someone suffers from a psychiatric mood disorder, the harder it is to get better. And the more medications you try . . . the less likely that another SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin-norepinephrine reuptake inhibitor) is going to help.

So you try a different class. You take one of the medications on reserve that we pull out when other things don’t work.

. . . And your symptoms slowly become “treatment-resistant” — even though you take what you’re supposed to take, do what you’re supposed to do. You keep every appointment, try to exercise, meditate in the morning. Sometimes nothing seems to make a difference. It’s exhausting even thinking about it.

These are all reasons to shift to a different treatment … an innovative one that can go above and beyond oral antidepressants.

Now wait just a minute… oral antidepressants help lots of people…!

Yes. They do. Millions.

Actually, 350 million people in the world are depressed.

16 million in the US.

4% of kids between ages 8-15 are, too.

Anxiety disorders are the most common mood disorder in the US — and 18% of adults suffer from anxiety disorders … almost 57,000,000 people.

Shocking, isn’t it?

Anxiety is the most widespread of all…

Every single one of these millions of people struggles and the struggle is real. Sometimes it’s just to get out of bed in the morning, sometimes it’s being paralyzed by a vague fear, sometimes it’s just to follow through and do what they know they should do — make the phone call, finish cleaning up the yard, deal with the paperwork. They can be pretty disabled by malfunctions in specific portions of their brain. Is it any wonder that so many take antidepressants hoping for relief that will allow them to function?

Most just want to be able to get back in the game.

Over 10% of Americans take antidepressants for depression and anxiety.

And we know that they’re really helpful for some people.

Just not all…not by a long shot.

Only HALF the Time

Jennifer Payne, M.D. is director of the Women’s Mood Disorders Center at The Johns Hopkins University School of Medicine — my alma mater. She says, “Even our best antidepressants work only about half the time.” And she goes on to say that the chance of success drops if the patient doesn’t respond to the first drug they try. In fact, the hope of recovery diminishes with each new antidepressant regimen that fails.

Their mood disorder slowly becomes “treatment-resistant,” even if they’re not. It’s for those who still suffer that we’re discussing options today.

Like IV ketamine, TMS, and ECT.

ECT – Its Troubling Side Effect

Until recently, after all the failed med trials, the gold standard for treatment-resistant depression was ECT, or Electroconvulsive Therapy. (The snazzier new term for it is Electrocortical Therapy. They took out the “convulsive” part.)

ECT has been in use in psychiatry for over 80 years, and it’s still available at hospitals for inpatient and outpatient treatment. Although it gets a bad rap in the popular press and in the media, it can be a lifesaving, effective treatment for severe depression and particularly for depression when psychotic symptoms are present — like hearing voices, or having delusional beliefs.

With ECT, you’re given general anesthesia and an electric current is passed through your brain to create a generalized seizure that lasts 30-45 seconds under very controlled circumstances, with muscle relaxers. The seizure is “seen” on an EEG monitor but your body doesn’t shake or convulse — just a toe wiggles. Treatment begins in a hospital center after you’ve been admitted as an inpatient and continues three times a week until the depression lifts–sometimes after 4 or 6 or 12 treatments.

ECT may be continued on an outpatient basis and stretched out and administered on a maintenance schedule (sometimes as infrequently as once a quarter) to help preserve remission.

Sometimes, ECT is offered on an outpatient basis to patients who can safely remain at home with family support — but they usually can’t work or go to school or drive during the weeks of treatment.

Clinical studies show this treatment to be 50-80% effective in reducing depression symptoms, and in those cases the patient feels much better. Because of this, ECT has been the “go-to” treatment for those with treatment-resistant mood disorders for whom no antidepressant regimen was successful for many, many years.

But there’s a problem with ECT.

Despite all of the modern advances in the administration of this treatment, ECT can inhibit the ability to lay down new memories around the time period of the treatment, and it can cause irreversible memory loss in a “piece-y” kind of way.

Bits and pieces of memories are lost. Certain things or certain periods seem fuzzy. It’s frightening because it can involve both recent and remote memory.

Well, when you’re at the end of your rope, when it feels like there is no choice, maybe a little bit of fuzzy thinking or poor recall around the time of ECT doesn’t seem like such a big deal . . .

But if you want to go to a wedding, recall a client’s name or the details of a contract, have an important discussion with your wife (or your accountant), drive to your cousin’s summer place without having to use a GPS … then fuzzy thinking, poor recall, or no memory of it at all are incredibly BIG things. It’s to be able to engage in and savor the moments that you’re getting treatment in the first place.

Remember, ECT was the “go-to” alternative treatment for treatment-resistant mood disorders because there was no real alternative.

Until now.

Now, there are more options, like TMS and IV ketamine infusions.

TMS Offers A Strong Success Rate And It’s Non-Invasive

TMS, or Transcranial Magnetic Stimulation, is a non-invasive treatment option that’s become more and more prominent in recent years. It’s more expensive than meds, but it’s effective for treatment-resistant depression as well other mood disorders and other maladies.

It’s Non-invasive. Nothing enters your body.

In this case, you’re is seated in a comfortable reclining chair – fully awake – because there’s no need for sedation. A magnetic coil is placed over your left temporal lobe just over the dorsolateral prefrontal cortex … and it sends pulses through your scalp into brain centers just below the surface. The pulses stimulate brain cells to send signals deep into the brain to activate, restore, and bring balance to the areas of the brain that control mood and anxiety.

TMS can be effective in 55-75% of people with treatment-resistant depression and other mood disorders. Because it’s non-invasive, there is nothing that lingers in the body to create lasting side effects between treatments or in the long-term. The effect that’s sometimes reported is a headache in the area where the tap tap tapping is heard when the impulses are released. This subsides in a little while.

No memory loss.

Great success in reversing depression.

No need for hospitalization… no need to suspend driving… no need for a leave of absence from work or from school like with ECT — even outpatient ECT.

For so many reasons, and for so many people, TMS is a much better alternative than ECT, which has become a last resort.

But there’s more… and I’ve probably saved the best for last.

TMS is effective, comfortable, and safe.

But there’s another option that’s even more effective.

That’s IV ketamine treatment for depression and other mood disorders.

IV Ketamine Can Replace Last Resort Treatments

Ketamine infusions are best given IV to ensure safety and to guarantee bioavailability — so that 100% of your precise dose (down to a tenth of a milligram) quickly reaches the areas of the brain and can get right to work. Like ECT and TMS, it’s recommended for those who have first tried an oral antidepressant without improvement.

You’re seated in a comfortable reclining chair (or maybe stretched out on a leather sofa!) in relaxing surroundings during the infusion. This treatment is so fast and effective, many patients are feeling better by the time the infusion is over.

Ketamine also treats suicidal thinking, basically erasing suicidal thoughts within 4 hours. This life-saving feature makes it a most desired choice for those who are are suicidal.

It’s a breath of fresh air. For some people, it feels like their first breath.

IV ketamine is typically given in the office as a series of six 40 minute infusions over about 2-3 weeks. And then you walk out … and go to dinner, get some sleep, and drive yourself to work the next morning or scoot off to class. There’s no hospitalization, no lost time. At Innovative Psychiatry, we schedule ketamine infusions in the evenings, so you don’t have to miss work or school. No one needs to know.

Like TMS, there are no side effects between infusions. There’s no memory loss. Period. That’s HUGE. During an infusion, you might experience mild nausea, so we just plan to avoid that altogether for you. There’s also a floaty, dissociative effect during an infusion — you should expect this. Most people find it very pleasant , not frightening, and it’s actually predictive of a good response to treatment.

Of course, there are other rare side effects of ketamine when it’s used in high doses in anesthesia. But we just don’t see them in our practice.

The effectiveness rate of IV ketamine infusions in our practice is 80%. That means that 80% of people who come in with treatment-resistant depression can get WELL. Depression symptoms disappear. For some people, maintenance infusions are used to maintain this wonderful, balanced, quality of life.

Joie de Vivre – the Joy of life.

If you’ve struggled to break out of the hollow, dismal, dark place of depression, consider this thrilling treatment. It can fill you with HOPE, then transform that hope to real, here-and-now, life-joy.

For us, it’s exciting to see people who have been so terribly ill come to life again. Live again. Love again.

The old days of suffering…without hope… are behind us.

There is hope for you, even if you haven’t been helped by antidepressants before.

Let’s meet and discuss new options.

To the recovery of your best self,

Lori Calabrese, M.D.

June 19, 2017
Breaking News: Another Way IV Ketamine SMASHES Depression

Another way IV Ketamine SMASHES depression

Sometimes news is so hot it sizzles.

It lures you away from whatever you’re into. It captivates you. And then — just face it — you think to yourself, with admiration, OMG. You say to yourself … whoever came up with that is brilliant. They nailed it.

Well, Mark Rasenik and his group from the University of Illinois Chicago College of Medicine nailed it. They presented absolutely breathtaking work in May at the SBP meeting — the Society of Biological Psychiatry. It’s the meeting where research is presented that is just so brilliantly conceived and executed that it’s mind-blowing.

Rasenik’s work is like that.

He and his group came in from left field with their brilliant discovery of a new way ketamine works which just might explain how and why it can begin to lift depressive symptoms in minutes.

Understand ketamine’s talents, then get creative

The goal was to learn what happens on a molecular level that causes IV ketamine’s fast depression relief. Because, of course, someone wants to design a drug just as effective as ketamine but without its side effects. This is the ever-loving quest for new drugs that wannabe like ketamine.

Now, we’ve talked before about how IV ketamine acts on synapses to stimulate them to grow, branch out, and flourish — multiplying the numbers of connections between neurons that send signals deep into the brain. We’ve also talked about neuroplasticity, and how it’s key to this process that causes the brain to change.

As new synaptic connections are built, and greater communication between brain cells develops, the brain gains the ability to see things in a different perspective, and your outlook becomes brighter and healthier. IV ketamine can jump start that process. Wait. No. It can turbo-charge it.

How to Get Those G’s Back to Work

So Rasenik and his team found that “g proteins” were packed on “lipid rafts” in the cell membrane with people who are depressed. In addition, their brain cell signaling is stifled, which may be the cause of that numbness depressed people experience.

If this is you, listen up. Numbness is no joke.

They’ve demonstrated that when SSRI antidepressants are used, they move g proteins from lipid rafts (I love that visual…like the G’s are languidly floating on a raft in the pool…taking time off being lazy) very gradually, and back into WORK mode. Which is how SSRI’s help some people who are depressed — but it takes weeks or months for relief.

You see, G proteins produce cyclic AMP, which is vital for the nerve cells to properly send their signals.

And, Rasenick and his team noted that the movement of the G proteins under the influence of SSRI antidepressants, was gradual … over a period of several days.

So, let’s take a breath here.

The Many Talents of IV Ketamine

We’ve talked about how IV ketamine stimulates neurons to flourish, grow branches, and become prolific with healthy connections for sending signals throughout the brain, especially into the deep brain structures like the hippocampus.

Now, Dr. Rasenick and his team have discovered that IV ketamine also gathers up the tools the nerve cells need so they actually can send signals throughout this new and bountiful network of connections, or synapses.

Those unemployed g proteins that were hanging out on the rafts, are pulled off the rafts and put to work to equip the brain cells to do their job.

And they work fast.

Remember how it takes several days for the g proteins to move off the rafts with an SSRI? Well, with IV ketamine, it happens in 15 minutes!!

So … do you see why ketamine acts so fast to remove suicidal thinking and depression?

I’m telling you, the more we know about IV ketamine, the more hope explodes with all of its potential.

Letting Go of OLD Ideas

There’s been a belief for years that ketamine’s one action was to block NMDA receptors. (Boy, does that seem like the dark ages now!) But ketamine is the only drug that blocks NMDA receptors AND moves g proteins off lipid rafts. It’s a double whammy, a one-two punch!

Once again, ketamine shows its highly targeted prowess in its assault on depression and its potential for assault on other psychiatric disorders.

In addition, ketamine and other compounds like it, improve glutamate levels, which SSRIs really don’t touch. When the processing of glutamate doesn’t function properly, that also contributes to depression.

So…wait a minute…that’s three actions ketamine uses to turn depression on its ear!

Oh, and the fourth: it turns on mRNA … to turn on DNA … to make more BDNF (Brain Derived Neurotrophic Factor) so that neurons grow new branches.

The Four Ways. Four different ways that ketamine smashes depression. This has brought a level of excitement into psychiatry like nothing else.

Someone should write a book.

A full 80% of those who are treated with IV ketamine infusions in our office respond, and many of those achieve complete remission of their symptoms. But, I’ve said before that it isn’t for everyone. If it’s not for you, we have other treatments like TMS to help you get better.

If you have symptoms of depression (chronic, recurrent, bipolar, postpartum), PTSD, and treatment-resistant OCD and have not been helped by anti-depressants, call or email us to arrange an appointment for a consultation. We’ll thoroughly check you out, and analyze what we learn, to determine the treatment most likely to truly help you feel better. I don’t mean to reduce your current symptoms, but to actually get well.

We’re Innovative Psychiatry. (Um, you’d have to be to translate lipid rafts and g proteins into treatment that works in your office … ) And we’ll work with you to find the best steps that will help you get well and live the life you want to live.

To the discovery of your best self,

Lori Calabrese, M.D.

June 8, 2017
Obsessive Compulsive Disorder Treatments Change the Game
Just because it feels natural…doesn’t mean it’s good for you

Macie is a 32 year-old administrative assistant who feels growing tension when she leaves the house. She opens and closes the door, locks it then unlocks it, and opens and closes it again to be sure it’s latched. Then locks it… and unlocks it. It doesn’t feel secure yet. So she repeats this ritual five times. For some reason, after the fifth cycle, she can finally leave. So she does.

She gets in the car, puts her key in the ignition, and starts it up. Then she turns it off, takes her key out, then reinserts it, and starts it up again. After three cycles, she’s ready to back her car out of the driveway.

These behavior patterns of repetitious cycles follow her through her day. For instance, when she goes to the restroom at work, she washes her hands, rinses them, and examines them. But they don’t feel very clean and the idea of the germs that are probably still there makes her shudder… so she sticks her hands back under the water, soaps them up, rubs them together and wrings them, rinses them, and turns off the water.

Nope…not there yet. It takes at least 3 more cycles like this before she can dry her hands and leave the restroom. She uses a paper towel to turn the doorknob.

People can be cruel.

Macie didn’t think much about these rituals until someone commented…someone else laughed… then became impatient waiting for all this to be completed. The comments of others began to wear on her…and she started to realize that maybe she was different than the others around her. And she felt ashamed.

She isn’t the fastest worker in her office, because of all these cycles that slow her down. But she has an eye for detail…and is great with spreadsheets. Meticulous, careful, accurate.

Her husband, Josh, learned long ago to be patient and tolerant. It didn’t take long for him to realize that pushing her, pressuring her to hurry up and get moving, only resulted in her anxiety shooting up, her tension doubling, and then . . . instead of 5 cycles to lock the door, she needed 12, and instead of 3 hand washings, she needed 9.

In short, heightened anxiety just made everything harder … and worse.

Why do some people act this way…?

Macie has Obsessive Compulsive Disorder, and only recently she realized it’s affecting her job, and her friendships.

Obsessive Compulsive Disorder is a combination of recurring, intrusive, unwanted or disturbing thoughts or ideas that cause a person to feel unsettled and distressed. Then, to relieve the misery they feel, they’re driven to perform a repetitive action. Behaviors like these — such as Macie’s hand washing or checking the door locks — tend to interfere with their daily functioning to a dramatic degree.

Now we’re not talking about someone who locks the door twice and goes on his way. The rituals referred to here are so numerous and compelling that people like Macie have a difficult time maintaining a job, or maintaining relationships, because of them. The pressure to keep going through the cycle until it feels right is so great that if the cycle is disrupted, it causes terrible stress and consternation.

You know that feeling you have when you’re on a road trip and the second day you can’t remember if you left food and water for the cat…? You don’t want to go back and start your trip over, but you also don’t want your cat to starve. It’s so troubling, and anxiety builds until you resolve the situation.

Well, multiply that distress by about 50, and you’ll have a glimpse of the distress Macie feels about failing to lock that door. Then imagine this happening all day long.

OCD is like having a huge nasty bully in your head

…that no one else can see

In Macie’s case, she knows in the back of her mind that the fears she has aren’t real…but logically knowing it doesn’t ease her distress. Because this is not a logical problem. It’s rooted in anxiety that doesn’t go away. Anxiety she doesn’t understand, and can’t explain away. So she continues with her routines as if they’re just part of everyday life. Every day.

For her…they actually are.

In many cases, someone with OCD doesn’t seek treatment until they’re fired from their job or lose a relationship with someone who ran out of patience. When sorrow mounts that’s caused by their OCD behaviors, they get ready to seek help.

Is OCD common?

About 1.2% of adults suffers from OCD, which can begin in childhood, adolescence, or adulthood. If you have parents or close family members with OCD, the risk of developing it is higher for you.

Also, if you have another psychiatric disorder, that also may increase your risk of developing this one, too.

And then there’s trauma. When a terrifying or profoundly distressing experience presents itself, it draws a reaction from you. Your reaction may be fear of it happening again, or disgust at the thought of it, or some other disturbing feeling. For some people after an experience like this, a pattern of coping goes into play. To keep the thought of it out of your mind, you do something that’s reassuring or distracting. The disturbing thought is often connected to the repetitive action.
- Fear of sickness from germs or chemicals => may result in feeling driven to clean incessantly, repetitively washing and washing your hands…even being afraid to touch people or objects others have touched.
- Fear of an intruder => may result in repetitive cycles of door locking and re-locking
- Fear of hitting someone with the car => may trigger the need to back up at stop signs, or pull off the road to check, or call the local hospitals
The point is that these distressing thoughts can compel the person who’s suffering to perform certain rituals, and those rituals can interfere with normal functioning in a productive life. In fact, they can be debilitating.

Is there treatment?

Yes, there are medications that bring relief in some cases. But of the patients who take medications, 40-60% receive partial relief or none at all. There are therapies like CBT and exposure therapy that sometimes help to ease the disturbing and intrusive thoughts, as well as the compulsions. But these treatments leave only about 10% of people with OCD successfully treated.

Which calls for innovative treatments.

Obsessive Compulsive Disorder Treatments

For this reason, we offer other options, like Transcranial Magnetic Stimulation, for patients who haven’t experienced relief from Obsessive Compulsive Disorder through medication and therapy. TMS is not systemic, so there are none of the side effects like you may experience with antidepressants.

IV Ketamine also shows great promise and success in treating OCD. Like TMS, IV Ketamine is a treatment that targets brain structures to bring relief to OCD symptoms.

Obsessive Compulsive Disorder treatments change the game.

We can learn more about what you need to feel better… LIVE better….through a thorough psychiatric evaluation. If you’ve suffered with the harrowing symptoms of OCD and have not experienced relief from the medications you’re taking, let us help match you to the solution best suited to you.

Helping you to find the life you ache to live is our highest, never-ending goal. Let’s join forces to find your solutions.

To the emerging of your best self,

Lori Calabrese, M.D.
June 1, 2017
Could Ketamine Help Cure Depression?

Ketamine is an illicit drug known as “Special K”, but it could have some legit antidepressant effects.

By Rachel Jacoby Zoldan | May 16, 2017

Depression is more common than you might think. It affects more than 15 million Americans, and the World Health Organization estimates that number grows to 300 million when you expand globally. There are a slew of different treatment options available to help alleviate its symptoms—think anxiety, insomnia, fatigue, and loss of appetite among others—with the most common treatment being serotonin reuptake inhibitors (or SSRIs). But since about 2000, doctors and researchers have been experimenting with ketamine—originally a pain management pharmaceutical, now abused as a street drug because of its hallucinogenic effects—as another potential way to treat the condition, according to Ruben Abagyan, Ph.D., a pharmacology professor at the University of California San Diego (UCSD).

You’re probably thinking, “Wait! What?” If you’ve heard of ketamine, also known as Special K, you know it’s no joke or generic OTC drug. In fact, it’s known as a dissociative anesthetic (meaning a drug that distorts perception of sight and sound, while producing literal feelings of detachment from the self and the environment). It’s primarily used by veterinarians for treating pain in animals, but it can also be prescribed to people for severe pain management, particularly those with neuropathic issues, a kind of chronic nerve pain, according to a 2014 study published in the British Journal of Pharmacology.

“It’s known that pain and depression are linked,” says Isaac Cohen, a pharmacological student who worked on the study. “Depressed people are more likely to dwell on pain and people in chronic pain are more likely to become depressed due to decreased mobility, a lessened ability to exercise, and other factors, he says. “Ketamine is unique because it may treat both pain and depression simultaneously, leading to better outcomes for both conditions.” And now scientists are arguing there’s not just anecdotal evidence, but also statistical information that shows ketamine can help lessen the symptoms of depression.

In the first-ever large-scale analysis of its kind, published in Nature, researchers found that patients who received ketamine reported significantly lower instances of depression. This research, conducted by the School of Pharmacy and Pharmaceutical Sciences at the UCSD, reinforces anecdotal data and small population studies that have also suggested ketamine’s antidepressive effects.

What sets ketamine apart from other treatments, specifically, is how quickly it takes effect. “Current FDA-approved treatments for depression fail for millions because they don’t work fast enough,” says Abaygan. Ketamine works in a matter of hours. That’s far less than SSRIs, for example, which can take six to ten weeks to reach their full capacity. And that difference in timing could quite literally be a matter of life or death, especially with those who are experiencing suicidal thoughts.

For their research, Abaygan and his team reviewed data from the FDA’s Adverse Event Report System, an agency which collects information about adverse effects (or unintentional effects of any kind) of any approved drug that has been reported by pharmacists and doctors. Specifically, they found 40,000 patients who were prescribed medication for pain and separated them into two groups—those who took ketamine and those treated with alternative pain medications (excluding NSAIDs).

The results showed a rather significant “bonus,” albeit unintended, effect. Half of the people who treated their pain with ketamine reported being less depressed than those who had taken alternative kinds of pain-reducing medication. Although we don’t know whether any of these patients, particularly those on ketamine, were experiencing depressive symptoms before taking any meds, the positive effect on mood, coupled with the common link between pain and depression, could warrant further discussion on ketamine’s use to treat depression more directly.

According to the researchers, ketamine is relatively inexpensive and if you’ve previously tried at least three other antidepressant medications with no success, it is typically covered by most health insurance plans. Point being? Don’t be so quick to write off ketamine just as a hallucinogen. It might really be special after all. (And if nothing else, guys, check out these ways to manage stress or depressive feelings at any time.)

[Read the Original Article Here]

May 31, 2017
No. 7 Medical Innovation for 2017: Ketamine for Treatment-Resistant Depression (Video)

Hope and Fast Treatment for the Severely Depressed.

For one-third of U.S. patients with depression, standard medications aren’t enough. With nearly 43,000 suicides a year, the need for effective treatment looms large. In 2013, ketamine, a drug commonly used for anesthesia, was studied for its ability to inhibit nerve cells’ N-methyl-D-aspartate (NMDA) receptors. Within 24 hours of receiving ketamine, 70 percent of patients with treatment-resistant depression saw an improvement in symptoms.Cleveland Clinic experts predict that 2017 will be the year that NMDA-receptor-targeting medications become widely available.

In this video, learn why ketamine for treatment-resistant depression is one of Cleveland Clinic’s top 10 medical innovations for 2017.

[Read the Original Article]

May 31, 2017
Mom’s Nurturing: Your Cooing Nourishes Newborn Neuron Growth

Mother’s Week

Did you enjoy Mother’s Day? Maybe you celebrated the day, or maybe it was a weekend whirlwind, but I’m hoping the people in your world have been celebrating the moms they love and appreciate all week long!

If you’re a mom, you know what mean. No gesture is too small. But even if you’re not a mom, I hope you’ve been celebrating and enjoying the moms around you. You know why…? Because showing appreciation enhances your own life, as much as it does the one you appreciate.

Mother’s Love

Now then . . . if you’re a new mom, I’m going to take a wild guess and assume you’re pretty exhausted. But in spite of it, I hope you’re peeking through your bleary eyes and feeling enthralled at the wonder that is your precious newborn.

She has your nose, you can see that. And maybe her daddy’s chin? Her hands are a new version of your mom’s…and her ears…well, they look like your brother-in-law’s, but in the tiniest, sweetest form… The more you study her sweet little face, the more you fall in love with her.

You want to do everything you can to make her life wonderful, warm, secure, and full of love. You want her to have the best nutrition so she can grow and develop to her best potential. You’ve looked for the safest car seat, the best pediatrician, the softest fabric books, the smartest toys already, right?

There’s so much to think about. SO much to worry about.

Do you get a pang sometimes, feel inadequate to be the mom she needs you to be? Even wonder if you can live up to her needs as she grows…? It’s completely natural to second guess yourself, in fact, most mothers do at some point. And to sometimes judge yourself harshly — too harshly — as if there were a thousand ways that you’re too poor or too busy or too scatter-brained to be the mom your baby needs you to be.

Oh Mama, we gotta talk.

Good news . . . for good moms

Here’s the good news.

With all the things you want to provide her…the best nutrition, the best opportunities, best schools, best tutoring, best tennis coaching, best, best, best…there’s something you’re already doing that’s such a huge benefit to her, so life changing . . . and it’s almost effortless.

Something that makes all the difference in her future. And you don’t need more money or more time or more focus to do it. It happens when you hold her, carry her, feed her . . . just spend time with her . . .

It’s your presence that’s worth gold to her.

Mom’s presence nourishes newborn neuron growth

You see…Your PRESENCE is actually helping her get smarter. Can you imagine such a thing? When she’s with you, snuggled in bed nursing, or in her stroller on a walk to the park, or in her papoose carrier on your chest or back…your presence stimulates the growth of brain cells…it actually speeds up production, and sparks connections, and makes her little brain so much more powerful.

Isn’t that just thrilling? No one can do for her what you do. Your nurturing nourishes neuron growth in your baby. Stimulates her brain to make more connections through brain cells.

In fact, there’s scientific research that proves it.

Neuroscientists at NYU have made some startling discoveries. It turns out a mom who’s engaged and nurturing her infant can apparently have a remarkable effect on her baby’s brain development.

The study showed that when the baby is in mom’s presence, the signaling production of brain cells, or neurons, in her baby’s brain increases remarkably.

When they’re separated, the brain activity becomes erratic, and brain cell production slows down to a crawl. How about that?

So, apparently mom’s nurturing presence helps regulate and control electrical signaling in a positive way that nourishes newborn neuron growth. Isn’t that wonderful?

Your cooing helps her build her language

So…when you’re with your infant, stimulating those neurons to grow and flourish…just by being there… what do you do with her, besides feed her and change her diapers?

Well, that comes pretty naturally, too.

You pick her up and cuddle her, or lift her in the air…kiss her face… and make happy, loving noises…

Bet you talk to her all the time, right? Make cooing sounds? Repeat her noises with your own?

So… why do you do that . . . do you know?

I mean, she can’t talk back, right? She doesn’t talk yet, does she? Or rather, she doesn’t seem to. So why do you talk to her…? And what is that irrational feeling you have that she is actually listening…? Responding…?

Well, it’s not irrational. And here’s why.

Your maternal intuition tells you to coo to your baby… to mimic her noises and joy … and when you do, you’re helping her build language.

University of Washington study shows the link between cooing and language

A team of researchers at the University of Washington studied the sounds we make to our babies and how it affects them. They labeled the sounds we make “motherese”… all those goos and gaas that are annoying to non-parents (who just don’t get it) but are such a delight to your baby.

And the beauty is, they’re a vital part of the learning process for your baby to build language. So your presence is helping her rapidly develop more brain cells to learn with, and your baby sounds help her to put together the puzzle of language.

No matter who you are, no matter where you’re from, no matter what language you speak, if you have a baby, you intuitively know how to slip into a secret language that babies understand.

When you make exaggerated, clear vocal sounds to your baby, it helps her distinguish language from other sounds. This study found that by the time a baby reaches 7 months of age, she can tell the difference between language sounds and other sounds. And by 11 months, she can tell the difference between her native language and other languages.

She’s an amazing baby.

Follow your instincts by cuddling and cooing

There’s lots more to talk about here, about the parental and baby sounds and the role they play in building language, but the point is, you don’t have to worry about expensive clothes, fancy schools, and exclusive camps. In fact, this is one place where no worries is a blessed relief. By just being there, holding and nuzzling your baby, feeding and changing her, and cooing and talking with her back and forth, you’re giving her an excellent start in life…

…by building her neuron development, her capacity to learn, and her ability to develop the power to speak with language that others can understand.

Just by being a loving mom. How incredible.

I’m a mom, too. A mother of four, and I, too, want to celebrate all the wonderful moms who simply love spending time with their children. And who by doing so, are giving them a great start on their own journey in life.

We at Innovative Psychiatry honor moms everywhere this week, and every week.

If you’re a mom, or a dad, and struggle with emotions that interfere with your desire or ability to be the kind of mom or dad you want to be, please get in touch with us for a consultation. Sometimes things go differently than we expected. And when that happens, we need support. And hope.

Don’t give up on finding your best self,

Lori Calabrese, M.D.

May 17, 2017
Straight Talk about Narcissism
How is it that he is just so full of himself? Why is it that everything is always all about her? There’s so much self-absorption these days that it’s dizzying. Seems like experts — on just about everything — surround us. People who know it all, get it right, and never think twice about what they leave in their wake. They are legends in their own minds.

They’re narcissists.

And they’re everywhere.

We need some straight talk about narcissism.

The Tale of Narcissus

You’ve heard the story, right? The Greek myth about the gorgeous young hunter who was mesmerized by his own image when he saw it reflected in a pool of water. So focused on getting what he wanted, and grabbing that image, that he stopped at nothing. To the point of exhaustion. To his own end.

This was a guy who thought he should have had it all.

Narcissus lived for himself, for his enjoyment, and for his own success. He gave to no one, and loved no one. Not even the lovely nymphs who did everything to seduce him. They needed him more than he needed them.

But for every narcissist, there comes a moment of crisis

It comes when they’re confronted with their own need.

For Narcissus, it came at the moment that he reached out for his own reflection in a pool and it dissolved. No matter how hard he tried, it slipped out of his grasp. He couldn’t believe he couldn’t get what he wanted … to the point that he wouldn’t stop til he keeled over in exhaustion.

His need just killed him.

Talk about being out of balance…

Narcissists are always out of balance.

But wait a minute.

What are we really talking about when we say narcissist? It’s all over the media these days. Is it someone who does something here and there that is sort of narcissistic — something a little selfish … or a little overblown (just a little) … or maybe something that shows little regard for other people’s feelings or needs? Or is it someone who has Narcissistic Personality Disorder?

Because they just aren’t the same thing at all.

What is Narcissism Anyway?

Narcissism is a character trait — one of many — and the actions or behaviors that display that trait are called narcissistic. If your ex is full of himself, constantly needs stroking, and doesn’t seem to care about you or what you need … it’s a good thing that he’s your ex.

If you’re healthy and well-rounded, you have a variety of traits that make up you. And you can’t help but display them in your everyday life. You can be careful, conscientious, generous, kind. Flirty maybe, impulsive … indecisive. Just plain lovable. Flexible. Compassionate. You’re 360.

And so if you sometimes do something and need an atta-boy, if you’re thrilled with a win, or sometimes a little too delighted with yourself … we forgive you. So you have a narcissistic moment … a moment when an action (here and there) in someone who is otherwise well-rounded and delightful may seem selfish and self-promoting. We all have these moments.

Narcissistic Personality Disorder

But some people have not moments, but days, weeks, months, and years, where this pattern is their prime modus operandi. Where narcissism is all they show. Where there’s no 360. There’s only 1. No matter what the setting, no matter who gets hurt, no matter how ridiculous . . . no matter if the formula (grandiosity + manipulation + lack of empathy) becomes so overused in so many inappropriate ways that what used to work just stops working for them.

Often to the point that they become completely enmeshed in a pathological tangle of self-promotion, insecurity, and disregard for others.

Know anyone like that?

A study of a large population conducted in 2009 determined what size segment of the US population might suffer from Narcissistic Personality Disorder. The conclusion was that approximately 6% demonstrate full criteria for this disorder, but many more struggle with the load of these symptoms without fully exhibiting all the diagnostic criteria.

People with full-blown Narcissistic Personality Disorder can be very difficult to deal with at times. They may come across as “know-it-all’s” or behave with such off-putting superiority that you’re left crushed, seething, or wanting to run screaming in the other direction.

Straight Talk About Narcissism

But, the surprising truth is that people with this disorder use these symptoms to shield their own crippling and painful shame and insecurity. It’s not at all easy to see that underneath because the force of their outward personality can be so overbearing.

And keep in mind, when I say they “use” these symptoms, it’s not a conscious action or habit. Their painful shame is so deep-seated, they’ve subconsciously developed these outward behaviors to protect themselves from the pain … and they don’t even realize it. About 50-75% of them are men.

Big thick wall. Itty-bitty little person inside.

I bet you know one. Let’s call him Brett.
- He probably likes to be the center of attention. Brett’s driven to talk about himself and typically over-embellishes and exaggerates his accomplishments. It’s like little white lies are woven into the fabric of every story he tells about himself. He’s always painting himself as the best, the most popular, the most successful, the most trusted of anyone in the story.
- Brett may be a little too quick to offer advice, when you didn’t even ask for it. He shows himself as pretty much being “in the know” about just about anything. He may talk about himself and his “insider” knowledge to appear more sophisticated than you are… or than anyone else. In doing that, it shores up his over-inflated ego (which is necessary for his survival) — but makes others feel inferior.
- Brett is offended if he’s not given preferential treatment in just about every circumstance. He detests waiting in line, is infuriated if his beer glass isn’t thoroughly frosted in a restaurant, and as far as he’s concerned, every waiter is slow and lazy. No matter what his need, Brett demands it be met instantly. His ambition skyrockets, he expects everything to revolve around him, and he lives with an undying sense of entitlement throughout his life.
- Some people dream of accomplishing great things, and enthusiastically work like crazy to accomplish their dreams. Brett feels it’s his destiny. He believes he’s just better than others, and prefers to socialize and do business only with those he considers among the elite. It’s clear to him that he’s naturally more special, and as part of the elite class he interacts with, he deserves only the best. This grandiosity is a classic symptom of narcissists, and so is his habit to belittle those who don’t have the status symbols he has.
- He has a knack for making certain people feel important — when it suits his agenda. His relationships advance quickly, and romance is an intoxicating whirlwind. The trouble is, this lavishing of compliments and charm has a hidden flip-side. Once Brett’s won your loyalty, the criticism begins, and he expects you to keep him on a pedestal that you reinforce daily. If you criticize or question him, you’ll get tossed out like yesterday’s garbage. Or fired.
- Competitive sports are fun for most people, but for Brett the competitive drive exists to prove his dominance. He MUST win. He must show he’s superior. By the same token, this profound sense of competition makes it so hard for him to share in a loved one’s success. His loved one’s beautiful home, nice car, or triumph at work is hard for him to applaud because it threatens his own dominance.
- For Brett, holding a grudge is his knee jerk reaction to any perceived insult or oversight … and that grudge puts the offender on the garbage heap of eternal contempt. Sadly, because of his deep insecurity and feelings of shame, the infraction can be as simple as someone not noticing his presence and saying hello. The term, “wearing their feelings on their cuff” is a constant for these individuals, and their reactions to those around them can result in their being held at bay socially, leaving them lonely.
- And there’s more than holding a grudge. As for himself, Brett doesn’t accept responsibility for a mistake. If you know someone like this, you probably have learned that anything that goes wrong is blamed on someone else who was “stupid” or a “poor excuse of a…” doctor, CPA, wife, husband…whatever… just fill in the blank. Their own shaky sense of self can’t bear the burden of an admitted failure, so being wrong about anything slides off people like Brett like butter off hot teflon.
- Along the same line, Brett’s feelings are fragile. He’s easily hurt, and can’t bear feeling rejected. Rejection is terrible for most people, but for Brett, it proves that he’s as worthless as he secretly believes he is. So his reaction to perceived rejection is likely extreme, and possibly even violent. It’s just too much for him to bear.
- One last hallmark of Brett’s disorder is that he uses people as needed for his purposes. Since he views everything from the perspective of how it affects him or has meaning for him, it’s easy for him to miss how he takes advantage of others. Brett is unable to put himself in the shoes of another…to feel that person’s emotions or discomfort. So he’s unable to feel what he’s done to to someone else — but at the same time he expects everyone to feel and be at the ready to remedy his own situation. Beyond that, any obstacle in his way to getting what he wants has to be remove…through manipulation or bullying…whatever it takes.
It’s easy to see why someone with this disorder might have difficulty building satisfying relationships. If you’ve grown up with or lived with someone who sounds like Brett, you may benefit from therapy, too. The atmosphere and dynamics for anyone who’s grown up with, or lives with, or works with a narcissist is often confusing and may feel abusive. It’s a complicated tangle, and you may need your own support to unravel it.

To the emerging and healing of your best self,

Lori Calabrese, M.D.
May 8, 2017
Does Your Teen Exhibit Signs of Bipolar Disorder?

Can You See It?

Teenagers can be so unbelievably moody. Well … a far more palatable word for it is reactive.

Overreactive (like yelling that brings the house down), intensely reactive (meltdowns that go on for hours, leave a hole in the drywall, or tear the room apart), egregiously reactive (with threats to jump off the roof, open a vein, down some pills), and . . . insufferably nonplussed. Apathetic. Unmotivated. Just downright bored.

Is this what kids are like now? Is this what your kid is like? (or Is this what you were like?) Is this what everybody else’s kid is like?

How do you know if what you’re seeing at home falls within the norm . . . or points to something bigger?

Like bipolar disorder. Does your teen exhibit signs of bipolar disorder? Signs that should point you in the direction of help. How can you tell the difference between adolescent drama and an agitated mania or mixed episode?

If you’ve never seen it before, how will you know?

Bipolar disorder isn’t diagnosed on the basis of a single symptom. Or a single episode of rage. Or an impulsive (regretful) moment.

Not ever.

But if you wonder about the changes you’ve seen in your teen’s behavior and state of mind — and what parent doesn’t wonder what’s normal anymore? — then sit up straight, because this is probably the most important reading you will ever do. It could save her life.

At first, it isn’t that easy to differentiate between a teen who’s reacting to frustration and a teen experiencing a bipolar manic episode.

Both are intense.

But are unpleasant.

And helping a teen grow up through the volatile reactions of adolescence, the moments of intimidation from challenging responsibilities, the sorrow of a spurned young love … can seem to mimic parenting a teen through bipolar disorder.

However, they bear no resemblance, as surprising at that sounds.

But if you’re the parent, how do you know?

Does Your Teen Exhibit Signs of Bipolar Disorder?

There are specific symptoms of bipolar disorder that go beyond your teen’s angry outburst. Symptoms that together paint a picture of an overall debilitating condition.

To make it easier to put this picture together… to see if there are symptoms compelling enough for your child to be evaluated by a psychiatrist … there are some helpful and well-known mnemonics that can help you know what to look for. (A mnemonic is just a way to remember something that’s really important.)

First, the manic symptoms to watch for… DIG FAST.

There’s just about nothing else that can dig you into a hole faster than being a little, or a lot, manic. That means having intensely happy, angry or wildly swinging moods with several of the following at the same time:

Distractibility —

jumping from one thing to another to another, without getting anything done, and just leaving a mess

Injudiciousness —

poor judgement with reckless behavior

Grandiosity —

that can start with feeling that you are just surrounded by idiots, that nobody really gets you or your vision, and it gets worse from there

Fast thoughts —

thoughts that fly through your head so fast it’s dizzying, sometimes with speech so fast it’s hard to interrupt

Appetite for risk —

fun, food, alcohol, gambling, drugs, sex, spending — it seems like whatever you do, you want more of, and risks you might never take are now opportunities you can’t wait to jump right into

Sleep needs diminish —

you can get by with very little sleep over days or weeks

Thoughts become increasingly disorganized —

and you can become hard to follow

Next, the depression symptoms that emerge in very low and incredibly empty states…SIG:E CAPS

Sleep changes:

with difficulty falling asleep or staying asleep, waking up too early, or wanting to sleep all day — or a mix of these

Interest loss:

loss of interest in things that used to interest you

Guilt /worthlessness:

brooding about all the mistakes you’ve made, how you’ve messed up, feeling ashamed of yourself, feeling worthless

Energy loss:

lack of energy, fatigue, listlessness

Cognition / Concentration:

poor concentration, cloudy thinking, inability to make decisions, forgetfulness

Appetite loss:

a loss of appetite for life, pleasure, food, and the things you used to enjoy

Psychomotor changes:

variable agitation when anxiety is high, or just dragging when lethargy is pervasive

Suicidal/death preoccupation

passive thoughts of death as a relief, intrusive thoughts of killing yourself, deliberate planning for suicide, impulsive suicide attempts

If you’re wondering what SIG:E CAPS means, it comes from the prescription pad your doctor uses. The term SIG: is printed on the pad and that’s where he writes the directions for taking the prescription.

It stands for a Latin word, signetur, which means “write on the label.” Since lethargy, or loss of energy, is such a strong symptom in the diagnosis of depression, E stands for energy, or the need to write a prescription for Energy in the form of an antidepressant. And CAPS refers to those capsules that will help the patient feel better. We used to think that antidepressants could be energy capsules — or should be energy capsules — and although we’re more sophisticated in our thinking of what antidepressants do and how they act, SIG: E CAPS sticks.

Sort of silly, isn’t it? But like all mnemonics, using relevant letters like this helps us, and the patient, remember the most prominent symptoms of depression and the depression in bipolar disorder.

So, does your teen exhibit signs that could indicate bipolar disorder? These tools, DIG FAST and SIG:E CAPS will give you a starting place to examine your teen’s frame of mind and behavior. And the earlier this potentially devastating illness is diagnosed, the earlier treatment can begin, and the more likely your son or daughter can feel better, function better, and live a more rewarding life.

Of course, psychiatric diagnosis and formulation is much more complex than simple observation, tallying checklists or counting up checkboxes. There’s a host of other symptoms, syndromes, disorders, developmental issues, and character traits that make teasing this apart an art as well as a science. That’s where we come in.

The Danger of Untreated Bipolar Disorder

Here’s something else to consider. When an adult over 30 is diagnosed with depression, they often have a frame of reference as to what life can be like. They have a compass, so to speak, from their memories of happier, healthier times.

On the other hand, when young teens are diagnosed, they quickly lose sight of happier times, of what it’s like to feel good. To be fully functional. That shortened perspective can be so dangerous as it feeds their despondency, and suffocates their hope when asking themselves, “why live?”

The pressure to find rapid and effective treatments for depression in teenagers continues to rise. Pressure to reduce the negative changes in their brains that will impact who they become as they mature. And also, the pressure to find treatments to ease the hopelessness during the years when impulsivity is strong, and most dangerous.

IV Ketamine for Teen Depression

One study at the University of Minnesota is currently accepting candidates to test the effectiveness of ketamine in adolescents who’ve suffered from treatment-resistant depression. The 3-year study began in 2014, and takes a look at the neurobiological mechanisms that make ketamine work — at an age where getting well can change the whole trajectory of your life for the better.

This is extraordinary.

They’re studying teens and how low doses of ketamine affect their depression. Change the course of their lives. Save their lives.

So it’s exciting to think that IV ketamine for unipolar and bipolar depression doesn’t have to be reserved just for adults.

The study will be completed this year, so conclusions are pending. But we’re hoping the conclusions will reveal ketamine is an effective drug that provides fast, safe relief for treatment-resistant depression and bipolar disorder, as well as other mood disorders in teenagers, too.

This is critically important because for many people who suffer with unipolar and bipolar depression, their symptoms began during adolescence … somewhere between the ages of 12 and 20.

Suicide-Driven Thinking

What’s more, during the teen years, the outcomes of serious major depressive disorder or bipolar depression can be devastating … even deadly. Suicidal ideation is sometimes the only trigger needed for a teen to make an irreversible decision.

And here’s why.

During the years before the prefrontal cortex has completed its development – usually in the mid-twenties – the risk of impulsive reactions to emotional pain are very high.

So to find a way to stop the suicidal drive that causes so many lives to be cut short is simply but profoundly life-saving.

And IV ketamine’s specialty is to erase suicidal thinking and hopelessness … fast. We’re talking in less than 4 hours.

There’s more to be learned about treating adolescents with IV ketamine.

But consider this. With everything that teens face in terms of the risk of life-long depression or bipolar disorder, as well as their elevated risk of acting on suicidal impulses, the sooner we aggressively study and support widespread adolescent treatment, the better.

Ok, that was a mouthful. I’m just saying that we need dramatically improved treatments for depressed teens and those with bipolar disorder. Their developing brains make rash decisions at times. Their susceptibility to treatment is at its peak when they’re young. And their risk of suicide makes this a terribly urgent need.

Meanwhile, we continue to seek every possible treatment to achieve the greatest possible relief for our adolescent and adult patients at Innovative Psychiatry. We evaluate each patient with a proverbial “fine tooth comb” to design the most effective and customized treatment possible.

Contact us for an appointment so we can learn more about you and provide the help so you, or your teen, can be restored to your very best self.

When you’re at ease, balanced, and resilient, you can perform at your best, love at your best, and achieve at your best. In short, you can enjoy your life and look forward to your future. What a beautiful thing.

To the restoration of your best self,

Lori Calabrese, M.D.

May 3, 2017
Bipolar Disorder in Teens: Early Treatment Leads to Better Outcomes
Don’t you just hate it?

Hate the drudgery and pain of fighting an illness that doesn’t respond to treatment?

Granted, there are some illnesses that you can find remedies for, and recover.

Maybe a steroid injection, or an antibiotic, and you start noticing improvement in a couple of days.

But not all disorders are like that, unfortunately. You know what I’m talking about . . .

Sometimes It’s Hard to Get Better

Some are much harder to fight, more complicated to treat, and the prognosis is less predictable.

Like cancer, for instance. Or multiple sclerosis … or Lou Gehrig’s disease. Some respond better to treatment than others, and some illnesses make recovery almost impossible.

If you have bipolar disorder, you may have noticed that the longer you have it, the less you seem to improve.

The older you get … the longer you’ve been treated. And the more medications you’ve tried, the more the symptoms seem to get worse.

Now that’s not the case for everyone. Some people see a psychiatrist for the baffling mania they’ve experienced. They can get on a schedule, take their meds, follow their prescribed lifestyle plan, and they feel better and better.

But not all.

Some spend all their savings seeking treatment, following their doctor’s advice, getting help from family members to keep medications on schedule … And years go by without improvement. Symptoms swing more and more out of control. And work performance deteriorates, becoming almost impossible. Family relationships become more strained… if not broken.

Why is that?

Bipolar Disorder Can Become Treatment-Resistant Over Time

A certain group of psychologists and neuroscientists wanted to know the answer. So they pulled together a pile of 8 papers and 2 more meta-analyses, which involved 8942 patients.

If meta-analysis is a new term to you, here’s a short explanation. When researchers do a meta-analysis, they combine the information from a number of different studies to see what the consistent outcomes are — despite all of the differences across the studies.

So you can try to imagine how many studies had to be used, and how many different factors had to be analyzed, to learn about the experiences of these almost 9000 patients.

Five of the studies compared the first manic episode with those that followed. The others compared those with fewer episodes and those who had more of them. The result of all this . . . ?

Those who received psychotherapy and/or medications at the earliest stages of the illness had the best outcomes across the board. Best outcomes in terms of symptom severity, social function, relapse, remission, and employment.

The take home message is . . . the sooner you are treated after your first manic episode, the sooner you feel better, are able to manage your symptoms, and continue with a rewarding life.

On the other hand, the more you cycle, the further you advance into later stages of this illness, the less effective your therapy and medication treatment become. So … the more likely you are to experience more cycling and more impairment … and the less likely you are be able to function in a job or support yourself.

And there’s more . . .

Bipolar Disorder in Teens: Early Treatment Leads to Better Outcomes

Another study in Bethesda, Maryland, scrutinized patients at the date of entry into their network, the Bipolar Collaborative Network, to determine whether their date of entry was associated with early onset of the disease. They determined that those who entered the network at a younger age were more likely to have had an early onset of the disease as opposed to those who entered the network at an older age. And those who entered at an older age were less likely to have people with the disease in their family.

They also found that those who developed manic symptoms at younger ages were more likely to have parents or grandparents with bipolar disorder.

So, this all comes down to a major conclusion:

Since bipolar disorder needs to be identified, diagnosed, and treated quickly after onset, it’s important for family members to recognize the symptoms to help your loved one seek and receive treatment…as soon as possible.

To that end, here are some symptoms of mania to watch for:

There is almost nothing else in psychiatry which can develop so quickly and be so devastating. Manic symptoms, or mildly-manic symptoms, which we call hypomania, can dig you into a hole fast. So we teach our patients and their families to look for symptoms that occur at the same time that they are developing marked mood swings, or an elevated or irritable mood:
- episodes of high energy, excessive happiness, or irritability
- feelings of excessively high self-esteem, or super powers
- a diminished need for sleep … being able to go for days with little or not sleep
- increased talking at a fast rate of speed, with such pressure that you cannot be interrupted
- easily distracted from one subject to another
- fast stream of ideas and thoughts
- taking great risks time and again, such as substance abuse, unprotected sex, and reckless driving
In addition, there are depressive symptoms to watch for:
- low, depressed mood
- diminished enjoyment in favorite activities
- low energy level and fatigue
- major changes in sleep patterns … such as sleeping too much, or inability to fall asleep
- inability to concentrate
- feeling “bored”
- diminished appetite, loss of weight, or sudden weight gain
- complaints of stomach aches or headaches
- thoughts of death or suicide
Some of these symptoms can be also be seen in children or teens with other psychiatric disorders. But if the teen has a parent who has bipolar disorder, it’s critical to evaluate for that.

But know this: bipolar disorder isn’t easily diagnosed. It’s not uncommon for a child or teen with bipolar disorder to be diagnosed with major depression or other psychiatric disorders before the bipolarity can be identified. It’s a complex illness that requires scrutiny and observation over time. Basically, the sooner the diagnosis can be determined, the sooner effective treatment can be initiated.

By the same token, if you have bipolar disorder and were not treated early after your first manic episode, don’t despair.

At Innovative Psychiatry, we specialize in “difficult-to-treat” disorders and are committed to search for the most effective treatment to help you rediscover your best self.

Call us for an evaluation and let’s use the tools at our disposal to identify and find the most effective treatment for your specific needs.

Because we believe in helping you discover your best self,

Lori Calabrese, M.D.
April 26, 2017

error: Content is protected !!