Lori Calabrese, MD

Category: Bipolar Disorder

Articles About Bipolar Disorder from Lori Calabrese, MD | The Ketamine Blog

Serious and Complex Condition

Bipolar disorder’s symptoms demonstrate a complex brain and behavior disorder characterized first and foremost by severe mood swings. Secondly, it includes an inability to regulate your emotions and responses  Because of that, you have times of extreme emotional lows we call bipolar depression, and times of extreme highs we call mania or hypomania. Therefore,  sometimes you suffer through both at the same time.

It’s notable that each mood can last for months or weeks or days… or even hours before it swings just as severely to the other extreme.

Sadly. people with this disorder often face suicidal thoughts, or specific plans for ending their lives. In addition, they show impulsivity. The result of the combination of impulsivity and suicidal thoughts is a dangerous mixture, that far too often ends in fatality.

For this reason, this disorder reduces longevity by an average of 25% less than healthy persons.

These articles about bipolar disorder are available to you to help you understand this condition better, and hopefully to better understand the one who suffers with it.

Causes of Bipolar Disorder

While we don’t know exactly what causes bipolar disorder, we do know that a combination of genetics, environment, altered brain structure and chemistry all  contribute.

For one thing, we know the amygdala and hippocampus play significant roles in this disorder. These structures in the brain help form new memories and process learning and emotions.

As a result, when the hippocampus and amygdala malfunction, the result can be a mixture of memories that store painful emotions that are so relentless that the sufferer finds it difficult to recover from hurts and traumatic events many years later, as well as to forgive someone who has hurt him.

These difficulties cause severe distress for the sufferer who finds it almost impossible to let go of traumatic memories and loss. Instead, he suffers the full pain of the memory each time it comes to mind.

Cheating Death

So, a damaged amygdala can lead to a lack of natural fear of danger. Furthermore, possibly linked to this is the pursuit of adrenalin-stimulating opportunities. A common trait in those with bipolar disorder, you tend to crave danger, thrills, and activities that “cheat death”… and other forms of high risk behavior. Since the amygdala consists of two parts – one on each side of the brain – if both are damaged it results in the sufferer’s inability to distinguish emotion response in the facial expressions of others. Consequently, this type of damage may be linked to autism.

Symptoms

Symptoms of bipolar disorder can include:

-mood swings
-difficulty regulating emotion
-intense outbursts
-rapid pressured speech
-hypersexuality
-high risk behavior
-visual and/or auditory hallucinations
-grandiosity
-delusions
-severe insomnia
-hypersomnia
-suicidal thoughts
-feelings of worthlessness
-hopelessness
-despair
-lack of energy or hyper-energy
-difficulty focusing or retaining information
-shame, low self-esteem and therefore sometimes a belief that one has low intelligence

Mixed States

Some people experience long periods of depression with negative beliefs about themselves, then long periods – or short periods – of mania or hypomania with all the more energized symptoms, including overconfidence and grandiosity. In addition, some people suffer from mixed states which is a mixture of both.

At the same time, this person may experience high energy, sleeplessness, racing thoughts, and rapid speech combined with irritability, rage, explosiveness, despair, and suicidal inclinations.

Types of Bipolar Disorder

Bipolar 1 – most intense and severe
Bipolar 2 – also can be severe, consists of longer periods of depression interrupted by hypomania, which is less intense than mania.
Cyclothymic Disorder – shorter periods of less intense depressive symptoms alternating with  shorter periods of hypomanic feelings.
Fear of Harm Bipolar Disorder – begins in children and consists of acute fear of harming others and/or of being harmed.

Bipolar Disorder of each type is a serious disorder. Continue reading these articles about bipolar disorder to learn more.

  • Reduce Stress and Stay Safe This Holiday Season

    Reduce Stress and Stay Safe This Holiday Season

    Although some things are easier said than done…

    Cecilia and Ben have been working remotely since March 2020, so they both work in their home. They’ve faced the challenge of setting up work spaces in their home so they both have privacy for their online meetings. It took some doing, moving furniture, opening up areas and storing what they could when they’d rather be relaxing on the weekend. It’s all been about reduced stress and staying safe and healthy.

    So they’ve adapted. And have designed their lives around working remotely in their own spaces. For their own wellbeing and for everyone else.

    They’re very careful about avoiding exposure to SARS-CoV-2, the virus that causes COVID-19. Twice a month trips to grocery store with gloves and masks. Very cautious. 

    Cecilia also has concerns about managing her bipolar disorder. With the help of medication, she manages fairly well. But she and Ben are careful about avoiding stressful situations to help with her stability.

    They were invited to share Thanksgiving with Jake and Robin, Cecilia’s brother and sister-in-law…so they discussed–again, at length–how careful Jake and Robin were about isolation and precautions, and were assured they were extremely cautious. Both couples agreed to a COVID test the week before the holiday.  All four tests came back negative.

    Halfway through the day on Thanksgiving, they were enjoying a quiet time together chatting as they prepared the meal.

    Suddenly, the doorbell rang.  Jake and Robin looked at each other puzzled as if to say, Are you expecting anyone?  No… are you?

    When they answered the door, a jovial group of 8 more people roared Happy Thanksgiving!!! and charged through the door. The eight people included the Robin’s cousin, his wife, their 5 children, and Cecilia’s elderly mother.

    Jake and Robin stepped out of the way, baffled, shocked, and horrified; Ben and Cecilia were equally horrified. Grandma came in with her walker. Four children ran through the house, and a baby in a carseat wailed from her position on the floor.

    After quick greetings, and well-intended but strained smiles, Jake asked the parents of the wild offspring if they’d had recent COVID tests and they laughed and said, “No, of COURSE not!!  Don’t you believe that whole COVID propaganda, Jake!! Relax! It’s Thanksgiving and it’s time for family!!!”

    The new arrivals then commenced to talk about a party at another cousin’s house a few days before and what a great time they had.

    “A party?  How many were there?”

    They held their breath.

    “Aww, I don’t know… 30 or so. You should see Tom’s oldest. She is really grown up!”

    So Robin said, “You know what? We love you guys and it’s great to see you…but we take this pandemic pretty seriously. We each got a COVID test last week to be sure we didn’t have the virus to expose to each other.

    “We don’t want to hurt your feelings but until this COVID thing is resolved, we’re not letting anyone be here in the house who isn’t carefully isolating, using precautions, and can show a negative test result. We’re really concerned about Mom, too, because she’s high risk–she’s vulnerable to the virus and all kinds of complications. And she’s being exposed to you guys today. You’ve been with at least 30 people who may or may not have COVID, so now she has been exposed to those 30 people, too.

    “To tell you the truth, you should all put on masks, and you should take her home. We can see that you don’t feel as cautious as we do, but we just have to protect our health and others the best we can.”

    With bruised feelings, the cousins and Grandma all accepted masks to wear and loaded back into the car. They weren’t happy about being sent away without welcome. To say they took it personally would be an understatement.

    The following week, Callie got a phone call from her mom.  Her mom had not been feeling well for a couple days, so she went to the ER. With a history of heart trouble and asthma, she was worried. The hospital COVID test was positive, and Grandma was admitted to the ICU. Within 4 days, her breathing had deteriorated, and become very difficult, so her diagnosis was upgraded to COVID and pneumonia. Doctors said it was grave.

    About the same time, Ben started feeling symptoms of severe fatigue, shortness of breath, and intestinal cramping. Cecilia drove him to a drive through testing center for another test. It came back in two days — positive.

    Ben was the sickest he’d ever been. So weak he could barely walk to the bathroom. Cecilia tried to keep him quarantined in the bedroom. And she wore a mask and gloves and washed her hands often. After about 16 days, Ben began to improve. And Cecilia was weary and discouraged.

    Cecilia’s daily calls to the hospital to check on her mom were frightening. Heartbreaking. Her mom was now on a ventilator. And her cousin’s wife was also sick with COVID.

    After taking every precaution, Ben and Cecilia still found themselves exposed to COVID and were facing the possible loss of her mother. Their fear and grief were only surpassed by their profound frustration and powerlessness. They really thought they could reduce stress and stay safe for Thanksgiving.

    You just never know, do you?

    But all the more difficult, Cecilia’s bipolar depression symptoms were rearing up in the face of the deep frustration she felt. First frustration, then anger, then rage…at her cousin who ignored all the warnings and put her mom and everyone else at risk. 

    She could feel her mood moving from neutral to a dark melancholy… bipolar depression was looming… she could feel it coming on.

    Oh no. How would she get through this and when her mom was in ICU? What if her mom died? It was all just too much. Her hope was dwindling. She felt both agitated and defeated… Even though she didn’t contract COVID, those around her who did played a role in her own condition worsening.

    Reduce Stress and Stay Safe at the SAME Time

    We’ve talked about how stress has become a traditional element of the holiday season, as we’ve allowed our traditions to become obligations. And how the stress that results from all those insurmountable obligations actually creates misery, sickness, and destructive conditions like depression and anxiety symptoms. So that to reduce that stress we need to make some hard decisions that put relationships and our own peace before the race to “get it all done.”

    We’ve also talked about how this holiday season 2020 is unique because COVID cases are increasing so fast that we’ve been asked not to travel, and to limit the gathering in our homes to those who live there–and possibly one or two who’ve tested for COVID and received a negative result, and who are extremely careful about isolation and protection.

    Of course, this appeal ricocheted around the internet and news media before Thanksgiving, and some heeded it.  Many others ignored it. 

    Aside from the precautions for limiting spread of the virus that is causing the COVID pandemic, there is another issue that deserves attention. That’s the tension, anxiety, and depression symptoms that can be relegated to the ongoing news about the virus and the damage it can cause. 

    Add to that the conflict that arises when individuals hold opposing opinions about their decisions for celebrating the holiday… and the disagreements that erupt. Yikes.

    This time of year is celebrated as a time of giving and receiving love and connection with friends and family. To worship true to your conscience, and hopefully be refreshed. Don’t you agree?

    So what can you do when friends and family stir up conflict?

    We all know someone who stirs up conflict wherever they go. The Button Pusher.  
    Then there are those who find their fuel by subtly inflicting guilt. We love them but we hate the guilt trips. 
    And every group has someone looking to push the crowd into doing something they don’t want to do…

    Yours isn’t the only family with these delightful people. 

    Aren’t you glad?

    The Good News. Disconnect your buttons before you have contact with the Button Pushers… Turn off your guilt switch and let the guilt purveyors buzz away while you walk away. And those Mr. Pushy types?  Just say NO.

    This is a year to consider fewer gifts and more emails, cards, letters, especially those cards with pictures enclosed or attached. Share your news without exposing yourself, your family, or the vulnerable family members to potential illness.

    Let the pandemic die down.  Give the vaccinations some months to do their job.  And let’s save Winter 2021 to hopefully move around the country and spend time with those we love.

    Reduce Stress and Stay Safe — Enjoy the Holidays and Enter 2021 Healthy and Happy

    And… if your efforts to reduce stress and stay safe are undermined like Cecilia’s and Ben’s were, you have options. They may be as simple as isolating and watching Christmas movies together, with popcorn and mugs of hot chocolate. But if you symptoms rise and intensify, if your medications aren’t effective in managing your symptoms of depression, bipolar depression, PTSD, alcohol use disorder, substance use disorder… IV ketamine treatment may be a very real and lasting help for you. It doesn’t work for everyone — because nothing works for everyone — but it can be extraordinarily effective even when everything else has failed.

    With a series of titrated ketamine infusions personalized specifically for you and your response, you can feel like your best self again. Think back to the last time in your life when you were at your best self for a good stretch. Ketamine treatment can help you feel like that again.

    It can be amazing, and has a remarkable effect on the structures in your brain. You can feel restored, with the energy to give your best on your job and in your relationships, with improved creativity. And hope.

    At Innovative Psychiatry, people with these conditions and more come through every week. We have an atmosphere we keep safe from the spread of COVID due to 21st century plasma cell technology we’ve installed that destroys the COVID virus in the air and on surfaces. With the technology available anywhere to keep our air and surfaces COVID-free, and meticulous procedures in our office, you can come for treatment with confidence, and relax in a quiet private treatment room with reduced stress where you can stay safe.

    Above all, take very good care of yourself, your health, your outlook, and the wellbeing of your family.

    We care about you, and we’re here to help you experience relief of symptoms and the power to enjoy this time of year by enjoying what you love and those dear to you.

    If you want to see what IV ketamine treatment can do for you, call us.

    We understand and can help.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Does Mine Look Like His?? How Disorders Look Different in Different People

    Does Mine Look Like His?? How Disorders Look Different in Different People

    It can be alarming to see you brother try to navigate his way through a challenging diagnosis like depression or bipolar disorder. His symptoms may be alarming for you, and while you’re trying to be supportive, he may feel the world is crashing in. His dramatic reactions can be overwhelming, especially when you had a friend with bipolar disorder who had a volatile temper, it seemed, and seemed hypersexed, but she didn’t act like your brother is acting now. Surely they got his diagnosis wrong. But the doctor says that disorders look different in different people…at different times and under different circumstances.

    And it’s good to know.

    Charlotte might be a good example.

    Charlotte first began to show signs of less confidence and depression around the age of 6. She tried so hard to have a stiff upper lip, to invest her effort and perform well at school to please her parents, and to be industrious. Her parents were always so proud of her. But they didn’t recognize depression in herbecause she tried so hard.

    Now, Charlotte’s family already showed signs of psychiatric disorders in other members. Her mom had suffered from depression since childhood, her oldest brother had suffered from depression since he was 4. Plus, her other brother received a diagnosis of bipolar disorder. He had actually displayed symptoms since he was a young child. See the similarities?

    In addition, Charlotte’s uncle struggled with Narcissistic Personality Disorder. So did her grandfather.

    So much going on in Charlotte’s extended family. In fact, so much woven through the whole family.

    But in her case, her primary diagnosis turned out to be severe treatment-resistant bipolar disorder. Plus alcohol use disorder, social anxiety, and some phobias.  

    Happily, her bipolar depression, social anxiety, and alcohol use disorder, eventually improved dramatically. Some aspects reached remission after IV ketamine treatment.

    Sometimes depression or bipolar depression expresses itself as anger… even rage. Sometimes it can look like alcohol use disorder. In one person it may look like sadness and despair. In someone else, it may show up as disrespect for others. One person with bipolar disorder may seemed quiet, full of sorrow, and hopeless a lot of the time, but another might feel angry, disillusioned, and seeking revenge. How is it that the same disorder can present so differently? It can look different in different people and with different circumstances.

    Lots of people wonder about the same thing. Why does one person with depression act so angry?  Then someone else with depression suffers from quiet despair..? One eats carbohydrates in large amounts, and gains weight steadily. While another has no appetite and loses weight at an alarming rate?

    Which came first?  The chicken or the egg?  Disorders have a way of emerging and creating more difficulties. Depression can give way to phobias, weight gain, social anxiety…

    Bipolar depression may show up as raging anger at times, unrestrained sexuality at times, and terrible despair in one person. Then, in another person, it may look like self-harming, unlawful behavior, and substance use.

    One reason? It’s not uncommon for someone with depression or bipolar depression to also experience anxiety, phobias, hypersexuality, or substance use disorder, alongside the original diagnosis. As a result, you may have a friend or relative who displays a certain cluster of behaviors, and you form the idea that this is what bipolar looks like.

    Then, someone else you know is given the same diagnosis, and while they display erratic behavior, it’s nothing like the behavior of your friend.

    The same disorder can look really different in different people.

    So now you can meet Grayson.

    He was first diagnosed with ADHD, then bipolar depression, and finally obesity. 

    It would be natural to assume that his depression, bipolar depression, and ADHD were all linked to each other. Since some people who exhibit ADHD symptoms as school age children, are later diagnosed with bipolar disorder. And depending on the type of depression you have, you may find you eat high carbs, or you may find out you eat very little. 

    Here’s Grayson’s experience:

    In Grayson’s case, ADHD emerged first when he was a child. About 6 years later, bipolar disorder became a more pressing concern, which SEEMED to lead to obesity. When Grayson is experiencing bipolar depression he tends to eat more, sleep lots, and feel listless and without energy.

    Disorders look different in different people.  

    In Grayson’s family, his own son was diagnosed with ADHD at the age of 7. Then, as he grew he was diagnosed with severe depression.  Grayson’s grandmother has suffered from depression all her life. His uncle has struggled with ADHD but learned to manage it in adulthood. 

    So.

    We know that depression, and many other psychiatric disorders, run in families. And these family connections call for us to show compassion for our family members who suffer from their own individual disorders. 

    If you suffer from depression along with other disorders, and if your current treatment isn’t working, feel free to call us.  Or ask your health care team to call us.

    We welcome the opportunity to work in conjunction with your healthcare team to help you get better.

    At Innovative Psychiatry, it’s true that we see multiple family members who each live with diagnoses and co-morbidities, and it’s true they may sometimes share the same diagnosis … or they may not. Although your symptoms need not necessarily be labeled, they do need to be evaluated as part of your overall self. And then they can be addressed, as needed, with appropriate treatment.

    While IV ketamine treatment is not the appropriate treatment for all of the symptoms you experience, we can work with your health care team to try to help you experience your best self.

    Does IV ketamine treatment help everyone who tries it? Unfortunately, no. But it does help many achieve remission and build fulfilling lives.

    So do try to avoid stressful situations or tasks during this season.

    Do make decisions that are productive for your own health and the health of your family.

    And do call us if we can help you get better with better with IV ketamine treatment. Give yourself the best opportunity for a fulfilled 2021.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Safety of IV Ketamine – What Do We Know About Repeated Infusions?

    Safety of IV Ketamine – What Do We Know About Repeated Infusions?

    Currently, with the growing use of IV or IM ketamine treatment for treatment resistant depression and bipolar depression, and years of clinical evidence to draw from, some people wonder if repeated use can cause adverse effects. 

    And while there is irrefutable evidence of serious adverse conditions among those who have used ketamine on the street in unmonitored doses, it’s time we learned more about the safety of repeated infusions of ketamine under a physician’s supervision. Thankfully, a prominent researcher has stepped up to the plate to give us answers to the question, “What is the safety of IV ketamine?” ~~

    Jackie’s sister Janie knocked on the door of her apartment. No answer. Her sister’s depression made it hard for her to see people…so it was common for her to not answer the door. Janie slipped the key from under the mat, and let herself in quietly. She found her sister in a ball in her bed… something was wrong. “Jackie, what is it? What’s happened?”

    Her 31-year-old sister was crying, and one look at her face told her she was more heartbroken than usual. She garbled through her tears, “I was so hoping ketamine treatment was going to help. I’d put all my hopes in it… that I’d get better, and be able to function, get a job and live like a normal person… But I was looking on the internet, and I found a site that said there are so many things that go can go wrong. I know it was just social media but I’m so afraid now…

    “What is the safety of IV ketamine? I mean I really need to know. I so want my life to get better.”

    Janie sat next to Jackie wrapped her arms around her… and held her while she cried. She reached for the box of tissues and gave her one.

    “I have to tell you, Jackie, I’m not sure. But what I’ve read sounded good. My impression is that it’s safe, and effective…most of the time. Even though there are no guarantees…it sounds pretty transforming for most people.

    “But I’m sure there are naysayers out there. So let’s research it together — now. Let’s find out. I feel pretty sure we can read more studies and doctors; reports, and figure out how true what you read is.”

    She continued, “As it turns out, I did learn you may improve after the first infusion, but you may not. It may take a few. We won’t rush it, though. You suffered so many years from this depression, let’s give this treatment every chance to help you get truly, deeply better.

    “My hope for you to get help is huge. I’m not an expert, but this is the best potential solution we’ve found anywhere. So let’s dig. Let’s find the best truth we can.”

    Jackie had stopped crying…she was nodding. She sat up in bed and pulled her laptop into her lap. Together, they started with pubmed.gov and searched for studies about ketamine for depression.

                                                      ~~

    Just what is the safety of IV ketamine treatment? …Really.

    Then, there are those who talk about psychotic breaks during treatment, and those who say they have severe bladder damage… and the list goes on. But does that happen?

    Let’s face it, if you’ve never received ketamine treatment, you know how desperate you feel to get something that can alleviate your treatment resistant depression. But you read these reports that seem to be all over the internet … and you don’t want to be duped. You wonder if ketamine infusions are not as safe as you thought, and you don’t want to add other problems to your already horrific treatment resistant depression.

    Don’t you just wish you could get help to empower you to live your life? This life. The only life you have. And fear says…What is the safety of IV ketamine treatment? You don’t want to jump from the frying pan into the fire, right?

    Then, there are the reports of alarming hallucinations that are supposedly so terrifying some people are afraid to undergo this treatment. So much exaggeration.

    A research team led by David Feifel, MD, whose reputation in studying ketamine for depression stands for itself, recently published a study about the safety of IV ketamine treatment.

    His research team used a survey sent to 69 providers — most of whom were psychiatrists — originally. Since some didn’t complete the survey, and some surveys were incomplete that number for the survey reduced to 27 providers who reported on a total of 6630 patients who had received repeated ketamine treatment by IV or IM administration.

    Their focus was to determine the amount of adverse events these patients experienced and reported to their doctors…and it was surprisingly low.

    The patients were divided in the survey results by the number of treatments they received, the length of time they’d been receiving them, and how many discontinued their treatment due to adverse events. 

    Considering all the scuttlebutt and rumors that you can read about, it turned out that out of the 6630 patients, only 47 had to stop their treatment because of a side effect. (That’s means 0.7%.) Of those, 33 of the 47 had reported psychological distress during the treatment.

    Sometimes that can happen with dissociation. People with complex histories, lots of losses, tremendous trauma, and incredible emotional pain can sometimes experience distress or fear during a ketamine treatment session.

    With an IM treatment, absorption is quick and ketamine can peak quickly in the body — and it may be more challenging to manage distress. With IV treatment, the infusion can be stopped or slowed, or additional medication can be given rapidly to help quell the distress.

    This is why it’s so important for patients to be appropriately selected for this treatment, prepared for it–for what they might experience. And why it is so important that distress be recognized and attended to in the best possible way.

    In addition, Dr. Feifel reported that only 2 people experienced hypomania, which is 0.03%. No one became addicted to ketamine. No one suffered cognitive deficits as a result of the treatment. And only 1 person out of 6630 reported psychotic symptoms.

    As far as bladder symptoms…there were 3, or 0.06%. Let’s remember that some of these patients received ketamine far more than 20 times.

    And this may surprise you…

    About a quarter of the 6630 patients had 5 or less treatments.  But 42% received what’s considered the standard number of treatments: 6-10. And that left 1/3 of the 6630 who received over 10 treatments, with 7% of that 1/3 receiving over 20.

    So this population was well distributed to reveal the adverse effects in a few vs. a larger number of treatments.  

    The researchers noted that a study in South Korea on ketamine treatment for chronic pain used ketamine doses of 1mg/kg — higher than most in this study.  And that dose produced very few adverse events, with the treatment being considered very safe and tolerable.

    All in all, the adverse events seen with repeat ketamine treatments given IV or IM are pretty low risk. Of course we still have to be aware of all of the possible risks, and of all that we still don’t know about long-term side effects, especially about the incidence and severity of bladder symptoms. We are learning all the time — from our patients, our colleagues, and researchers around the world.

    And we learn from anecdotal experiences we read about of those who’ve used it on the street without medical supervision. 

    Dr. Feifel’s sorely needed report provides evidence about the safety of repeated parenteral (IV, IM) ketamine treatments. But even in those extremely rare situations where an adverse side effect occurred, we don’t know the particulars that may have contributed to it.

    But for many people who suffer treatment resistant depression or bipolar depression... or PTSD… and who look at the risks and benefits of a series of IV ketamine, the potential benefits often outweigh the risk of an adverse effect.

    Maybe that’s true for you, too.

    You deserve to have the power to live and enjoy your life.

    At Innovative Psychiatry, we’re uniquely equipped to keep you safe (and we’re working to do that even in the pandemic!). We welcome you into our treatment offices. Especially now you may need the freedom, relief, and extraordinary joy that ketamine infusions can provide.

    And if you, or your family or friends, want to know about the risks of repeated infusions in real world patients and real world outpatient settings, the data speaks for itself.

    And we’re always searching for more.

    Don’t miss the opportunity to feel like yourself… even if you haven’t been yourself for so long you don’t remember. You’ll recognize the real you when depression lifts and you are yourself again.

    Give yourself the chance to experience freedom, joy, and hope.

    If you believe ketamine treatment can help you, call us.

    We believe in who you can be.

    And we’re here to help you enjoy you again.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Bipolar Mixed States: The Doctor Who Diagnosed It in the 12th Century

    Bipolar Mixed States: The Doctor Who Diagnosed It in the 12th Century

    If you suffer from mania, you’ve also experienced the transition that leads to it.

    Someone identified that transition emotion over a thousand years ago. Surprising?  Here we are in the 21st century, with all the technology and neuroscience we’ve discovered at our fingertips, and we still face that same emotion. And it often plays a strong role in bipolar mixed states.

    What is it?

    Anger.

    So many in our current society speak of various psychiatric disorders as if they’re a product of modern contrivance. Sometimes in psychiatry, our role is not only to treat those suffering from a disorder, but to also defend them against the cruel cynicism of skeptics who discredit their struggle.

    For someone who suffers from emotions that plunge so low, so dark, they don’t know how to hang on to a fiber of life… then without warning, those feelings change…shift…and become energized then agitated… with no reason….until they’re replaced by anger then rage….and more energy than can be managed….until they’ve reached a state of euphoria, unlimited possibility, and very high creative energy….  Someone like this knows the helplessness of erratic emotional states.

    And if you’ve experienced these wide changes in emotions, you know it’s painful.  When it’s happening inside you, it feels normal. It feels justified…because you don’t realize it’s happening because of malfunctioning signals in your brain.

    If you feel anger…even rage… it just must be justified, right?

    But many people with a disorder like this have to experience it for many years before they can identify those moments when their mood swings in a new direction. It’s hard.  Really hard.

    So let’s talk about this ancient philosopher and physician from the 12th century, Avicenna.

    He saw this disorder, this syndrome… and described it.  He talked about how it affected both the psyche and the body.  Pretty profound for a guy who lived around the year 1100 AD.  He called this condition “melancholia” and in present day mental health we might think of melancholia as depression. 

    But the syndrome he described included mania. And mania specifically identifies what we now know as bipolar disorder.

    In his early descriptions, he divided this condition into two phases, the early phase and the chronic phase. Symptoms of the early phase were described as suspicions of evil, fear without cause, quick anger, involuntary muscle movements, dizziness, and ringing in the ears.  

    For the chronic phase of melancholia, he described moaning, suspicion, sadness, restlessness, and abnormal fear such as the “sky falling upon one’s head,” or “being swallowed by the earth.”

    In our current environment, we would likely consider these last two as delusions, or psychotic features.

    Not all people with bipolar disorder have delusions during manic or depressive episodes. But in some cases, it happens.

    Avicenna also described some symptoms we might now see in “bipolar mixed states” such as increased libido, involuntary laughter, and acting as though one is king… which we’d now call “grandiosity.”

    These can all be symptoms of the manic phase of bipolar disorder.

    These are descriptions that are more than 1100 years old. But they describe a condition that we still see today, and work hard to identify and treat. What is so hard is identifying it first. An episode of anger does not mean you have bipolar disorder — not by a long shot. And even if you have bipolar disorder, getting angry could be just… getting angry. It may not mean you’re in a manic, hypomanic or even mixed state.

    How to tell? Sometimes it’s difficult. It may take several episodes. Sometimes it can take years.

    You don’t have to let it. The good news is that mixed mood states are treatable. If you’ve been ridiculed for the medicines you take, or the psychiatric treatment you participate in… if people around you don’t believe this is not only a valid and debilitating disorder, or think it’s something modern day doctors have dreamed up, here’s proof your struggle is valid. 

    People can be so… uninformed. You have to just shake your head in disbelief.

    According to Avicenna, people have been suffering with this at least since the 1100’s. It’s still the real deal.

    And he described bipolar mixed states without using the term itself: a combination of depressive and manic symptoms all tangled together at the same time. With a back drop of depression, and the addition of agitation, grandiosity, heightened sexual drive, anger, and emotions that are easily aroused, changed, that alter quickly. 

    There are doctors who attempt to diagnose bipolar disorder as specifically depression with at least one clear episode of mania or at least one clear episode of hypomania. But for a large population of patients, this is utterly frustrating. Because what they have–and what you may have–are mixed states, or mixed episodes.

    If you’re one of them, you know.

    You KNOW you’re not either black or white emotionally. You KNOW you’re not specifically depressed or manic.  

    While you may be depressed at times, and you may experience mania at other times, you know that you also have all sorts of combinations of emotions in between the two.

    It can feel like you are a vertical accordian with shifting degrees of manic and depressive symptoms at the same time and with the ratio shifting throughout the day, or from day to day … over sometimes every few days. So many variations make it hard to identify, difficult to explain, and frustrating to report. Symptoms like grandiosity and anger can signal other disorders, as well.

    And you know it’s real, though you may be told something different.

    When you suffer like this, you first need validation that there are things happening inside you that you don’t cause.

    This is a very difficult condition, and what you experience may be different than what someone with the same diagnosis experiences. But it’s real.

    And it’s treatable.

    Bipolar disorder can be challenging to treat effectively — and may need patience and determination for you and your doctor to tame — but hang on to hope.

    We’ve only talked about bipolar mixed states and mania but there is also depression in bipolar disorder. And bipolar depression is also extremely difficult to endure. It can be terrible.

    Thankfully, bipolar depression can be treated effectively by IV ketamine. 

    Another aspect of the depression in bipolar disorder is the risk of suicidal thoughts. And IV ketamine can remove those thoughts and give you the freedom to live in joy.

    At Innovative Psychiatry, we offer IV ketamine treatment for bipolar depression and see patients whose treatment has helped them emerge from the depressive symptoms that held them down. Not everyone, of course, but many.

    And these patients often talk about how much easier their condition is to manage since the depression is gone.

    While bipolar depression can be tough to break, ketamine treatment can break it. Give yourself the opportunity to see how good you can feel, how productive life can be, without bipolar depression undermining you.

    If bipolar depression interferes with your life, call us.

    We’re here to help you achieve remission, with resilience, hope, and the joy of a loving and productive life.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Does Psychiatric Treatment Suffocate Creativity in the 21st Century?

    Does Psychiatric Treatment Suffocate Creativity in the 21st Century?

    Have you avoided treatment fearing it would subdue your talent?

    This is a very real concern for some intelligent, talented people who suffer from certain disorders. The idea that suffering yields brilliant satire, beautiful music, heartbreaking poetry, and dazzling art that enrich mankind. It’s been a subject of controversy for eons. But is it true? If your treatment suffocates creativity, you can do something about that.

    We speculate about the connection between artistic genius and depression or bipolar disorder. Theories emerged that Vincent Van Gogh’s severe depression. He suffered serious bouts of anxiety, and possibly suffered from bipolar disorder.

    He self-medicated with alcohol… Of course, no medical treatment was available for his symptoms. 

    Ludwig von Beethoven stands as another historic creative genius we celebrate who suffered from bipolar disorder. Were his enthralling symphonies created by his illness?  

    Franz Haydn, his teacher and fellow composer, had remarkable words for him as he was getting to know him. “”You will accomplish more than has ever been accomplished,” he said. “You’ll have thoughts that no other has had. You will never sacrifice a beautiful idea to a tyrannical rule, and in that you will be right…”

    He was brilliant…there’s no question. And some would argue that brilliance and bipolar disorder sometimes go together. And he grew deaf. A tragedy for a musical genius. His behaviors as reported by his peers may have been indicative of depression. Maybe bipolar disorder.

    Still can you imagine his frustration at not hearing his own music?

    We must remember that our belief in the presence of a diagnosis of these figures in history is conjecture. That we’re basing our views on what we read about them, what their contemporaries said about them. And we try to piece together the puzzle pieces.

    So, if you’ve experienced severe bipolar I disorder, you may relate to some of these recollections of tormented icons. Their symptoms may seem pretty familiar to you.

    Again, there was no effective treatment available to him at that time, so we can only wonder.

    To learn whether treatment suffocates creativity, we have to fast-forward to the most recent 30 years of psychiatric treatment…and even better, the last five.

    In the days when Prozac was such a breakthrough, and then Paxil, I remember someone describing the way she felt. She said it was like she was “coated in wax.” 

    The early SRIs, and later the SNRIs, provided so much help to depressed people that they were considered a breakthrough at the time. People would joke, “the city needs to add Prozac to the drinking water. It could quite possibly solve all of society’s problems!”

    With time, we learned that these medications made a dramatic difference in quality of life for about 33% of those who suffered, and with some tweaking, titrating, and blending, over time that number increased to 50-65%. 

    But, eventually, it turned out that these medications weren’t always as remarkable as they seemed.

    There were plenty of people who stopped taking the medications because of the side effects of weight gain, sexual dysfunction, and more.  Plenty of others continued to take them and gained the weight and lived with the reduced sexual drive for the sake of functioning in their lives.

    Of the creatives who took these medications, some claimed the medicine impeded their creativity, while others found that with a clear mind, they could create more effectively.

    Those with bipolar disorder often take a mood stabilizer like lithium or depakote, and may experience more stability. But many others need a variety of medications to yield a more stable mood. And many others with bipolar disorder don’t experience any real or lasting relief from these medications.

    Does Psychiatric Treatment Suffocate Creativity In All This?

    While it wasn’t uncommon to hear patients complain of dampened creativity while taking SRIs and SNRIs, that’s not the case across the board. 

    Some who are treated for severe depression are relieved to discover they are able to be creative again. Others, not so much. It varies between people and can also depend on the symptoms. 

    And creativity and bipolar disorder share some genetic links, as well as some deviations from typical ways of thinking. Creativity includes new thoughts, original ideas, and freshness in composition of art, music, construction, etc.

    Still, neuroscience research reveals that the most productive creativity in someone with bipolar disorder happens when that person is in a non-extreme state, or euthymic period, or a hypomanic period.

    So, what about the last 5 years?

    Ketamine Treatment Doesn’t Suffocate Creativity

    Not only is ketamine treatment effective in treating depression and bipolar depression in far more people than SRIs or SNRIs, but it can actually enhance creativity. It’s in a category all its own.

    Ketamine treatment’s extraordinarily rapid and robust effects can proliferate the brain cell connections and the communication between different parts of the brain. These benefits can expand so dramatically that you can, and likely will, find yourself in a remission that defies all logic. 

    A kind of remission that finds you catching up on all the chores you’ve avoided for the last several years, advancing your career in ways you’d never thought about before, building strong, healthy relationships, and having fun…I mean really having fun.

    You can wake up singing songs that may have followed you while you dreamed, dancing spontaneously while you get your coffee. You may find yourself immersed in joy.

    Of course, ketamine treatment doesn’t do all this for every single person treated with it, but these benefits are widespread and common. There are a handful of sufferers who don’t enjoy these outcomes, but the vast majority do.

    In this day and age, on the brink of life changing treatments for severe psychiatric suffering, you have the opportunity to enjoy singing, dancing, and loving. 

    Watch the Clouds Part and the Sun Radiate Into Your Life

    At Innovative Psychiatry, we celebrate with our patients as they taste of a brightness of life and a hope that had always alluded them before. We provide ketamine treatment in a pandemic-safe, cautious protocol that protects our patients and our staff. 

    With this exacerbated environment for increased depression related to the pandemic,  it’s more important than ever to give yourself the additional support of a treatment that can renew your emotional energy and your patience to cope. 

    Does psychiatric treatment suffocate creativity? No…it doesn’t have to.

    If you’ve feared treatment because you fear losing your creative edge, call us.

    We’re here to help you open your doors and windows to let the light of your gifts shine through.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Ketamine Slashes Anhedonia in Treatment Resistant Bipolar Depression

    Ketamine Slashes Anhedonia in Treatment Resistant Bipolar Depression

    Depression shows its face in a lot of different ways:

    If you live in the misery of bipolar depression, anhedonia is right there, up close and personal.  So what is it? Anhedonia is the loss of interest or pleasure in things you used to enjoy. So you stop enjoying.  But if you can’t enjoy... life can taste like… sawdust. Bipolar depression is never fun. It’s interesting that those who suffer the type of depression that’s dominated by anxiety often have trouble sleeping…and tend to lose weight. While those who suffer from the type of depression dominated by lethargy tend to gain weight and sleep long hours…. like 19 hours straight. And anhedonia is right there, in your face, when you’re depressed. It can permeate your life and creep into conditions that sometimes tag along with depression and bipolar depression, like PTSD or substance abuse. And ketamine slashes anhedonia in these conditions.

    Now, here’s the problem. In bipolar depression, there is plenty of evidence that shows that the usual treatments for bipolar depression don’t relieve the anhedonia. In fact, they sometimes actually blunt the rewarding experience. We’ve talked about this in other articles, referring to the activity of cell bursting in the lateral habenula. 

    Let’s be frank. When you’re depressed, you want to feel better. NOT feeling isn’t good enough. You need to be able to enjoy.

    We talked about how important that is. To live a fulfilling and rewarding life includes enjoying. Because without any enjoyment, life is more of a drudgery…and you trudge through proverbial mud day in and day out.

    Who Says So??

    Peer reviewed studies have demonstrated that depressed patients with anhedonia have a poorer prognosis for recovery than depressed patients with no anhedonia. And anhedonia can also cause emotional blunting and even physical blunting, like inability to experience sexual pleasure or orgasm.

    A study published in the American Journal of Psychiatry demonstrated that when anhedonia is present in a major depressive episode, it can predict that suicide is likely to end that life.

    In 2014, there was no FDA approved treatment for anhedonia…and the suicide rate was climbing, and continued to climb and is still climbing. Currently, suicide is the 10th leading cause of death in the US.

    All that illustrates that “not enjoying anything’ isn’t as tepid as it may sound. It can actually be life-threatening.

    And in the meantime, in order to understand depression and bipolar depression, you do need to wrap your head around anhedonia.

    Ketamine Treatment Slashes Anhedonia in Bipolar Depression

    A neuroscience research team led by N. Lally that included Carlos Zarate and D.A. Luckenbaugh, looked at the effects of ketamine on anhedonia in Oct 2014. The study showed that ketamine causes rapid-acting anti-anhedonic effects in treatment-resistant bipolar depression. To go a step further, they found it it improves and relieves anhedonia independently of its antidepressive benefits.

    Over half of people diagnosed with treatment resistant bipolar depression suffer from serious anhedonia. And the researchers in this study demonstrated… and concluded….that ketamine treatment is vital for the treatment of anhedonia in patients with bipolar depression.

    We’ve talked before about how bipolar depression is characterized by an intensity that distinguishes it from major depressive disorder. And these researchers found that even when a patient with bipolar depression can laugh at a joke, or likes eating something sweet, he lacks the motivation to to go to the effort to get it for himself.

    So lack of motivation is embedded in anhedonia, and to restore motivation requires alleviating the anhedonia.

    But standard antidepressants aren’t always effective for anhedonia, at least there’s no proven evidence of it. So something had to give.

    And ketamine treatment seems to target regions in the brain that cause anhedonia. Not as part of its antidepressant benefits, but independently.

    We also know that IV ketamine also stops suicidal thoughts…and again it seems that it can do this independently from its antidepressant benefits.

    Is it any wonder so many are so excited about the restoration they’ve experienced after ketamine treatment?

    And what about you?

    Do you know what anhedonia is like from your own experience? Do you recognize the description of not enjoying things you used to enjoy…of having no motivation to drag yourself out of bed or to do anything?

    Ketamine treatment can be an ideal treatment for your symptoms, even when nothing else has worked — and sometimes, especially when nothing else has worked! — and can relieve depression by targeting a variety of areas in your brain, It’s almost as if it’s custom made just for you to dissolve your bipolar depression symptoms.

    I’m not saying ketamine treatment is a cure-all. Far from it. Depression and bipolar depression are complex disorders that require multifaceted treatment approaches. When anhedonia persists no matter what you do or try, you may want to consider ketamine treatment.

    Ketamine Slashes Anhedonia For You, Too

    At Innovative Psychiatry, we offer ketamine treatment for treatment resistant depression and bipolar depression. And our patients often tell us they’re amazed at the relief they experience and at how much easier it becomes to manage their lives after treatment.

    If you haven’t experienced relief, or even just partial relief, from the prescriptions you’ve taken…and you still don’t enjoy… call us.

    If you find yourself thinking about dying, or wish you didn’t have to wake up in the morning… reach out for help. Don’t go it alone. Call the National Suicide Prevention Lifeline at 1-800-273- TALK (1-800-273-8255) or in the US, text HOME to 741741 to connect with a crisis counselor at the Crisis Text Line.

    And learn about how we’re using IV ketamine infusions to help stop suicidal thinking in depression.

    You really can enjoy again…the fragrance of a flower, the energy to have fun, the motivation to accomplish your goals and build healthy relationships.

    Give yourself the chance to find out how good you can feel.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Bipolar Disorder Treatment for Depression and Suicidal Thinking

    Bipolar Disorder Treatment for Depression and Suicidal Thinking

    Treating bipolar disorder with all its comorbid symptoms can be a delicate process.

    Some people suffer tragically when all’s right with the world. The COVID-19 changes have made the last 5 months especially difficult for them. Those who suffer severely lack the medications and treatments to help them function during this period of isolation and quarantine.  For example, bipolar disorder treatment for depression, anxiety, and suicidal thoughts is all the harder in crises like these.

    Many people suffer with these symptoms when the world is balanced and functioning. However, during this period of crisis their difficulties torment them mercilessly.

    Bipolar disorder is one of the most severe psychiatric disorders, but unfortunately it has not received the most attention for studies, breakthroughs, and relief. Not even close.

    This serious disorder plays a significant role in the lives of people who live in shelters, in jail, or who commit suicide.

    To take it a step further, some doctors warn that no one should still be prescribing antidepressants for bipolar disorder.  

    I’m not one of them—but more on that in a bit.

    It’s true that depression is a terrible symptom of bipolar disorder. In most cases, it dominates many more of your days compared to mania or hypomania. And it’s vital to find a way to treat the depression while also avoiding the mania (or hypomania).

    Add to that the other conditions that often run hand in hand with mood disorders. Those that accompany the depression and mania — like severe anxiety, panic disorder, and OCD. Anxiety can appear as a cluster of conditions that vary in severity, with flares that occur willy-nilly. Boy, can they exacerbate each other! And boy, can a simple straightforward medication for an anxiety disorder suddenly make your mood disorder worse. And vice versa.

    If you or someone you care about has bipolar disorder, you know what I mean. The meds that are supposed to help can be hellish.

    Then, there’s another point to be aware of… 

    Bipolar Disorder Treatment for Depression, Anxiety, and Suicidal Thoughts …is Tricky

    An article in Psychiatric Times recommended we use evidence-based medications like lithium, quetiapine, lamotrigine, lurasidone, and cariprazine, and avoid antidepressants in people with bipolar disorder. And they have reasons for that.

    Those are excellent medicines. But what about when a patient doesn’t respond to any of them?  

    But people are individuals. And we design and personalize the treatment for each individual.

    For instance, when we find that patients with bipolar disorder also have severe anxiety disorders (panic disorder, OCD), the anxiety can be hard to address with therapy alone or occasional medications. Sometimes it’s just so bad that it needs to STOP. We can sometimes control these it best with a concurrent SRI — the current updated term for SSRI — to suppress panic attacks or OCD. 

    Why do that? Because some people with frequent unpredictable panic attacks just can’t function very well. Some people with OCD are tortured by it.

    Give them an SRI and it could go a long way towards suppressing all of that. But then … their mood can really go haywire. Rapid cycling can occur — and everything can spiral out of control.

    There is no one-size-fits-all for psychiatric treatment. Especially if you have bipolar disorder. And its friends. Anxiety? Agitation? Hyped-up energy? Frustration? Each symptom must be teased apart and treated carefully, without upsetting the other symptoms. Without upsetting the rest of your life.

    Because the fact is, bipolar depression can be severe,  unrelenting, and life-threatening. To expect someone with severe bipolar disorder to muscle through bipolar depression along with panic attacks, anxiety, OCD, being untreated, too, is cruel. While you’re waiting for the proposed mood stabilizing medicines to relieve the plethora of symptoms you suffer…when it never happens, it can feel pretty desperate. You can feel pretty hopeless.

    People who suffer from bipolar disorder live at risk for ending their own lives. Their frustration with unrelenting symptoms, their shame over behaviors when their mania –or hypomania– is not controlled, and their impulsiveness during mixed states make effective treatment so important.

    The stakes are high.

    Sometimes an SRI can ease the panic attacks…or the OCD… without actually relieving the depression.

    And yet, what’s the alternative?

    For some patients, these medicines can help prevent hypomania or mania, and in some they also stabilize depression, too.  But when they don’t help the depressive symptoms, something more really does need to be done.  Pretty quickly.

    Ketamine Treatment Can Help with Bipolar Depression

    And ketamine treatment can relieve bipolar depression pretty quickly. It helps many patients whose depressive symptoms aren’t relieved by these mood stabilizing medicines or SRIs. But we use it carefully. Because ketamine infusions occasionally induce hypomania.

    At Innovative Psychiatry, we see people with bipolar disorder improve dramatically from ketamine treatment’s extraordinary antidepressant effects on their bipolar depression. By bringing relief with this treatment to the dangerous and overwhelming threat this condition causes, and by reversing the suicidal thoughts that can accompany it, mood stabilization can become easier.

    Bipolar disorder is not a walk in the park, but effective treatments and personalized, innovative psychiatric care can bring you joy, peace, and a rewarding life. 

    It’s what we do. It’s what we live for.

    We invite your healthcare team to work together with us to get you back to your best self. Please feel free to have them call.

    If you suffer from bipolar depression, call us.

    You actually can live very well with the right treatment for you.

    We’re here to help. 

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Explore: Method to Differentiate Bipolar Depression vs Unipolar Depression

    Explore: Method to Differentiate Bipolar Depression vs Unipolar Depression

    As you may know, May is mental health month.

    IV ketamine can restore her joy whether it's bipolar depression vs unipolar depression.

    And as such, it’s a good time to talk about symptoms of mental health disorders, don’t you think? We want to increase understanding and dispel stigma which will help people who suffer gain better access to the help they need. Stigma is steeped in ignorance about something someone doesn’t understand. In addition, the global circumstances of these last few months have impacted the mental health status of so many. So let’s use this month to broaden understanding and better equip us to respond to ourselves and those around us. So here’s something to talk about: A new way to differentiate bipolar depression vs. unipolar depression may be emerging.

    Leading Cause of Disability

    The leading cause of disability in the world today is not heart disease or cancer…it’s depression. Depression is that common. We talk about severe depression and we talk about bipolar depression. When you see someone with either of these conditions, they may look rather similar from your vantage point, but they’re actually two distinctly different conditions.

    When we diagnose someone in this depressed state, it can be difficult to determine whether they suffer from major depression or bipolar depression, unless they have a history of mania or hypomania to determine the difference.

    Unipolar depression and bipolar depression don’t feel the same…but they do sort of look the same.

    Which is why a doctor asks whether you’ve had times when your mood was elevated, you felt energetic, hyperactive, maybe irritable, angry… and overly confident…all at the same time?

    For this reason, so many with bipolar disorder are first diagnosed with major depression, especially those with bipolar II disorder, since their symptoms include far more depression than hypomania.

    When you first see a psychiatrist about your depression, it’s important to be patient. Because some of your symptoms may not have emerged yet…and you may appear to have unipolar depression. Then later, mania or hypomania emerges, and your doctor may change your diagnosis to bipolar disorder, along with your prescriptions.

    Because of the challenge of diagnosing someone accurately who has a low mood, researchers have been seeking a means of using some sort of biological markers to determine scientifically the proper diagnosis and character of the depressive symptoms.

    This man is in pain but doesn't know if it's bipolar depression vs unipolar depression.

    Something that would differ in patients with unipolar depression from those with bipolar depression. Possibly brain activity. Or maybe proteins in the blood? Possibly genetics?

    Exploring Bipolar Depression vs Unipolar Depression

    An interesting study conducted by Brain and Behavior Foundation researchers, led by Mary Phillips, Ph.D., performed with a relatively small group of subjects, suggests a way your doctor might differentiate the two disorders clinically to aid in accurate diagnosis.

    Using functional magnetic resonance imaging (fMRI), full brain scans were conducted on a group that included 18 bipolar patients who were in bipolar depression, 23 depressed patients who’d been diagnosed with major depressive disorder (MDD), and another 23 who were healthy without a diagnosed disorder.

    It’s unfortunate that their study involved so few, and also that 90% of those with bipolar disorder were diagnosed with bipolar II disorder, leaving only 10% who had bipolar I disorder. A more evenly distributed group might have told us more.

    Even so, they did make some significant observations.

    The working memory system is used by the brain to maintain, manipulate, and update information that is associated with tasks that are presently at hand. When the networks of nerves in this system are damaged, learning – reasoning – and decision- making ability can be disabled.

    This is particularly true in those with mood disorders, like depression.

    So, the researchers gave each participant an easy task and a difficult one, while the participant was undergoing an fMRI brain scan. The design of the tests was to highlight that people form expectations about a task before they fulfill it.

    Bipolar depression vs unipolar depression can both be treated effectively with IV ketamine treatment.

    A person might feel the task will be easy, so there’s little stress in performing it. But if he expects the task to be difficult, his stress increases before he begins.

    It turned out, that there were patterns of neural (brain cell) activation in the medial and lateral areas of the prefrontal cortex, that were related to how easy or difficult a task would be.

    Mechanism Defends the Person with Bipolar Depression From Emotional Pain

    The researchers reported that people with bipolar disorder may actually block anticipation of a negative experience to avoid experiencing negative emotion while performing a task. That basically people with bipolar disorder seem to have a built in defensive mechanism to help protect them from negative emotions.

    So enlightening. People with unipolar depression don’t do this. They feel what they feel. But those with bipolar experience such damage from their negative emotions.

    As I said earlier, unipolar depression and bipolar depression may look similar to someone observing people suffering from these. But they feel different.

    Let’s add to that, that both of these disorders can often end in suicide, unfortunately. Even so, it’s more common in bipolar disorder.

    There are traditional medicines for people with these disorders. And those medicines do help a lot of people.

    But not all.

    For that reason it’s important to seek help until you find treatment that helps you feel better, function better, and live a rewarding life.

    IV Ketamine Doesn’t Differentiate Between Bipolar Depression vs Unipolar Depression – It’s an Extraordinary and Robust Depression Treatment

    At Innovative Psychiatry, we offer IV ketamine treatment to help you experience relief from severe depression that prescriptions haven’t helped…. And for bipolar depression that is unrelenting in spite of prescription medications.

    Bipolar depression vs unipolar depression for this woman is still crushing.

    IV ketamine treatment isn’t effective with mania or hypomania. But the mania or hypomania is easier to manage and treat without bipolar depression. This treatment can be exceptionally effective for both unipolar and bipolar depression. In fact, it can be utterly life-changing.

    And… in regard to the risks of suicidal thoughts, IV ketamine treatment can erase those thoughts in an afternoon. A few hours. And if you’re not plagued by thoughts of death and dying, you’re a great deal freer to work toward healing, restoration, and joy.

    In this current global crisis, suicides have been increasing, among those with disorders, healthcare workers, physicians, and more.

    IV ketamine can save lives by removing thoughts that lead to suicide.

    IV ketamine has given her joy instead of depression.

    If you suffer from bipolar depression or unipolar depression, and medications haven’t helped, call us.

    Let us help you find your joy again, and your hope. The current global crisis is temporary, but it has affected the outlook of millions. The good news is that joy can be restored, and hope can return. You can feel resilient, and equipped for what life has in store.

    We’re here for you, and we’re working within a safety protocol so you can be treated without fear.

    Better days are ahead.

    To the restoration of your best self,

    signature of Lori Calabrese, M.D.

    Lori Calabrese, M.D.

  • Ketamine Restoration in the Amygdala Repairs Social Connections

    Ketamine Restoration in the Amygdala Repairs Social Connections

    Nick walked in after school, slamming the door behind him.

    His mom looked up, startled by the noise. “What’s that dirty look about..?? You’re so judgmental!!” Nick was fuming, and with that he headed upstairs. His mom followed him upstairs and spoke softly, knowing her son was apparently volatile. She didn’t realize that what just happened could be repaired by ketamine restoration in the amygdala.

    “Nicholas, I’m sorry my face looked judgmental. I wasn’t feeling judgmental…I was startled by the noise the door made, and concerned that you seemed so upset. Did something happen..?”

    Nick crumbled. 

    He didn’t know why he misread his mom, or why he was so angry. Nick hated himself for being hateful. He just felt so angry so much of the time, and when he wasn’t angry, he just wanted to cry… what was wrong with him?

    “Sorry, mom.  I thought you were mad about me slamming the door. I have a lot of homework and I just don’t want to do it. It all seems pointless.”

    Nick’s mom knew he’d been under a cloud since the last school year. He was seeing a psychiatrist, which he always dreaded. The medications didn’t seem to be helping, in spite of the fact he was on his third different medicine.

    He’d all but refused to see the therapist any more. As his mom, she just wanted him to feel better and enjoy his adolescent life, but she was hitting a wall. All she knew to do was to encourage him to keep trying and to provide a little comfort where she could.

    “Why don’t you come downstairs, and I’ll make you a sandwich. Eating something might help your homework seem a little easier to face.”

    Ketamine Restoration in the Amygdala

    While Nick ate, he decided to mention to his mom what his buddy in History had told him.

    “Mom, you know Zach? He’s been down for a long time…even longer than me. He told me today that he’s getting IV ketamine treatment. He said he took pills for a year and they didn’t help, no matter what brand the doctor ordered. Anyway, his dad read about this treatment, and Zach says it’s already helping.”

    “Really Nicholas? Does his doctor give him the treatment?”

    “No, he said his dad is taking him to a different psychiatrist who does it. He says his own doctor is all for it. He’ll go for two or three weeks and he’ll be done. So far, he’s finished the first week.  I can tell he’s doing better. He smiles and laughs. It’s weird. But I also envy him…”

    “I tell you what, Nicholas. You go work on homework, and I’ll see what I can find out about this treatment. IV ketamine you say? We’re going to find help, honey.”

    Three months later, Nick walked in the door, smiling ear to ear.  

    “Hi Mom. Since it’s Friday, is it ok for me to go to a movie tonight with Zach and Tim?  Oh and by the way, Chelsea said she’ll go to prom with me.”

    Nick beamed.

    “Oh that’s fantastic, Nicholas! I’m so glad she said yes. She’ll be on the arm of the nicest and best looking guy at school!  And sure, the movie’s fine. Zach and Tim are great guys.”

    IV ketamine restoration in the amygdala can make all the difference.

    Depression Can Impair the Amygdala’s Ability to Process Faces

    To the casual observer, this may all sound a little too easy. And for some people, it might be. Everyone’s different. But for most people like Zach and Nicholas, their misery is reversed by a series of 6 IV ketamine infusions, sometimes a few more.

    And in some cases supplements are needed to address low blood levels of certain hormones or nutrients first. But, when you consider the comparison of that to years of traditional antidepressants that aren’t working, it’s an easy choice.

    On top of that, the prospect of joy – and hope – in place of the damaged relationships caused by a short temper, a hopeless outlook, and absent motivation, is again…an easy choice.

    Humans like to feel good. When you don’t, you’re not very pleasant to be around, you know? Is there anything that makes you feel worse than severe, unrelenting depression complicated by anxiety and phobias?  It’s misery.

    And the thing is, it colors the way you see everything. You can be looking in someone’s face who’s just preoccupied, and interpret their expression as angry, critical, irritable… then you snap at them about it, and they feel attacked from out of nowhere.

    Guess what?  There’s a scientific reason you do that. It’s not just your imagination. And the good news is that IV ketamine treatment actually changes something deep in your brain to help you interpret their facial expression for what it’s intended to be.

    To understand this, we need to talk about the a wonderful structure in the brain called the amygdala.

    Ketamine Restoration in the Amygdala

    The amygdala consists of 2 almond shaped structures deep in the sides of the brain at the temporal lobe. It’s one part of the limbic system which processes emotion, records emotional memories, influences behavior, motivation, and the sense of smell, as well. 

    One key job the amygdala performs is helping you to look at facial expressions in others and determine their emotion. For instance, if you see someone frowning, with their face tense and lips tight, do you assume they’re happy? Of course not. It’s your amygdala that sees their expression and determines they may be angry.

    Well, when someone is suffering from a disorder like severe depression or bipolar depression, their amygdala may be malfunctioning.

    Study Explores Ketamine’s Effect on Amygdala Function

    So recently, a team of researchers led by Joana R.A. Loureiro in Los Angeles and Chicago set out to study what effect two rapid acting depression treatments have on the amygdala’s ability to accurately process facial expressions. Using functional MRIs (fMRI) they tested 44 adults who were all experiencing an episode of severe depression.

    They divided the group into two parts: 17 subjects were given an individualized number of treatments of ECT and 27 were given IV ketamine infusions 2 or 3 times a week until they had received 4 infusions. 

    This was an interesting approach because both forms of treatment affect brain function and emotional processing, so they wanted to see if it worked at the level of the brain cells. 

    Since interpreting the facial expressions of others is such an important part of social functioning, they focused on the subjects’ ability to accurately do that. The subjects were tested by the task of matching emotional faces on a screen. If the face at the top of the screen was smiling, they needed to match the face at the bottom of the screen that was also smiling.

    They found that both modes of treatment improved the accuracy of the subjects’ amygdala function.

    When Depression Impairs – Ketamine Repairs

    Now, about the type of scenario that Nicholas and his mom experienced. At the moment he walked in the door he believed he saw criticism and judgment in her facial expression, when her look was actually surprise and concern.

    When someone is severely depressed, it’s as though they have an affinity for negative feelings and beliefs. So, when they see a facial expression that appears negative to them, it goes to the bone. They feel it so deeply and lightening fast.

    It’s easy to see that this type of misinterpretation and reaction only further damages relationships that are already fragile when someone is severely depressed.

    And even though both ECT and ketamine improved the amygdala’s function, ECT is a treatment that carries some bias and even stigma for its side effects and history.

    We also know that ketamine not only blocks the NMDA receptors but it also activates AMPA receptors and an array of other actions that can make you feel remarkably better.

    And there’s another life-changing benefit ketamine can provide:

    IV ketamine can stop suicidal thoughts in a few hours.

    This in-depth study shows yet another way that depression impairs your function, and how ketamine treatment can restore it better than ever.

    Reach Out for Ketamine Restoration in the Amygdala – And Get Your Joy Back

    At Innovative Psychiatry, want to help you feel a lot better than just “less depressed.” We want you to experience joy, a song in your heart, hope for the future, and energized motivation to build the life you want, with healthy and strong relationships.

    It’s almost like using a car jack to crank up your life and replace the pain and loss with new ideas, new projects, new joy in relationships.

    If you can relate to Nick, and you want to feel joyful and able to care about others as you put your best foot forward, call us.

    We want to work with you and your healthcare team to help you experience extraordinary relief. 

    Reach out now for hope.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Does Hopelessness Accompany Suicidal Thoughts or Cause Them?

    Does Hopelessness Accompany Suicidal Thoughts or Cause Them?

    Tim dragged himself into the school cafeteria where the photographers had set up equipment to take school pictures.

    He felt angry, bitter, sullen, and hopeless. What purpose could there be in school pictures? What’s the point? he thought. Tim hated being at school. He felt like he would self-destruct if he didn’t get out of there. Then it was his turn for his portrait. He stared at the camera. The photographer said, “Smile!” (Does hopelessness accompany suicidal thoughts…or cause them?)

    He just stared straight ahead. Enduring. He knew if he smiled it would make him look like a horror-movie character. Click. Flash. And it was over.

    Tim got up, and dragged himself out of the cafeteria and out the back door of the school.  He shuffled home. He couldn’t stand being there any longer. 

    Right behind Tim in the line a pretty girl waited her turn. Emily smiled for the camera. She didn’t want to. But she tried to do the right thing. Her sad eyes gave away her despair. Emily lived in a neighborhood where everyone knew each other, got together, barbecued, and enjoyed the community.

    The problem with that is that one of her neighbors offered to spend time helping her with her music lessons. Her parents encouraged her to take advantage of the expertise of this “nice man.” Luis was 41, college educated, and very musical.

    Emily didn’t know how to tell her parents that every time she went to his house, he had other ideas in mind. She felt ashamed. Troubled. Scared. Dirty.

    She tried to be responsible and do everything expected of her. Her parents just knew she was a good student, kind, and obedient. Does hopelessness accompany suicidal thoughts…or cause them?

    Once when Emily tried to tell her mom about Luis, her mom corrected her before she could get it out. She told her to be sure to be respectful toward him when she was at his house.

    Emily clammed up.

    But she was reaching the breaking point. After two years, she didn’t think she could take this any longer. She didn’t know how to stop it. She was feeling more and more hopeless that there would ever be an end to it. And Luis threatened that if she told anyone he would hurt her family.

    So Does Hopelessness Accompany Suicidal Thoughts or Cause Them?

    Both Tim and Emily were losing their strength to hang on. Of the two, Tim was the most likely to be identified by teachers as one who might need to see a psychiatrist. His facial expressions, attitude, and disposition made him a likely candidate for that kind of help.

    Emily, on the other hand, seemed quiet, compliant, and responsible to the school staff. Her teachers guessed she must come from a very nice family.  Emily’s depression wasn’t easy to notice because she didn’t let it show. Her goal was to please those in authority in her life.

    Tim’s doctor, on the other hand, diagnosed him with bipolar II disorder. He prescribed medication, but Tim did not feel much better.

    Tim directed his anger at his dad. Because he felt his dad lacked understanding for his condition. He resented his dad expecting him to function when he felt so bad. He wished he could crawl into a hole and hide from the world.

    Emily felt completely alone in the world because she couldn’t talk to anyone about what she was going through. And though her parents were good people, they had no idea she continuously faced such a horror.

    We can look at Tim and Emily and draw our own conclusions. But you have to ask yourself does hopelessness accompany suicidal thoughts…or does it cause them?

    Tim’s problem wasn’t his dad so much as the symptoms of his illness that weren’t relieved by his medicine. And Tim didn’t know how to approach his dad in a way to help him see what he was going through. His dad just felt he needed to discipline his belligerent son.

    In Emily’s case, it seemed that her problems could be resolved by simply blowing the whistle on Luis. That message is plastered on the walls of the school… “Tell someone!”

    She’d heard that message all her life.  She could go to the school nurse, or a teacher she trusted, or even a police officer. But she didn’t.  When she would think about it, all she could think of was how hurt her parents would be that she talked to a stranger instead of keeping their business in the family. 

    She was also afraid her dad might do something crazy to Luis that would get him arrested, then  what would her mom and brothers do?

    Every time she thought about talking to someone she hit a wall of all the reasons why she couldn’t…

    Then, in a two week period, two students in the high school took their own lives.

    Everyone wondered why. 

    No one dreamed Emily was sad or had any reason to do such a thing. Except her heartbroken parents… because Emily left a note. And Luis was arrested.

    Tim’s dad was devastated. He’d been doing his best to help Tim get the treatment he needed, but each new medication required several weeks –sometimes months — to see if it helped him feel better. Talk therapy takes time, everyone said. And he hadn’t heard of a treatment like IV ketamine. He just assumed Tim’s doctor would do what was best for his son.

    It was so hard to know the difference between his son’s bipolar symptoms and just a bad rebellious attitude. He worried about it all the time. Just not knowing how to respond to Tim’s responses.  He wished he had a guide book. But now it was too late. He just didn’t realize how severe it was.

    These two deaths stunned and rocked the school they both attended. Two very different students who didn’t know each other, but who both could have been helped…if only…

    Does hopelessness accompany suicidal thoughts…or does it cause them?

    If you knew Tim or Emily, you’d likely have been grief stricken by their deaths. Probably baffled.  And for good reason. Because hopelessness and despair come in different forms. And you probably wish you could have helped them.

    Tim’s hopelessness was within him, as a symptom of a severe and difficult-to-treat illness.

    Tim probably spent most of his time in the throes of bipolar depression. When your mind and outlook are so dark so much of the time, you can desperately need a break from it. 

    But if you know of no medicine that will supply that break for you…  if your doctor knows of no medicine that will help without trying one after another… you get your hopes up over and over…only to experience a new type of grim despair. Hopelessness grows after years of this…and it may dawn on you there’s nothing that can help.

    And you don’t know where to look for hope.

    Emily’s hopelessness was internal, too. She felt trapped by an external force. If that external force could have been removed from her life, she probably could have recovered. Unless conditions like PTSD or severe depression complicated her condition. But even those conditions can be relieved with a novel and advanced treatment like IV ketamine.

    Children and teens should be able to live healthy, active, trusting lives in a perfect world. But it’s not a perfect world.

    When they’re assaulted, and wounded, they may need special care with a skilled therapist, support from friends and family, and treatment to help them heal. Sometimes that can be treatment with a novel, advanced treatment like IV ketamine.

    A group of researchers led by Ilya Baryshnikov, M.D., asked whether the hopelessness people with depressive disorders experience is a crucial predictor of suicidal thoughts and plans.

    They guessed that hopelessness was the sign that a person would be having suicidal thoughts, so they conducted an in-depth study which was just published this month in the Journal of Clinical Psychiatry.   

    They followed 406 people for 10 years, and used diagnostic tools to determine what role hopelessness played, as well as what role the severity of the depression played, in each person’s experience with suicidal thoughts.

    Standard tools like Scale for Suicidal Ideation, Beck Depression Inventory, Beck Hopelessness Scale, Beck Anxiety Inventory, Perceived Social Support Scale – Revised, and Eysenck Personality Inventory helped them evaluate the state of mind as well as personality traits of their subjects. 

    They found that hopelessness served to explain the suicidal thoughts, but wasn’t so much a crucial prerequisite… and that it’s actually the severity of the depression that leads to suicidal thoughts.

    In the cases of Tim and Emily, both needed intervention. For Tim, IV ketamine could have possibly changed his whole world. By helping him to achieve remission, and restoring his energy and hope, his world — and his relationship with his dad — could have been transformed. 

    It’s likely his dad, like so many, had no idea that IV ketamine was an option. Much less understanding about what it could do for his son.

    For Emily, it is possible the long term stress of abuse wore down her resilience, undermining her resolve to protect herself and report Luis. To trust her parents and make them listen, so they could help.

    In her case, too, IV ketamine could have helped restore her emotional strength to do what was needed to make herself and other girls in her neighborhood safe …to speak up.

    At Innovative Psychiatry, we see teens like Tim and Emily — and find the transformative effects of IV ketamine treatment can bring restoration not only to their outlook, but to many aspects of their lives. Relationships grow stronger, energy for school improves their performance, and their hope and joy billow. Not for everyone, certainly, but for most,

    If you, or your teen, have been depressed from major depressive disorder or from bipolar depression, and oral antidepressants aren’t working, call us. Let’s talk about whether you’re a candidate for IV ketamine treatment.

    If you’ve suffered from a major trauma that other treatments haven’t helped, call us. IV ketamine treatment can restore you if PTSD has impaired your function in life.

    IV ketamine can be dramatically effective also with severe social anxiety, alcohol abuse disorder, substance abuse disorder, and can stop suicidal thinking in an afternoon.

    We want you, and your teen, to be restored to the best you ever, and have a rewarding a fulfilling life with your own joy… and hope… abounding. 

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

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