Lori Calabrese, MD

Author: Lori Calabrese, M.D.

How Ketamine Turbo Boosts Brain Compost to Improve Your Mood
In a recent post, we talked about the impact of Brain Derived Neurotrophic Factor (BDNF) on the prolific development of neuronal synapses, or nerve connections, in the brain. BDNF is like a rich, organic compost that spurs dense growth. And we talked about how IV ketamine turbo boosts brain compost and multiplies the connections in your brain that improve your mood and sense of well-being.

Ketamine Turbo Boosts Brain Compost to Improve Your Mood

We described how BDNF creates an environment like “compost” for increasing these synapses to upgrade communication throughout the brain. It stimulates neurons to grow and branch out, and it increases the complexity and density of these branches. It’s like stimulating little saplings to develop into strong, complex riotous oak trees. BDNF increases the density of the forest and the density of the forest canopy. When the synapses are weakened, thinning out, and breaking down in the brain, depression and suffering is usually involved, one way or another.

So, if you want to clear out your darkened mood, then you need to clear out weak and broken down synapses. Replace them with healthy neurons loaded with abundant branches, which are called dendrites, and loads of connections, called synapses.

You’ll need to take a proverbial rototiller to your “brain garden” and clean out the deadwood, weeds, and broken roots. Mix in new soil, fertilizer, mulch, and compost, and let new tender neurons begin to leaf out.

That heavily “treed” neuronal forest will just naturally bring bright thought patterns and stimulation, just like all that new soil, mulch, and fertilizer would bring new growth and beauty in a garden. Because brain derived neurotrophic factor – BDNF – “brain compost” – improves your mood by providing a rich growth environment for your neurons and synapses. The more healthy synapses your have in your brain, the better you will feel.

BDNF on Steroids

In that previous post, we also featured the extraordinary result of IV ketamine on our “brain garden,” and that rich “compost” seemed to multiply the BDNF like gangbusters… which fostered remarkable multiplication of synapse connections…as if in a fast-motion animated cartoon.

That rich and deep synapse vegetation results in a high-speed and dramatic improvement in exchange of information throughout the brain:
- - improving cognition
- - relieving depression
- - removing thoughts of suicide
  - and equipping the brain to ‘reset’ itself with brighter and better thought processes, mental and emotional hygiene, the adoption of exercise, and more productivity going forward.
Since BDNF helps neurons and their connections grow, like fertilizer helps plants do the same, they become stronger and healthier. But even more dramatic is the appearance of new branches that that emerge, proliferate, and multiply, especially in the hippocampus and pre-frontal cortex.

Picture a bean plant you gently cover with fertile soil. You add a little water and set it in the sun. When you wake up the next morning, you hope and expect to see a tender shoot already poking through the earth…right?

We do, too. But we try to be patient, and give it several days, at least.

Take a Look at Your Beanstalk, Jack!

IV ketamine treatment is so powerful in its effect on BDNF that it’s as if your brain wakes up and within days you begin to have a dense forest growing where that little bean plant was.

BDNF obviously contributes dramatically to the “landscape” of the brain, and IV ketamine gives it a turbo boost.

But then, does that change as time goes by?

Ramshackle, Rundown Garden

We’ve made the point that IV ketamine puts BDNF on steroids — increasing the density and complexity of neuronal branching in the brain and increasing the number of connections between one cell and another.

But what happens to someone who’s depressed and has been stressed for a long time? Then BDNF is depleted, the dendrite branches get severely pruned back, the synapses break down, and and the hippocampus shrivels.

That’s a serious state, and a perfect description of what it’s like in the brain of someone with chronic depression. What it’s like in your brain if you’re chronically depressed.

It feels like a wasteland.

IV ketamine treatment can change that.

IV ketamine infusions work in a number of different ways, but the most striking thing they do is increase the rich compost of BDNF–to proliferate neurons, leaf out dendrites, increase synaptic connections, and re-establish a rich network of communication in your brain that can return you to your best self.

In some people, a series of IV ketamine infusions will return their “brain garden” to its optimal state … and they may not need further infusions.

But others may find after a time that they feel depression or other symptoms returning — their neurons and synapses have dwindled and shriveled again — and they need a new infusion to breathe new life into their garden of connections.

It’s Individual…One Size Doesn’t Fit All

No one knows in advance what will be needed, but to find a way to bring their brain to life is such a rejuvenating joy that most are beyond delighted to tap into this wonderful opportunity for energy, connection, and hope. For new growth.

And how about you?

How is your brain garden?

Is it prolific with verdant life and freshness?

Or does it need a turbo boost?

Unlike your bean garden, we can actually test your DNA to help determine the likelihood that you’ll benefit from IV ketamine.

Come join us to learn about you, and what can help you be the best YOU you can be. Contact us so we can give you a thorough evaluation. It’s the kindest thing you can do for yourself.

To restoring you to your best self,

Lori Calabrese, MD
February 23, 2017
Why Some People Get PTSD…and Others Don’t

Ever notice how some people seem to collapse under an onslaught of traumatic experiences, and others almost seem to rise above them? Almost as if demonstrating their resilience? Why some people get PTSD and others don’t..that’s the question.

People tend to say the latter type is “strong”… and the former type is weak…unable to withstand or overcome much. More stigma that we have to fight. But is that what’s going on..?

Strong or Weak…? Really…??

What is it that increases the risk that trauma can traumatize you? We’re talking about big T Traumas and little t traumas. Is it about how much or how little? About how much stress you’ve had. How many put downs. Or how much yelling you’ve endured. And how much fear. Too much neglect. Or too little attention. About too little protection… and too few resources. How little money.

How much struggle.

Traumatic experiences can etch themselves into you–into your memories, into your emotions, and into your biology. And what we’ve learned is that what puts us at risk for that–besides the horrible events themselves–is something that is already etched into us. A gene.

A gene?

Genetic Widget

There’s a serotonin transporter gene called SLC6A4. This little genetic widget has two arms–and in the best of all possible worlds, the arms are both long arms. But if you were born with one or two short arms instead of two long ones, you are more likely to develop major depression or PTSD in response to a traumatic life event.

It’s almost as if those little short “arms” can’t carry quite the emotional load as the longer arms of the corresponding gene in those who aren’t so impacted.

Or…maybe the longer arms shield their owner from the emotional pain that accompanies heartbreak or trauma in some way.

Of course this is all just a way to bring science to life, but the fact is, having a short arm on that gene increases the risk that you will suffer deeply and longer from life events such as verbal or physical attacks, traumatic events, and long term debilitating difficulty.

And there’s more.

Genetic Test Predicts Outcomes

There’s also a genetic test we can use to determine if you might be someone who would respond well to ketamine treatment.

What?

For decades, psychiatric medicine has relied on trial and error from one medication to another to find the one that is most effective for a given patient.

But now…there is actually a test to help predict your outcome in advance and whether you’re likely to respond quickly and robustly to a treatment for severe depression and PTSD that is as innovative as a ketamine infusion.

Neuroscience is advancing quickly, and treatment options for people who suffer with major depression, bipolar disorder, PTSD, and other psychiatric disorders are becoming more reliable and predictable. These discoveries were unheard of less than 10 years ago…even five.

More on the Horizon

And there’s yet another breakthrough on the horizon. And that’s the possibility that we might be able to use science to potentially prevent psychiatric disorders from developing–for example, to protect first responders and military from the risks of trauma before they enter a crisis situation.

So imagine… if firefighters, paramedics, SWAT team members, and military personnel facing potentially traumatic experiences could feasibly be treated with IV ketamine to prevent the event from becoming a debilitating traumatic experience. Or—think about this—imagine if someone who is genetically vulnerable to developing depression or PTSD in response to a traumatic life event could be buffered from the risk of developing it.

One of the exceedingly bright researchers studying ketamine, and interested in “repurposing it,” talks about the exceptional potential of this drug for potentially preventing psychiatric disorders. Working with lab animals, her work with ketamine has opened up a treasure chest of new possibilities.

If you haven’t seen it before, it’s worth your time to watch the TED talk about this by Rebecca Brachman.

She expounds on the sparkling new hope surrounding psychiatric use of ketamine treatment. It has already offered healing to so many who suffer, and in the future, may potentially protect others from the risk of such suffering.

Don’t put psychiatry in a box.

Don’t put people who suffer with psychiatric disorders in a box.

The possibilities are endless.

Rapid and effective treatments are emerging.

And hope for your life to be the best it can be is billowing.

Please call for an appointment if you’re concerned about the emotions and reactions you’re experiencing in response to what life has thrown at you. Let’s work together to find the right innovative solution for you.

To your best self,

Lori Calabrese, MD

February 15, 2017
The Stigmatizing Term: Mentally Ill

Stigmatizing Term: Mentally Ill

I used to think I was an expert in this stuff. The stigma of it all. Mental illness.

Man, I hate that phrase. I don’t hate many things, but I hate that phrase. Always hated that phrase. Truly, I think I hate every awful syllable of that phrase. I never utter it.

People who know me know this is true.

But most people–probably most of the patients that I treat–don’t know this about me. It’s not something I share, and it’s never been something I broadcast. I think most people assume that psychiatrists are experts in mental illness.

Mental illness sounds like such a dirty word.

Here’s what we psychiatrists are: experts in disorders of the brain… and the mind… and the spirit… and the body—disorders that go on to affect the brain… and the mind… and the spirit… and the body. 360 degrees. Experts in treating people who are full of shame. Who are isolated, distanced from their families, cut off from their friends. Cut off from their insurance, denied life insurance, denied disability insurance. Experts in helping people who are stigmatized every day for what they have. As though what they have reduces them to the thing itself.

Experts in the diagnosis and treatment of psychiatric disorders.

Depression. Bipolar Disorder. Anxiety. Panic. Obsessions. Addictions. Bulimia. Trauma.

There are illnesses, disorders, and diseases that affect your ability to walk, to digest food, or ability to function in the presence of others. Sciatica, ulcerative colitis, panic disorder. But specifying an illness that affects your brain, your mind and spirit as separate or somehow different from all of the other problems we treat in medicine delegitimizes that illness.

So let’s start there.

We psychiatrists are not only experts in diagnosis and treatment, we are the stewards of our knowledge, and it behooves us to guide society’s perceptions about our field and the people we care for. To help our culture catch up to our science.

You’ve heard someone say, “…it made me physically ill…” and it left a specific impression, right? Spoken in those words, we assume she felt nauseous, and that because she felt “physically” ill, it was all the more intense, believable, legitimate.

Our society struggles to find ways to legitimize illness, disease, or disorders caused by brain anomalies. People can handle discussing a brain tumor, a stroke, or multiple sclerosis, but when the symptoms affecting behavior, or moods, or thought processes don’t have a clear lesion that explains them, it seems to hit a proverbial nerve.

The Dark Ages of the Brain Finally Ends

It wasn’t until the last ten or fifteen years that researchers began finding out why those behaviors existed. And so, because of that absence of information, throughout the history of mankind, people who suffered with these disorders were ostracized, isolated, imprisoned, and dehumanized…or dismissed as “weak,” or “undisciplined.”

But that was then.

This is now.

Introducing: DNA, fMRI, BDNF, Amygdala, Hippocampus, et al…

Now we know more in neuroscience than we’ve ever known before. We have functional MRIs, that show unmistakable changes in brain activity in those with specific disorders compared to those who don’t have them.

We have 108 genetic DNA markers that are linked to schizophrenia and other illnesses.

Certain brain structures differ in people with depression, bipolar disorder, and schizophrenia.

We’ve found reduced levels of BDNF (brain derived neurotrophic factor), different genetic polymorphisms of key enzymes in the brain that affect how neurotransmitters are metabolized, and higher blood levels of certain inflammatory markers in different psychiatric illnesses.

Now, in the 21st century, we have facts.

Neuroscience is quickly becoming more and more proficient at understanding, describing, and measuring emotional shifts, behaviors, cognition, and emotion, through brain activity. No longer are behaviors and symptoms that weren’t understood by mankind in the past given fictitious explanations.

When have you heard someone say, Joe is physically ill. . . when describing his cardiovascular disease?

We might tell someone Joe had a massive MI because of blockages in 3 major vessels to his heart.

Sound legitimate?

Of course.

We describe illness and health events specifically and in some detail.

Sarah was diagnosed with Type 2 diabetes. She’s trying to lose weight, and feels nauseous when her blood sugar gets too low.

Or…

Jim was just diagnosed with Parkinson’s disease. No wonder he’s been shaking so much.

Again, legitimate, right?

What’s more, Parkinson’s is a neurological disorder…so we’re crossing the threshold into neuroscience and its disorders and illnesses.

Call ‘Em Like We See ‘Em

Let’s take it another step.

My sister-in-law saw a doctor last week to understand her mood swings and extravagant spending the last few months. She was diagnosed with bipolar disorder. I think she and her husband are beginning to understand a lot of things she’s been doing that seemed out of character for her.

Legitimate? Absolutely.

It’s as natural and valid to describe what a loved one is experiencing in their health as it is to describe their move to a new house, or the addition of a new baby.

All of these scenarios speak of a health condition that brings challenge and impact to this person’s life, as well as his or her family.

To isolate health issues sourced in the brain as ‘different’ is to alter the listener’s perception of their validity. Health is health. The well-being and function of the entire human body is a vital part of living well for every person.

When any part of your health is compromised or impaired, your entire life can be affected.

There is no difference in validity or impact in the case of illness in the gut, the kidneys, the liver, the heart, or the brain.

And in each case, the physician is focused on finding treatment that improves the health and wellbeing of her patient.

We’re at the end of the darkness related to psychiatric disorders.

Stigma No More

There’s no place for stigma.

Brain tumors are not caused by guilt or bitterness, neurofibromatosis is not caused by criminal intentions, and bipolar disorder and PTSD are not caused by poor parental discipline or weakness.

People get sick.

And medical science and neuroscience want them to get better. We want them to get better.

Let’s leave stigmatizing talk and stigmatizing terms like “mentally ill” behind and move forward into greater understanding, support, and treatment to help each person in our world discover his or her best self.

Call us to discuss your health and areas of unrest, and let’s explore how we can help with depression, PTSD, bipolar disorder, and anxiety. We can offer innovative treatment options like IV ketamine treatment and TMS to improve your life, and help you feel much better.

To the discovery of your best self,

Lori Calabrese, MD

February 9, 2017
IV Ketamine Infusions Restore Your Power to Enjoy

IV Ketamine Infusions Restore

Jacob couldn’t remember the last time he was really at his best self. He’d struggled from day to day since he was about 4. Getting out of bed, getting dressed, and going to school, from first grade through high school… every day had been awful and just exhausting. As he got out of the car for school each day, he’d look at his mom with pain in his eyes–and then drag himself into school, throughout his day, and through the night.

His parents didn’t know how to help. They talked with him and tried to do things that would cheer him up. But his inner pain seemed suffocating, and they felt helpless.

One day when he was 14, they found him on the floor behind the sofa, wedged against the wall in a fetal position.

He just disconnected…ran out of the energy to endure any longer…from the dead emptiness inside. The anxiety. All of it.

He thought about how to end his life every day. Some days he was obsessed with visual images of that final act.

Treatment-Resistant Depression

His doctor prescribed an SSRI, an SNRI, and then different combinations of medications, but none of them worked. Not really.

Eventually he refused to take any more, or attend any more therapy sessions.

School was something he just endured, or avoided, until he graduated.

College was a roller coaster–and life had been too hard for too long. He was exhausted. Isolated. Disinterested. And he eventually dropped out.

A Drug Called Ketamine

Then he read an article online about a drug called ketamine that was helping people recover from severe depression.

And he started looking for more information about it–studies, information, and just about anything he could find about this anesthesia-turned-club-drug-turned-antidepressant.

He found a few interesting articles, a few sensational titles, a lot of talk…and fascinating research that had been going on for years on using IV ketamine infusions to restore life for people with severe depression.

Who knew?

Was it possible there was a treatment for crippling depression and anxiety that could work when nothing else did?

His parents were pretty skeptical. They looked for hard science, research studies he could participate in, or a doctor he could see who knew something about this kind of treatment.

Turns out it’s pretty hard to find a psychiatrist who gets the devastation of depression and anxiety and hopelessness. One who can sift through the complexities, discuss the risks and benefits of all of the available treatment options, in order to provide the best possible options for someone whose symptoms just haven’t gone away.

Jacob’s first infusion of ketamine was extraordinary. The terrible heaviness that had weighed him down since he was four lifted for the first time about half way through the infusion.

And when his parents met up with him, they saw a lightness in his expression that they hadn’t seen in years. His treatments continued…his symptoms faded.

He had missed most of his childhood, and he spent most of his young adulthood wanting to die. But when IV ketamine infusions restored his ability to enjoy and experience beauty in life, it changed everything. He couldn’t believe it, but he actually wanted to live now. And was so glad he could.

How Effective Are IV Ketamine Infusions?

Before we go on, it’s important we point out that ketamine infusions don’t work for everyone. Every one’s brain is different. Everyone’s needs are different. And for some people, IV ketamine infusions don’t work.

But we see a lot of Jacobs.

Because IV ketamine infusion therapy does produce remarkable results in 80% of patients who have suffered with treatment-resistant depression, and the terrible, persistent depressive episodes in bipolar disorder, and for large numbers of patients with unrelenting anxiety disorders.

What is it about ketamine that delivers such dramatic, fast results? How does it affect your brain that it causes this wonderful, fresh relief…?

First, let’s talk about growth factors. The brain has its own special growth factor, called BDNF–brain-derived neurotrophic factor. That growth factor is like really rich, earthy compost. And we think that one of the really remarkable things about ketamine is that it turns on signals and opens up pathways so that the brain begins to manufacture and release more BDNF.

This is kind of radical news.

Most people don’t know that the brain continues to grow new cells all throughout life–and when there is rich compost, these cells, called neurons, grow new branches, and form more and more connections.

The Role of Glutamate

Glutamate is the most prolific neurotransmitter in the body. It operates throughout higher levels of the brain, so it’s especially effective in a widespread and quick proliferation of synapses. It causes them to branch like trees in fast motion, creating a virtual forest producing abundant relief, especially in a part of the brain called the mPFC (the medial prefrontal cortex).

Some neurotransmitters bring a calming balance to the brain and mood, others bring a stimulated excited balance. Serotonin is one of the calming ones… Glutamate is one that excites the neurons.

Because glutamate is so prolific and widespread, when it’s stimulated to increase, the impact on mood is fast to take hold and spread.

Now, when uptake of glutamate from the synapses is disturbed or blocked, you experience less of the feelings of reward…like for instance the enjoyment of a sunrise, or the fragrance of a rose. This impaired ability to “enjoy” is a symptom of depression.

However, and this is great news, when glutamate is released, there’s a prolific blooming and branching of synapses, which quickly connect different parts of the brain to each other. It’s almost like watching a film in fast motion as the synapses branch into more and more neural connections. The result is a rapid improvement in communication between networks of cells in the brain. And your ability to feel good quickly improves.

So how to get glutamate to be released??

Enter IV ketamine.

Ketamine Stimulates Budding New Branches in Brain Cells

Low dose IV ketamine infusions cause a burst of glutamate.

Those bursts of glutamate trigger the branching of dendrites (the branches on the tree) and the budding of bunches of synapse communication junctions, and in a short time, you feel better and better.

So how does it do that? We think that IV ketamine infusions cause bursts of glutamate that very quickly stimulate AMPA receptors, which activate calcium channels, which lead to the release of BDNF (good compost), which turns on the mTOR pathway, which — voila! — increases protein synthesis right in the brain. Neurons are made of protein. So dendrites branch. Synapses form.

New growth. New connections. Not just in the structure of your brain but in the very fabric of your life.

Psychiatrists get really excited about these things. You should get super excited, too. Geez.

Think of a brain cell like a tree in springtime that explodes with the stretching and unfurling of new branches, new growth, new buds, all stretching towards the sun. That’s what happens. If you have been so tied up in knots, wound up with tension and anxiety, and deadened to the joy of life…you can feel your shoulders relax for the first time in years.

Second, a study by the National Institute of Mental Health in August of 2015, revealed that ketamine reduces suicidal thoughts, as an independent and parallel benefit to the antidepressant effect it provides. And studies at Yale, Oxford, NIMH, Houston’s Baylor College of Medicine and New York’s Mount Sinai School of Medicine provided overwhelming evidence of the remarkable effectiveness ketamine demonstrates against treatment-resistant depression.

How?

Because of glutamate, and the richness of BDNF, and the fast-growing synapses branching out on neurons throughout the prefrontal cortex, causing relief to bloom along with them.

Breakthrough Innovative Treatment

Isn’t this amazing?

If you’ve suffered from depression, or bipolar depression…or crippling anxiety, you KNOW how amazing this is.

You’ve known the desperation, misery, and despair.

Maybe you’ve forgotten what it’s like to feel good, or even to feel ok.

You’ve lost touch with enjoying yourself.

But all that can change now.

Now you can feel good in ways you’ve forgotten.

Find your love of music, or art, or reading.

You can feel again.

Because of glutamate.

Because of flourishing synapses.

And because of ketamine.

Let us help.

Call us for a thorough evaluation so we can discuss innovative treatment options for you. IV ketamine infusions restore your ability to enjoy your life, and we’ll help you with whatever it takes to accomplish that.

To the emerging of your best self,

Lori Calabrese, MD

February 1, 2017
Ketamine Off-Label = New Hope

Ketamine Off-Label

Talk about ketamine off-label and it’s hard not to get a raised eyebrow or two. The one-eyebrow raise is the curious, skeptical, quizzical, or disapproving look when someone hears about IV ketamine infusions for depression, just before she takes a deep breath and then dismisses it. But the two-eyebrow raise is another matter entirely.

What Hope Feels Like

The two-eyebrow raise happens in men and women—or their spouses, parents, or adult children–when they see first-hand what hope feels like. When the veil lifts, when the suicidal thoughts stop, when the anxiety falls away. It is the sign of disbelief… but another kind of disbelief—not the one-eyebrow kind. The kind of disbelief that shouts out amazement. And hope.

There’s a face cream out there somewhere called Hope in a Jar. IV Ketamine is like that—it’s in a vial, a sort of tiny, nondescript little glass jar. And it offers hope for the relief of suffering to people with unrelenting depression…and anxiety…and suicidal thinking. Symptoms that have lasted for months, or sometimes years on end.

Ketamine is nothing new. It’s been around for more than 50 years as one of the safest and most widely used medicines in anesthesia. In the OR, in the ER, in pediatrics, on the battlefield, and around the world, even in the most primitive medical settings. But for almost as long, it’s been stolen and used illegally at extremely high doses as a recreational drug for the “out of body” experience that people report.

“Special K”

Because of that, when researchers discovered several years ago that ketamine has surprising effectiveness against depression, it was hard to break through the credibility problem ketamine unfortunately acquired under its name, “Special K,” the street drug.

In fact, almost every headline in the press about ketamine tries to grab your attention with something sensational: “Street Drug” “Party Drug” “Special K”.

How about grabbing your attention with this: Hope. Relief. Resilience.

To someone with depression, anxiety, or PTSD that won’t stop, hope is new. And even though ketamine isn’t new, the way we’re using it is completely new, and fresh, and offers a way out of despair for people who have just given up on feeling better.

Research studies using ketamine have exploded, and demonstrate that low doses of intravenous (IV) ketamine provide remarkable anti-depressive benefits.

In fact, it goes way beyond “benefits.” In a mountain of cases, IV ketamine off-label provides remission from depression and anxiety in people who can’t remember a time when they weren’t depressed… as well as suicidal.

And get this: in most cases, those who’ve been suicidal feel relief within an hour or two. This is remarkable and unheard of before in an anti-depressant, since before now anti-depressants have required weeks or months to provide full benefits.

But there’s a problem.

A problem…?

How can there be a problem with a medication that brings relief and even remission from depression and anxiety for a huge percentage of people who’ve not received relief from other antidepressants?

It sounds more like a miracle than a problem…!

The answer is simple.

Off-Label Ketamine Use

While the FDA has approved ketamine for use in anesthesia, it hasn’t been approved by the FDA for use as an antidepressant.

Is ketamine the only drug that’s used for off-label purposes?

Absolutely not.

Other Medications Used Off-Label

When the FDA approves a drug for a given purpose, the drug is approved for use. Physicians begin to prescribe it for that indication but are free to use their expertise and best judgment to prescribe it in other circumstances, too. And it’s not unusual for “side effects” to emerge that are so beneficial that the drug is prescribed for the side effect more often than it’s prescribed for its original use. In fact, 20% of the prescriptions written these days are for off-label uses.

Surprising, isn’t it?

One example of drugs commonly used off-label is beta blockers. These medications are approved by the FDA to control blood pressure, but cardiologists know they’re also very effective and widely accepted as standard medications in the treatment of heart failure, too.

Psychiatrists prescribe them for performance anxiety, stage fright, to treat tremor and restlessness, and sometimes to reduce aggression.

Even though they haven’t been approved by the FDA for those uses, they’re widely accepted and prescribed as the optimum treatment for entirely different problems than the ones they’re approved for.

Another example is the drug trazodone, which is approved for use as an antidepressant, but is usually prescribed off-label for sleep. Also, amitriptyline, approved as an antidepressant but prescribed off-label to prevent migraines, to treat nerve pain, and to improve motility.

Or metformin, a diabetes drug which is prescribed off-label to reduce food scavenging and promote weight loss.

So, many drugs are prescribed for off-label uses at some point. Some are so widely used for the off-label use their original purpose is all but abandoned.

Risks With Off-Label Use

That’s not to say there are no risks in prescribing medication off-label.

There are.

Plenty of risks exist for both the patient and the physician. Risks always accompany our looking outside the box. And occasionally a drug is used off-label and, because there hasn’t been enough testing, tragic outcomes result in the drug being removed from the market.

But that’s a very, very low risk for ketamine. Anesthesiologists have been using ketamine for decades in much, much higher doses than the the doses studied to treat depression and anxiety. This is not an untested drug. It’s safe, with minimal side effects that dissipate in minutes.

IV Ketamine infusions used off-label for depression require fractional dosages of ketamine compared to other uses, with minimal side effects that wear off in minutes. And the results are extraordinary.

Safe, FAST, and So Effective

People who’ve suffered throughout their lives with depression so severe they’re looking for an exit, are experiencing restored lives from the lifting of depression. They feel relief and renewed creativity that improves almost daily throughout their initial IV infusion course.

These most critically depressed patients often experience relief from suicidal thoughts within the first hour or two after their first IV ketamine infusion.

You’ve heard that traditional antidepressants–SSRIs, or selective serotonin reuptake inhibitors and others–work through the monoaminergic system on specific neurotransmitters.

But we’ve moved way beyond talking about monoamine neurotransmitters in psychiatry.

We talk about inflammatory cascades across the blood-brain barrier. New signalling systems. Dendritic branching and synaptic density. Neural networks.

New lingo. New news. New hope.

Ketamine works to bring balance to the body’s glutamate signaling system, a different system that hasn’t been addressed before in depression treatment. Ketamine works in a startling and effective way: it stimulates mRNA through the mTOR pathway to remodel neurons.

Wait. Say that again.

Ketamine turns on DNA to actually stimulate the growth and branching of neurons and to create more dense connections between them. It can literally stimulate the remodeling of neuronal trees and improve neuronal rearborization.

English, please.

Ok, here we go: IV ketamine infusions flip the DNA switch to “ON” to help neurons regrow the branches and connections that have been pruned away by stress.

This is extraordinary.

It’s so exciting that we should be throwing ourselves into studying it further, waking up early, reading voraciously, giving TED talks.

And low-dose ketamine infusions do several other nifty things that we’ll talk about in future posts. Things like bringing into balance the body’s glutamate signaling system–a different system that hasn’t been addressed before in depression treatment.

So addressing that imbalance ignites a whole new hope for depressed patients.

A New Approach

This alternative approach to treating depression and anxiety has so many benefits. It works fast, often within an hour. And continues to relieve depression through the weeks of treatment. Those treatments can provide depression and anxiety relief that lasts for weeks or months, or perhaps much longer.

As far as safety, there hasn’t been extensive testing for the long term effects of ketamine off-label use in depression. But there’s still the data from decades of ketamine use for anesthesia. As an anesthesia medication, the doses are much much higher, and it’s a safe drug with minimal, time-limited side effects.

Some people achieve remission after one treatment. But most need a short series of IV ketamine infusions over about 2 weeks to achieve remission—and still others need a bit longer. There are those who need maintenance doses to keep their depression at bay . Still, for those who are helped, this off-label treatment is a life-saver.

It’s hope. Pure and simple. And exhilarating.

Ketamine: Life Saving Innovation

So, it’s true this use of ketamine off-label hasn’t been through the scrutiny of the FDA’s approval gauntlet. Even so, the literature has shown striking benefit to severely depressed patients who have not received effective treatment in the past.

If your results from your depression and anxiety medication have been unsatisfactory, consider exploring a breakthrough option. Please do call for an appointment.

We’ll learn so much about you and the factors that can help predict your response to IV ketamine infusions through a thorough evaluation.

I look forward to meeting you.

To restoring you to your best self,

Lori Calabrese, MD

January 26, 2017
Bipolar Disorder: Why Are You Acting That Way?

“I hope I don’t have bipolar disorder.”

“It’s not bipolar, right?”

“How do I know if it’s his bipolar disorder or if he’s just being a brat?”

“Everyone just throws that term around like it’s the menu of the day—bipolar disorder is so overdiagnosed, it’s not funny.”

The words are tough to hear. The phrases can feel ugly.

And the diagnosis often carries fear and even shame for a lot of people who feel judged, scrutinized, and stigmatized by it.

But the fact is, bipolar disorder is caused by changes and variations in your brain and how it works …with all its sparks and fire, and all its awful, slow sludge. Changes you couldn’t possibly have prevented. You aren’t to blame. And we’re here to offer you the support and treatment you need.

So, let’s chat a bit about what those physical causes are. We know that bipolar disorder causes extreme changes in mood, behaviors, and thinking. Your mood changes can happen over a period of months, or weeks, or even hours.

You may feel happy and energetic. Or you might feel extremely stimulated with feelings of creativity, power, and superiority for a few months. Or…intensely irritable, volatile, and impatient. It can change on a dime.

This can last for hours, or days on end, or for months.

Then your feelings can change…slowly or more abruptly… to a dark melancholy or despairing depression for just as long. Or maybe shorter. Or maybe longer…Yikes.

Not Easy. But Also Amazing…

Bipolar disorder is not fun. It’s tough, it’s exhausting, and it can dig you into a hole fast. Still, there are aspects of this disorder that can actually be amazing. Things like a perception of beauty, and heightened creativity, and exquisite sensitivity that can give you a much more delicious taste of life than the average guy on the street.

People who find their mood is dark and melancholy for months, then finally begins to brighten for awhile, experience the most common form of bipolar disorder.

But you know what? Just as the changes may happen over a long period of time, they also may swing over a period of weeks, days, or hours, with happy or agitated periods of energy, then crashing to a pit of despair, then back again… even in the same day.

The frequency, the intensity, the breadth of the symptoms – and the rate of switching – vary widely across the spectrum of the disorder.

Meanwhile, it’s important if you have these mood swings over either a short time frame, or a much longer period, that you take the step to get a thorough evaluation. If your moods and your behaviors change in a way that makes you feel out of control of your life, or like you’re sort of trapped in your emotions, then that’s your signal to reach out for an evaluation. You don’t have to figure it out all alone.

Because we’ve been working on figuring it out for centuries.

Circular Insanity

Sounds pretty awful. You may know that a generation ago it was known as manic depression. And before that, in 1851, it was called circular insanity. The condition we now call bipolar disorder reaches back to the earliest observations of despair and melancholy in 400 BC. It’s not new. It goes way back. Misery has always been easy to spot.

But early psychiatrists, who were attentive and meticulous observers, recognized that in some people, despair had another face in bipolar disorder. A person could suffer from one illness that had two extremes, rather than two separate conditions. And…the two extreme symptoms were related to each other.

Medicine has researched bipolar disorder deeply since that time, and it is the most fascinating and possibly the most broadly researched and investigated brain-based health condition.

That’s right. Bipolar is not just bad behavior, or uncontrollable anger, or a flaw in someone who doesn’t control himself. It’s a brain-based condition that needs treatment.

The National Institutes of Health says that 2 percent of Americans suffer from this disorder. But of that 2 percent, they say 83 percent are particularly severe.

Other surveys put the numbers much higher when you take a broader perspective and include more subtle forms of depression and mania—at anywhere from 3 to 10 percent.

So Many Without Treatment Struggle … And Feel Misunderstood

Here’s the tragedy, though. Because of the stigma sometimes associated with this diagnosis, as well as misidentification of the symptoms, misunderstandings about the treatments, and financial constraints, not even 40 percent are treated with even minimally adequate treatment.

That means there’s a huge number of people struggling every day in their work, their relationships, and their homes, unable to understand why everything is so hard. Why they feel so alone and misunderstood.

Sometimes a person with bipolar disorder feels like he or she’s actually got two different sides: the “wild” one who stirs up problems …. and the “nice” one who has to live with the fallout.

And that’s what treatment is about — to create stability, to help the “wild” one blend into the nice one so life, work, and relationships are manageable again.

But What About You?

What does this mean for you and your family?

One thing we know is that there’s a tendency to inherit this disorder. So if you see these symptoms in yourself or your child, someone else nearby in the family tree very likely has it, whether they’ve been diagnosed or not.

If you aren’t the one in your family with bipolar disorder, you may wonder what your role is and how to cope with the ups and downs. Keep reading … we’re going to address relationships with a person who has bipolar disorder in future posts.

Hopefully, this post will help you gain some understanding of what your loved one goes through, and why.

Bipolar disorder, like other brain-based disorders, is not a sign of weakness or bad behavior in the person who has it, but rather is a result of changes in the structure and function of certain anatomic elements of the brain.

The Amygdala in Bipolar Disorder

One key area that’s a source of symptoms for this disorder is the amygdala, which is located in the temporal portion of the brain. This little lima bean-shaped duo organ is located on each side of the brain, in the temporal lobes. The amygdala alerts us to fear, it responds to things that are rewarding, and is also the seat of aggression. It identifies for us those things in our environment that are emotionally important to us.

If a fire is ignited near us, we see danger. In a bipolar person that alarm is multiplied. If we see something rewarding, like a bar of chocolate, or a fragrant flower, or the sweet smile of a baby, the amygdala lights up, and we feel a flush of pleasure.

But if you have bipolar disorder, the response of the amygdala is exaggerated and you may feel that reward with far more intensity.

Basically, the amygdala activates far more emotion in persons with bipolar disorder than it does in the rest of us.

So you feel those emotional reactions with more intensity.

And understandably, you’re likely to express those emotions with more intensity, too.

There’s also evidence that the amygdala itself is smaller in children with bipolar disorder, and is assumed to be too small; but it’s been reported as both smaller than it should be… or larger in adults with this disorder. There’s still so much to learn.

Let’s look, though, at more of the brain structures that explain still more about bipolar disorder.

The Prefrontal Cortex – Dorsolateral and Ventral

Another key area in the brain that’s significant for you if you have bipolar disorder is the prefrontal cortex. It helps us consider facts and choose our behavior in response. This area helps with mood regulation, and helps us inhibit behaviors we may feel like doing, but know are not socially advantageous to display.

There are two key players in the prefrontal cortex for people with this bipolar disorder. They’re the dorsolateral prefrontal cortex, and the ventral prefrontal cortex.

The ventral prefrontal cortex is securely connected to the amygdala. Like the amygdala, it also responds to what’s rewarding or not rewarding. In people with bipolar disorder, it responds with more intensity than it does in those who don’t have this disorder.

The dorsolateral prefrontal cortex is the more rational part, and tends to moderate emotional reactions. In people with bipolar disorder, it’s far too inactive.

Which means that the emotional networks of the brain in bipolar disorder are exceptionally active, and the networks that moderate those emotions are less active or ineffective.

The result? Highly active emotions in a person who doesn’t have the equipment to regulate them. Plus highly stimulated aggression, again without the inhibitions to control it. This is a brain that just can’t do its job.

Bipolar Disorder is a Biologic Illness

All of this is to say that bipolar disorder isn’t an excuse for misbehavior–as sometimes cruel, uninformed individuals might think. It’s the result of altered areas of the brain that heighten emotion when that brain is also lacking the equipment it needs to manage emotional responses.

For this reason, if you live with bipolar disorder, you can know this is a condition just as real as diabetes or heart disease and just as debilitating.

And just like other illnesses, if you have bipolar disorder or other mood disorders, you need support and help through treatment.

We’ll talk more soon about how this disorder affects your life, your work, and your social connections. But for now, let’s just understand that your illness is caused by things in your body that aren’t working properly. Those things need to be treated.

Some people experience a stable and rewarding life with the right medicine, good therapy, and good structure in their lives. But some need an alternative treatment to enjoy a fulfilling life.

Experience Improvement

The only way to determine what might be most helpful for you as an individual requires a thorough evaluation with diagnostic tests.

That’s why we’re here. We have the expertise it takes to tease apart complex symptoms from the complex life stories that embed them, to rule out other conditions that mimic or masquerade as mood disorders, and to offer sophisticated solutions to get your mood, thinking, and behavior back on track.

And we offer an array of treatment options to help you find your best self — including effective ways to stimulate the firing of large neural networks with TMS, and ground-breaking opportunities to stimulate your own neuronal rearborization with IV ketamine.

There have never been more exciting opportunities to get well and stay well.

Call for an appointment so we can do a full evaluation, and create a plan for you.

You can experience a more fulfilling and rewarding life, even with a diagnosis like bipolar disorder. You just can’t do it alone.

Contact me and let’s get started.

In support of your best self,

Lori Calabrese, M.D.

January 19, 2017
The Doctors: Woman Shares Her Experience Undergoing Ketamine Infusions for Depression

Julie, who says she has suffered with clinical depression almost her entire life, recently underwent two ketamine injection treatments to treat her condition. She joins The Doctors to share her experience with the controversial new treatment.

January 15, 2017
There’s No Shame in Shyness
Shyness is a natural reticence to interact with people you don’t know. For those who are shy, it can be very painful and interfere with their social development.

Introverted ? …or Shy?

You may have heard it said that shyness is just introversion. But, this isn’t really true. An introvert may or may not be shy. Introversion is in a person’s makeup causing aloneness to be energizing. Extroversion is a personal state for those who are most energized by interaction with people.

Shyness, though, is another matter. Some shy people really long for social interaction, but are too inhibited to seek it. It’s an offshoot of social anxiety, where there may be fear of rejection, worries about how you’re seen by others, or negative feelings about yourself.

As a symptom of social anxiety, shyness can include the belief that everyone is talking about you negatively, or that you’re just not acceptable to others for unknown reasons. A shy person might say to herself, “If they’d just get to know me, they’d see I’m actually a great person.”

But the shyness can be expressed on the outside by a withdrawn demeanor, or sometimes even a scowl. And those around him may not realize he wants friendship. So a vicious social cycle can form.

Feeling Shy is Universal

Most of us feel a little shy at some point in our lives, but when it happens it’s usually transient due to new surroundings or new social settings. But for some, the withdrawal and anxiety is so intense, it prevents interacting with others in situations where it’s really important.

Add to that the physical symptoms that may show up like deep blushing, profuse perspiration, rapid heartbeat, and upset stomach — and a difficult situation can become unmanageable.

If you or your child experiences intense shyness, do you find yourself in any of these situations? Do you:
- Cancel social events at the last minute?
- Have a small or nonexistent circle of friends?
- Avoid activities that would otherwise have been pleasurable?
- Tend to be passive or pessimistic?
- Have low self-esteem?
- Use the computer excessively to you avoid face to face contact with others?
What Causes Such Social Avoidance and Shyness?

Some people are just born more highly sensitive and emotionally reactive. They show withdrawal and shyness as they grow to be toddlers. If they lack adequate social support, they naturally withdraw.

Sometimes, their nature is at odds with other family members and they don’t feel they fit in.

Other times, shyness is caused by experiences where they feel shamed or traumatized. This can also happen with a move to another school or city where they have to start over building a supportive group of friends. The vulnerability they feel, or teasing by their new acquaintances, can trigger a shyness and anxiety they never felt before.

In addition, abrupt changes in family life, or a sudden change like living with a family member, or divorce, can trigger this loss of confidence and withdrawal.

In both children and adults, negative hurtful interactions or harsh criticism from parents or other family members, or cold family relationships can be damaging and lead to social avoidance, shame, and shyness.

The same is true of school and work where public embarrassment, and highly competitive, critical or hostile environments can cause the same type of damage to a sensitive person.

So What Can You Do About Shyness?

Be kind. Whether to yourself or your loved one, patience and support are the ticket.

Don’t force social situations … the confidence and stamina to face them will come in time with support.

Talk with someone you trust, or ask your loved ones about the events of their day and how it all makes them feel.

Validate for yourself or your child that deep need we all have to belong, and the conflict with the fear of rejection.

Work on thought patterns, criticism of yourself and others, and develop different ways of thinking about these things.

Remind yourself and your loved ones that shyness is something everyone feels at some point. With time, patience, and support it will become manageable.

Over time, you may find you’re ready to set manageable goals for interaction in user-friendly situations.

Spare Yourself or Your Child Excessively Hostile Situations

…until your confidence has improved and you can choose your battles.

You’re a beautiful person, and there’s no shame in your shyness.

Loving yourself as you are can help you combat those inner doubts that make your shyness so painful.

Your sensitivity protects the treasure within you so you can make social decisions that actually enhance your wellbeing.

If social anxiety holds you back from things you want to experience in life, we can help. Innovative Psychiatry provides treatments that break through tradition and accelerate your progress. Call us today to schedule an appointment for evaluation.

To your ever blooming best self,

Lori Calabrese, MD
January 12, 2017
Attitude of Gratitude: How to Rise Above Tragedy

WHAT DOES GRATITUDE HAVE TO DO WITH HAPPINESS?

We’ve been talking about the science of happiness. The things researchers have been learning about what actually make us happy, as well as what doesn’t make us as happy as we think they will.

The funny thing about happiness is that it’s sort of counter-intuitive. For instance, if we only think of ourselves and what we want, we begin to sink, and grow less and less happy.

Even if we get EVERYTHING we want! The richest men in the history of humanity who were focused on accumulating for themselves and got everything they wanted…were usually miserable. The ancient king Nebuchadnezzar, for one. And Howard Hughes might be another example.

SELFISHNESS HURTS

Another dramatic example is King Solomon, who lived around 970 BC. He had it all…wealth, fame, and 700 wives. But… he was miserable. The more he gathered for himself, the more miserable he became. (Since building a healthy relationship with one spouse is pretty challenging already, it’s probably not that surprising he was overwhelmed and stressed out trying to do it with 700!)

Solomon wrote three books in his lifetime, and the final one was about the misery of trying to make yourself happy by getting everything want.

GIVING FREELY COMPOUNDS JOY

On the other hand, men who used their wealth and power to improve the lives of people, and make the world a better place, have often been much happier. Men like John D. Rockefeller, who began giving 6% of his paycheck to charity at the age of 16, and lived his life not only building his wealth, but also perfecting systems of giving his money away to improve the lives of others. He has often been called the wealthiest man in the world, but he was also one of the most generous. John enjoyed his wife and family–a strong pillar of happiness.

But then there was also his contemporary, Andrew Carnegie, who may really have been the wealthiest with the equivalent of $374 billion. In addition to building his massive steel company, he spent the last 20 years of his life traveling to see friends, and helping others. Mr. Carnegie enjoyed his visits with friends like Mark Twain, Teddy Roosevelt, and so many others. He had humility, and valued his friendships.

These are just two examples of generous wealthy men who found happiness in giving and valuing their relationships. But it’s not hard to think of more from early times to the present. Genghis Kahn for instance (huge surprise!) and of course Bill Gates, among a host of others.

GENEROSITY AND AN ATTITUDE OF GRATITUDE

The fact stands that it’s not wealth that brings happiness, but generosity, strong relationships, and a passion for something.

So…we talked about in our post last week about the science of happiness, we learned that it isn’t getting that brings us joy, but giving. Not taking advantage of someone else to our own ends, but serving and caring for the welfare of others.

A huge study that included 200,000 people in 136 countries found that being generous had a positive effect on a person’s happiness in 93% of the countries involved. Another study conducted at Notre Dame found that the more people gave of themselves and their money, the happier they were.

As humans, we need to have something bigger than ourselves to live for.

We humans actually like to sacrifice for the good of others. How’s that for a surprise…?!

Another pretty important factor is having an attitude of gratitude. Rather than taking credit for everything we accomplish, and for all the good in our lives, we’re happier putting humility to work and expressing our gratefulness for the good in our lives and the potential for good even in the toughest situations.

Is that because we know we don’t have power to control everything?

[Because if we think we can, the burden of controlling all things in the world around us to ensure safety, prosperity, friendship, and happiness, is a big truckload to pull around…but let’s save that for a future post.]

SILVER LININGS

The beauty of gratitude is that it acknowledges we can’t do it all ourselves. It also says that there’s good to be found in every circumstance of life, no matter what it is. By choosing to be grateful in a difficult circumstance, we open the door to solutions.

There’s a man who is a world-class expert at finding silver linings. An expert at choosing gratitude.

His name is Jon Morrow, and if you haven’t learned about him or met him up till now, you may want to connect with him before you forget.

Jon was born with muscular dystrophy, and is unable to move anything but his lips and his eyes.

Yes, he’s paralyzed. He can’t move any other part of his body. But he’s not numb. He feels pain just like you do. In fact, pain and struggle is part of every single day of his life.

And yet, you know what? He’s developed, through decades of suffering, an overcoming approach to every challenge. He looks for the silver lining no matter how bad the circumstances, and he always determines to turn every difficulty into something in his favor.

GRATITUDE EXPERT

He’s grateful. Grateful for his life. He admits it’s not been an easy way to live, but he also knows if it had all been easy for him, he might have done nothing with his life.

Ten years ago he was in poverty, in a hospital bed, and completely dependent on Medicaid to support him and his $120,000/year medical bills. He felt trapped. If he earned more than $700/month, Medicaid would drop him. So he couldn’t build a business…because he needed medical care.

Jon hadn’t found his flow. Remember how in our science of happiness post we talked about how finding your flow motivates you to live with passion and purpose? Jon hadn’t found his yet…he felt pretty much stuck.

But, since the rules of Medicaid had him stuck, he set out to change the rules. It took courage, but the flow was beginning to trickle. He invested two years of his life writing for a successful online publication for free, because he couldn’t make more than $700/month anyway.

PUT GRATITUDE ON THE OTHER FOOT

He told the publisher there was one stipulation…he’d write for them awhile for no pay, but eventually there would come a time he’d need some favors in return.

Now, Jon is a guy who was accepted into MIT…but he couldn’t afford to go. Jon is no slouch, in fact, he’s a pretty sharp guy. So his writing was received with enthusiasm by this organization. This continued until 2 years later, when he was ready to take the next step.

He told them it was time, and he needed some favors. He needed to move to Mexico where medical care costs far less. (That $120,000 bill per year in the US only cost $18,000 in Mexico!)

He told them he needed to start a consulting business and asked for help reaching some people through their mailing list to market his services.

They happily agreed, and in 30 days, this guy had a full-time consulting business that supported him with $10,000 per month. Now, ten years later, he’s a millionaire, and he can live wherever he wants to.

Now, let’s talk about what makes happiness in light of Jon’s story.

It’s human nature to feel sorry for ourselves when things don’t go well. We all know that. But Jon Morrow will quickly tell you he may be tempted to feel sorry for himself…but he can’t afford a single second of it without being defeated.

JON MORROW’S ATTITUDE OF GRATITUDE

To overcome whatever he’s faced with, he looks for a way to find benefit in his circumstances – to seek out that silver lining – and he looks for ways to make it better than if it had never happened.

If you’re angry, bitter, or tied in knots of self-pity, you can’t think that way. When all thoughts are turned inward, it’s tough…really tough…to get them turned outward again.

And like we said before, happiness relies on counter-intuitive responses. Focusing on ourselves snuffs out the joy. But looking for ways to help others, well, that fills us with power. And happiness.

I encourage you to read more of Jon Morrow’s writings. He’s learned some profound lessons about happiness, success, and giving of himself through his 34 years of struggle. He’s started a new blog to give back by teaching the world these principles that have brought him so much richness in life.

So learn from his story the lessons of gratitude and generosity, of finding your flow, and always finding a way to turn every negative circumstance to your favor. When you do, your garden of happiness will be fertilized, nourished, and will grow so full you’ll have to give some of it away.

And…if your own struggle makes happiness seem beyond reach, schedule an appointment to see if you’re a candidate for innovative psychiatric treatments like IV ketamine therapy or transcranial magnetic stimulation. We’ll learn so much after a comprehensive evaluation.

We’re here to help you live a more fulfilling and rewarding life, and look forward to hearing from you.

To your increasing happiness within your best self,

Dr. Lori Calabrese, MD

January 5, 2017
Newsweek: Could Ketamine be the Ultimate Cure for Depression?

Ketamine, or “Special K” as it is commonly known, is a powerful anaesthetic that leaves the user feeling lifeless and physically detached from their senses.

However, medical experts now believe the popular party drug could be the leading treatment for severe depression and suicidal thinking.

According to the Washington Post, studies over the past decade have proved Ketamine’s efficacy in mental health patients suffering from severe depression who find traditional antidepressants ineffective.

[button url=”https://www.newsweek.com/ketamine-can-help-cure-depression-422201″]Read Full Article Here[/button]

December 29, 2016

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