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.

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

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

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

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

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

People can be cruel.

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

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

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

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

Why do some people act this way…?

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

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

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

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

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

OCD is like having a huge nasty bully in your head

…that no one else can see

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

For her…they actually are.

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

Is OCD common?

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

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

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

Is there treatment?

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

Which calls for innovative treatments.

Obsessive Compulsive Disorder Treatments

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

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

Obsessive Compulsive Disorder treatments change the game.

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

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

To the emerging of your best self,

Lori Calabrese, M.D.
June 1, 2017
IV Ketamine + Neuroplasticity = Relief, Relaxation, and Relishing Life

I could use some of that. We hear that all the time. Relief, relaxation and relishing your life can sound so far away … but it doesn’t have to be. As word gets out about IV ketamine treatment for depression and other psychiatric mood disorders, more and more studies are emerging.

New information is surfacing about the effectiveness of this medication. And it’s inspiring more discussion, more research, and deeper understanding of the causes of depression.

And there’s more.

As evidence grows through research and clinical data, it seems clear that depression interferes with the neuroplasticity in the brain. Including diminished neurogenesis in the hippocampus and diminished synaptogenesis in the prefrontal cortex. In other words, depression messes with the growing neurons or brain cells and the synapses or connections that allow the neurons to communicate with each other.

A big factor in this is that stress reduces an important growth factor called BDNF, or Brain Derived Neurotrophic Factor. Sort of a “compost” for neurons. Without BDNF, your neurons become tattered and sparse.

They diminish in size and number … and thin out.

When you’re depressed, these measly neurons with their poor synaptic connections just have a much tougher time communicating with each other … so there is less creative thought, if any. Well-being tanks. And your world becomes darker, less hopeful, and without future. It’s a bad place to be in.

A brain that is well-connected is a brain that experiences creative thought and well-being. A brain in the dark is a depressed brain.

IV Ketamine + Neuroplasticity

Here’s where neuroplasticity comes in. (Don’t let the word shut you down.)

In this context, plasticity refers to the brain’s ability to change at any age … whether for better or for worse. So the term “neuroplasticity” refers to the ability of your neurons to adapt and remodel themselves. In the past 10 years or so, neuroscientists have come to understand that your brain is constantly remodeling itself throughout your life. And when it remodels itself, it remodels its networks, And because of that, it remodels how it works.

So, to put it briefly, when you think dark and despairing thoughts, or angry and vindictive thoughts, day after day after month after year, this thinking actually reshapes and remodels your brain. It’s kind of shocking, really.

The brain remodels itself. Your brain remodels itself.

Dark, negative and hopeless thoughts have a detrimental impact on your brain’s structure and on how it functions. Your brain changes to fit your thought processes … to respond to your stressors. By the same token, if you read inspiring and creative books, spend time with joyful people, and create joyful experiences, your brain can change over time for the better.

The very structure of your neurons can change — in a lush way. Richly. For the better. For your good.

Wow.

This is where people say, “I want some of that.”

Well, this is an oversimplification, of course. It doesn’t account for all of the different factors, illnesses, and environmental influences that shape the way your neurons look and act — grow and function — but it IS an illustration of one way the brain can change. At any rate, It appears that one reason IV ketamine treatment is so effective for so many different psychiatric symptoms is because of the way it enhances neuroplasticity in the brain.

Growing Your Brain Structure Garden

For example, when you take the time to learn a new language as an adult, you’re putting parts of your brain to work that respond by growing to accommodate.

A study of taxi drivers in London revealed that through the process of memorizing the streets of London to pass certification, that a specific structure in the brain enlarges to manage that information. The hippocampus is the memory center in the brain, and this study revealed that drivers who’d been driving taxis for decades had the largest hippocampi of the group.

Just an example to show how the brain changes with the right type of stimulation.

By the same token, the amygdala is the fear center in the brain, and it’s been studied extensively in childhood trauma, and in adult anxiety, depression, and bipolar disorder. The newest research shows that the size of the amygdala can change rapidly in response to recent stressors — even in people who’ve never had any of the these conditions. The left amygdala was smaller in people who’d had a recent stressor — it didn’t even have to be longstanding or chronic. And the shrinkage was enough to be seen on an MRI.

So here’s the point.

Ketamine’s Rapid Action

Ketamine acts rapidly in numerous ways, and its fast action is changing lives, as well as saving them. It stimulates changes in the brain that affect its structure and its function.

One example is that it quickly matures new neurons so they’re functionally mature and doing their job within 2 hours. Traditional antidepressants just can’t do this. As more neurons proliferate, mature, and migrate from the hippocampus into far-reaching brain regions, ketamine also stimulates the formation of more synapses, especially in the prefrontal cortex. The greater the communication throughout the brain, the better functioning the brain, and the greater the well-being of the individual. You.

The more synapses that are generated, the more neuroplasticity, or ability to change and grow, the brain will enjoy. And a growing, adapting brain provides a higher level of living and learning for you to experience. Plus a greater sense of joy and well-being.

Let the Sunshine In

It’s as if the proliferation of neurons – and the synaptic connections that empower them to communicate – opens doors and windows in the brain to let the light and fresh air in. This wonderful circulation of signaling gives the brain new thoughts, new hope, new relief.

Basically, IV ketamine + neuroplasticity = relief, relaxation, and relishing your life.

If you’d like to know more about innovative treatments for your psychiatric symptoms, please call for an appointment so we can evaluate what’s going on.

Innovative Psychiatry is committed to help you find and develop your best self. Let’s work together.

Joining forces with you to discover your best self,

Lori Calabrese, M.D.

April 18, 2017
Ketamine Wannabe Drugs … of the Future

Ever have somebody copy you? You know, try to be like you? Imitate what you do, where you go? try to get what you have? They wannabe like you. Well, maybe not just exactly like you — kind of like you and better than you all at the same time.

It’s happening with ketamine.

We’ve been talking for awhile now about the breakthrough of low dose IV ketamine. In fact, everybody’s been talking about ketamine for treatment-resistant mood disorders. We’ve expounded on its effectiveness in relieving suicidal thinking, treatment-resistant depression, and other psychiatric disorders. Did you catch the discussion about which route is most effective and why we use it? Check it out here.

You should know about all the ways it’s changing the horizon for psychiatric treatment. Like how it stops suicidal thinking within hours, rather than weeks. And how people who have lived with depression and despondency for years — no matter what medication they were taking — can feel depression just lift within hours. Maybe you’ve been there yourself, or you know someone who has.

But there’s more to talk about.

The discovery of ketamine’s therapeutic effects on depression has opened doors to more revelations of the chemical sort. Mechanisms of action. Delivery systems. Ways of leveraging the funding of pharmaceutical companies to develop more versions of ketamine, maybe with the same or similar benefits, but without any side effects …

Think of it like this:

Ketamine wannabes want to “be like” ketamine and wannado like ketamine — except better, without side effects, for longer.

But it turns out that’s easier said than done.

Since ketamine is no longer under patent, it’s unlikely that a pharmaceutical company would be interested in investing the necessary funds to conduct extensive trials and research about its effectiveness to treat mood disorders at this stage … at least on ketamine specifically.

Or that a company would shell out time and money to study long-term response and remission rates, or long-term safety, for a well-known generic like ketamine — even if it is being used in a new way in new settings to treat new conditions. There just wouldn’t be the return on investment in the long term.

However, by making changes in the molecules and targets that provide the therapeutic results for ketamine, new versions of the drug in the form of ketamine wannabe compounds that specifically target mood disorders are being designed and developed, and are in the race for FDA approval.

Ketamine Wannabe Drugs

So grab your chemistry lab goggles, and let’s explore some of these molecular discoveries among ketamine-wannabe molecules.

Ketamine is a racemic compound — it has two parts that are mirror images of each other joined together like Siamese twins. If we split it right down the middle where the mirror images join — presto! — we have two “new” drugs. One faces right and the other faces left. We call the left-facing one “S” or in the world of pharmaceuticals, “es–” as in esketamine. So it turns out in this case that changing the structure of ketamine slightly could give us the same benefit, hopefully fewer side effects, and easier use. In other cases, molecules like ketamine are coming down the pike that act on similar targets or in similar ways to help with depression without some of the potential side effects of ketamine.

They both wannabe and don’t wannabe like ketamine. They wannado better.

Esketamine

Esketamine has been approved in Europe for a decade and a half – specifically for anesthesia – and Janssen Pharmaceuticals has acquired a patent to utilize it in the US as an intranasal spray for treatment-resistant depression.

The Food and Drug Administration has awarded “breakthrough” status to esketamine to zoom its advancement through to approval with less interference from various obstacles and the usual red tape that slows everything down.

They plan to specify it for use it in a clinical setting (as opposed to at home) for the sake of controlling the dosage, as well as to prevent sale on the street.

Rapastinel

Another pharmaceutical company – Allergan in Dublin, Ireland – has designed a peptide in this same “ketamine-like” category. You may know that a peptide is a chain of amino acids bonded together in a specific way, and this one looks pretty effective as an adjunctive treatment in depression. It has characteristics like being fast-acting and long-lasting and it’s given as an IV infusion, like ketamine.

Ketamine’s action with NMDA receptors is to block ion channel activity. Here’s where rapastinel is different. It binds to the glycine site on the receptor and regulates or modulates it by changing the shape of that site. Pretty cool. The result is that rapastinel reportedly has a minimum of dissociative or out-of-body side effects that are sometimes experienced with IV ketamine infusions.

Rapastinel is in Phase III trials in the US as an adjunctive treatment for major depressive disorder, and more trials are expected in Europe and Japan. Soon, it’ll be ready for FDA approval for use in the clinical setting to treat depression.

AV-101

Still another pharmaceutical company in San Francisco is working to create a small molecule drug that possesses all the good traits of ketamine without its potential dissociative side effects: VistaGen Therapeutics.

This molecule is one that’s back on the scene from over 30 years ago. At that time, it couldn’t cross the blood-brain barrier to do its work. And consequently, couldn’t impact the depressive symptoms a person was experiencing.

But now, the molecule (which is considered to be a “pro-drug”) has been revamped and this current version does cross the blood brain barrier, And when it does, it’s metabolized from a pro-drug into an active drug that modulates a certain glycine binding site at the NMDA receptor — unlike ketamine and different from rapastinel.

So while ketamine completely blocks certain NMDA receptor ion channels, AV-101 just sort of regulates the receptor gently…which seems to result in gentler side effects.

A New Frontier – Ketamine and Ketamine Wannabe Drugs

There are plenty more versions of modified “ketamine wannabe” molecules in the wings, developing to hopefully even replace ketamine at some point. Hoping to improve on ketamine’s action. Aspiring to lesser side effects. Working towards easier administration. We’ll just have to see how that goes.

And one day this miraculous breakthrough medication – ketamine – may become obsolete like so many cornerstone discoveries of the past.

But right now, boy are these exciting times! We’re on the threshold of a brave new world in psychiatry. A world where people who’ve suffered without relief for years, even decades, can finally experience relief and build a fulfilling life.

One last thought…

All of the companies working with these small molecule drugs are investing in priceless research that’s opening more doors and windows of understanding –. which will, in turn, only increase the benefits for people who just haven’t responded to or tolerated anything else.

For example, we know that ketamine, rapastinel, and AV-101 all work at the NMDA receptor site. So it’s been assumed that that action is the key to their effectiveness. However, when researchers blocked the AMPA receptor, none of these drugs worked. I’ll say it again. None.

Which revealed that the AMPA receptor needs to be activated for the drugs to deliver their fast antidepressant, anti-suicidal results.

And this revelation may lead to more breakthroughs for more who suffer … through ketamine wannabe drugs.

We’re on this. We stay up at night. We watch closely to glean all we can from the research that’s exploding, so we can continue to provide the most up-to-date, cutting edge, fresh discoveries that neuroscience offers.

And…we’ll be here to help you find your best self.

So call us, and let’s find the right innovative solution for you.

To the emerging of your best self,

Lori Calabrese, M.D.

April 12, 2017
IV Ketamine and Treatment-Resistant Mood Disorders

IV Ketamine and Treatment-Resistant Mood Disorders

After reading today about a beautiful young man – let’s call him Tom – whose life ended tragically at the crossroads of despair, I started thinking.

Like many of my own patients, he had a wondrously warm and giving heart — and a compassionate heart the size of Montana for homeless animals.

His talent for music generated moving, exquisite collections of melody and lyrics that stunned listeners with its charm.

Such sensitivity, such beauty for the world to enjoy.

But his life ended far too soon, because he could find no relief for his illness.

Bipolar disorder.

Tragedy Without IV Ketamine

I’ve treated many people with similar stories in my office. I’ve offered the best that we had–medications, combinations, the latest research, the newest adjunctive treatment, supplements, recommendations for lifestyle changes, collaboration with the the best therapists in the area, resources, articles, support–everything I had. I never stop trying. But until a few years ago, we had little to offer those who didn’t respond to traditional treatment. Or who were just sick of it.

And that’s tragic. Really, really tragic. But more common than we can bear to think.

It’s not just about bipolar disorder or treatment-resistant depression. We’re talking about postpartum depression, PTSD, and other psychiatric mood disorders.

I thought about Jacie. Jacie wasn’t expecting to get pregnant when she did, but she was happy about it, and enjoyed the feelings of wonder about this tiny new person growing inside her.

But around the time her second trimester began, she noticed her initial lilting emotions weren’t lilting anymore. In fact, she felt gray…dull…and couldn’t seem to relate to the idea of a baby.

Once the baby was born, everything was a struggle. She felt angry, frustrated, and exhausted beyond belief. And guilty that she wasn’t enjoying this innocent baby girl. In desperation, she talked to her doctor honestly about how she had been feeling. And her fear she might do something to hurt herself or her child.

He referred her to a psychiatrist he trusted, and she began seeing her. Her depression had gone on a long time — untreated.

IV Ketamine and Treatment-Resistant Mood Disorders

When depression comes during pregnancy, it can be so much worse than postpartum depression that begins after the baby is born … and so hard to treat. In Jacie’s case, her depression didn’t budge, and the persistence of it affected her relationship with her baby, and her marriage.

She was surrounded with people who loved her. She was fortunate in that sense. But nothing seemed to ease the agitation and misery she endured. Or her self-hatred and guilt that she resented her baby and didn’t know how to change it, or feel better. To be the kind of mom her baby needed.

Traditional antidepressants and psychotherapy just aren’t effective for some people. If you’re one of them, or you know one of them, you know what I mean. Since depression is caused by a complexity of changes in the brain, there’s no simple solution.

And in my musings, another man came to mind — Dan. He’d suffered with PTSD for over 15 years. War time trauma, loss of friends in combat and the powerlessness he felt to save or protect them; it all tormented him.

He’d been told he should be “getting over this” by his friends and his family. Oh, they meant well. But they had no idea what they were saying. And suggestions like those didn’t help. Not at all.

He struggled just to get through the day … to have a relationship with his wife … to work at a job, to pay the bills.

He wanted to be productive, but every time he had a few good days or weeks, it didn’t last because of the dreams, the night terrors…the reactions to noises or touch. Then he’d lose his confidence, walk off the job, and withdraw again.

The loss of life, of peace, of relationships, of fulfillment, for people like these has been unavoidable till now.

For those who couldn’t benefit from the traditional treatments for mood disorders, there just weren’t any solutions. IV ketamine and treatment-resistant mood disorders went to war.

Your treatment-resistant mood disorder won’t win over IV ketamine.

These stories are just examples, but they represent multitudes of individuals whose lives have been interrupted, oppressed, tormented, or in some cases cut short, by symptoms of disorders that remained unaffected by traditional treatment.

And that’s why I thought of all of these people.

Because the ineptness of so many antidepressants left me feeling powerless to help; too many of my patients were crippled by their disorders, but desperately wanted the same chance at building happiness and fulfillment as anyone else.

Too many.

And that’s why I’m excited now and so full of hope.

That’s why I talk so often and so enthusiastically about this emerging frontier of new therapeutic uses for that anesthetic-turned-antidepressant, IV ketamine.

Because for all all the Toms, Jacies, and Dans who found no help at all from previous treatments, 80% now experience relief, restoration, and often total remission after IV ketamine treatment.

We’re still working to find solutions for that other 20%, and we won’t stop. But we’re helping 80% of those for whom we had nothing, nada, zip…zero… that would help.

All my training didn’t prepare me for the heartbreak of those who are so desperate for relief and can’t find it. But hope is growing, and ideas are flourishing for ways to use this new knowledge to spawn more solutions.

Relief and Solutions are RISING

So after my musings about those who weren’t helped, and the sadness I feel that we didn’t find solutions soon enough, it’s exhilarating to know there’s an entire frontier opening. A new world of treatment for those who weren’t helped before, through the discoveries surrounding ketamine for depression and other new solutions that will spring from it.

IV ketamine and treatment-resistant mood disorders … it’s a fight to the finish, and ketamine is winning.

Are you wondering if you’ll ever be able to have a life…? If you’ll ever get to feel stable — emotionally, financially, socially?

You really aren’t alone. Sometimes you just can’t see there’s support at your fingertips… help just beyond your line of sight.

Reach out and let’s talk about the things in your life and feelings that interfere with the power to live life the way you want to.

Power to find your best self, and share it with those around you.

Power to enjoy.

To the power for finding your best self,

Lori Calabrese, M.D.

April 3, 2017
IV Ketamine: Doing What Prozac Can’t

Excitement about IV Ketamine

Recently, I shared my perspective about the consensus statement released by the American Psychiatric Association’s Council of Research on Novel Biomarkers and Treatments Task Force. Their statement was about the use of IV ketamine for treating mood and other psychiatric disorders.

That Task Force, in its consensus statement, assured members of the APA that there’s compelling evidence that IV ketamine has the ability to provide rapid and robust antidepressant effects in patients with treatment-resistant mood disorders.

Well, I was delighted to see that NPR published an article this past Monday, March 20, 2017, about Gerard Sanacora, M.D., Ph.D., Professor of Psychiatry at Yale School of Medicine, and his personal reflections on IV ketamine for mood disorders. You should read the article, too.

Gerard Sanacora is a member of the same Task Force. He says he’s treated hundreds of patients who are severely depressed with IV ketamine and is excited about the results in these patients’ lives.

He says doctors have asked him how he can use a medication when there is still unknown data about long-term use.

What Would You Do?

His answer?

“If you have patients that are likely to seriously injure themselves or kill themselves within a short period of time, and they’ve tried the standard treatments, how do you not offer this treatment?” he says.

Well, that’s how I feel, too, and why I offer IV ketamine infusions. In good conscience, with what I know about ketamine, how could I not? It’s what growing numbers of other psychiatrists are feeling, too.

Ketamine has an effect no other medicine has had before. Within hours it can erase the suicidal thoughts of someone who’s been on the verge of suicide for some time.

It removes the self-destructive thoughts, and the terrible mental images of death. And it happens fast.

This one extraordinary effect is changing the way we approach severely depressed individuals. There is something we can do to bring our patients relief from this dangerous, life-threatening symptom. And it succeeds in bringing them relief in 80% of cases.

Dozens of doctors responded to surveys in the US and Canada, reporting that over 3,000 patients have been treated for mood disorders with ketamine. The good news is spreading, as well it should be!

Even so, as we’ve discussed before, IV ketamine treatment has still not been studied in enough depth to answer some questions that remain unanswered. And that’s because of the lack of large-scale trials. Large-scale trials are needed. And with the attention ketamine is receiving from pharmaceutical companies, I expect those trials are just ahead.

More Questions

James Murrough, M.D. at Icahn School of Medicine at Mt Sinai in New York, worries that because of the lack of large trials, it’s not yet known how long a treatment regimen can be continued safely. And it’s true that it will take years of studies to establish that.

From his perspective, that’s troubling because IV ketamine can wear off in a few days or a few weeks. Repeat infusions are necessary to prevent the return of depression. So, unless a form of ketamine is developed that lasts a great deal longer, we’ll need to continue giving those treatments to those who need them… until they achieve remission.

But in spite of that, he strongly feels the case for IV ketamine is warranted and justified…much stronger than a few years ago. And so do we.

Most Promising Since Prozac

“There’s warranted caution that’s balanced with an optimism that says we’ve never had a new medication for depression since the era of Prozac,” Murrough says.

IV Ketamine: Doing what Prozac Can’t

No new medication for depression since Prozac!!!

So just a quick review: Prozac emerged in the 1980’s and was the first of a “new class” of depression drugs targeting serotonin, one of the neurotransmitters.

Prozac opened a world of possibilities in psychiatric treatment. But there have been far too many who suffered from mood disorders and were never helped by Prozac and its offshoots.

Since then, sure, there have been new medications and new neurotransmitters that have caught our fancy — mine, too. But no drug has has been more effective, more rapid, and more transformative — with an entirely novel mechanism of action — than IV ketamine.

Period.

IV Ketamine – Doing What Prozac Can’t

Because ketamine acts on a different neurotransmitter than Prozac and other common antidepressants. Instead of Prozac’s focus on serotonin, ketamine acts on glutamate, another neurotransmitter that acts on a different system. Murrough says that because ketamine’s been so remarkably successful, the pharmaceutical companies are pulling old drugs off the shelf that act on the glutamate system.

They’re as excited as we are at the possibility of creating a whole new class of more effective drugs for depression.

So, there is actually a possible contender in the ring for ketamine being developed. Related to ketamine chemically, it’s called esketamine and is in testing. It’s not been considered by the FDA yet, but that’s not far off.

And it’s one of a mountain of medicines in development that are related to ketamine, according to Gerard Sanacora.

He also said, “This is probably the most interesting and exciting new development that I’ve seen in my career, and probably going back over the past 50 to 60 years.”

And that’s certainly the case for me, too. For all of us who are seeing our patients doing better, looking better, and feeling better – after decades in practice.

These are such exciting times in psychiatric medicine. I’m so thrilled to be a part of this life-changing and life – saving historical time. And I’m thrilled you are too.

Until recently, our patients with treatment-resistant mood disorders weren’t getting better.

Now they are.

IV Ketamine is Changing – and Saving – Lives

They’re living again, building fulfilling lives again, looking to the future with HOPE.

If you know someone who’s been lost, sad, full of shame and despair, and just doesn’t seem to get better, there’s new hope now.

Encourage them to call us, or call us yourself for an in-depth evaluation. There is specific lab work we can do that will actually help us know if IV ketamine is likely to work and work quickly. It’s been successful with about 80% of our patients who have received infusions.

IV Ketamine isn’t for everyone, but with appropriate screening, it may be exactly right right for you. It may be exactly what you’ve been waiting for. And if you’re struggling with a treatment-resistant mood disorder, you owe it to yourself to find out.

You can feel better.

Much, much better.

To the release of your best self,

Lori Calabrese, M.D.

March 22, 2017
Treatment-Resistant Depression Meets Its Match

Do you know someone who’s been listless and hopeless for a really long time? More than weeks or even months … someone who’s been taking antidepressants for years, and has never really felt better?

Have you noticed how years of despair affects a person’s outlook so deeply that their personality seems to change?

Clare’s story

Take Clare. She began feeling more and more overwhelmed when she was in 8th grade. A string of unfortunate events seemed to pound her down further and further, until she’d lost her ability to recover.

It was as if life formed a dark tunnel around her and she couldn’t face it any more. She started avoiding school because facing it was too hard.

She came to believe it would never, ever get better. And she became volatile at times, and subdued at times. She grew to have a generally defeated attitude, and overreacted to small frustrations.

Treatment – Resistant Depression Leads to Overwhelm and Failure

This once cheerful, go-getter teenage girl withdrew into a place where she could no longer function, no longer face others, no longer spend time with friends.

After high school she tried to go to college, and her psychiatrist changed her medications to something that he hoped would help more.

But she’d try her hardest and do well for a semester, then fail the following semester. So she’d work up all the energy she could to succeed and do well again, then fall apart a few weeks into the next semester.

Eventually, she dropped out of college because her grade point was no longer high enough to stay.

Failure, Despondency, and No Reason to Live

Clare thought about dying often. On a few occasions, her mom or a roommate walked in to find her with a pile of pills in her lap and a big glass of water, about to carry out a plan…

This is what treatment-resistant depression looks like. In the beginning, the despair seems justified after a series of overwhelming or heartbreaking events. But, eventually, the unchanging, unrelenting despair washes away hope. Any reason to live seems to erode away.

Neurotransmitters Play the Culprit

Neuroscientists have discovered that there are multiple brain-based and physical causes for depression. Large networks of neurons can be affected by cascades of inflammation that affect many systems and many neurotransmitters.

Neurotransmitters are chemicals in the brain that help one part of the brain communicate with other parts. In most cases, the more neurotransmitters in the brain communicate with other areas throughout the brain, the better you feel.

For some people, SSRIs may help. But if they don’t, we start thinking about whether we should try an approach that might stimulate GABA, dopamine, or norepinephrine activity.

In addition, the weeks or months that are required to determine whether an SSRI is effective mean that the one suffering is left to endure in a seemingly untreated state. If you talk to someone who’s been handicapped by crippling depression, and tell them you have a new drug to try, but it may be months before we know if it will help, his response will likely be dripping with despair.

And that despair sometimes ends in loss of life.

Gaining Understanding

Psychiatrists didn’t realize years ago that all depression can’t be successfully treated with SSRIs, so only a portion of the depressed patients they treated were actually being helped.

But, we’re learning.

Thanks to continued study, we’ve learned more and more about what areas of the brain are involved in depression, and the various neurotransmitters that are involved, as well.

Without question, there’s been a critical need for rapidly acting and effective treatments that provide relief for people who suffer from treatment-resistant depression, and have for a long time.

Why IV Ketamine?

And in searching for such treatments, IV ketamine – the decades old anesthesia drug – has risen to the task and is shining.

Because in addition to treating treatment-resistant depression, IV ketamine is also demonstrating its exciting effectiveness in successfully treating bipolar depression, post-traumatic stress disorder, and acute suicidal thinking in about 80% of cases in our clinic.

To take it a step further, the action of IV ketamine with suicidal thinking is independent of the antidepressant action. Many patients receiving IV ketamine infusions find the suicidal thinking disappears before the infusion has even finished!

Never before have we had a medication so fast and effective for people tormented by suicidal thoughts.

So many start ketamine infusion treatments in a dark and despondent place. Then at the end of the infusion, a look of amazement and relief floods their face. And they tell you things like, “this moment is the first time in 7 years” they’ve felt relieved and hopeful.

To me, it’s pretty miraculous.

And if you’re burdened with treatment-resistant depression, bipolar depression, or PTSD, it could feel like a miracle to you, too.

I hope you’ll take the time to read the other articles linked in this post. Information is your link to feeling better.

The more you learn, the more your hope can grow, and the sooner you can take action.

We believe in you, and the life you can live. A fulfilling and satisfying life is possible, with the right treatment.

Make an appointment for a complete evaluation, and let’s work together to find the right treatment for you. We want you better, so you can restore your best self.

To the release of your best self,

Lori Calabrese, M.D.

March 15, 2017
JAMA Psychiatry Weighs In: The “Ketamine for Depression” Buzz
JAMA: “Ketamine for Depression” Buzz

The mental health community is all a-buzz about IV ketamine for treating depression and other psychiatric disorders, and for good reason. For the first time, people who’ve been treated without success for years are experiencing relief and enjoying their lives.

For anyone who has suffered from psychiatric disorders without relief for a prolonged time, the possibility of a breakthrough treatment that actually works can mean the difference between life or death. Or utter misery vs. hope. Most folks would go for hope … wouldn’t you?

This anesthetic-turned-street-drug has returned to the scene to restore its reputation by providing a remarkably successful, and fast, reversal of depression in patients who’ve not experienced relief in a very long time– some of them for decades.

In addition, these infusions in single doses or in a series of doses, reverse suicidal thinking, often within hours, if not before the IV infusion is even completed. Now that’s lifesaving.

What’s more, suicidal thoughts disappear immediately in many cases, whether the depression is relieved or not.

So yes, some of us in the psychiatry community are excited about what IV ketamine can do.

Psychiatrists Containing Enthusiasm

But … we know we have to contain ourselves, and maintain a scientific approach to this “off-label” use of the anesthetic ketamine. So we read the research, keep up with the published studies, and pore over the data to be sure our enthusiasm doesn’t get ahead of us.

We talk to each other endlessly, scour the journals, go to conferences, stay up late, stay at the office late, pull together every shred of published research, every letter to the editor, every blog and YouTube video.

Then, we watch TED talks. And we tweet, we message, we write. And we see dozens of people every day who are depressed. Sick of it. Suicidal. We offer many treatments. And we offer hope. Some of us offer off-label treatment with IV ketamine. And some of us have seen hundreds of ketamine patients, and administered nearly 1000 infusions. (That’s us.) We’re in the trenches. Deep.

Now comes this timely release to further illuminate the path for psychiatrists who are moving forward to help their patients with this breakthrough treatment.

So what does the APA (American Psychiatric Association) and JAMA Psychiatry (Journal of the American Medical Association Psychiatry) have to say about this unexpected surprise that treats psychiatric disorders?

In the March 1, 2017 issue of JAMA Psychiatry online, a consensus statement was released by the American Psychiatric Association (APA) Council of Research Task Force on Novel Biomarkers and Treatments regarding the off-label use of ketamine in the treatment of mood and other psychiatric disorders. The best and brightest are on that Task Force.

The Task Force made the point that there is compelling evidence that IV ketamine has the ability to provide rapid and robust antidepressant effects in patients with mood disorders who had previously displayed resistance to treatment.

Limited “Ketamine for Depression” Data

They acknowledged the sample sizes were small in these studies. And use of low dose ketamine for psychiatric disorders has increased at such a rapid rate that there’s a lot we still don’t know.

So, one point they made is that there’s limited data. The strongest data about the use of ketamine in the treatment of psychiatric disorders is for the treatment of major depressive episodes where there are no psychotic features.

Their concern was that even in the case of major depression, some of data that was evaluated had been collected from only the first week following one dose of ketamine treatment.

Again, limited studies, limited number of patients, limited information about outcomes, side effects, impact of long-term use.

Still, we know that anesthesiologists have been using this drug for decades and have found it to be quite safe in controlled settings. But the APA Task Force’s statement isn’t intended to decrease the use of ketamine in treating psychiatric disorders. But instead to highlight where we are and the most critical things to consider for keeping its use safe while research on ketamine proceeds.

Criteria for Ketamine Treatment

So, initially, the Consensus Statement recommends we take several steps when we see a patient to help determine if ketamine treatment might be appropriate for him or her. They include:
- Performing a comprehensive evaluation to determine that the patient meets appropriate diagnostic criteria for depression
- Ensuring the patient has completed adequate courses of FDA-approved antidepressants before considering ketamine
- Thoroughly reviewing the psychiatric and medical history as well as the patient’s potential risk factors for ketamine treatment
- Carefully evaluating any history of substance abuse, including baseline urine toxicology screens
In addition, they said the physician should thoroughly discuss ketamine treatment with the patient before use. The possible benefits of it, as well as the possible risks associated with its use for any given patient. This empowers the patient to make a truly informed decision about whether the benefits are greater than the risks. Of course — that makes sense. It’s the very basis of collaborative treatment in medicine and the basis of informed consent. Then, like with any medical procedure, we should obtain written consent before beginning the infusion.

Precautions with Ketamine

Next, in terms of specifics, spikes in blood pressure sometimes occur with ketamine infusions, so patients receiving ketamine therapy ought to be in a facility setting where we can manage any unexpected medical incident.

Even so, ketamine is considered “reasonably safe” at the recommended dosage of 0.5mg/kg over 40 minutes.

Because of ketamine’s natural action, patients experience dissociative effects that should pass momentarily. Or some may have short-lived vivid experiences of heightened perceptions, or intense ideas or memories.

Understandably, patients who experience effects like this may react with behaviors unlike their usual personality. So, physicians must be prepared to treat episodes of that nature. Which is why we want to see ketamine administered in specially prepared clinical settings, instead of at home.

Suicide Prevention

Also, as effective as ketamine is with suicidal thinking, there’s still the risk that the self-destructive thoughts or plans won’t lift for some patients. So it’s vital that physicians evaluate their patients after ketamine treatment before discharging them home.

Overall, psychiatrists must form a comprehensive plan for managing the patient’s depression along with needed followups. Ketamine is a highly effective drug to be incorporated into the overall treatment and management of depression.

The APA Task Force strongly advised that psychiatrists develop a standard operating procedure for administration of ketamine.

At the very minimum, it should incorporate these points:
- Signed informed consent and pre-procedure evaluation
- Baseline assessment of vital signs: blood pressure, heart rate, O2 saturation
- Continual evaluation of patient’s mental and physiologic status throughout the infusion
- Management of side effects that may occur during the treatment
Studies are lacking to evaluate the efficacy of long-term use of ketamine treatment for depression.

The most useful data to date indicate that infusions given up to twice a week and within four weeks are effective. Patients should be monitored with a rating instrument to assess changes in mood.

Avoid Abuse or Dependence

The Task Force also recommends that dosing of ketamine be discontinued if infusions can’t be reduced to one per week.

The committee members agreed that ketamine is an incredibly promising treatment but must be used with standards that ensure the highest level of safety.

Ketamine is the most abused drug in Asia. So the widespread use of it in the US – for therapeutic purposes – must be surrounded in safeguards to avoid the advent of abuse or dependence, in spite of its benefits.

JAMA: Ketamine for Depression – The Buzz

All in all, the buzz is that ketamine is the most promising new treatment to date for depression. The data is limited, it’s true. There’s much to be explored. But, we’re working rapidly to pull together all of the available evidence and all of the best practice recommendations as we proceed. This treatment is bringing hope where there was very little before.

We’re thrilled to be on the forefront, and we’ve developed our protocols for IV ketamine very carefully. Not only to set the bar for the standard of practice in our field but to exceed the standard.

At Innovative Psychiatry, our protocols comply with the recommendations of APA Council of Research Task Force on Novel Biomarkers and Treatments published in JAMA Psychiatry. But, we go above and beyond those. We educate you. Then, provide you with the research articles that we read ourselves. And ensure that we offer IV ketamine infusions as a psychiatric treatment — not simply as a medical procedure.

To that end, we work with you and your physicians and therapists for the best possible results. And we pull out every stop to help you feel better and enjoy life again when nothing else has helped.

Call for an appointment, and let’s work together to help you rediscover your best self.

To your emerging best self,

Lori Calabrese, MD
March 9, 2017
Why Some People Get PTSD…and Others Don’t

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

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

Strong or Weak…? Really…??

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

How much struggle.

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

A gene?

Genetic Widget

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

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

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

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

And there’s more.

Genetic Test Predicts Outcomes

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

What?

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

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

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

More on the Horizon

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

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

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

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

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

Don’t put psychiatry in a box.

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

The possibilities are endless.

Rapid and effective treatments are emerging.

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

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

To your best self,

Lori Calabrese, MD

February 15, 2017
IV Ketamine Infusions Restore Your Power to Enjoy

IV Ketamine Infusions Restore

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

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

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

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

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

Treatment-Resistant Depression

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

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

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

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

A Drug Called Ketamine

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

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

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

Who knew?

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

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

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

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

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

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

How Effective Are IV Ketamine Infusions?

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

But we see a lot of Jacobs.

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

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

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

This is kind of radical news.

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

The Role of Glutamate

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

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

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

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

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

So how to get glutamate to be released??

Enter IV ketamine.

Ketamine Stimulates Budding New Branches in Brain Cells

Low dose IV ketamine infusions cause a burst of glutamate.

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

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

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

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

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

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

How?

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

Breakthrough Innovative Treatment

Isn’t this amazing?

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

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

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

You’ve lost touch with enjoying yourself.

But all that can change now.

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

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

You can feel again.

Because of glutamate.

Because of flourishing synapses.

And because of ketamine.

Let us help.

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

To the emerging of your best self,

Lori Calabrese, MD

February 1, 2017
There’s No Shame in Shyness
Shyness is a natural reticence to interact with people you don’t know. For those who are shy, it can be very painful and interfere with their social development.

Introverted ? …or Shy?

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

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

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

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

Feeling Shy is Universal

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

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

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

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

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

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

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

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

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

So What Can You Do About Shyness?

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

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

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

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

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

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

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

Spare Yourself or Your Child Excessively Hostile Situations

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

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

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

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

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

To your ever blooming best self,

Lori Calabrese, MD
January 12, 2017