Category: Anxiety

Articles about Anxiety from Lori Calabrese, M.D. | The Ketamine Blog

When you feel that sense of dread or uneasiness about something in the present or in the future, that’s anxiety. Everybody feels that way at some point. An interview for a job, meeting your fiancee’s family, a major exam…. But for some people, the unpleasant dread can be overly intense and ongoing. When it’s so intense that it interferes with your life, causing you to miss work, or miss social opportunities… then it may be a disorder. These articles about anxiety shed light on the difference between moments of anxiety, and a lifetime with a severe, debilitating disorder.
Anxiety can be as mild as a transient feeling of butterflies, or so intense and overpowering you think you’re having a heart attack so you call 911.

Types of anxiety disorders:

1. Social anxiety

is the overpowering and relentless fear of being watched and judged by others. It can cause you to feel afraid to meet new people, to believe everyone in the room is talking about you, and to feel intensely self conscious in the presence of others. This is a serious mental health condition that can prevent you from interviewing for jobs or excelling at the one you have, or from meeting new people and building relationships.

2. Postpartum anxiety

This is emerging as a serious disorder in woman, at least as prevalent as postpartum depression. It can express symptoms like panic, fear of harming the baby, poor bonding with baby, obsessive worrying, inability to eat, sleep, or relax. Also, it can include the obsessive fear the panic will never resolve.

3. General anxiety disorder

obsessive and continuous worry about one’s health, work, social contacts and interactions, as well as daily routine circumstances and experiences…that repeat almost every day for at least six months.

4. Panic Disorder

Characterized by repeated and overwhelming panic attacks with accelerated pounding heart rate, sweating, trembling, shortness of breath, and feelings of impending doom. Often brought on by triggers, but not always. The attacks lead to a fear of the attacks, and a driving desire to avoid them, which can often lead to agoraphobia.

5. Test anxiety

Irrational dread of testing in spite of being well prepared. The anxiety can rise until the person’s displaying symptoms of panic like accelerated heart rate, headache, nausea and sweating. Can result in the mind going blank, and general functioning shuts down.

6. Phobia-related disorder

Agoraphobia – fear of enclosed public spaces, fear of open spaces
Arachnophobia – fear of spiders
Acrophobia – fear of heights
Dentophobia – fear of dentists
Claustrophobia – fear of enclosed, confined spaces
Aerophobia – fear of flying
Aquaphobia – fear of water
Zoophobia – fear of animals
Coulrophobia – fear of clowns – (not officially recognized but widely claimed)

7. Separation anxiety

Occurs in children and adults, and expresses as fear of being apart from people to whom they’re attached. They often worry that something terrible will happen to the person they’re connected to, and so avoid separation from that person as well as avoid being alone.

8. Selective mutism

A rare disorder in both children and adults where people don’t speak in specific situations, even though they have well developed language skills. It’s often associated with extreme shyness and fear of social embarrassment, and usually begins before the age of five.

9. Obsessive -Compulsive Disorder (OCD)

Considered to be connected to anxiety disorders, but there is controversy as to whether it belongs here. At the very least, that person who suffers from OCD has feelings of anxiety and usually feels powerless to control the intrusive thoughts they have, or their reaction to them.
This is not an exhaustive list, but rather examples of anxiety disorders.

Treatment of Anxiety Disorders

Some people suffer from a cluster of anxiety disorders and mood disorders combined, while some struggle with only one. Since anxiety disorders are best treated for the specific diagnosis, the more complex a person’s condition is, the more complex it may be to treat.

Transcranial Magnetic Stimulation (TMS)

demonstrates promising outcomes for some types of anxiety. Cognitive behavioral therapy shows the most promising outcomes as a form of psychotherapy. Psychotherapy combined with anxiolytic medicines, serotonin reuptake inhibitors (SRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can be helpful, as well.

IV ketamine treatment has demonstrated favorable outcomes in some patients with some types of anxiety. Social anxiety can be debilitating and interfere with the desire to build life, family, and career. Ketamine treatment is one of the most effective treatments for social anxiety. There is exciting work being done with OCD patients and ketamine treatment also.
We invite you to continue reading the following articles about anxiety by Lori Calabrese, M.D.

Fix Your Inner Life: Embrace the Truth About Yourself

Be sure it’s your real self you’re showing. Because it is your real self that needs to be loved. Daphne Rose Kingma

It’s the most healing thing you can accomplish as you work through the changes in your thinking, your responses, your outlook and attitude about people and your world after ketamine treatment. As you build an infrastructure of peace and generosity…fix your inner life and learn to embrace the truth about yourself.

Self-doubt, self-defensiveness, and pretense eat away at your self-respect and love of yourself…and can lead to depression. But you want to reduce the stress in your life to help your wellbeing thrive.

How do you reduce the stress? By facing the truth that eats at you or that you hide from yourself.

What sort of truth..? Well, that you’re human, for starters. That you’re not always perfect in your responses to life’s stressors. And that there are plenty of things you can learn to make your life work better for you.

Things like humility, admitting your shortcomings, and asking for forgiveness, to name a few. To accept yourself as a learner in this life and not to expect yourself to know everything out of the gate.

Using Pride as a Shield of Protection

Pride drives many of us to present ourselves as infallible, until we realize that pride also shackles us from the fulfillment of intimacy in relationships.

Replacing pride with love can be scary. It can make you feel exposed and vulnerable until you get used to it. But doing so can transform your life and drive loneliness away.

Something we do as humans is to construct personas that we tell ourselves others will find more likable or respectable than who we really are. But a persona that you construct is always stilted. Unnatural.

Have you ever been around someone who’s utterly at home in his own skin? Isn’t he or she absolutely enjoyable and relaxing to be around? The reason they’re enjoyable and relaxing to be around is because they’ve found a certain degree of peace with who they are.

They accept themselves as they are so there’s no need for pretense. When someone is trying to prove themselves, it can make you uncomfortable. But when you sense they have nothing to prove, you subconsciously feel like you can relax.

At the same time, you get the sense that their mental health is pretty good.

It’s the exception to meet someone like that, rather than the rule. Most of us aren’t free of pretense, until we learn what we need to learn so we can be who we are.

This shouldn’t be so hard. You know?

But we live in a world that feels dangerous and makes us think we have to protect ourselves. So we do. We build walls around ourselves. Thick, impenetrable armor to keep ourselves safe.

And we guard that armor, those walls, to stay safe. Then, if anything threatens to expose us under the armor, we get anxious and defend it. Don’t we?

So, after all that work, we’re reluctant to knock down those walls. We don’t feel safe without the armor.

And that’s why we have to learn to see what the walls and the armor are costing us. We have to see that they’re interrupting our social development and our opportunities for close, fulfilling relationships.

They also require that we remain vigilant, prepared to defend any attack on our security in the armor. So we can’t relax. We can’t let our guard down.

Fix Your Inner Life

You have to change the way you think. The way you respond to things.

You may need to get really honest with yourself. You may find you have to learn how to embrace the truth, and learn to accept yourself as human, fallible, and forgivable. When you do that, you may also feel more lovable.

And when you feel lovable…and LOVED… you’ll tend to find it much easier to generously love others.

Ok. I know it’s certainly easier said than done. It’s an uncomfortable process to look head-on at things in yourself you haven’t before. But, it leads to a very comfortable, confident, joyful way of living.

Ketamine Treatment Can Help You Achieve Remission

This isn’t news. We’ve known this for years.

But, if you’ve had ketamine treatment, and feel much, much better, you sure want to stay better, right?

Well, one important aspect of staying better is to unravel the conflict you carry inside you that you may not even realize is there.

But…it IS there. And it interferes with the peace within you. So what can you do?

Embrace the truth about yourself.

Just like letting go of what you NEED to let go of, when you embrace truth about yourself it helps you relax with who you really are.

Accepting your shortcomings, and dropping that guard that says you’re flawless, admirable, or beyond reproach, helps you embrace the truth that you’re a real living fallible human worthy of giving and receiving love.

And there’s another plus: doing so will increase your self respect.

Sound pretty far out? What if you don’t know what you have inner conflict about? Or how to tell if your guard is up?

What if you’ve been presenting yourself the way you think people expect you to for so long you don’t remember what it was like to be yourself?

Scrutinizing Your Inner Self

Start with looking closely at that experience or event that scratches at your conscious memories. What are you telling yourself about it? What about it might be seen differently?

Pay attention to your inner voice…do you find yourself defending yourself over what happened? What could you be “hiding” from yourself?

It might be related to some sort of blame you place on another person… or something you’re hiding from yourself. Look deeper. Could you have caused the situation, even though you didn’t intend to? Is it possible you share responsibility for what happened?

And what happens when you look at the other person’s role with a heart of forgiveness and understanding? Can you see how the outcome might not have been his/her intent?

Then. Just say it. “It’s my responsibility that so-and-so happened. ” Or…share the responsibility… ” I share in the responsibility that so-and-so happened. I didn’t intend for it to go down the way it did. He/she probably didn’t intend it either. I’m human, and I was wrong. I handled the situation badly. I’m truly sorry, and I’ll really try to not do it again.” Then move on with the resolve to make good decisions and to treat others well going forward.

I Was Wrong

It’s very difficult sometimes to reach this point. But giving up the fight and accepting that you’re fallible can be so liberating. You THOUGHT it could destroy you, hence the long arduous combat in your mind.

But when you really see that you were wrong…you can accept that it happened. And the fight inside you…the defensive arguments in your head…begin to disappear and become quiet.

And that quiet is a deposit of peace into your inner self. Enjoy the reward of harmony you feel.

Then take what you’ve learned and apply it to the next situation that comes to mind…because another situation will. You’re human and fallible. And so is everyone you know.

Going forward, you may find you’re a little less judgmental, a bit less inhibited…and more and more relaxed. In that relaxed and peaceful state, it’s much easier to feel better.

With these things at work within you, you can accept yourself as human, and realize that through forgiveness of yourself you are more able to love and receive love. And that brings joy.

Remember, this discussion is NOT to say that if your remission fades away, it’s your fault.

IT’S NOT.

But since stress remodels and prunes the signaling circuitry in the brain, which can lead to depression and other disorders, it stands to reason that the more you can remove stress from your life, the better the environment is for remission to thrive.

At Innovative Psychiatry, we want to be a part of your recovery as you use your ketamine treatment to help you bring change in your thinking, your outlook on life, and your attitudes.

Everyone needs these changes, but not all understand how to make them.

If you’re not in the habit, but have experienced joy from ketamine treatment, changes like we’ve talked about can help you continue to enjoy that joy, increasing love…and freedom from emotional pain.

January 28, 2019
Treatment of Psychiatric Disorders: 2019 Year of Promise

Compounds and methods for treating severe psychiatric disorders are getting better and better…

Charlie sank into a chair in utter discouragement, as she realized she had awakened again, after hoping as she went to sleep that this would be her last night. Her last time to breathe. Night after night she prayed to die in her sleep. Morning after morning she woke up again. Ugh.

She felt betrayed by whatever cruel powers that be…that there seemed to be no compassion for her misery…and no escape.

She dragged herself to the bathroom and turned on the shower. Instantly, she saw an image of herself hanging by a rope from the shower head.

And she screamed.

Then climbed into the bathtub and stood sobbing under the shower.

Finally, she shampooed her hair, soaped up her body, rinsed, and turned off the water.

There was nothing to do but go to work…AGAIN…and try to function…AGAIN… and hopefully not get fired, because of her poor performance. Tears filled her eyes…

Suicidal Thoughts Can Be Deadly

Charlie is one of millions in the US who want to die as a result of depression. Approximately a million people commit suicide each year, and many times that amount try but survive. And many times more than those get struggle with suicidal thoughts that keep coming back.

Because relatively few tell anyone they’re thinking about or even considering suicide, it’s been impossible thus far to estimate the number.

They don’t want to die, they just don’t want to live with this kind of misery any more. Maybe you know someone like this… or you’ve felt like this yourself.

You are the ones we want to reach, to help, and to treat so you can rebuild fulfilling and rewarding lives again.

Ketamine Treatment Continues to be Misrepresented

With all its talents — with all its extraordinary mechanisms of actions — IV ketamine treatment may need a good PR firm!

When have you seen a safe, rapid, extraordinarily effective, life-saving treatment misrepresented, misunderstood, lambasted, and gossiped about more than ketamine? (Think about that for a minute.)

I saw a comment in STAT magazine the other day that took the cake.

There were lots of great comments, some more informed than others. But you do sort of expect that in a national publication. And… there was a lengthy comment–difficult to decipher–claiming ketamine was inherently dangerous.

It was clear the individual didn’t know about the research and data. All the information that’s poured out around the globe about ketamine and related compounds for psychiatric disorders over the last 10-15 years.

The commenter seemed to only be acquainted with its dangerous and highly abusable street form, Special K. And with the extremely high doses used on the streets… repeatedly over and over and often… he or she had seen the damage that abuse of ketamine can do.

As a psychiatrist, I hate to see it represented that way, but I cherish free speech, and freedom of expression. I also cherish scientific advancement and use it — every day — to relieve suffering.

Ketamine should definitely be administered under a psychiatrist’s close supervision, not self-dosed.

Then … there are the articles by young residents and clinicians, aspiring academics, and others. Those who have little true experience with the medicine or the treatment. But they’ve jumped in to write reviews of the literature or opinion pieces about it.

The best way to learn about ketamine treatment for psychiatric disorders is to hear directly from experts who actually use it — with many, many patients — every day in their offices or research units to treat psychiatric conditions. In this case, from the neuroscience researchers and psychiatrists who have worked with it a long time.

Because the truth is, the majority of physicians have read snippets about it here and there. They’re just now getting up to speed. And some have distorted ideas about it.

An article in VeryWell Mind by Naveed Saleh, M.D., May 2018, made some erroneous statements about ketamine treatment for suicidal thinking.

First, he claimed that ketamine is best absorbed through the intramuscular (IM) route, which is just simply false.

Ketamine is 100% bioavailable only when it’s given by the intravenous (IV) route. In IV form it’s delivered straight to the brain tissues that so desperately need its benefits. IM and IN (nasal spray), lozenges, troches, and oral liquids are all less bioavailable.

In addition, there are other problems with IM injections of ketamine that we’ve discussed and that are described in that Time Magazine article we talked about.

He also made claimed that if ketamine is to be widely-used, it most likely will be as an adjunct to other medications. Another misunderstanding of his research. Because the evidence says…

Ketamine Treatment Acts Independently of Other Medications

While that may or may not be true, my vote is that it won’t need to be. Evidence shows it doesn’t depend on other medicines for its mechanism of action. It’s not dependent on other medications to create a “partial response” that it augments. It acts independently on its own merits.

In fact, the most robust research is in patients where medication has FAILED — patients who have TRD, or treatment-resistant depression.

The left half of the ketamine molecule, known as esketamine, is nearing completion in its FDA trials and IS being tested as an adjunct to other medicines, not as a primary or stand-alone treatment. It’s being packaged as an intranasal spray, and has had some serious setbacks while seeking FDA approval.

It’s exciting to see what new glimpses researchers will find as they continue to study ketamine and other related compounds for treatment of suicidal thoughts, depression, bipolar depression, PTSD, OCD, social anxiety, and addictions. Maybe it will be a new action not yet identified, or maybe additional applications or conditions that could be responsive to this extraordinary treatment.

But the majority of patients who receive IV ketamine treatment report that other antidepressants or anxiolytics have failed, and, even if they walk in on antidepressants and mood stabilizers, they attribute their response and remission to ketamine treatment.

Ketamine Treatment of Psychiatric Disorders…

At Innovative Psychiatry, we see the majority of patients with severe treatment-resistant depression, bipolar depression, and suicidal thoughts. respond and achieve remission. They are real-life, real-world people just like you or people you know. Often, they don’t have just one thing or just one disorder — because psychiatric symptoms and disorders are complex and tend to run hand-in-hand.

We call that complex psychiatric cormorbidity.

Don’t let the term scare you.

It just means that when we see patients with treatment-resistant depression — as in unipolar depression and bipolar depression — they often also have other things, too, like social anxiety, PTSD, OCD, and addictions.

They’re often hopeless. Often suicidal.

It’s one of the reasons we’re so interested in following the research in using ketamine to treat suicidal thoughts and these other psychiatric conditions — and one of the reasons I write about them so often and devote space to them here.

Suicidal thinking can disappear within a few hours with IV ketamine treatment. Think about what that would be like for you … or someone you love.

If you’d like to consider ketamine treatment, give us a call. We can talk it through.

The Microbiome Has Been Underestimated

The microbiome is the collection of genes included in the trillions of bacteria, fungi, and viruses that populate the gut along nerve pathways connecting your brain to the rest of your body. These microorganisms provide our immune system and all work together to help our minds and bodies function properly and in partnership.

Another area psychiatry is advancing quickly forward is in its understanding of the importance of the microbiome and its effect on psychiatric illness.

When the balance between good organisms is outweighed by “bad” organisms, we become sick in some way. This may be an upset stomach, a systemic virus, or a disorder like depression, to name a few. Restoring the balance of these systems in our gut can help restore our health.

In fact, physicians have come to understand that sometimes the extensive use of antibiotics may destroy so much bacteria that the good bacteria that fights disease becomes depleted.

The more we learn, the more we can refine this essential part of our bodies to support our emotional well-being, as well as fight inflammation throughout our bodies.

But, we’re also learning it’s possible to overdo good organisms, too. And other disease symptoms can begin if there are far too many of them. It’s a balanced eco-system we’re looking for… We’ll be talking more about that soon.

Plans Unfolding for the 2019 Year Ahead

And we’re brimming at Innovative Psychiatry. (How’s that for 2019?) With new initiatives, new efforts, and exciting plans.

We’re expanding our hours and our availability, and preparing to publish our outcomes peer-reviewed journals in the hope of adding to the growing body of evidence of ketamine treatment’s remarkable benefits for treating an array of psychiatric disorders. (I’ll keep you posted as that develops.)

We hope to present our outcomes at more national and international conferences this year.

On top of that, we’re adding some opportunities to help us get more help to more of our patients to finance the cost of their treatment, and help fight for insurance companies to reimburse patients for the cost of their treatment.

Ketamine Treatment: Getting Better, Giving Back

Another opportunity in the wings is a program we’re developing — the first in the country– that would allow us to help patients Get Better and Give Back to their communities with special volunteer opportunities.

This program can help patients who would not have access to treatment any other way.

As we get all our irons in the fire scheduled and the details sorted out, we’ll update you so you’ll know what to watch for. G

2019 promises to be a year of hope, and a year of gratitude and goodwill, as we see more people feeling better... and getting well… after years of struggling without solutions.

We want to see progress made toward insurance companies covering ketamine infusions for psychiatric disorders. The medical billing code for ketamine infusions exist but it is usually rejected when it is linked to a psychiatric diagnosis. We continue to fight stigma and stigmatizing terms.

Hope is on the horizon. It’s going to be a good year.

If you battle depressive symptoms, or suicidal thoughts like Charlie, that haven’t gotten better, despite various medicines you’ve tried, please get in touch with us if you’re interested in ketamine treatment.

It consists of several doses of IV ketamine, usually about 6, and sometimes a few more, over 2-3 weeks. Ketamine isn’t appropriate for all patients — and doesn’t work as well for some as it does for most of our patients — so it’s not for everyone.

But we see such high percentages of response, we can say that most likely the chances are it will be a great help to you.

Most of our patients find after a full series of infusions, they can do things they’ve procrastinated about for years, enjoy things they used to enjoy, take advantage of energy to work, create, and socialize they had found impossible, in many cases for years. And build relationships and careers that are rewarding and satisfying.

We look forward to talking with you, and helping you find your smile again.

To the best YOU you can be in 2019,

Lori Calabrese, M.D.

January 7, 2019
Advances in Psychiatric Treatment: 2018 in Review
Happy New Year!! The big silver ball falls tonight to celebrate the birth of 2019.

Let’s celebrate the unprecedented, transforming, and ever-accelerating advances in psychiatric treatment this year and the neuroscience that backs it up.

Celebrate is the word. Because we’re so grateful to the courageous researchers around the beginning of the 21st century who dared to test new ideas and compounds to treat psychiatric disorders.

This testing, and subsequent investigation, snowballed into a field of life-changing breakthroughs and developments like ketamine treatment, transcranial magnetic stimulation (TMS), and other “outside the box” novel treatments.

We’ve watched TMS press forward from an almost incredulous idea to its more prestigious position as a very effective non-drug treatment for patients with major depression and OCD who have not responded to traditional treatments.

True advancement risks misunderstanding, distrust, and adjustment before it’s accepted, and the breakthroughs in psychiatry are no different. There have been skeptics and naysayers, and those who prefer to “wait and see.” But tireless researchers press on.

Psychiatric Treatments Are Improving

Ketamine treatment has, in a relatively short time, emerged from being a who? kid on the block to a blockbuster this year. We know it as possibly the most rapid, robust, and effective treatment for patients with treatment-resistant depression and for depressed patients with suicidal thoughts.

The discovery of its hidden talents and the explosion of research publications testing at its effectiveness for PTSD, OCD, addictions, and anorexia (actually one of the first published studies on IV ketamine!) has inspired numerous investigations into other rapid-acting medicines by demonstrating its widespread and neuroplastic actions in the brain.

Across the fields of psychiatry and neuroscience, 2018 has been a very good year, with breakthrough research published all year long.

Let’s look at some of the 21st century discoveries that have been rising to new heights in 2018.

Outside The Box

Schizophrenia and Autism Spectrum Disorder
In 2018, the ballooning mental health crisis drove researchers to find more biological causes for these illnesses, and more ways to treat them effectively.

For instance, researchers identified master keys (neat name!) in terms of genetic markers that identify complex disorders like schizophrenia and autism spectrum disorder (ASD).

And after studying the genetic connections, they found that too much of a specific master key: MIR-137, can result in symptoms of schizophrenia … and too little of it can result in symptoms of ASD.

How’s that for a startling connection?

Just knowing this can potentially pave the way for development of treatments for these disorders — using MIR-137, for example.

Better Therapy for PTSD

Since treatment for PTSD has traditionally been burdensome for both therapist and patient, treatments are being sought that are effective but more practical. Research supported by NIMH produced a new psychotherapy approach, called written exposure therapy, or WET.

By writing about the specific traumatic event, patients were found to improve as much in only 5 sessions as they improved in 12 sessions with cognitive processing therapy, or CPT.

5 sessions are better than 12, wouldn’t you say? For patients tormented by severe PTSD symptoms, 5 sessions are far better than 12. Just ask them.

Better Suicide Prevention..?

Since there are 45,000 suicides in the U.S. every year, it’s essential to develop ways to predict and prevent suicide in individuals that don’t rely on that individual telling someone. Because, many of those who succeed in ending their lives never tell anyone, so it behooves us to find more effective ways of predicting … and preventing.

Researchers tackled electronic medical records and found that half of those who commit suicide and 2/3 of those who try but fail, have had a mental health evaluation in the last year.

Using these records, they leverage things like diagnosis, substance abuse, use of mental health emergency treatment and in-patient hospitalizations, self harm, and scores on Patient Health Evaluations, to predict those patients at risk for suicidal intent and death.

By better predicting those most likely to attempt suicide, we hope to provide adequate treatment in time… and help restore the lives of those who have lost hope.

It’s not enough … but it’s just one more way to try to reach and help some people before it’s too late.

Social Media Surprise

We think of social media in the “fun” category, don’t we? Or do we? If you’re like me, you know more people than you want to admit who have sworn off social media. But why? Isn’t it all about the fun? …or is it?

The first study ever to examine the link between social media usage and mental health issues found that there’s an undeniable link between the amount of time you use social media and the intensity of the loneliness you feel.

Or, put another way, if you’re depressed to start with, the less time you spend on social media the less depressed and lonely you’ll feel.

These researchers only included Facebook, Instagram, and Snapchat in the study.

Now… finally…

Ketamine Treatment Continues to Demonstrate Its Prowess

There are so many more breakthroughs and advancements we could talk about that they would fill a book…and it’s just too much for one blog.

But it’s an exciting time in the world of mental health disorders as neuroscience researchers continue to delve into and investigate the causes, mechanisms, treatments, and prevention of these disorders.

Your hope for recovery… and remission… is more warranted than it’s ever been. You really can get better…even well.

During 2018, physicians and researchers have collaborated, exchanged, and built upon the information that’s accumulating to support the rapid and robust antidepressant treatment of more and more disorders.

We’re Learning about Doses

A study published in October 2018, led by Massachusetts General Hospital researchers, tested four ketamine infusion doses against each other to determine the more effective dose.

Their trial tested 0.1mg/kg, 0.2mg/kg, 0.5mg/kg, and 1.0mg/kg of ketamine in a single 40 minute infusion. The results showed that the two smallest doses weren’t very effective at all for depression, but the two largest were.

And that’s the range that we usually use at Innovative Psychiatry. It’s a very small dose…smaller than the dose typically used for anesthesia.

More study is needed, testing these two against some slightly higher doses. And also more testing with these two doses measuring the most effective dose against bipolar disorder, social anxiety, PTSD, OCD, general anxiety, panic attacks, addictions, and eating disorders.

The more we learn, the more we need to know!

And We’re Learning What Doses Halt Suicidal Thinking in Outpatients

I presented my work using ketamine infusions on an outpatient basis with suicidal patients, and reported how quickly it works to halt suicidal thinking, and the doses required in Oxford, England at the First International Conference on Ketamine and Related Compounds and again at KRIYA Conference 2018 in San Francisco.

Ketamine’s Impact on G Proteins Transforms Depression Treatment

Extensive work on ketamine’s antidepressant actions with G proteins shows these actions are independent of the NMDA receptors… and that it relieves depression faster than SSRIs can by quickly sliding the G proteins off the lipid rafts. Plus…and this is a big plus…it also lasts longer than the half life of ketamine itself because the Gs are much slower to return to the rafts.

A November 2018 study demonstrated that removal of G proteins from the lipid rafts was not only rapid…beginning within 15 minutes…but that returning to the lipid rafts was much slower after ketamine treatment than after SSRI’s.

All of this knowledge lights the path to more research as well as customizing personalized treatment for major depression … and soon, for other psychiatric disorders.

Advances in Psychiatry Treatment

Ketamine treatment is quickly becoming more sophisticated. The more we learn, the more effective your treatments will become.

Those naysayers who scoffed in the early years of ketamine development, who said ketamine will never see the light of day, have reason to rethink their stance now about this tide-turning treatment for those afflicted with disorders like major depression or anxiety.

The snowball is rolling down the hill and is quickly becoming gargantuan. It’s exciting to consider…at this rate… the wonders we’ll learn about ketamine and all the other new insights into psychiatric treatment this coming year in 2019.

It just keeps getting better. And more hopeful.

Restoration is Available for You

So before you look forward, take a quick look back. If you face your own daily battle with symptoms of mood disorders. If you have sought treatment for severe depression, bipolar depression, social anxiety, PTSD, OCD, substance use disorder, and even suicidal thinking… and if that treatment hasn’t relieved your symptoms, perhaps you should consider ketamine treatment.

We encourage you or your doctor to contact us and discuss this extraordinary treatment that’s taking psychiatry by storm.

Not for any other reason than the hope of getting you better and getting your life back. Reclaiming your joy, your relationships, your work satisfaction, and overall fulfillment in life.

We love collaborating with your healthcare team to help you reach the best health and wellbeing you possibly can.

Ketamine treatment won’t make you someone you’re not. But it can restore you to the very best version of yourself. A version you may not remember right now, but the one who’s buried inside you underneath the difficult symptoms that can seem to dominate everything.

Ketamine, like any other medicine, isn’t for everyone…but if you’ve suffered without relief from numerous other medicines, it may be just right for you. Ketamine struts its best stuff in those who are the most severely ill.

This treatment has nothing to do with the world of “getting high…” It just works in your brain in interesting ways to get a lot done fast. It works on your mRNA, your BDNF, your lateral habenula, in your synapses and signaling systems, and in your cell walls with the G proteins and lipid rafts. So much happens so fast. And day by day, the symptoms of disorders fade away.

You can be vibrant, creative, motivated, patient, and engaged. You can enjoy the little things again, build your relationships again…put thoughts together and excel again.

Start your New Year 2019 on the path to wellbeing and feeling whole. Call us.

We’re eager to help you find the life you were meant to live without symptoms blocking the way.

To the restoration of your best self in 2019,

Lori Calabrese, M.D.
December 31, 2018
Dissociation: Is It Key to Ketamine’s Antidepressant Response?

That Floating Sensation May Predict Ketamine’s Healing At Work

Know anyone who’s depressed?

I don’t mean someone feeling blue or disappointed, but really depressed. The hard-to- function type of depression. The hard-to-think-hard-to-get-out-of bed kind of depression. Where everything looks dark and hopeless, and you doubt yourself and your value…and it continues and gets worse for months or years.

Severe depression. The kind that makes you want to die, and you can’t see any value in your life…and those thoughts start coming… that everyone who knows you would be so relieved if you were gone. Lies that kill.

Depression like this messes with your outlook, your decisions, your abilities, your energy, your motivation, your perception of your own value… and it’s almost insurmountable to get out of bed.

We Call Your Disorder “Treated” Only If You Feel Better

In some cases we call this Major Depressive Disorder, or MDD. In others, it may be the depressive part of the cycle in bipolar disorder. Depression of this magnitude can be debilitating. And it needs to be treated effectively. In fact, no matter what treatment is used, if you don’t feel better, then it’s the same as if your depression weren’t treated at all.

No matter how many pills you’ve swallowed or how many therapy sessions you’ve attended —

Treatment must produce results you can feel and confirm. Or else it’s not effective. And if you aren’t feeling better and functioning better … well, what’s the point?

Ketamine is a medicine that was developed in the 1960’s and ’70’s as an anesthesia medicine. It’s been used for 50 years safely with children, adults, and senior citizens. It regulates glutamate in the brain, and blocks the NMDA receptor which prevents it from causing you to feel depressed.

AMPA Gives You Power to Adapt and Develop Flexibility

It also fires up AMPA , which is another glutamate receptor that is responsible for most of the fast excitatory transmission in the brain.

In other words, it’s the AMPA receptors that are behind the synaptic plasticity, which means they empower the connections between brain cells to grow and flourish and move signals around the brain much more rapidly.

Plasticity basically means changeability. Or…changeableness. (Are those even words…?)

So, synaptic plasticity changes the connections in your brain and makes them grow and bud and sprout like crazy…which helps you to develop more and more ability to adapt the way you think, the way you respond, the way you see events and circumstances so you can develop flexibility, healthier thinking habits and more resilience, too.

This is one big part of what makes ketamine work so well.

Ketamine’s Antidepressant Response

Then it tells the cell to make more and more AMPA fast, so you feel better and better rapidly. And this is just one action ketamine performs to fight depression. There are lots of others, but let’s focus on this one for now.

We’ve talked often about ketamine treatment, provided in tiny doses roughly equal to 0.5mg/kg given IV over 40 minutes by a psychiatrist who is adept with psychopharmacological methods that make the most of each infusion.

Ketamine is a molecule that modulates the excitatory neurotransmitter glutamate.

We’ve talked about how important close supervision by a psychiatrist is to determine the rate and dose needed specifically for you, and your brain, so you have the quality of response to the medicine that will provide the best outcome for you.

And…we’ve pointed out that some providers have popped up in the landscape who give the same dose to every patient, or the same protocol, or varying doses to every patient with little attention to precision rate or infusion length. This is super easy for the provider, easy for the clinic. There is no infusion pump, and the only rate control is the rolling wheel on the IV tubing.

You see where I’m going.

Care in Ketamine Administration Yields Better Results for You

We’ve hypothesized that this less precise administration of ketamine may be the reason that non-psychiatrists and psychiatrists alike who use this one-size-fits-all method for treating depressed patients was resulting in a lower percentage of remission from mood disorders across the board.

We know that we’ve seen an 80% response in treatment-resistant patients by using this precise and remission-focused approach.

Well, researchers published a study in February this year in the Journal of Affective Disorders along this line. It demonstrated how the various dissociative effects can predict how much antidepressant effect a person will receive from a ketamine infusion.

Led by Mark J. Niciu, a team of researchers including Carlos Zarate (a leader in ketamine research), conducted a followup study to their previous work to determine whether the quality of dissociation was correlated to a positive antidepressant response.

Dissociation…and Ketamine’s Antidepressant Response

We’ve all been interested in this. Is dissociation “just a side effect,” or does it MATTER? Is it necessary to have dissociation for ketamine to “work?” Or for depression to lift? For anxiety to dissolve? For trauma to heal? And what dissociative features, exactly? How intense are we talking about? And for how long?

The researchers took a group of 126 people from 18 to 65 with mood disorders – 84 with major depression and 42 with bipolar disorder and asked them to complete rating scales just after their treatment about what they experienced during their ketamine infusion.

Dissociation is basically a detachment from reality, but it can include detachment from yourself (depersonalization), detachment from your surroundings (derealization)…and sometimes a sense of amnesia.

The Study:

Now, each patient involved in the study was currently experiencing a full episode of depression that had been going on at least 2 weeks. Prior treatments had failed all of these subjects. In some cases just one, but many had tried multiple treatments.

Researchers selected the subjects very carefully. None of them had psychotic symptoms and none of them had dissociative symptoms at baseline.

Some patients received a ketamine infusion (yep, just one, not a series) at a prescribed dose of 0.5mg/kg over 40 minutes and others received a placebo…

And guess what?

People who experienced dissociation during their ketamine infusions had much more improvement in their depressive symptoms – the more intense the dissociation, the better the improvement.

And the specific dissociative feature (remember there are 3: depersonalization, derealization and amnesia) that was most strongly associated with responding to ketamine? Depersonalization.

The antidepressant effect was strongest at Day 7, not 3-4 hours after or a day later.

You Can’t Know Without Testing – There’s So Much to Learn

Isn’t that interesting? You’d think the response would have been strongest during the first 24 hours, but not so in this study. You know… the miracle WOW that everyone seems to expect. (Boy, do we have to explain and help reset expectations here.) When you think about how ketamine restores signaling structures as well as all the other things it does, it does stand to reason that as the structures in the brain improve, so would the antidepressant effects.

The research team encouraged more studies to pin down and confirm their findings. And we do, too. But it’s exciting to consider that the very dissociative experience you feel during a ketamine infusion is actually connected to the wonderful restoration it does.

Understanding Your Treatment and Your Healing

It’s important to know that the experience itself is important… important for your improvement and healing.

When you understand this, it’ll help you not be afraid.

And it’ll help you understand that the dissociative experience during treatment is not something we see as bad or unwanted or as an adverse event that needs to be avoided or abolished. It’s an integral part of the treatment itself, and something that we have come to understand is critical for transformation.

With proper treatment, and fine control of the dose and rate of your infusion, we work towards just the right place for you … where your treatment, and your dissociative experience during your treatment, fuse together in the best possible way, to give you the best possible outcome.

Now that’s a sweet spot!

When you’ve felt trapped by a disorder, you’ll do just about anything to live a fulfilling life and wake up every morning with hope.

Every single step of research that shines another light on ketamine’s extraordinary impact on depression and other mood disorders brightens the path for all of us who treat patients with ketamine, and for those who suffer from all these mood disorders and haven’t been helped by anything else before.

There really is hope!

We Want You to Enjoy a Rewarding Life

Here at Innovative Psychiatry we continue to see people like you who suffer and have given up. Then, after a ketamine treatment series, we often see them achieve remission and enjoying their restored ability to create, to invest themselves, to build relationships, and to savor life’s moments. We see this everyday.

If you’re struggling with a psychiatric mood disorder that has not improved with other treatments, call us. We’re here to help you find the relief thousands of others have found.

This is a new era, and you really can feel better…you can even feel well. Kick that disorder to the curb… let’s work together to help you live again.

To the reinvigoration of your best self,

Lori Calabrese, MD

September 24, 2018
Why Ketamine Over Esketamine? It Works and It’s Available NOW
Treatment for Psychiatric Mood Disorders Has Been Quietly Waiting To Do Its Magic for 50 Years

He was 48, in the midst of a booming career, and like some others who demonstrate that special kind of genius, he had periods when depression came over him unexpectedly…and made it extremely difficult to function.

Because of his star-level performance most of the time, his boss gave him some room during these times to find “whatever he needed to find” to get back on his feet. It was humiliating…and he felt powerless to change it. He wished he could disappear into a hole and never come out.

After a lifetime of trying to physically and mentally brute his way through the days, training himself to function anyway no matter what…using muscle memory...he was growing weary of the battle.

Prolonged Years Fighting a Mood Disorder – Demoralizing

These long bouts made him feel foolish and stupid…like he couldn’t find two thoughts to rub together, and anyone who knew him could certainly see the pain and vulnerability in his face.

His productivity and accomplishments tanked during these times, and co-workers made insensitive and cruel remarks.

“They’re jealous, honey,” his wife tried to soothe him. “Because they can’t keep up with you most of the time. You’ll be yourself again…just hang on.”

Finally, in desperation, he decided to pick up the card his sister had given him six months ago for a psychiatrist she really liked, and make a call. He didn’t know what he’d say…but at least he was calling.

…You Have to Take the First Step

Mary answered the phone. She had a soft voice, and she didn’t sound rushed. And at the end of her greeting, she asked him, “How may I help you?” It blew his mind. He didn’t know.

So he hesitated. He hadn’t called a doctor’s office in years.

“Uh. I’m wondering if I could have an appointment. I’m in bad shape. A couple times a year I get like this. Depressed, I think, but it makes me feel dumb, and weak.

“May I ask your name?”

“James.”

“Thank you, James. I think you’d really give yourself a chance to feel better if you met with the doctor as soon as possible. She has a number of advanced forms of treatment for depression that might make a real difference for you.”

“Well, I ran out of hope a long time ago.”

“Not today you didn’t–you called!”

When James arrived at the office, it was his Hail Mary last ditch effort. He sat down in the waiting room and spotted beautiful binders with The Ketamine Library on the front.

They were filled with articles and studies about ketamine treatment. It seemed the more he browsed, the more the articles answered any question he could think of…Something new for depression. hmmm. As he began to read the articles, he was astonished at the reports people gave and how much better they felt…

The articles also referred to esketamine, something about mirror images … and said it wasn’t yet available. He wondered why it was advertised when it wasn’t yet available. And he wondered how the two were related… so he kept reading…until his name was called. He stood up and walked into the office, hoping beyond hope that this time would be different…

Why Ketamine Over Esketamine (Still Testing for FDA Approval)

As esketamine nears completion of its FDA trials, and crawls closer to the coveted approval status, people all over the US who suffer from mood disorders are clamoring for more information.

Why Ketamine Over Esketamine?

The answer is rather logical.

Recently, I was asked some questions about the behavior of s-ketamine and r-ketamine, the two enantiomer Siamese twins that you get when you divide the ketamine molecule. S- stands for left, and it’s the left half of the ketamine molecule that has been named esketamine.

Someone said he had been excited about esketamine, but as he understands more about it, his enthusiasm is waning. So he asked:
- - What is an AMPA receptor?
- - Is it a part of the NMDA receptor, or a separate thing itself?
- And is it possible that there could be a synergistic effect of ketamine (Dextro + Levo) combined — meaning is it necessary to have both halves of the ketamine molecule to get the full benefits when ketamine is used for depression and other psychiatric disorders?
Why Ketamine Over Esketamine? Because It Works…and It’s Available NOW

This was my response:

“Thanks! Wow–these are great questions!

“There are 3 kinds of glutamate receptors: NMDA receptors, AMPA receptors, and kainate receptors. (Each kind has variants.) So AMPA receptors are just one of the 3 kinds of glutamate receptor and they’re different from NMDA receptors. They exist independently of NMDA receptors but they can be on the same cells next to NMDA receptors–and they often are.

“Even though there is so much interest in glutamate receptors, it’s the AMPA receptors that are really responsible for the majority of FAST excitatory transmission in the brain.

“And it’s the changes in AMPA receptors that are really at the core of synaptic plasticity.

The Nitty-Gritty On NMDA vs. AMPA Receptors – Clearing the Fog

“And long-term synaptic plasticity can last from minutes to a lifetime–a brilliant phrase that’s well known in neuroscience. Hold that thought.

“Here’s where it gets so exciting: a molecule (let’s think medicine) can bind to an NMDA receptor or to an AMPA receptor.. or to either or to both. Sometimes, a molecule can bind to an NMDA receptor and when it does, the NMDA receptor tells the neuron to make more AMPA receptors and bring them up to the surface quickly –

“Then, the numbers can increase rapidly, dramatically, and can stay high. This helps create quick responsiveness, flexibility, growth and change….and it can be for the long-term.

“Ketamine binds to NMDA receptors. And for a long time, people thought this was why it helped with depression. But then a lot of other drugs that bind to the same place failed when tested in depression and function as antidepressants.

“Hmmm…

The More We Learn, The Better It Gets

“What we now know is that ketamine directly binds to AMPA receptors and directly increases their numbers and the phosphorylation of those receptors (i.e., the activation of them) — wow! If AMPA is a major player in plasticity (and it is!) and AMPA production, activation, and movement in neuronal members increases long-term synaptic plasticity (and it does!), it may help you understand why we are all so incredibly excited about using sub-anesthetic doses of ketamine for depression: because it not only directly activates NMDA receptors (which can up the number and the location of AMPA receptors on the same cells), and because it also directly activates AMPA.

“More action, more firing, more growth… more opportunity for flexibility of thought, more opportunity for the kinds of changes that people with depression want to see in their lives.

“We see this every day in my office.

“Finally, it’s possible that there is a synergistic effect when both the r- and s- forms (the dextro- and levo- forms) of the ketamine molecule are present — which is what we use in our IV ketamine infusions. I need to explore this more, and we need more research into which form of ketamine — the r-, the s- or the racemic compound — best activates AMPA.

“Calling all neuroscientists!”

Another Question: Why Aren’t All Doctors Seeing Equal Results?

Truth be told, this is only a smattering of questions we’re all asking about ketamine, about esketamine, and about what might be the best treatment for the majority of patients who suffer with symptoms of major depressive disorder, panic disorder, social anxiety, bipolar disorder, PTSD, OCD, and substance use disorder…not to mention suicidal thinking.

Because there are a variety of ways doctors are administering ketamine, and because research is going on in laboratories and hospitals around the world to better understand what ketamine does, how it works, and what its limitations are, there are mixed reports coming from all directions.

Outstanding Outcomes Emerging in Private Practice

My intent in telling you what I see is to inform you to make the best decisions for your health. And at Innovative Psychiatry, we’re seeing the majority of our patients with treatment-resistant disorders enter remission daily, weekly, and all the time in between.

Now it’s true that there are some patients who don’t seem to be helped by ketamine, and we don’t yet know why. But. We’ve found that even some who weren’t helped initially…and went home disappointed…later responded to the treatment and entered remission within a few months. We can’t explain that….

It does matter how this medicine is administered, and we adhere to the best research, the best recommendations, and the best psychiatry we can offer — and we see outstanding… really extraordinary… results with IV ketamine treatment. We know that all doctors, and all clinics, aren’t getting the best results. But those of us who are … well, we know at least part of the reason why.

The only thing that motivates us here at Innovative Psychiatry — and always has — is finding solutions that help our patients get better. So they can live and enjoy their lives, their work, and their families.

If you’ve tried at least two traditional antidepressant treatments with no relief, ketamine treatment may be the solution. It has been for over 80% of our treatment-resistant patients up till now. No other medicine for mood disorders has come close.

If you haven’t been helped by other treatments, call us.

This is National Suicide Prevention month, and we’re here to tell you that ketamine treatment can stop suicidal thinking in just a few hours. Often less. So that when those obsessive thoughts of death and dying stop, you can use the freedom that gives you to really dive into treatment and therapy that can help you save and rebuild your life.

Find out how much better you can feel.

To the reinvigorating of your best self,

Lori Calabrese, M.D.
September 17, 2018
Rapid-Acting Antidepressants Help You Get Better FAST
Smash Treatment-Resistant Mood Disorders with Rapid-Acting Antidepressants: Like Ketamine Treatment

We’ve talked before about the line to the throne where ketamine treatment now reigns. Formulators in a lab were seeking to create a new anesthesia, and they thought they’d found one. They called it Sernyl—but the unpredictable side effects, hallucinations, and sometimes violent behavior, drove the pharmaceutical company to take it off the shelves.

It was not the kind of medicine doctors wanted to give their patients. Through a series of leaks and improprieties however, it began to drift onto the streets as an illegal substance. The drug was phencyclidine, or PCP. Remember during the ’70’s and ’80’s? If so, you know the havoc that PCP – or angel dust – wreaked on the street crowd.

Rapid-acting Antidepressants

But those researchers weren’t willing to give up. They kept working and developed another safer anesthesia that had some of the dissociative properties Sernyl had, but less in side effects when used at therapeutic doses.

They coined it a “dissociative anesthesia” and it became internationally popular in the surgical suite, in the emergency department, and in war zones around the world.

That medicine was ketamine hydrochloride. And testing for treating depression began forty years after ketamine was developed and widely used as an anesthetic.

And we’re now seeing outstanding results, as in remission of depression and other mood disorders, in both research studies and the clinical setting.

So it’s not surprising, is it? That ketamine treatment has become the role model for emerging new medicines that treat mood disorders.

Still, knowing what ketamine treatment can do for major depression, postpartum depression, social anxiety, bipolar disorder, PTSD, OCD, and suicidal thinking isn’t enough for neuroscience researchers.

They want more.

If ketamine does great work treating patients with treatment-resistant mood disorders, there must be more medicines that will also work as well.

Or so they hope..?

Antidepressants that Work as Well as Ketamine Treatment

So the search is on to find other rapid-acting antidepressants that eradicate major depression, PTSD, bipolar disorder, OCD, social anxiety… and stop suicidal thinking in four hours…or less, like ketamine treatment does.

It’s a tall order, but it’s the quest of the hour.

Conventional antidepressants improve symptoms by increasing levels of neurotransmitters like serotonin and norepinephrine.

But it takes 9-12 weeks or more for someone to experience that improvement. So the loud and strong need for rapid-acting antidepressants shouts its demand for these solutions.

Why? Because when patients with severe disorders are inundated with thoughts of suicide, if those thoughts can’t be eradicated quickly, the risk of death is high.

In addition, lost work time as well as abandonment of the medication regimen, is more likely to happen. In short? Patient safety is compromised.

Seeking Ketamine Wannabes

So, there’s a strong focus on compounds that CAN bring fast relief. They include ketamine, scopolamine, and “mechanistically-related” compounds. We’ll get to those in another blog post.

But researchers added some newer ones to this list in the surge to find more rapid-acting medicines.

Compounds like:
- Antagonists of metabotropic (mGlu) 2/3 receptors
- Negative allosteric modulators of α5-containing GABA A receptors
- Psychedelic compounds like psilocybin
I know…I know… sounds like Greek.

How about this?

These compounds need to demonstrate their effectiveness in large groups of people. Most importantly, when medications fail to help people get better, these compounds need prove they can be effective.

And…as always…the biggest challenge is finding ways to make the positive effects last.

Rapid-Acting Antidepressants Help You Get Better Fast

Since the use of ketamine for depression began, the path of discovery started when ketamine first caused remarkable relief for depressed patients, but that relief didn’t last more than a few days or a week.

Researchers tested a variety of methods, and discovered an effective regimen was 6 ketamine infusions given every few days over 2 weeks.

By doing this, it seemed to bypass the short term beneficial effects and instead prolong them. As we’ve moved forward in clinical practice, we’ve found that increasing the number of infusions in some cases can ensure remission. That is, if the initial six fell short of that goal. And we’ve worked with different infusion protocols over 2-3 weeks.

Like all aspects of psychiatry, personalizing the treatment to fit the patient’s needs yields the most effective outcomes.

Review of Literature Clarifies the Search

A brand new review was published in Current Pharmaceutical Design July 29 focused on these specific compounds and their potential. The team, led by Jeffrey M. Witkin, reviewed the current literature on compounds that produce immediate symptom relief.

They determined that a foremost system for producing rapid effects is by amplifying excitatory neurotransmission (by glutamate) while activating AMPA receptors.

These drugs cause glutamate to flow out of the cells which provide what researchers hypothesize is a triggering mechanism to increase the amplitude of AMPA receptors.

They concluded that the focus in pharmaceuticals these days is rapid-acting antidepressant compounds like ketamine, scopolamine, and psilocybin. All of these need extensive study. And they pointed out that two medicines, rapastinel and esketamine are in the last stages of FDA trials.

So let’s look again at the up and coming compounds and medicines in the running to potentially supply the benefits that ketamine is now providing:
- Ketamine — still at the top
- Esketamine (developed by Jansen, a division of Johnson & Johnson)
- Rapastinel (developed by Allergan)
It’s probably fair to say that in the next few years we’ll be bombarded with many new medicines that operate quickly to treat mood disorders. But that’s the way of progress.

Even though esketamine is only half the ketamine molecule — with its own challenges and problems — it’s generating anticipation despite the problems that can come with an intranasal medication.

Keep in mind that FDA approval doesn’t guarantee a medicine is superior to others. But it’s a sign we’re in a new era of better, faster, and more effective medicines for psychiatric disorders.

Ketamine still reigns supreme. And physicians will likely need to combine esketamine with traditional antidepressants and mood stabilizers. Even so, mood disorder treatment is better than it used to be. Remember before ketamine treatment?

Back then, it was necessary to wait for weeks or months to enjoy the benefit of a medicine.

Times are changing and suffering is declining.

At Innovative Psychiatry, we’re celebrating the onward development of pharmaceutical progress, while also providing the outstanding benefits that ketamine can offer to our patients with treatment-resistant illnesses.

Our specialty is treating disorders that haven’t gotten better with other treatments. We’re here because we want to help you experience life like you were meant to live it.

To the restoration of your best self,

Lori Calabrese, MD
August 13, 2018
True Recovery From Trauma and How to Find Restoration

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

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

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

What matters is that it traumatized you.

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

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

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

Sometimes It’s Appropriate to Let Yourself Feel Loss

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

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

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

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

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

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

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

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

Let’s look at another perspective.

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

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

NO.

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

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

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

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

Let’s set labels aside.

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

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

True Recovery From Trauma

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

Resilience … takes time to develop.

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

The Secret of the Phoenix

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

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

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

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

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

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

To the restoration of your best self,

Lori Calabrese, MD

July 30, 2018
Anxiety and Panic Disorder: Can This Condition Be Quelled?

Anxiety and Panic Disorder – A Tormenting Presence

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

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

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

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

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

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

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

“Yes, I have a dog.”

“What’s his name…?”

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

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

He cut her off…

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

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

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

Panic Attacks Can Take Many Forms

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

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

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

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

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

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

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

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

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

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

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

Anxiety is a bear, but panic attacks are dragons.

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

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

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

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

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

Then what?

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

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

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

Novel Advanced Treatments To Consider for Anxiety and Panic Disorder

Sound weird?

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

Transcranial Magnetic Stimulation (TMS)

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

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

Ketamine Treatment for Anxiety and Panic Disorder…?

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

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

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

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

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

Add to that PTSD, OCD, and suicidal thoughts.

This medicine is life changing.

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

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

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

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

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

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

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

One infusion. For pain.

Symptoms of Panic Disorder, Agoraphobia, and Major Depression IMPROVED

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

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

Still.

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

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

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

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

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

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

To the healing of your best self,

Lori Calabrese, M.D.

July 9, 2018
The Heartbreak of Suicide: You and Ketamine Can Help

The Heartbreak of Suicide – What Can We Do?

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

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

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

And others who suffer like she did.

Quietly. In silence… and despair.

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

Traditional Depression Treatment Fails Sometimes…Then What?

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

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

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

Psychiatric Disorders Can Be Hard on Relationships

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

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

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

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

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

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

And that’s the tragedy.

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

What do you do?

The Heartbreak of Suicide

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

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

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

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

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

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

There’s Hope That Rises Above Traditional Treatment

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

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

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

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

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

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

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

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

Still, stop and think.

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

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

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

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

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

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

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

What do you think?

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

I hope not.

But the stigma is right there. Along with shame.

What if I’m overreacting..?

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

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

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

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

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

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

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

Ketamine Treatment Ends Suicidal Thinking in 4 Hours or Less!

The heartbreak of suicide can be prevented.

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

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

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

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

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

Please call us. Let us help you get better.

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

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

To the healing and restoration of your best self,

Lori Calabrese, MD

June 11, 2018
Outrageous Behavior: Mood or Personality??

Outrageous Behavior: Mood or Personality Disorder?

You met her at your friend’s house, and you’ve been dating a few months… Then you notice a blouse in her purse with price tags… no receipt. What???

Did she steal this stuff? You really like her, but …. theft? What the heck is going on…?

When you ask her about it, she tells you she borrowed the top from a friend for your date on Friday.

Hmmmm…

A week later you notice the blouse is hanging in her closet. Is she going to return it?

She’s been a little on edge lately… could it be guilt? But you hate to rock the boat because the nights are so HOT lately…

Then, another shock. She borrows your credit card to put gas in her car…(which seems off)…and you discover she spent nearly a thousand dollars on dinner with “friends!”

Outrageous Behavior: Mood or Personality…?

Confrontation time. Is this amazing and beautiful woman a scammer? A con artist? Is there any other explanation?

Her response is to lash out, scream expletives, and take off in her car. She returns in a couple hours and she’s been crying. She tells you she doesn’t know what got into her, or why she did any of it. That she really likes you and wants you to respect her – and trust her. That sometimes she loses her perspective and just does things she can’t explain.

After a long and tearful discussion, you learn that she did shoplift the blouse. She won’t take it back to the store, or pay for it— too risky. She could get arrested. But she’s got a better idea, she says: she’ll give it away. Donate it. And the next thing you wonder is… if you’re in over your head…

Scammer? …or maybe bipolar disorder..?

So is she messed up? Is she just someone who gets off breaking the law? or is there another explanation?

To find out, she needs to put her trust in a skilled and experienced psychiatrist.

A good one, who will tease apart her symptoms, their causes, and work to bring her disordered mind to order and peace.

It could possibly be that she’s fundamentally a rule-breaker. Someone who doesn’t think they apply to her–and doesn’t think what she’s done is a big deal. On the other hand, since she seems to care a great deal, you should pause. Ans she should be evaluated.

Untreated bipolar disorder can cause all kinds of outrageous behaviors along with the sorrow and remorse

Is She Hysterical or Just Seeking Attention…?.

Sometimes, outrageous behavior can be a source of embarrassment to those who love you.

Take Jason, the manager of the cell phone shop in town. You have no idea what he deals with until one day a glamorous woman walks into the shop crying, “Jasie, Jasie…pleeease I need your help!! There’s a spider in the car!!”

You can see Jason is embarrassed. He tells her he’ll be able to break away in a minute after he rings up this customer.

“But Jasie!” She’s all a-flutter, breathless, in a panic. She takes off her beautiful shoe and holds her tan, pedicured little foot up to show him. “See that dot? I think it bit me!!” And she sobs and sobs big tears that splash on her cheeks…

You can see Jason has his hands full. So, you gesture for him to go ahead and tend to her…it’s ok…you don’t mind waiting. He takes her to the back and her sobs get louder. “I was at home, all alooone…. So I got in the car to go see Celia, and suddenly I saw that spider!! I was terrified Jasie! I didn’t know what to do!!!”

Unbelievable.

Jason tells her under his breath that her foot looks like it will be fine, and promises to take her to dinner after work. She goes out the door smiling ear to ear and tells him to call her at Celia’s. Her bracelets jingle as she waves.

You Can Love Them… But Do Get Them Help

You really feel for Jason. He was clearly embarrassed for his customers to get this glimpse into his private life. You wonder how on earth he stays with such a drama queen. You know you couldn’t take it.

He smiles half-heartedly and rings up your purchase. Then apologizes for the scene. He quietly explains she’s had some serious blows lately and she’s been upset a lot by a series of little things. “I guess she’s just having a bad day…” he quipped.

So what on earth is the story with this lady? Is she like this all the time? Is this anxiety or drama? How can you tell the difference?

Once again, her story needs to be teased apart, and a deeper history collected. It’s possible that the “blows” Jason referred to were multiple deaths in the family, betrayal by her best friend, combined with a lost pet, or some other major crisis.

People do sometimes reach the “end of their rope” and find it hard to cope with the most minor thing.

When that happens they may exhibit signs of depression or anxiety, which can be treated … to help them get their footing again.

But it’s important to know the full picture. Was she always a drama queen? Or did she have a history of coping well until just recently…? Enduring traits can suggest an underlying personality structure that just seems to get more and more fixed and unyielding as a person gets older.

Outrageous Behavior – Mood or Personality?

Meanwhile, your boss’s secretary is silently miserable. She’s married to a guy who acts superior to everyone. He boasts all the time and makes degrading comments to waiters at restaurants or when he’s buying something in a store.

Then word gets out that he’s having an affair with her next-door neighbor. Another affair. After all the I’m sorry’s and all the lies. After all the promises. She’s devastated.

What is the matter with someone like him? Is he just a total jerk?

Maybe he is. I know you may wish you could give him a swift kick, but there’s likely more to the story.

On the one hand, he could be a narcissist. But to find out would require some in-depth information gathering to figure that out. Still, there are other possibilities, too.

Has he suffered a job loss? Maybe he feels betrayed by a layoff right in the middle of his career. He may be depressed if something like that is the case. It’s still not an excuse for making his family miserable.

Nor is it an excuse for infidelity. But, sometimes people take that road when they’re down on themselves. In fact, sometimes people do all sorts of destructive things when they feel bad, rather than seek help.

Still, sometimes depression shows up in men by their anger, irritability, and short temper. If it’s depression, it can be treated. And getting the depression successfully treated may help him set things right again in his life.

Miss Jekyll or Mrs. Hyde…

The romance you’d always dreamed of. Finally, you’d met the most interesting and charming woman. She was everything you’d hoped to find: beautiful, fun, a hilarious sense of humor, always with a twinkle in her eye… and a wildcat in bed.

She was so natural in a crowd and loved to entertain. She seemed like the ideal companion, lover, and partner. You felt so lucky.

Oh, there were little moments while you were dating that caught you by surprise, sure, where she seemed to react to a small thing you did or said. Moments that seemed to come out of nowhere… but the next time you talked, all was forgotten.

Her charm was addictive…and made you feel like a million bucks.

But several months later, everything seemed to change. She wasn’t so pleasant when you were alone. Sometimes you felt like she drank too much. And when she did, she wanted to do more and more risky things. She said you just didn’t know how to have fun.

The next day she stormed into her job and slammed her keys on her boss’s desk, shouting, “I QUIT!!”

When she got home and told you the story… well, you didn’t say a word. You didn’t dare.

Then, one night, she stormed out of the house. Again. You got in the car to find her… and when you spotted her she was walking in the dark…and agreed to get in the car. But, as soon as you asked what was going on, she screamed she was going to kill herself and threw open the car door as you were flying down the highway.

You were so relieved to park in the driveway. So much drama.

The next week she tells you she’s having an affair with her optometrist. That you just weren’t spending enough time with her.

What happened…?

You’re friends tell you she’s crazy and you should pack your stuff and leave no forwarding address. You think there’s more to it. You see her when she’s sweet, thoughtful, caring, nurturing… she can be a wonderful person.

But this is scary.

What do you do??

Once again, there can be a handful of explanations. Some are more hopeful than others.

This is a good time to get an insightful psychiatrist involved. Because she may just be a brat who never learned to be accountable for her behavior. However, that’s probably not the most likely explanation.

People with bipolar disorder sometimes have these outrageous behaviors, but when they’re not manic, they can be deep thinking, insightful, considerate people.

People with borderline personality disorder can sometimes appear like this.

Even people with substance abuse disorders can show these symptoms.

You’re right to not make a snap judgment. As to what you should do, that’s another matter. If she has a psychiatric mood disorder, she can be treated and go on to live a fulfilling life. But you may want to see a counselor you trust, to help you navigate this relationship.

With counseling, you can learn how to be a therapeutic presence in her life, while taking good care of yourself. With counseling, you may also determine this relationship is not the best for you or for her. But follow your instincts and get support for both of you in the interim.

You’re not alone.

So many, many stories. So many lives in disarray. Outrageous behavior rings the gong. It makes everything stop–or it should make everything stop. Because so often it damages the lives of everyone it touches. Sometimes it’s personality, plain and simple and enduring. (Which is really hard to take.)

But so often, outrageous behavior is the bellwether of damaged or disordered brain functioning. Sometimes, the ones with outrageous behaviors are likely damaged (by genetic factors, environment, concussions, illnesses, substances–you name it) and unable to function in a normal, healthy way. So they behave in ways that cause damage to others and to their own overall lives.

In cases like these, the first step is to withhold judgment, as tempting as it is to judge and label. How often have you heard that you don’t know someone’s story until you walk a mile in their shoes?

When you see behaviors like these, you may be seeing symptoms of a disorder, rather than someone who’s deliberately choosing to be a brat. Deep down, it’s the desire of most of us to enjoy the respect of those around us. Most of us restrain our reactions to maintain that respect. But there are those who just can’t.

Rule of thumb: If it looks like bad behavior, check it out.

Ask an expert. Not your friends. Not a Facebook group. Because you might be mistaking a terrible mood or anxiety disorder as someone’s personality — or personality disorder. And that same person just might behave “respectably” and with constraint if their disorder were effectively treated. This is where shame lives. This is where stigma comes in.

Let’s take a breath before we judge. Let’s stop the stigma.

If you’ve experienced some of these behaviors and you secretly carry your shame and wonder what’s wrong, or if you see outrageous behaviors in someone you love, reach out. Innovative Psychiatry offers novel and advanced treatment for psychiatric mood disorders, including IV ketamine infusions — one of the most extraordinarily effective treatments in psychiatry. It can give you your life back.

We want to see you well and are eager to work with you to determine what will give you the best results.

Call or schedule an appointment. You can have control over your impulses, and build strong relationships in your home and your work.

To the release of your best self,

Lori Calabrese, M.D.

April 30, 2018

Category: Anxiety

Articles about Anxiety from Lori Calabrese, M.D. | The Ketamine Blog

Types of anxiety disorders:

1. Social anxiety

2. Postpartum anxiety

3. General anxiety disorder

4. Panic Disorder

5. Test anxiety

6. Phobia-related disorder

7. Separation anxiety

8. Selective mutism

9. Obsessive -Compulsive Disorder (OCD)

Treatment of Anxiety Disorders

Transcranial Magnetic Stimulation (TMS)

Be sure it’s your real self you’re showing. Because it is your real self that needs to be loved. Daphne Rose Kingma

What sort of truth..? Well, that you’re human, for starters. That you’re not always perfect in your responses to life’s stressors. And that there are plenty of things you can learn to make your life work better for you.

Using Pride as a Shield of Protection

Replacing pride with love can be scary. It can make you feel exposed and vulnerable until you get used to it. But doing so can transform your life and drive loneliness away.

At the same time, you get the sense that their mental health is pretty good.

And we guard that armor, those walls, to stay safe. Then, if anything threatens to expose us under the armor, we get anxious and defend it. Don’t we?

And that’s why we have to learn to see what the walls and the armor are costing us. We have to see that they’re interrupting our social development and our opportunities for close, fulfilling relationships.

Fix Your Inner Life

You may need to get really honest with yourself. You may find you have to learn how to embrace the truth, and learn to accept yourself as human, fallible, and forgivable. When you do that, you may also feel more lovable.

Ketamine Treatment Can Help You Achieve Remission

Well, one important aspect of staying better is to unravel the conflict you carry inside you that you may not even realize is there.

Embrace the truth about yourself.

Just like letting go of what you NEED to let go of, when you embrace truth about yourself it helps you relax with who you really are.

And there’s another plus: doing so will increase your self respect.

Scrutinizing Your Inner Self

Pay attention to your inner voice…do you find yourself defending yourself over what happened? What could you be “hiding” from yourself?

And what happens when you look at the other person’s role with a heart of forgiveness and understanding? Can you see how the outcome might not have been his/her intent?

I Was Wrong

And that quiet is a deposit of peace into your inner self. Enjoy the reward of harmony you feel.

Going forward, you may find you’re a little less judgmental, a bit less inhibited…and more and more relaxed. In that relaxed and peaceful state, it’s much easier to feel better.

Remember, this discussion is NOT to say that if your remission fades away, it’s your fault.

Compounds and methods for treating severe psychiatric disorders are getting better and better…

Suicidal Thoughts Can Be Deadly

Because relatively few tell anyone they’re thinking about or even considering suicide, it’s been impossible thus far to estimate the number.

Ketamine Treatment Continues to be Misrepresented

When have you seen a safe, rapid, extraordinarily effective, life-saving treatment misrepresented, misunderstood, lambasted, and gossiped about more than ketamine? (Think about that for a minute.)

I saw a comment in STAT magazine the other day that took the cake.

It was clear the individual didn’t know about the research and data. All the information that’s poured out around the globe about ketamine and related compounds for psychiatric disorders over the last 10-15 years.

Ketamine should definitely be administered under a psychiatrist’s close supervision, not self-dosed.

Because the truth is, the majority of physicians have read snippets about it here and there. They’re just now getting up to speed. And some have distorted ideas about it.

Ketamine is 100% bioavailable only when it’s given by the intravenous (IV) route. In IV form it’s delivered straight to the brain tissues that so desperately need its benefits. IM and IN (nasal spray), lozenges, troches, and oral liquids are all less bioavailable.

Ketamine Treatment Acts Independently of Other Medications

Ketamine Treatment of Psychiatric Disorders…

It’s one of the reasons we’re so interested in following the research in using ketamine to treat suicidal thoughts and these other psychiatric conditions — and one of the reasons I write about them so often and devote space to them here.

The Microbiome Has Been Underestimated

Plans Unfolding for the 2019 Year Ahead

Ketamine Treatment: Getting Better, Giving Back

2019 promises to be a year of hope, and a year of gratitude and goodwill, as we see more people feeling better... and getting well… after years of struggling without solutions.

Hope is on the horizon. It’s going to be a good year.

It consists of several doses of IV ketamine, usually about 6, and sometimes a few more, over 2-3 weeks. Ketamine isn’t appropriate for all patients — and doesn’t work as well for some as it does for most of our patients — so it’s not for everyone.

Happy New Year!! The big silver ball falls tonight to celebrate the birth of 2019.

Let’s celebrate the unprecedented, transforming, and ever-accelerating advances in psychiatric treatment this year and the neuroscience that backs it up.

This testing, and subsequent investigation, snowballed into a field of life-changing breakthroughs and developments like ketamine treatment, transcranial magnetic stimulation (TMS), and other “outside the box” novel treatments.

Psychiatric Treatments Are Improving

Outside The Box

Schizophrenia and Autism Spectrum Disorder

And after studying the genetic connections, they found that too much of a specific master key: MIR-137, can result in symptoms of schizophrenia … and too little of it can result in symptoms of ASD.

Better Therapy for PTSD

By writing about the specific traumatic event, patients were found to improve as much in only 5 sessions as they improved in 12 sessions with cognitive processing therapy, or CPT.

Better Suicide Prevention..?

Researchers tackled electronic medical records and found that half of those who commit suicide and 2/3 of those who try but fail, have had a mental health evaluation in the last year.

Social Media Surprise

Or, put another way, if you’re depressed to start with, the less time you spend on social media the less depressed and lonely you’ll feel.

Ketamine Treatment Continues to Demonstrate Its Prowess

Your hope for recovery… and remission… is more warranted than it’s ever been. You really can get better…even well.

We’re Learning about Doses

And We’re Learning What Doses Halt Suicidal Thinking in Outpatients

Ketamine’s Impact on G Proteins Transforms Depression Treatment

A November 2018 study demonstrated that removal of G proteins from the lipid rafts was not only rapid…beginning within 15 minutes…but that returning to the lipid rafts was much slower after ketamine treatment than after SSRI’s.

Advances in Psychiatry Treatment

Restoration is Available for You

Not for any other reason than the hope of getting you better and getting your life back. Reclaiming your joy, your relationships, your work satisfaction, and overall fulfillment in life.

Ketamine treatment won’t make you someone you’re not. But it can restore you to the very best version of yourself. A version you may not remember right now, but the one who’s buried inside you underneath the difficult symptoms that can seem to dominate everything.

That Floating Sensation May Predict Ketamine’s Healing At Work

We Call Your Disorder “Treated” Only If You Feel Better

AMPA Gives You Power to Adapt and Develop Flexibility