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.

  • A Bit of Bipolar Science and a Dab On Schizophrenia, Too

    A Bit of Bipolar Science and a Dab On Schizophrenia, Too

    Like other disorders of the brain and mind, bipolar disorder is complicated. 

    With all the movies and cartoons made at the expense of people who suffer from disorders like this, we want to help more people know more about some of the facts with a bit of bipolar science.

    It’s different for each person. The length and intensity of manic episodes, the distribution of time from one end of the spectrum to the other. How hallucinations and delusions fit into the mix. These symptoms are individual.

    It’s physical. It can shake and shatter your body, through intense and sudden swings from one extreme to another. 

    Plus, it can cause such unexpected assaults on your emotions that your body is exhausted. Those swings can feel almost like a convulsion at times.

    It can also create sensations. Some people with this disorder complain of feeling like they have fire ants on their brain. Of course, there are no insects involved. But the disordered circuitry creates a sensation in some cases.

    And it’s mental. It changes your perceptions of what you see and hear. By coloring the way you interpret what happens, it tattoos that impression deeply in your memory. It can distort your view of yourself, and marinate your thoughts in shame. Then it can turn on the firehose of pain and rage, until you’ve experienced such extremity of horror, you can feel like you sweat blood.

    But, that’s not all. Bipolar disorder also seems spiritual, sometimes pulling you into its dungeons of horror until you lose all connection to your own spirit. Righteous indignation can morph to revenge. A little anxiety can billow until it’s a life-threatening terror.

    And yet, this disorder can be all of these things, or it can be none of them. OR… you can begin with these experiences, then medication can help them melt away. OR… there may be no medication that mitigates them at all.

    What you can’t know when all that is happening, is that specific changes in your brain cells are translated to the violent swings and misery you face in your daily life. You may find yourself craving a bit of bipolar science to try to gain perspective about what’s happening to you.

    To help reduce the stigma surrounding bipolar disorder, and the behaviors of people who suffer so deeply from it, let’s look at a tidbit of breakthrough science related to the spectrum of “bipolar disorders.”

    A Bit of Bipolar Science…

    You’ve heard of the blood-brain barrier, right? Relatively few people outside the medical field have any remote idea what that is. So if you’ve heard of it, consider yourself “in the know.” Kudos!  

    OK. There are two types of blood barriers in the brain. One is the blood-brain barrier, or BBB. The other is the blood-CSF barrier. And that’s the one we’re going to talk about now.

    So the blood-CSF barrier keeps the blood and whatever is in it separate from your cerebral spinal fluid (CSF). Since the CSF is constantly washing the brain tissues, it needs to be free of contaminants, toxins, or components that are harmful to the brain’s delicate circuitry and structures.

    The CSF performs a couple of primary functions.  One is to cushion and protect that most vital organ – your brain – that keeps everything else humming along. And the other is to keep the toxins in your brain and spinal cord flushed out.  

    CSF and the Choriod Plexus

    But…Where does the CSF come from?

    BruceBlaus Wikipedia Commons

    So glad you asked. The choroid plexus produces this most vital and beneficial fluid. There are special cells that secrete it, and other tissues absorb it.

    Because the ventricles of your brain can handle 150ml of CSF at a time, but the choroid plexus actually makes 450ml a day!  Clearly, as it circulates, it also is absorbed or drained off and replaced by more. 

    This keeps your brain cushioned and protected by fresh CSF at all times.

    If the choroid plexus makes too much CSF, and if the pathway for draining off excess become blocked, then the amount of CSF in the brain can increase dangerously, increasing pressure in the brain. And a condition known as hydrocephalus can develop, along with the risk of brain damage.

    By the same token, if the choroid plexus makes too little CSF, the brain cannot function. And the cushion it provides to help it remain buoyant within the bony chamber of the skull is inadequate.

    So there’s a need for balance between the CSF, the cavities in the brain, and the circulation of it.

    About Psychosis

    So let’s talk about how the choroid plexus relates to schizophrenia and bipolar disorder with a bit of bipolar science.

    There are four cavities in the middle of the brain called the ventricles. The CSF washes and cushions the brain all around, and is produced and distributed from choroid plexuses in these ventricles.

    New Research

    Newly published research sponsored by Brain and Behavior Research Foundation (BRRF) has directly linked the size of the ventricles with psychosis. While the size of ventricles is not specifically correlated to schizophrenia and bipolar disorder, the volume of the choroid plexus is significantly larger in subjects with psychosis.

    In addition, these researchers found that the volume of the choroid plexus in siblings, parents, and children of those with psychosis was less than the affected individual but still significantly larger than those unaffected by psychosis in their family. This demonstrated that the volume of the choroid plexus is something one inherits to a large degree.

    But here’s the big news.

    They found that when a subject had a larger choroid plexus, they also tended to have lower cognition, less grey matter, a smaller amygdala, larger ventricles, and fewer connections between neurons. 

    All of these things can be connected to the pathological processes that cause psychosis. 

    Now that’s news.

    But there’s more.

    That increased size in the choroid plexus in subjects with psychosis was also associated with increased levels of interleukin 6 (IL-6). IL-6 is a signaling cell in the immune system. 

    So here’s the rub.

    A bit of bipolar science helps this woman understand her terrible depression at least a little.
    IL-6 can penetrate and seep through the protective barriers between the brain, blood, and CSF.  Since researchers know that IL-6 is a strong suspect connected to bipolar disorder and schizophrenia, the identity of the gang of thieves behind psychosis – you might say – seems to be emerging. Add to that the connection between IL-6 and the reduced amount of grey matter in the cerebral cortex, and the case just grows stronger.

    “Our findings suggest the involvement of the choroid plexus across the psychosis spectrum, with a potential mechanism involving the neuro-immune system, which functions in regulating the brain and interacting with the body’s immune and inflammatory systems,” the team concluded.

    If you struggle with bipolar disorder, schizophrenia, or episodes of psychosis, you may appreciate the work of these researchers that sheds more light on what happens in the brain causing these difficult episodes.

    Neuroscience researchers are making great strides in learning more than has ever been known before about the symptoms of these disorders. And the more we understand, combined with a bit of bipolar science, the more research will lead to better treatments.

    No matter what your difficulty, whether you struggle with bipolar disorder, PTSD, social anxiety, severe depression, or even thoughts of suicide, we may be able to help. IV ketamine treatment is emerging as a dramatic game changer for people who suffer from specific types of symptoms. And happily, the types of symptoms keep growing in number.

    But if you think you’d like to know if IV ketamine treatment might help you, please call us. We’ll help you find out if you might be a candidate for ketamine…because some people aren’t. But if ketamine is for you, you can experience a transformation in your own life.  

    While ketamine isn’t showing promise for psychosis, it can bring remarkable relief to your depression symptoms. Every little bit helps, doesn’t it?

    Since bipolar depression can be the most debilitating symptom for many patients, resolving the depression in your illness can make your life so much more manageable.

    As research learns more, we’ll be right there using it to help our patients. Our whole purpose is a better life, and more hope, for you.

    Lori Calabrese, MD explains esketamine FDA approval and what it involves.

    To the restoration of your best self, 

    Lori Calabrese, M.D.

  • The Pain and Marginalizing of Stigma

    The Pain and Marginalizing of Stigma

    Young woman holds her hair back while she thinks about the pain and marginalizing of stigma.

    Stigma Isolates, Humiliates, and Separates

    As I think about what to write today, my thoughts are filled with a comment I received from a man who’d read last week’s blog, which you can read here. He wrote that he also suffers from bipolar 1 disorder and was upset and hurt by the description of the young man in the story who showed signs of violence. For him, a description like the one I wrote perpetuates stigma because it portrays someone suffering from a psychiatric disorder as a “dangerous” person.

    Pause. Deep breath here. Not what I intended.

    My concerned reader made the point that he takes medication to manage his symptoms and works hard to keep them from dominating his life. He emphasized that he had never thrown a lamp or a table (like the young man I’d described) … which is often the case. Most of the time, mood dysregulation is not accompanied by physical explosiveness or violence. He was right.

    And he felt that last week’s blog misrepresented him and others like him.

    It was heartbreaking to me that this reader felt hurt by my story. I never want to cause pain to anyone with my writing. But it can be hard to prevent. My readers come from a wide variety of backgrounds and experiences. My practice, on the other hand, consists primarily of the most ill, treatment-resistant patients for whom medications have failed.

    So today, I want to go a little deeper and talk about stigma and the damage it causes.

    And I want to explain why I write the accounts I do of severely ill patients and how they suffer.

    The Pain and Marginalizing of Stigma

    So what is stigma anyway? 

    We get the word “stigma” from the ancient Greeks, who used it to describe a mark made on the body that signaled to others to avoid or shun the bearer of the mark. And, we use it the same way today. Except in our present culture there’s no need for a mark on the body… with our words we make a mark on the soul.
    pain and marginalizing of stigma

    Stigma creates shame, disgrace, humiliation…and the bad reputation that goes with certain things in our society. It’s associated with anything in someone’s life that labels them. A label that results in judging someone by the label rather than on their own merits.

    Labels like this separate people from the group just as lepers were separated from the city in ancient times.

    An example might be the experience of prison. When someone breaks the law and is sentenced to prison, that label hangs over them, as much within themselves as from the outside. This person might feel they’re “less than” others, that they deserve less respect. And they’ll almost certainly run into narrow minded people who will hold that fact from their past over them… impose upon them the pain and marginalizing of stigma to bring them shame and humiliation. 

    But the fact is, that some of those who spend time in prison continue a lawless lifestyle and others use the opportunity to improve their lives and accomplish great things. Still, it’s fair to say that improvement isn’t easily won. That person has to work very hard to rise above the experiences from his or her past.

    Another example of stigma seems to accompany psychiatric disorders. There are those in our society who still associate the need for psychiatric treatment as a sign of weakness, “craziness,” and/or questionable character.

    Working to Reduce Stigma and Increase Enlightenment

    As we work to reduce stigma, and open conversations about brain disorders, behavior disorders, and the medications we use to manage them, we have to look honestly at individuals, and who they are.  And we need to try to understand each other.

    Because not all diabetics are alike. Not all the people with bipolar disorder are alike. Not all the people with PTSD are alike. Each one is an individual — with their own unique needs, symptoms, challenges, and vulnerabilities.

    Most of us know someone who suffers from diabetes, either Type 1 or Type 2. There is some amount of stigma associated with diabetes. If you’re well informed about this condition, you know that while diet and exercise can help improve the condition for people with Type 2 diabetes, there is nothing someone with Type 1 can do to make this condition go away.

    It’s pretty short-sighted of anyone who tells a person who suffers from this disease that they just need to stop being so sloppy about how they take care of themselves.

    While it’s true that diet and exercise can improve their control of symptoms, it’s a disease that progresses and is not preventable.

    Words can cut deeply … and we never really know the story that people keep hidden in their hearts.  

    In both cases, diet and exercise help in its management, but that’s true in a wide variety of illnesses. People with coronary artery disease, arthritis, hypertension, asthma, obesity, as well as depression, bipolar disorder, PTSD, and more…all can enjoy improved symptoms through diet and exercise. Improvement. Not cure.

    The cruelty of stigma lies in the cutting words and attitudes the “unenlightened” use to build a box around an individual without knowing his story.

    Pain and Marginalizing of Stigma ISOLATES

    Disorders like bipolar I disorder, bipolar II disorder, major depressive disorder, PTSD, substance misuse, dependence and addiction, eating disorders, OCD, panic disorder, ADHD — are not understood…and are not familiar….to a very broad segment of society. And what human nature doesn’t understand, human nature too often misjudges.

    But what we DON’T want to do is marginalize individuals no matter what their experience is. 

    Man sitting alone is isolated like stigma isolates.
    And just what do I mean by “marginalize” exactly? I mean that I don’t want anyone to feel shut out, alienated, trivialized, or ignored in any way by my words or actions. Whether you use all your strength to hold your symptoms under control or whether your medication helps you do that, your experience is important. You are important. And you matter.

    When someone suffers from one of these disorders, but has no outward symptoms — because of medication or their own unique disease process — they can feel blocked out and unheard…misunderstood and not represented.

    (By the same token, if you only know someone who takes medication that’s working, and never has any symptoms that show, it’s super easy to think that people with psych disorders should have their symptoms under control. Nothing should show.)

    Maybe you know someone with kidney disease who looks and acts like anyone else. And maybe I know someone with kidney disease who is thin, pale, with only patches of hair.  When I meet your friend I may believe there is no way your friend is ill.  And you may believe that my friend has something much worse than kidney disease because she looks so terribly ill.

    But in fact, they both have the same disease but it differs in severity.

    Why Assume Everyone’s the SAME?

    This is the case with disorders that are related to the brain. Why is a disorder more severe in one person than another?  I don’t know. I may know some factors that could affect its severity, but I don’t know why one person has bipolar I disorder and another has bipolar II, or a third person has cyclothymic disorder.

    None of these three got off scot-free. They all suffer.

    The pain and marginalizing of stigma results in silent suffering.
    And why does one person respond to medication and another doesn’t?  If I knew the answer to that, I’d go on vacation more often!  These are questions I’ve been studying to find answers to all the years I’ve been a psychiatrist.

    For those who respond to medications, I’m very glad and thankful.  For those who don’t, I search and read and research and seek hope for those patients. And when I write about people with severe cases of their illness, it’s to show others who suffer in this way that they aren’t forgotten. That there is no shame in their symptoms.  Because in their case, the medicines aren’t working. And the symptoms run rampant.

    It can be devastating.   

    Don’t Misinterpret Symptoms: Hollywood vs. Reality

    And I want to add –quickly– that a table or chair that is flung out the window is not necessarily a sign of danger to others. It signals dysregulation, sure, and warrants a very careful assessment. Because often, even someone who is markedly dysregulated can draw the line between hurling an inanimate object and hurting another person.

    Hollywood has a way of exploiting the human suffering of mental health problems, to intensify fear. That’s Hollywood. Get to know individuals and take note of how they differ from what you see on the big screen.

    Coronary Artery Disease

    One of my neighbors has coronary artery disease.  He took medications, but eventually had to have open heart surgery.  Does that mean that everyone with coronary artery disease needs open heart surgery?  

    No.  In fact, I have a relative who has coronary artery disease, who manages to live a full life with medicines, diet, and exercise and has never needed surgery.

    These individuals tell their own personal stories. And report their own personal symptoms.

    Words can be so hurtful even when they’re not intended to be. We’ve all done it. Without realizing someone’s personal story we tell the story of someone else that’s too close to their own…and it sounds to them like we’re judging them.

    Pain and Marginalizing of Stigma… is Cruel

    By the same token, when a treatment or clinic pops up that seems to promise a world of wonder to everyone, (which nothing can do, by the way), people can feel trivialized and ignored. Because they may not fit in that “slot” for a variety of reasons.

    Let’s put up our antennas and notice when the pain and marginalizing of stigma has someone walled off from the world. Alone. Isolated.

    Psychiatric disorders marginalize people, and we marginalize them, too.  Every doc-in-a-box or one-size-fits-all protocol marginalizes your individual experience of suffering by suggesting there is a panacea.  

    Of course, there’s no universal cure, but there IS hope in a jar. Remember that story? 

    That was the story of ketamine treatment as a medicine prescribed “off label” because of its unique healing abilities in addition to the purpose it was FDA-approved for.

    One Size Fits Some

    ONE SIZE DOES NOT FIT ALL. Each patient needs to be custom treated for his own individual version of disorders. Each person also needs to be ACCEPTED and supported for who he is, and what he manages in life.

    Let’s vanquish the pain and marginalizing of stigma. Let’s stop leaving people isolated in their suffering. And let’s look people in the eye and seek to understand their struggles.

    Let's get to know each other, so we can understand what each person manages in life.

    If you don’t know what he manages, ask him. Let’s try harder to get to know each other, and respect each human for the life he or she manages.

    And you know what? If you suffer greatly, or if your struggles are partially managed by medication, I want to hear from you. Not that I can solve your challenges, but you matter to me. And you matter to a lot more people than you may be aware. You are included here. And your experience can help someone else feel less alone in the world. Please share your comments below.

    And if you’ve read about ketamine treatment and you want to see if it can help you, call us.

    We want to help you experience some degree of relief from your symptoms, whether it be a little or a lot.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

    To the recovery of your best self,

    Lori Calabrese, M.D.

  • Family: Suffering Together With Psychiatric Disorders

    Family: Suffering Together With Psychiatric Disorders

    If you have a family suffering together with psychiatric disorders reach out for support. You all need it.

    “I don’t care what the &%@!* you think!! It’s all your fault!! I’m outta here!!!”

    With that, Ben picked up the massive carved oak coffee table and  threw it at the window. It hit the window and the wall with a thud, pushing the window frame in a contorted mangle of metal and glass out toward the garden, knocking a gash into the wall with the impact. Families that are suffering together with psychiatric disorders know this scene so well…

    The table fell to the floor, unaffected by its collision, except for a few paint scrapes off the wall. The wall, however, didn’t do so well.

    By then, Ben had already grabbed a china lamp and slung it toward another window. The shattering glass of the window and the shattering china in the lamp base formed a tinkling wind-chimes sort of symphony as they fell.

    Ben beat his face with both fists, cursing his life.

    Suffering Together

    A little girl like this one can be lost in the chaos when a family suffering from psychiatric disorders is in turmoil.

    Little 6-year-old Sara shrank back into the shadows of the hallway. She knew not to cross her big brother at times like this. He was her hero and had been her best friend ever since she was born.  He was kind, patient and included her even though he was 7 years older. 

    It scared her when he got like this, but she also instinctively knew he just couldn’t help it.  She knew he’d probably cry again after this rage subsided, because he felt so helpless to control it and so sad about hurting the family.

    She slipped back into her room and quietly closed the door to play with her dolls…and try to not hear what was happening.

    Then her mom’s gentle voice sounded soothing and reassuring. She was helping him calm down, like she had so many times before. After 30 minutes or so  (it was hard to tell time, but especially when every second seems like an eternity…) she heard Ben trying to talk through sobs… she knew what he was probably saying, and she wanted to go hug him. But she thought it was better to let mom do that right now. He might be embarrassed to know she heard all of that.

    Each One Copes in His Own Way

    Sara felt confident the “storm” had passed, but then the front door slammed so hard the house seemed to crack. She quietly opened her door to look and listen. Ben and Mom were talking in low tones in the living room…but she could see her older brother’s door was open.

    Then a car started and screeched away outside.

    Ohhhhh.  I guess Ben’s episode made Gregory mad again.  (Huge sigh)  I wish everyone could just be happy.  We must be the only family that goes through this.. 

    Out of nowhere Scruffy, their mixed breed little dog, scooted between Sara’s legs and into her room for safety. She picked him up, and could feel him trembling…

    Hugging Scruffy close to her, Sara withdrew back into her room and ever-so-quietly closed the door.

    Quiet Distractions Provide Solace

    She set up a tea party in her closet where it would be extra quiet… and brought in Baby Alive and Jenna to share it with her.  hmmm….we need one more, she thought.  She reached under her bed and pulled out Timothy, her cream-colored teddy bear…and took him into the “tea room” in her closet floor. With the light turned on, she pulled her closet door shut.

    Shame Torments

    Ben had stopped sobbing by now…and was looking at his feet. It’s never going to stop, he thought.  What’s wrong with me?? I always ruin everything. I’m the black sheep of this family.

    Why can’t I be like everyone else…?  I’m so worthless, stupid, bad, and rotten to the core. I should never have been born… I’ll probably end up being a criminal…

    “Whatcha thinking, Ben?” Ben’s mom waited patiently for Ben to gather his thoughts.

    While Ben was searching for words, the front door opened. 

    Learning to Support Each Other In the Family

    His dad was home from work. Ben tried to look pleasant.

    “Hi Dad…”

    “What’s going on…?  Has something happened…?” Ben’s dad spotted the bashed windows and looked worried. Then his eyes fell on Ben’s swollen red face. Ben felt humiliated and didn’t know what to say.

    “Hi Bill.  How was your day?”  Ben’s mom hated to bombard him with the latest family crisis when he’d just walked in from a stressful day. And she also hoped to give Ben a break from his dad’s scrutiny.

    “It was fine, Lil. Is everything ok?”  

    The air in the room hung heavy with tension. But they were a family, and they needed to face times like these together, so Lily spoke up.

    “Everything’s fine, honey. Ben had another episode today. It was terrible for him…well, for all of us. He’s feeling pretty discouraged right now. We were talking about what we could do to find a doctor that might help more than Dr. Mendolssohn has. Someone maybe who specializes in adolescent bipolar disorder?”

    Ben focused on the pet hair on the rug. Bill nodded and stared at his feet, hands in his pockets. Lily stroked the sofa cushion. When a family is suffering together with psychiatric disorders…well, each one harbors his own secret pain.

    A big part of that pain is helplessness.

    This young man is angry because his family is suffering together with psychiatric disorders and he feels helpless.

    Bill spoke first. “I noticed the car is gone…did Gregory leave?”  

    Ben sighed.  Lily nodded.

    “And Sara…?”

    The NON-Squeaky Wheel Needs Attention, Too

    Lily sprang up from the sofa and headed for Sara’s room.  Her little girl had been so quiet…and with all the turmoil, she forgot to check on her. Guilt swelled up and threatened to choke her.

    Tap, tap, tap.  “Sara? May I come in please?”  Lily tried to sound cheerful.

    Tap-Tap-Tap. “Sara?”

    Lily opened the door and didn’t see Sara.  

    “Sara??”

    A tiny muffled voice squeaked, “yes, Mom?”

    Lily got down on her knees and looked under the bed. Nothing.

    She looked on the other side of Sara’s bed. Nothing but a couple stuffed animals.  

    “Sara? Where are you?”

    The closet door opened. Sara’s hair was disheveled and the rims of her eyes were red. She’d been crying.  Lily rushed over to her and swooped her up in a hug.  

    “Whatcha doing in your closet..?”

    “Tea party…”

    “Wanna help me cook supper?”

    “Yeah!”  

    She swung Sara onto her hip and off they went to the kitchen, chattering about the tea party.

    With Psychiatric Disorders, Symptoms Can Look Like Bad Behavior

    Ben is walking alone to sort his thoughts because his family is suffering together with psychiatric disorders.

    Bill was sitting with Ben, helping him with his algebra homework.  He knew a lecture about behavior wasn’t what Ben needed. He needed acceptance and support. Bill had made plenty of mistakes while he learned how to provide what his family needed in times like this.

    So.

    Another day. Once again they’d survived another major bump in the road. Tomorrow they’d call the insurance company about the damaged windows. But for now, they were thankful for peace.

    He and Lily did their best to try to help Ben’s self-image remain strong…though they knew all too well that their best efforts might not be enough. They also tried to be sure Gregory had their time, support, and attention, too. It was easy in this household to be overlooked.

    They were learning to avoid reacting with even more conflict or criticism. But rather to choose words and tone that soothed. Everyone needed it. And they believed their reactions were improving.

    Family: Suffering Together with Psychiatric Disorders

    Which brings up little Sara. They worked hard to try to protect her innocence and sweetness. But they couldn’t protect her from the frequent upheavals in her own home.

    Families suffering with psychiatric disorders work hard to keep their relationship strong.

    They also knew they had to be sure to communicate and make time for their relationship with each other. That was usually the first to be sacrificed.

    Most of the time they were both stretched pretty thin.

    Breathe.

    Got anyone in your family with a psychiatric condition?  It might be an eating disorder, bipolar disorder, severe depression, social anxiety (yes…that’s a disorder too), addiction, PTSD… there are lots of possibilities.

    No matter what the condition, and whether it’s you or someone else, a family with a psychiatric disorder suffers together, feels helpless together, gets frustrated together… no one escapes.

    And while it’s easy to blame, that doesn’t accomplish much, does it?  It just makes the wounds infect.

    When it gets right down to it, there is likely some genetic connection that links you all to the disorder. In this family, Ben drew the short straw.  And bears the stigma. 

    But just as Bill isn’t to blame for the high blood pressure he inherited from his grandmother, and Lily isn’t to blame for her kidney stones, Ben inherited the tendency to develop his condition before he was ever born.

    To try to manage his blood pressure, Bill either jogs or takes a brisk walk every night after work while Lily cooks dinner. Lily is careful to stay hydrated to avoid more stones. Ben tries to get out and play football in the afternoons and they work together to see that he eats balanced meals and gets to bed early. And they all take medication for these health problems.

    When The Brain is Disordered, It Can Be Hard to Maintain Order At All

    Not just for the person with the condition, but everyone close to him, too.

    So don’t be fooled. The family tries to maintain these routines, but that’s not as easy as it sounds. It takes a concerted effort, and they try to support each other and understand when things don’t go as planned. Because, when a family is suffering together with psychiatric disorders, everything is more complicated, it seems.

    Families like this have plenty of bad days.  More days than they care to admit actually… where all the opportunities to manage their collective health slip through their fingers.

    But they do try. And when things fall apart, they help each other get up and try again. Or at least they try to. Sometimes everyone just gets sick and tired of it all. So they retreat into their corners to recover a bit, then come together and face their life together again. At least that’s their intention.

    Life Is Challenging on Some Level for Us All

    If you don’t have a person in your family who has a health condition, maybe things go smoothly for you…?  But I bet they don’t go as smoothly as you wish. Nobody’s life is perfect.

    Still, if you do have one or more family members who endure chronic illness, (the genetics often strike multiple times in a family) you probably feel like no one can imagine what it’s like. You likely feel isolated and alone. Maybe you feel embarrassed, because your life isn’t perfect. And you’re right to some degree. No one knows what it’s like to live your life. But you don’t know what it’s like to live someone else’s either.

    I can say this however… that if your family suffers with a member who has a brain or behavior disorder, we know it impacts the whole family. And our hearts are with you.

    Is Your Outpost Suffering Together with Psychiatric Disorders?

    Family is our most important outpost of support. No matter what the challenges a family faces, they don’t manage them well all the time.  In fact, it’s fair to say there are LOTS of times the whole family seems to implode.

    Some families have financial struggles. Other families have marriage struggles. And still other families have health struggles.  But whatever the challenges, pulling together is the best way for everyone to come out in the best shape possible.

    But then, that’s life, isn’t it?

    It’s for you we work at Innovative Psychiatry to find better solutions, more effective treatments, and the compassion and support you need. And we’ve found extraordinary results for families like yours with ketamine treatment. You may have a family member with bipolar disorder, major depression, or PTSD. If so, call us.

    She just might be a candidate for IV ketamine treatment. That also goes for social anxiety, addictions…and of course suicidal thoughts. ALWAYS take suicidal thoughts seriously. And let us help.

    But don’t forget to take note of other family members who may be suffering in addition. They may need treatment, too, so they have the energy to conquer the days, weeks, and months of stress at home.

    There is help available for your family. To feel better, with restored hope, and more harmony.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

    To the fresh emergence of your best selves,

    Lori Calabrese, M.D.

  • Can Genetic Clues Really Predict Bipolar Disorder and Schizophrenia?

    Can Genetic Clues Really Predict Bipolar Disorder and Schizophrenia?

    Can genetic clues really predict bipolar disorder in people like this young woman, who doesn't understand her disorder.

    If you struggle with bipolar disorder, and the symptoms that seem to dominate your life, it may help you to know that many psychiatric disorders don’t really come with a list of predictable symptoms.

    If you have times when you’re short-tempered, highly energetic, sure of yourself, and quick to argue, you may have a mood disorder…or you may have had a frustrating week at work… And so goes the conundrum. You may feel like you’re low on energy most of the time, or find it hard to identify purpose for your life. How do you know if you’ve got something going on? How can you get a clue? It may seem far-fetched, but can genetic clues really predict bipolar disorder and schizophrenia?

    We look for clues all the time–little signs and symptoms that herald bigger problems to come. If you have all that going on… and it seems to run in cycles…  depression interrupted by periods of energy, over-confidence, a strong drive to win arguments… then periods when you can only think about dying…or ending your life yourself… Well, chances are, this may be more than a bad week at work. In fact, you should probably see a good psychiatrist in your area to help sort it out — because you may have a disorder. And if you do, treatment can help.

    So, let’s say maybe you feel intrigued to talk someone you just met into having risky sex with you…or maybe you’ve lost touch with the limits of your credit cards and feel inspired to do lots of shopping or travel and splurging. Maybe spending money gives you exhilarating feelings, but you feel like you’re accomplishing so much– and …you don’t notice this is out of character for you. You think it’s great.

    Oh boy.

    Your Disorder May Display Different Characteristics Than Someone Else’s

    Fighting cranes depict the unexpected conflict from someone with bipolar disorder.

    People with bipolar disorder don’t usually display all the symptoms, but they do display some of them. Whether it’s something like getting frustrated that leads to a major blowup and rage…and display of super human strength… or something like feeling untouchable and indestructible that leads you to do things that are so risky (so incredibly fun!) that the adrenaline just courses through your veins. Rather than feeling fear per se, you feel exhilarated — and want more of that feeling.

    Let’s look at it this way…

    If you contract a virus, something like the common cold, it’s easy to predict your symptoms, isn’t it?  

    Sneezing and a runny nose is how it starts.

    Sound familiar?  

    If it’s a particularly nasty cold, you might even have a fever. Then, the runny nose gives way to a stuffy head, maybe a cough or a scratchy throat, and you just feel awful. So predictable. We can pick up on the first inklings

    But some psychiatric disorders aren’t quite so easy to pick up on. 

    So Many Symptoms – Who Can Tell?

    Sure, there’s depression.  Everyone knows what that is…right? Or maybe not…  If you broke a nail right before a black tie event, that may seem depressing. But we’re not using the word appropriately when we say that. Because major depressive disorder (MDD) is a disorder… i.e., an illness. Grab your file and smooth out that nail. It won’t interfere with your fun at all. But if you have MDD, it’s not likely you’ll be able to have a very good time. Depression just takes the fun out of everything.

    Shopping can be fun, but sometimes spending way too much can be a sign of bipolar disorder.

    At the same time if you shopped for the event, spent your entire month’s earnings on an outfit for the affair, and left yourself with pretty much nothing to live on or pay bills with until your next paycheck, it’s pretty clear you used poor judgment. And poor judgment is not a disorder. It’s merely doing something risky that seemed like a good idea at the time …but a tough decision to live with the rest of the month. On the other hand, poor judgment can be a symptom of a disorder.

    Oh. Like when?

    So can explosive outbursts. Fits of rage. Or destruction of property. Again, they can be, but of themselves aren’t necessarily signs of a disorder.  So it begs the question: are there clues that predict whether a disorder is in the making? Are there genetic clues that really predict bipolar disorder and schizophrenia? Well… the answer is sometimes. And maybe.

    (This is where we tear our hair out.)

    You do need a psychiatrist to figure all this out. 

    Thirty years ago, a psychiatrist may or may not have been able to help. But chances were much better than they were 100 years ago, you know?  At that point, psychiatrists stumbled in the dark and devised theories to explain patients’ behavior, with little scientific evidence. There was so little we knew about the brain. Sometimes they helped their patients, but often they couldn’t. 

    In the absence of neuroscience discovery, psychiatrists did what all scientists do: they hypothesized. And they looked for evidence to see if they were right.

    Is it any surprise this branch of medicine was cloaked in stigma? 

    Can Genetic Clues Really Predict Bipolar Disorder and Schizophrenia?

    Now we’re advancing into the 21st century, and we’re still fighting the stigma that began in the dark absence of clear scientific evidence.

    So, let’s talk about where we’ve come in psychiatry.

    Now we can separate the genes on the chromosomes.

    You know what chromosomes are, right? Your DNA. But that tiny microscopic structure – that’s a map of who we are – is made up of genes. Now those are really tiny.
    We know what many of the chromosomes actually do. We also know that a tendency to develop various diseases can be found in specific positions on certain chromosomes.

    By the same token, certain clusters of genes in certain locations on the chromosomes can indicate personality traits that emerge in someone who has not yet developed a disorder. Genetic clues that can perhaps predict the later onset of bipolar disorder and schizophrenia… and the list goes on.

    Nicholas Pediaditakis, M.D.’s article in Psychiatric Times under the title, “The Dog That Did Not Bark,” explains how this might work. Sometimes, certain clusters of genes are missing… like if the “barking” genes are missing, it could result in a dog that doesn’t bark. 

    A child's temperament can be a clue to bipolar disorder or schizophrenia through genetic personality predictors.

    When that happens in people the genes that express themselves as personality traits, can create a “lopsided” personality, as he put it.  So the genes that would express themselves as socially outgoing may be missing or sparse, which can show up in the person as aloofness or an aversion to social situations along with a sense of autonomy. 

    Of course, this is an oversimplification for our purposes in this post, but the point is that this person is “premorbid”(in the sense that he doesn’t have signs of a disorder yet), but his “lopsided” personality can be a signal of schizophrenia or bipolar disorder that may be lurking in the future.

    Dr. Pediaditakis goes on to say that this premorbid asocial trait may result in a group of individuals who may be vulnerable and later turn out to develop schizophrenia or bipolar disorder. It’s sort of like a preview in the developing brain. He says,

    “This synchrony is an emergent property of complexity. This probabilistic shift heralds the expression of the disorders and results in the development of characteristic symptoms for both schizophrenia and bipolar disorder.”

    The Give and Take That Leads to Gifting and Brilliance

    He also says that while both of these disorders tend to include psychosis at some point, there is also some trade off with traits that can be quite favorable.

    For instance, since their personality doesn’t include social traits, it’s as though they’re able to think in terms of unconventional alternatives and distinguish original and revolutionary patterns …whether scientific, mathematical, artistic, or musical. 

    Basically, since they have some freed up space in their head, they can also be remarkably gifted. Sound familiar?  

    Can genetic clues really predict Can genetic clues really predict bipolar disorder? This brooding man wants to know.

    It brings to mind the book and movie, “A Beautiful Mind,” about John Nash, Jr., the gifted mathematician who suffered from schizophrenia. And Vincent Van Gogh, the brilliant but tormented artist. And entertainers like Carrie Fisher, Mel Gibson, and Mariah Carey (to name just a few) who’ve struggled with bipolar disorder along with their creative brilliance.

    There’s a physiological reason, one only identifiable by neuroscience, that these great talents are simultaneously struggling with a severe disorder, while also displaying their creative gifts. The two might actually be linked, if indirectly.

    Neuroscience Leads the Way to Understanding More About These Disorders

    Molecular genetics, functional neuroimaging, and translational neuroscience has made great advancements in the diagnosis and treatment of both bipolar disorder or schizophrenia. Stigma about disorders like these is dying a slow death… we hope, in time, it will disappear altogether. 

    And we hope that time comes soon.

    Modern medical and neuroscience breakthroughs are exploding. And they raise the question: Can genetic clues really predict bipolar disorder and schizophrenia? There’s so much more we’re learning about brain circuitry, the hippocampus, the amygdala, the lateral habenula… and what is called translational neuroscience, where we take basic science research and translate it into clinical applications that help people. Like you, and the people you love.

    In the meantime, if you’ve been diagnosed with bipolar disorder, and if the medicines prescribed for you haven’t helped, you need treatment that works.

    You Deserve to Feel Better

    Ketamine treatment can make a dramatic difference in managing your bipolar disorder by wrangling bipolar depression. Scores of people in your position have been relieved to discover the difference ketamine treatment makes. 

    If your medicines are helping, you’re in a wonderful position. You’re finding you’re able to live your life with less difficulty and build upon the things that matter to you. But if your medicines aren’t working, if you’re tormented, living in chaos, and unable to invest in your job or relationships because of your symptoms, call us.

    Can genetic clues really predict bipolar disorder? Ketamine treatment can can give you great relief, if it does..

    At Innovative Psychiatry, we see people with bipolar disorder get much better all the time. Because lifting them out of depression that just hasn’t wanted to budge is a game-changer. When ketamine relieves depression, there is so much more time and energy left for managing your life. 

    We’re here to see that you get the help you need to enjoy your life, build up what’s broken down, and relish your friends, your family, and your work, as well.

    It can get better for you.  You’ll see.

    Can we stop suicide? Yes, with a series of IV ketamine infusions.
  • The Oddities, Charm, and Suffering of Bipolar Disorder

    The Oddities, Charm, and Suffering of Bipolar Disorder

    Suffering of bipolar disorder can include indiscretions in dating and dancing.

    “Though I am often in the depth of misery, there is still calmness, pure harmony, and music inside me.”  —Vincent Van Gogh

    May is Mental Health Awareness Month, and I’ve been thinking about how to disrupt the stigma of “mental illness.” It’s a term I don’t like – but it’s still used throughout the world, unfortunately. To me, “mental illness” is an archaic and stigma-ridden phrase. Because it can isolate people who experience these illnesses in their own dark corner of misery, and surrounds their condition with mystery and skepticism. Yet cardiovascular, pulmonary, or liver disease are all discussed in the light of day and with credibility. There should be no difference. So, let’s talk about the ins and outs of one “brain” illness: the oddities, charm, and suffering of bipolar disorder.

    My patients encounter stigma every day. Family members and friends who are furious with them, and just worn out by it all. Critical. Disgusted. Steeped in stigma.

    And many of my patients are steeped in shame. It’s for them — and their families — that I’m writing today… and for you.

    So let’s talk about what a person can be like who endures the suffering of bipolar disorder. Because the symptoms of a disorder like this one can seem to be intertwined with the person’s personality … for better or for worse. 

    In fact, neuroscience researchers have discovered a genetic connection that influences the personality development of a person with bipolar disorder. We’ll be talking more about the scientific side of bipolar disorder in a future post.

    Emma was diagnosed with bipolar I when she was 15.  She’d stolen her parents’ credit card, and had charged $4700 in a weekend taking friends to nice restaurants, shopping for clothes, and attending concerts. She felt like a million bucks…and tried to spend a million, too.

    Her parents got alarmed, and she got admitted to a mental health crisis unit where she could be evaluated for 72 hours. It was here that she received her diagnosis of bipolar I disorder. The doctors there started medications to help stabilize her mood, and discharged her within a week.

    Shock and awe. Not enough time to see how the medications really worked, or to wade through her questions and fears about this new diagnosis. This wasn’t how it was supposed to go.

    She left confused, a bit shell-shocked, and with no small amount of anxiety as to what life would be like now. The shame she felt gripped her. How could she face anyone? She believed she’d never be able to show her face again anywhere… and the new pills she was taking made her feel weird.

    Bipolar disorder patients seek risky behavior, like this rave party.

    Emma’s next few years were tumultuous, as the medicines didn’t help her stabilize, but even seemed to make her more unstable. Add to that the hormonal changes of adolescence and their affect on symptoms, and the instability…better said, the roller coaster… of her emotions was almost impossible to endure.

    Everywhere she looked, she saw disapproval. Despite regular and frequent visits with her psychiatrist, she felt miserable and her symptoms seemed to get worse and worse.

    Emma and her parents participated in therapy, to become educated about this illness. They also learned how to support structure in her life, as well as methods of helping her decompress when the need arose. 

    Oddities, Charm, Suffering of Bipolar Disorder… So Many Facets

    But her ability to participate with them in counseling got sporadic as her symptoms worsened. During depression she couldn’t get out of bed, and anxiety made leaving the house seem insurmountable.

    But there were also transient periods when she felt a bit more like herself. Her sense of humor had always been spectacular, and often kept her family in stitches. Those light-hearted fun times reminded them of the history they shared, and endeared her to them all the more.

    But…her bedroom floor. Trashed! It was the place clothes and food wrappers went to die. And personal hygiene? …Let’s just say that was a work in progress. She didn’t bother to shower unless she was badgered. But she was feeling better, and creating magnificent, enchanting poetry, so no one wanted to argue with her about hygiene. They had all learned to choose their battles.

    Still, there were also the times when she came home drunk or high.  She told her parents she was sorry, but they feared for her…and wondered what to do.

    She craved the calm, a break from the suffering of bipolar disorder.

    The irony was that when her friends were high, they acted crazy. However, at the same time, when she was high it made her mind feel clear and grounded. She didn’t crave the substance, she craved the clarity. But her parents knew the dangers of addiction.

    She was an odd bird, and she knew it. She figured she’d always feel like the odd one out.

    But, for real, she had to give her parents credit. She could see they were really trying to understand. But it wasn’t a walk in the park.

    At times she felt anxious and angry, and couldn’t tell why. But her parents would react in ways that seemed to her more like an attack. So she responded in kind.

    So Complicated!!

     Through therapy they learned that “pulling rank” and trying to force her to comply only served to escalate her reactions and agitate her when she was manic. They learned to listen patiently when she verbally shot words like bullets in a long tirade. They learned this was a symptom.

    And they learned it was important to treat her with respect, in spite of her outbursts. After all, she wasn’t a spoiled child, she was ill. And… they learned that during times of peace, her talents, empathy, and growing wisdom had a richness they’d never seen in anyone before.

    They had to admit this was new territory, and they couldn’t fall back on their old parenting patterns without making matters worse.

    She was still their Emma, but there were times they didn’t recognize her. The counselor helped them see that all of these behaviors together were part of “their daughter with bipolar disorder.” Good times, bad times, times she amazed, and times she broke hearts.
    Happy young woman having fun in better times.

    Though Emma came home from the crisis center filled with shame, through counseling and the love and acceptance of her parents, along with time, she found she was slowly healing. She and her parents learned together that the mood swings – which were sometimes violent – were not a sign of her contempt for them, but rather a shift in her brain cell function that was involuntary.

    So her parents learned to show her they were standing with her when she found herself in mixed states, exploding with manic energy, rage, and heartbreak.

    Emma had made a friend at the crisis center, and was saddened for her and the awful scenes she described with her parents. Her friend felt so alone and hopeless because her parents viewed her behaviors as threats to their authority, rather than symptoms, and tried to shame her into compliance. Before long, her friend ran away from home.

    Emma knew she was really lucky to have parents who tried so hard to support her and stand with her in this illness.

    At times, she felt upbeat, pleasant, and enjoyed time with her parents, as well as a friend. In those same times, Emma often waxed poetic, writing pages of melodious rhyme, describing her magical wonder of the world as she saw it. Her words carried wisdom far beyond her years, and her creativity resulted in thoughtful and meaningful gifts for those she cared about.

    But as the wonder bubbled up…the bubbles came faster and faster until she felt as though she was all bubbles, like helium…and she was floating, exhilarated, and able to do anything.

    The Suffering of Bipolar Disorder Can Appear To Be Something Else

    People with bipolar disorder seek risky behaviors like climbing this water tower to paint graffiti on it.

    She’d climb a water tower and paint graffiti at the top, or she’d have sex with three different guys in the same night, or shoplift something from Macy’s.  Why?  Because she could do anything. (or at least she thought she could.)

    Was she rebellious? Not intentionally. But she was manic at those times, and her perceptions were distorted, as well as her judgment. And impulsive. Oh my…intensely impulsive. Could that be fixed by her parents’ discipline? Ummm…not likely. Impulsivity and distorted perceptions are symptoms of bipolar disorder.

    Unfortunately, there were times the police brought her home, or the store security officer called her parents, or… once…she found out she was pregnant.

    Sadly, she miscarried 6 weeks later. It was all so terribly painful. The grief so suffocating. She really wanted that baby. It didn’t matter that she struggled to care for just herself…she wanted that baby more than she wanted air.

    The grief continues to this day. On bad days, the pain of it rises up fresh and in waves. It’s almost more than she can bear. And the pain never lessens, or heals, but is always fresh and suffocating…because of the disorder in her brain. And the pain she feels when the waves return often push her into another mixed state episode.

    But eventually, with sleep, healthy meals, and medication, she begins to recover each time.

    Then, just about the time she feels a little stable, here come the bubbles again. And she forgets to go home by curfew because of the adventure she’s on. Then the crash… and eventually, the recovery.

    The Suffering of Bipolar Disorder Untreated Leads to Worsening Symptoms

    Sad woman with suicidal thoughts because of suffering of bipolar disorder.

    Years later…?  Emma was 22, and the periods of depression became too frightening. The pressure within her gave way to visions of her death. The pain, then the end. The determination to end the pain rose higher and stronger. The risk of an impulsive act that would remove her hope permanently led her parents to deeply research the options that might be available to help her. 

    They learned about IV ketamine treatment and how it can end suicidal thinking in a few hours. They discussed it with her psychiatrist and made arrangements to see a psychiatrist who offered this treatment and would consult with Emma’s doctor to coordinate her care. 

    All three of them made the trip together, planning to stay for a couple weeks and make it a sort of vacation. They hoped the break and new scenery would do her good. And they believed that saving their daughter was the best investment they could make.

    They’d read of people who had experienced help from bipolar depression with IV ketamine treatment, but their greatest concern was to help her continue to live. 

    They’d also read that people with bipolar disorder have an average life span of 25 years less than those who don’t have this illness. They could see the risk and felt they had to take measures to protect her.

    After the couple of infusions, she didn’t appear to be so deeply and dangerously depressed. Her mom mentioned the suicidal thoughts, asking if there was any change.

    Emma blinked. Oh yeah. As a matter of fact, she realized she hadn’t had any thoughts like that in 2 days. With all that was going on…she forgot that was why she was here. Her parents exchanged a hopeful glance.

    With another infusion, her mom noticed she was picking up after herself. And she got in the shower and shampooed her hair…then blew it dry!  Now this was a moment both parents noticed…but tried to not make an issue of it.

    By the end of the series of treatments,  Emma’s mom saw a light in her eyes that had been gone for months. And Emma suggested a shopping trip and lunch, which never happened when she was depressed.

    Once they arrived back home, Emma was upbeat, and disappeared into her room to organize it and clean. This was no small chore, mind you. She asked her dad to carry out the 3 huge trash bags of trash she picked up from the floor. He jumped at the chance.

    This young woman is happy since ketamine lifted her depression.
    Emma, herself, was surprised about her own motivation and initiative. And she found she enjoyed the sun filtering through the trees…the ducks paddling around the pond at the park, and the aroma of someone’s barbecue cooking outside.

    There was no question about it. She was feeling better. In fact, she felt better every week. She slept better at night, and had more energy for living during the day. A few weeks later, she realized she had a song playing in her head. So she hummed along. Her mom flashed a grin at her. It was so good to see her feeling so much better.

    Emma has had some rough days and weekends since her IV ketamine treatment. Times when she felt exhilarated and knew she might make a bad decision. But she’d learned to call her doctor, report the subtle symptoms, go in and do what she needed to do to avoid sliding into hypomania.

    Overall, her life improved dramatically after ketamine. Every month she sent a note to her ketamine doctor to let her know how she was doing. She missed fewer appointments with her local psychiatrist and her therapist. And somehow she seemed better able to manage herself now.

    While Emma still has challenges, her life is happier and easier to manage. She’s more productive and was able to go to college and actually do the work. What traditional medications couldn’t do for her, IV ketamine treatment could.

    At Innovative Psychiatry, we see patients who suffer from bipolar disorder often. Patients who experience significant improvement through IV ketamine treatment. If the suffering of bipolar disorder, especially bipolar depression, begins to return at some point, we’ll quickly arrange an appointment so you can receive a new infusion to refresh your well being. 

    If you suffer from bipolar disorder or another mood disorder, and you’ve not been helped by the medicines your doctor prescribes up till now, please call us.  We will schedule a consult to determine if you’re a candidate for IV ketamine treatment. And if you are, you can begin your treatments right away.

    Be the best version of yourself with ketamine treatment for the suffering of bipolar disorder.

    We’ll help you connect with the version of the best you that has become hidden, and help you feel and function better, so you can enjoy a rewarding and fulfilling life.

    We’re here to disrupt stigma.

    And innovate— not just with fresh new effective treatments like ketamine, but innovate with understanding. 

    We don’t just infuse ketamine—we infuse compassion, and we infuse hope.  We live for that.

    With respect and appreciation for the beauty of your best self,

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
    This image has an empty alt attribute; its file name is Angled-dark-blue-Lori-Calabrese-MD.png

    Lori Calabrese, MD

  • Ketamine Restores Brain Circuitry Damaged by Depression – FAST

    Ketamine Restores Brain Circuitry Damaged by Depression – FAST

    Ketamine restores brain circuitry to bring joy to depressed people.

    In a world where things go wrong and people get sick, every once in awhile something comes along that makes things right again. I’m talking about something that’s so dramatic in its solutions we’re tempted to call it a “miracle.” 

    But we won’t.

    We’ll call it a game-changer.

    Because IV ketamine treatment is changing history.

    Nothing elicits our excitement like a tool that helps people to the degree this one does. So many people with complex co-morbid psychiatric disorders drop their shackles of symptoms …and discover they’re free to live rewarding lives.

    IV Ketamine Restores Brain Circuitry

    Ketamine does exactly that in the vast majority of those who were before hopeless in their condition. People whose severe illnesses prevented them from working, from building relationships, from enjoying anything. People whose lives were at risk because symptoms like suicidal thinking were made worse by their own despair.

    The World Health Organization (WHO) declares depression and other severe mood disorders the leading cause of disability throughout the world. And yet, until the last several years, at least a third of these people could not be helped.

    But, in the last decade, an often-abused anesthetic has emerged as a game-changer that millions were searching for.

    Ketamine — so safe and effective that the WHO lists it as one of its 10 essential medicines — is now rising as one of most effective and extraordinarily restorative treatments we’ve ever had.

    But to be clear — and to be fair — there are still some who don’t benefit. We continue to watch for more research that helps us understand why. And to look for and learn ways to possibly help them and more.

    New Study Throws Open the Shutters on Synapse Restoration

    Conor Liston, M.D., Ph.D

    A study just released this month by Conor Liston of Weill Cornell Medicine, and colleagues, revealed yet more than we knew before about how ketamine works to achieve this remarkable restoration.

    Dr. Liston is a leading researcher in the field of circuitry specific to the prefrontal cortex and its impact on cognitive and emotional processes. It’s the dedication of researchers like Dr. Liston, and a host of others, that has helped us understand and use the benefits of ketamine for our patients. We never take our neuroscience researchers for granted.

    The combined effort of research teams like Dr. Liston’s in the U.S. and Tokyo resulted in expanded understanding of just what happens when ketamine reaches the brain in someone who’s stressed and depressed.

    Of course their work is performed in the laboratory with lab animals, but gives insight about what happens in the brains of people, and how ketamine restores brain circuitry for them. Insights like this are changing the course of psychiatric treatment.

    Ketamine’s Active Role with Neurons and Dendrites

    The researchers used a “cutting-edge” technology that included light microscopes and allowed them to view the tiny dendrites and dendritic spines of synapses (in the medial prefrontal cortex) over time, so they could see what happens there over several hours, and then what happens after more than a day.

    It turned out that the neuronal circuits changed first, with a readily observable change in behavior, in the initial 3 hours after ketamine. (Hold that thought: the circuit activity changes first.)

    Then, over the next 12-24 hours, they saw that the number of spines had increased by well over half of those that had been lost during stress.

    So they realized that the new spines and synapses were the result of the improved circuit activity. 

    Extraordinary.

    New Technology Opens New Doors

    This is the first time we’ve had an inkling into the timing of the effects and repair instigated by ketamine. The improvement seems to be a one-two punch. Once the spines survive a few days, they form new connections, and then within another 2-7 days, improved behavior and function became apparent.

    This brand new discovery of ketamine’s effects helps us understand that there can be an immediate response to ketamine, and then a longer lasting reversal of symptoms that occurs a little later.

    Both of these functions are important.

    Old Treatment Replaced by New Insights

    Remember that the old premise for treating depression was to increase the availability of neurotransmitters like serotonin to improve the movement of signals in the brain. For some people this was enough to help relieve the depression.

    This weeping woman needs to know ketamine restores brain circuitry and lifts depression.

    But in too many others, it did very little to relieve anything. We know now that stress prunes the signaling structures themselves. Stress from life, illness — whatever — breaks down, weakens, and destroys the synapses. The dendrites, dendritic spines, and synapses that are the highways the signals travel must be rebuilt.  Without these structures, neurotransmitters like serotonin, dopamine, and norepinephrine can’t do their job.

    Ketamine comes along and reverses this destructive process. It repairs damaged circuits, rebuilds new dendritic spines and synapses, increases connections, and lubricates signals with neurotransmitters … in the medial prefrontal cortex and in other key parts of the brain, too.

    This revelation about how ketamine restores brain circuitry will most likely contribute to the ongoing development of new psychiatric drugs. We’re excited about the possibility that new medications can be designed to do all of this before they’re used by physicians for our patients.

    Getting Closer to Bigger Breakthroughs

    So we have a new paradigm, a new pattern to build upon. We may see over 80% response in patients with ketamine now, but we’re shooting for the time when researchers can improve upon this across the board… to be able to truly relieve psychiatric suffering — hopefully in our lifetime.

    And we keep getting closer.

    The Modes of Response Vary

    As it stands now, there are some people who are so responsive to ketamine treatment that they feel remarkably better after the first infusion, and with each treatment, they become more and more hopeful, brighter, more joyful, more creative, and more resilient.

    There are others who sense nothing for 3 or more infusions, then finally experience improvement, relief, and eventually joy just like the first group. These may require a few more than six infusions to reach that point.

    woman wearing blue denim jacket standing in front of white concrete buildings

    Then there are those who may have 8 or 9 infusions. They may experience a few days of improvement throughout the process, but seem to keep losing the beneficial effects. In those cases, we explore other body systems and serum levels to find areas that need to be treated so the “treatment-resistance” can be penetrated, then with another infusion or two they finally achieve the same joy and resilience. We call it remission. And we fight for it.

    Still, of course, there remains that small group who don’t seem to improve, so we continue to press on, to explore reasons…and possible solutions.

    Science …and ART

    IV ketamine treatment is the most remarkable treatment for mood disorders we’ve seen. And clinicians and researchers are looking beyond “mood disorders” all the time. Addictions and substance use disorders, for example, were considered to be disorders of motivated behaviors and treatment focused on teaching behavior control. We’ve learned so much, and while treating these disorders is complex, we’re finding IV ketamine can play a dramatic role in reducing craving and contributing to abstinence. “Dramatic” is an understatement.

    Overall, the administration of IV ketamine treatment is both a science and an art. 

    Ketamine Treatment is a Process Toward Restoration

    At Innovative Psychiatry in South Windsor, CT we encourage our patients to have patience with the process. To hold a commitment to see it through to fulfillment. And to consider a “booster” infusion if benefits subside or fade — whether it’s once every year or two, or twice a year…or every 3-4 months, if necessary.
    woman wearing black V-neck T-shirt during daytime

    Because every brain is different, and every life has its own unique character and pitfalls. It may be necessary to build and improve the infrastructure in your life. To accept yourself and others as they are, and learn to embrace the joys of life and ignore the stressors. All of this can help strengthen your remission and help it last longer.

    If you’ve suffered the symptoms of a disorder without relief from treatments or medications, call us.

    We’re committed to your restoration and eventual joy.

    To the rediscovery of your best self,

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
    signature of Lori Calabrese, M.D.
    Lori Calabrese, M.D.

  • Behind the Buzz: How Ketamine Changes the Depressed Patient’s Brain

    Behind the Buzz: How Ketamine Changes the Depressed Patient’s Brain

    The anesthetic-cum-party drug restores the ability to make connections among brain cells. The Food and Drug Administration’s approval last month of a depression treatment based on ketamine generated headlines, in part, because the drug represents a completely new approach for dealing with a condition the World Health Organisation has labelled the leading cause of disability worldwide. The FDA’s approval marks the first genuinely new type of psychiatric drug—for any condition—to be brought to market in more than 30 years.

    Although better known as a party drug, the anesthetic ketamine has spurred excitement in psychiatry for almost 20 years, since researchers first showed that it alleviated depression in a matter of hours. The rapid reversal of symptoms contrasted sharply with the existing set of antidepressants, which take weeks to begin working. Subsequent studies have shown ketamine works for patients who have failed to respond to multiple other treatments, and so are deemed “treatment-resistant.”

    Despite this excitement, researchers still don’t know exactly how ketamine exerts its effects. A leading theory proposes that it stimulates regrowth of synapses (connections between neurons), effectively rewiring the brain. Researchers have seen these effects in animals’ brains, but the exact details and timing are elusive.

    A new study, from a team led by neuroscientist and psychiatrist Conor Liston at Weill Cornell Medicine, has confirmed that synapse growth is involved, but not in the way many researchers were expecting. Using cutting-edge technology to visualize and manipulate the brains of stressed mice, the study reveals how ketamine first induces changes in brain circuit function, improving “depressed” mice’s behavior within three hours, and only later stimulating regrowth of synapses.

    As well as shedding new light on the biology underlying depression, the work suggests new avenues for exploring how to sustain antidepressant effects over the long term. “It’s a remarkable engineering feat, where they were able to visualize changes in neural circuits over time, corresponding with behavioral effects of ketamine,” says Carlos Zarate, chief of the Experimental Therapeutics and Pathophysiology Branch at the National Institute of Mental Health, who was not involved in the study. “This work will likely set a path for what treatments should be doing before we move them into the clinic.”

    Another reason ketamine has researchers excited is that it works differently than existing antidepressants. Rather than affecting one of the “monoamine” neurotransmitters (serotonin, norepinephrine, and dopamine), as standard antidepressants do, it acts on glutamate, the most common chemical messenger in the brain. Glutamate plays an important role in the changes synapses undergo in response to experiences that underlie learning and memory. That is why researchers suspected such “neuroplasticity” would lie at the heart of ketamine’s antidepressant effects.

    Ketamine’s main drawback is its side effects, which include out-of-body experiences, addiction and bladder problems. It is also not a “cure.” The majority of recipients who have severe, difficult-to-treat depression will ultimately relapse. A course of multiple doses typically wears off within a few weeks to months. Little is known about the biology underlying depressive states, remission and relapse. “A big question in the field concerns the mechanisms that mediate transitions between depression states over time,” Liston says. “We were trying to get a better handle on that in the hopes we might be able to figure out better ways of preventing depression and sustaining recovery.”

    Chronic stress depletes synapses in certain brain regions, notably the medial prefrontal cortex (mPFC), an area implicated in multiple aspects of depression. Mice subjected to stress display depression-like behaviors, and with antidepressant treatment, they often improve. In the new study, the researchers used light microscopes to observe tiny structures called spines located on dendrites (a neuron’s “input” wires) in the mPFC of stressed mice. Spines play a key role because they form synapses if they survive for more than a few days.

    For the experiment, some mice became stressed when repeatedly restrained, others became so after they were administered the stress hormone corticosterone. “That’s a strength of this study,” says neuroscientist Anna Beyeler, of the University of Bordeaux, France, who was not involved in the work, but wrote an accompanying commentary article in Science. “If you’re able to observe the same effects in two different models, this really strengthens the findings.” The team first observed the effects of subjecting mice to stress for 21 days, confirming that this resulted in lost spines. The losses were not random, but clustered on certain dendrite branches, suggesting the damage targets specific brain circuits.

    The researchers then looked a day after administering ketamine and found that the number of spines increased. Just over half appeared in the same location as spines that were previously lost, suggesting a partial reversal of stress-induced damage. Depression-like behaviors caused by the stress also improved. The team measured brain circuit function in the mPFC, also impaired by stress, by calculating the degree to which activity in cells was coordinated, a measure researchers term “functional connectivity.” This too improved with ketamine.

    When the team looked closely at the timing of all this, they found that improvements in behavior and circuit function both occurred within three hours, but new spines were not seen until 12 to 24 hours after treatment. This suggests that the formation of new synapses is a consequence, rather than cause, of improved circuit function. Yet they also saw that mice who regrew more spines after treatment performed better two to seven days later. “These findings suggest that increased ensemble activity contributes to the rapid effects of ketamine, while increased spine formation contributes to the sustained antidepressant actions of ketamine,” says neuroscientist Ronald Duman, of the Yale School of Medicine, who was not involved in the study. Although the molecular details of what happens in the first hours are not yet fully understood, it seems a restoration of coordinated circuit activity occurs first; this is then entrenched by neuroplasticity effects in synapses, which then maintain behavioral benefits over time.

    [To prove that new synapses were a cause of antidepressant effects, rather than just coinciding with the improved behaviors, the team used a newly developed optogenetic technique, which allowed them to eliminate newly formed spines using light. Optogenetics works by introducing viruses that genetically target cells, causing them to produce light-sensitive proteins. In this case, the protein is expressed in newly formed synapses, and exposure to blue light causes the synapse to collapse. The researchers found that eliminating newly formed synapses in ketamine-treated mice abolished some of the drug’s positive effects, two days after treatment, confirming that new synapses are needed to maintain benefits. “Many mechanisms are surely involved in determining why some people relapse and some don’t,” Liston says, ” but we think our work shows that one of those involves the durability of these new synapses that form.”

    And Liston adds: “Our findings open up new avenues for research, suggesting that interventions aimed at enhancing the survival of these new synapses might be useful for extending ketamine’s antidepressant effects.” The implication is that targeting newly formed spines might be useful for maintaining remission after ketamine treatment. “This is a great question and one the field has been considering,” Duman says. “This could include other drugs that target stabilization of spines, or behavioral therapies designed to engage the new synapses and circuits, thereby strengthening them.”

    The study used three behavioral tests: one involving exploration, a second a struggle to escape, and a third an assessment of how keen the mice are on a sugar solution. This last test is designed to measure anhedonia—a symptom of depression in which the ability to experience pleasure is lost. This test was unaffected by deleting newly formed spines, suggesting that the formation of new synapses in the mPFC is important for some symptoms, such as apathy, but not others (anhedonia)—and that different aspects of depression involve a variety of brain circuits.

    These results could relate to a study published last year that found activity in another brain region, the lateral habenula, is crucially involved in anhedonia, and injecting ketamine directly into this region improves anhedonia-related behavior in mice. “We’re slowly identifying specific regions associated with specific behaviors,” Beyeler says. “The factors leading to depression might be different depending on the individual, so these different models might provide information regarding the causes of depression.”

    One caveat is that the study looked at only a single dose, rather than the multiple doses involved in a course of human treatment, Zarate says. After weeks of repeated treatments, might the spines remain, despite a relapse, or might they dwindle, despite the mice still doing well? “Ongoing effects with repeated administration, we don’t know,” Zarate says. “Some of that work will start taking off now, and we’ll learn a lot more.” Of course, the main caution is that stressed mice are quite far from humans with depression. “There’s no real way to measure synaptic plasticity in people, so it’s going to be hard to confirm these findings in humans,” Beyeler says.

    [Read the Original Article]

  • NYT asks: Can We Stop Suicides? Here’s Our Response

    NYT asks: Can We Stop Suicides? Here’s Our Response

    Can we stop suicide? Yes, IV ketamine is saving lives daily.

    An article published this past Friday, Nov. 30, 2018, in the New York Times Opinion section, asks about a possible remedy for suicidal thinking. Well researched, but not quite well enough. Keep reading…

    Author Moises Velasquez-Manoff explored the notion that maybe…just maybe…we can quell the epidemic rate of suicide. He points out that the suicide rate keeps rising, and according to the Centers for Disease Control and Prevention, suicide is now the 10th leading cause of death. After nearly two decades of growing statistics, suicide seems to be higher than it’s ever been. 

    Tragically, medicines to quell that tide have not kept up with the death statistics and doctors have been increasingly helpless to save a life in time.

    Until now. As research and clinical use of ketamine has increased, thousands of suicidal patients have been saved, giving them time to participate in therapy and other treatments so they can heal and rebuild fulfilling lives. 

    Best Mainstream Article on Ketamine to Date

    Can we stop suicide? Yes, with a series of IV ketamine infusions.

    Kudos to Mr. Velasquez-Manoff for his thorough research about ketamine and its effectiveness in treating suicide. All too often, articles in national publications provide a narrow, myopic view of ketamine and what it can do. 

    These articles have sometimes misrepresented the potential of this medicine because of a lack of thorough research. While there’s more to the story, which we’ll talk about, there’s lots of good information here for you to read and pass on to your friends and family.

    So…Can We Stop Suicide? 

    Let’s take a stroll through this NYT article, and talk about the truths and the half truths in the quest for what matters.

    NYT: Using ketamine to treat depression and suicidality is somewhat controversial. Numerous small studies suggest that it holds great promise, but it’s only now being tested in placebo-controlled trials with hundreds of patients. 

    Dr. Calabrese: It’s true that it’s been controversial. Like with many controversies, those who make the effort to find and read the research results for themselves quickly understand the value and significance of this drug. Too many listen to hearsay and scuttlebutt and form erroneous opinions… 

    “Ketamine will never get approved for this,” or “There are too many dangers with ketamine,” they say ….  cautious? skeptical? negative Nellies?

    We hear their voices loud and long. But clearly, in real-world psychiatry, this is a medication that is revolutionizing outpatient practice.

    Can we stop suicide? Yes, with a series of ketamine infusions.

    In all fairness, there is plenty we don’t — and can’t — know. Not yet. IV ketamine treating for treatment-resistant depression (TRD)  — and other psychiatric disorders —  has only been in moderately wide use for a few years. And it will be years before we really know the long-term consequences of single and repeat infusions, even with these tiny doses. Of course. That’s what long-term means.

    And we want to know long-term physiologic effects from low-dose repeated ketamine infusions or maintenance treatment — on the bladder, particularly.

    What about long-term impact on quality of life? Let’s talk about that. Since ketamine infusions for TRD use a much, much smaller dose than is ever used in anesthesia, and since we have 50 years of surgeries to go on, it seems pretty unlikely that a short sequence of a few tiny doses of ketamine will have any more negative impact on an individual’s quality of life than their severe treatment-resistant depression did.

    What we hear — and what my colleagues around the country hear –is that ketamine treatment can be transformative. 

    At the same time, the idea that it’s only now being tested in placebo-controlled trials is only true if the author is referring to this decade. Early trials at the beginning of this century were purely investigative to see what ketamine could do.

    We’ve said all along, ketamine isn’t for everyone.

    Still, its effectiveness is extraordinary especially for those who are most severely ill, and at highest risk for suicide.

    In the last few years, trials that were launched even earlier have finally gotten published. It takes time to conceptualize a study, and get it approved by the ethics committees and reviews boards that do these things. Then to  recruit exactly the right patients if you’re a major academic center,  collect, and analyze the data… we’re talking about a lot of time. 

    But even with that said, placebo-controlled trials have flourished in the last few years, as witnessed at the International Conference on Ketamine and Other Compounds for Psychiatric Disorders 2018, where researchers came from across the globe to present their findings. And more roll off the presses each month.

    NYT: Now, scientists think that they may have found one — an old anesthetic called ketamine that, at low doses, can halt suicidal thoughts almost immediately.

    Can we stop suicide? Yes with ketamine treatment.

    Dr. Calabrese: Yes! Isn’t that great news? In the last 50 years, there has been nothing that could stop suicidal thinking in 4 hours or less — sometimes within the first hour.

    And the beauty is that IV ketamine treatment doesn’t just make the suicidal thoughts easier to bear, it erases them.

    I wish it happened this way with every patient, but we still haven’t found a medicine that works the same way on everyone. Even so, psychiatry has never seen a medicine do this so quickly, so clearly, and so effectively in so many patients.

    NYT: After her suicide attempt, Louise’s psychiatrist suggested she try ketamine. She agreed, and received an infusion intravenously. Within hours, her sense of well-being improved. The hospital discharged her. Back home, she discovered that going to the market was no longer a “herculean task.” Getting her car washed wasn’t an insurmountable chore. “Life was better,” she said. “Life was doable.”

    Can we stop suicide? Yes, with a series of ketamine infusions.

    Dr. Calabrese: I love that the author included Louise’s story. Her description is characteristic of the descriptions I hear from my patients after ketamine treatment begins to take hold. And note that her response was hours after one infusion, not a series. Then the hospital discharged her.

    A single ketamine infusion can provide a wonderful respite from the heavy lead blanket that is depression, the emptiness and vacancy of feeling, the darkness and despondency…for a few days, or a week, or maybe even 2 weeks.

    But we know that one infusion fades.  Pretty much everybody knows that. 

    If your doctor provides you with only one ketamine infusion, it’s almost cruel…it whets your appetite for how life could be…only for it to be snatched away again in a week or two.

    This is the reason “ketamine treatment” has come to mean a series of  IV infusions at tiny doses over 2-3 weeks. It’s the repetition of infusions close together that seems to stack the benefits and overcome the temporary nature of a single infusion.

    What we’re feverishly all working to find out is: exactly how many infusions? 6? 8? Should the dose be based on real body weight or ideal body weight? Some ask if it should be based on body weight at all or just fixed like they’re doing with esketamine. Should the series be all one dose? or should the dose increase? how fast and how high? is there a best dose? 

    Research has not answered these questions yet.

    In our practice, we are sticklers for data, and we collect (and are about to publish) our outcomes.  We’ve already presented them at conferences in Europe and in the U.S.

    Can we stop suicide? YES, with a series of ketamine infusions.

    Here’s a clinical pearl: dose titration is important, and many physicians and nurses don’t titrate the dose to achieve the best response.

    This practice is often the cause for patients to believe ketamine doesn’t work for them. Not in every case, but far too often.

    Seek out a psychiatrist who is up-to-date.

    There seems to be so much misinformation circulating, and  disappointed patients could possibly avoid disappointment if they — and their doctors — had access to more up-to-date information. Doctors only know the up-to-date information if they take the time to search it out.

    NYT: The drug seems to address a longstanding problem in emergency psychiatry. Sedation and physical restraint aside, doctors have few ways to quickly stop suicidal ideation, or thoughts of killing oneself. The current crop of anti-depressants can take weeks and sometimes months to work, if they work at all. They may also, paradoxically, increase suicidality in some patients. Talk therapy takes time to help as well (assuming it does).

    Dr. Calabrese: This is a paradox to be sure. The antidepressants prescribed to treat depression can sometimes actually increase suicidal thoughts and actions as a side effect in some people. Confusing and discouraging if you’re suffering without solutions. And they’re slow to work.  Even lithium and clozapine — clear anti-suicide champions — are slow to work.

    Imagine what rapid relief would feel like.  Quick relief from suicidal thoughts — whether you’re an adult or an adolescent or even a child — can give you time to do the work to scaffold things into your everyday life that can keep you well.

    One infusion can give you relief. Several can cement remission. Not for just hours or a day or a few weeks or a month. For many patients, remission gives them the time and space to make changes that keep their symptoms at bay.

    Imagine that instead of sitting in an ER or on an inpatient unit somewhere.

    NYT: Dr. Michael Grunebaum, a Columbia psychiatrist who studies ketamine, thinks the drug should no longer be relegated to a last-line treatment. “It makes sense that it move up in the treatment algorithm in E.R.s and inpatient units,” he told me. (Although if emergency rooms everywhere began offering ketamine, it could create new problems, he adds. As has occurred with opioids, people might claim to be suicidal when, in reality, they’re trying to get high.)

    Dr. Calabrese: There’s an important point we need to make here. When a psychiatrist provides ketamine in the safest, most therapeutic way, the psychiatrist manages the dose and rate and the therapeutic experience so that the biological changes that ketamine induces — dendritic branching and synaptic proliferation — can be optimized. One of the indicators of this during the infusion is the degree of dissociation. With an infusion (as opposed to IM or intranasal or oral use), this can be very carefully controlled. And the responsibility for controlling the access, and the infusion experience lies with the doctor. This is not about getting high.

    Because people have used ketamine abusively in clubs and on the street, the massive doses they use in those settings — and repeat far too often — can provoke frightening hallucinations.  Some people crave that, and use more and more.

    If you use ketamine on the street you may think you “get” ketamine treatment…what it’s like… and that it’s likely all about the “trip.” But, that’s a street culture thing. That’s not the science of medicine that heals depression and anxiety and erases suicidal thoughts.

    Can we stop suicide? Yes, with a series of ketamine infusions.

    But when psychiatrists provide this medicine with skill and deep expertise, titrating the dose and the number of infusions, working synergistically with the rest of the patient’s medications and clinicians, it’s neither dangerous nor addictive. 

    The goal is remission, not ketamine ad infinitum.

    When a patient needs a new dose every month, ad infinitum, that patient likely didn’t achieve remission in the first place. 

    We want remission for you.  We want you to get better, get going, and give back.

    All in all, we loved Moises Velasquez-Manoff’s article. And glad we’ve had this opportunity to set the record straight.

    It’s refreshing to read a journalistic article about ketamine treatment for mood disorders that’s as close to accurate as this one.

    The question was, “Can we stop suicide?” And the answer is a resounding YES, most of the time, if you let us know you need the help.

    It’s wonderful when journalists help spread the word about novel and advanced treatments that relieve severe symptoms like suicidal thinking. The goal is to find relief and remission from the suffering. And new hope that you take with you into your future.

    At Innovative Psychiatry we see patients every week who experience renewed joy, purpose in life, creativity, motivation, and initiative after a full course of ketamine treatment. And those who have the best results are often the ones who had the most severe symptoms.

    Can we stop suicide? Yes, with a series of ketamine infusions.

    Even if no other medicine or treatment has helped you before, even if your doctor told you there was nothing more they could do to help you, even if you’ve been sick for decades, you are  not hopeless.

    So take hope.

    So many people with a story like yours have gotten better with ketamine treatment.

    If you have lost hope, call us.

    Find out what it’s like to feel alive, hopeful, and able to to build a new life. Chances are we can help you live again… and enjoy the little things in life like you haven’t in what may seem like a lifetime. 

    We want to help you get well.

    Can we stop suicide? Yes, with a series of IV ketamine infusions.


  • Ketamine KRIYA Conference 2018

    Ketamine KRIYA Conference 2018

    KRIYA!!

    Ketamine KRIYA Conference 2018-Dawn of a new field.

    The most phenomenal ketamine conference to date!  

    Last weekend I attended and presented at the ketamine KRIYA Conference 2018 in San Francisco. This conference emerged as the most dynamic gathering of front-line ketamine practitioners I’ve ever experienced.

    And what an event!

    The ketamine KRIYA Conference 2018 was extraordinarily different than any other research or clinical conference I’ve attended. It’s clear that the realm of ketamine treatment for psychiatric disorders is growing wider and deeper. 

    There was a true spirit of inquiry, extraordinarily open collaboration, and presentations of risks, failures, and triumphs. Sheer transparency. Openly exposed vulnerabilities. A clear admission of the limitations of what we know. The latest information about clinical uses of ketamine in psychiatry. 

    The insider news.

    What happened when Raquel put all of it — and all of us — together?

    Palpable energy instantly exploded!

    During the presentations — which were riveting. As we met for coffee. Chatted on the beautiful conference grounds, sprawled out over the steps, snugged down into comfy couches, talked over creative and inventive lunches, inhaled coffee (for some of us, all throughout the day!) — there was the sense that we needed to learn from each other as fast as we could. So … we shared Ubers and Lyfts and dinner tabs. 

    We came from all over the country … and from as far away as Russia.

    We’re serious about this.

    And what a weekend! We learned so much from each speaker and each other. We talked about our data, our practices, our experiences, what we’ve learned. What we still don’t know.

    Ketamine KRIYA Conference 2018 helped this man reach light in his life.

    Soooo many different backgrounds, so many different approaches providing patient care, so much desire to reduce suffering in our patients.

    Founded by Raquel Bennett, Ph.D., KRIYA is the Ketamine Research Institute and it is devoted to understanding the use of therapeutic ketamine in psychiatry and psychotherapy.

    I must give a shout out to Raquel Bennett.

    In such a few short years, she single-handedly founded, organized and grew KRIYA, an organization devoted to helping people heal and live fuller lives through safe, legal, and effective ketamine treatment. She is originator of the first international ketamine conference — KRIYA’s first conference, in 2015 — on the therapeutic use of ketamine.

    Raquel has earned our respect, appreciation, and applause for the enormously hard work of bringing together experts who work with therapeutic ketamine in very different ways, using different routes, for different therapeutic purposes, in all aspects of psychiatry and psychotherapy, as well as in chronic pain and hospice.

    Ketamine is a visionary medicine.

    But Raquel Bennett, Ph.D, is a visionary.  

    Fantastic speakers, wonderful food, and gorgeous (read: non-hotel) settings gave all of us opportunities to pick the brain of someone nearby. We shared, we ate, we discussed, we listened. And at the end, we kept talking until they put away the chairs, and turned out the lights … until we each left for the airport. And then checked in and kept going.

    Meet me in Terminal 2. I’m at Starbucks. Find us in the International Terminal.  We’re sitting in the food court.

    Until one by one, each had to break away to catch a plane.

     … You haven’t seen anything til you’ve seen the excitement that comes from connection.

    Many thanks to Raquel and her incredibly talented, organized and generous team for making this all possible.

    Ketamine KRIYA Conference Founder Raquel Bennett.
    Raquel Bennet, Psy.D.

    Though our backgrounds are different, and our methods varied, it was clear that we share the same passion: to help reduce suffering from psychiatric symptoms and physical pain.

    Next, let me say, I can’t possibly share it all with you here — there were 30 different speakers over 2 days, fascinating and varied discussion panels, and a lively sharing of experiences and ideas that kept us on our toes till the wee hours.

    This conference was thrilling.

    Thrilling.

    I attended KRIYA last year.  But there has been so much growth, so much more research, so many new frontiers since then … that this gathering really can’t compare.

    These 30 speakers ran the full gamut of experience with using therapeutic ketamine in psychiatry — different practice settings, different studies, varied doses, varied routes of administration, varied preparation. Varied goals.

    This was no room for small or closed minds.

    We ALL learned and grew during those two days.

    Raquel Bennett opened to set the stage for this smorgasbord of ideas. 

    She said, “We are witnessing the birth of a new field.”  She spoke about how ketamine was developed for anesthesiology and has served that field well. But the therapeutic use of ketamine has birthed a new field of ketamine in psychiatry.

    Ketamine KRIYA Conference 2018 demonstrates the difference between anesthetic ketamine and psychiatric ketamine.

    And she emphasized that the two are as different as apples and toast.

    One way they’re different is in the goals of treatment. For anesthesiologists, ketamine has been used for managing consciousness or sedation and addressing physical pain. In psychiatry, the goal of treatment is all about treating psychiatric symptoms and managing psychiatric distress.

    The second difference is in training and areas of expertise, diagnostic skills, and managing emergencies, and she described the differences between anesthesiologists and psychiatrists. Anesthesiologists are best at managing surgical emergencies, interventional pain procedures and life support.  But psychiatrists are experts in diagnosing psychiatric conditions and managing psychiatrist emergencies.

    The third difference is in the type of patient who presents for treatment.   In psychiatry, our patients need a lot of contact, a high degree of emotional safety, and a great deal of emotional support and reassurance. Things we’re deeply attuned to by our psychiatric training.

    She also talked about the differences in routes of administration as well as the dose used  for each type of patient to reach the individual goals of sedation vs. relief of psychiatric symptoms.

    Add to that the amount of preparation required in each field. An anesthesiologist can walk into the surgical area, say hello to his patient, and tell him to count backwards from 12. 

    However, psychiatrists and psychologists offering ketamine treatment invest in substantial and detailed preparation of the patient before beginning ketamine treatment — to prepare for the treatment itself, the treatment experience, and how to metabolize or make sense of the treatment experience. 

    And the preparation involves not only  a thorough history of symptoms, treatment course, previous medication and treatment failures, but also a thorough developmental and social history. 

    Our education and training centers on entering into an ongoing therapeutic relationship with our patients and the critical understanding and provision of a safe, therapeutic frame to do the deep work we do.

    These two fields are two different animals. 

    Dr. Bennet encouraged everyone to learn from everyone else, in effect, to “cross pollinate” these fields and help each other to improve in clinical practice.

    Then she described the use of ketamine in psychotherapy as a “lubricant” for psychotherapeutic work. 

    Several of the speakers described this method in their practices.  This is called ketamine-assisted psychotherapy, or ketamine-facilitated psychotherapy.

    Ketamine KRIYA Conference 2018 demonstrated what ketamine treatment can do.

    And she went a step further, to describe the use of therapeutic ketamine in psychotherapy as a tool for deep spiritual exploration. This is where the goal of treatment is not symptom relief per se, but personal growth, self-knowledge, or transcendent exploration.

    All in all, she encouraged matching the treatment to the individual patient, recognizing our responsibility to learn more about varied strategies and to share our findings within our field.

    Speakers were diverse and fascinating. If you’ve been keeping up with progress in the field of psychiatric ketamine treatment, some of these names are sure to jump out at you:

    Will Van Derveer, M.D., Wesley Rylan, M.D., Scott Shannon, M.D., Michael Stanger, M.D., Jeffrey Becker, M.D., Jason Wallach, Ph.D., Dan Engle, M.D., Lori Calabrese, M.D., John Krystal, M.D., Phil Wolfson, M.D., Jeff Guss, M.D., Elias Dakwar, M.D., George Greer, M.D., Evgeny Krupitsky, M.D., Patrick Sullivan, D.O., and Jennifer Winegarden, D.O.

    And we had some lively and fascinating panelists, including Gary Bravo, M.D., Alison McInnes, M.D., Steven Levine, M.D., Steve Best, M.D., Veronica Gold, M.F.T., Greg Wells, Ph.D., Bob Grant, M.D., Genesee Herzberg, Psy.D., Jessica Katzman, Psy.D., Jennifer Dore, M.D., Julie Megler, P.N.P., Steven Levine, M.D., Steve Best, M.D.,  Sandhya Prashad, M.D., Steve Mandel, M.D., and me.

    Oh yes, I mentioned I also presented my own data, and am excited to tell you more about that…

    But… that will have to wait for another day … Without question, our fledgling new psychiatric field has turned a corner.

    Ketamine KRIYA Conference 2018. 

    We’ll never forget this one. We can only hope they keep getting better…if that’s possible.

    As exciting as this wealth of information may be, if you’re suffering from depression, bipolar depression, PTSD, OCD, social anxiety, substance use disorders…and even suicidal thinking, don’t wait. Call us. 

    Thankfully, if your symptoms are mild, there are a host of antidepressants and other medicines and treatments that can hopefully help you.

    Ketamine is at its best for those who are severely suffering. 

    Ketamine KRIYA Conference 2018 educated psychiatrists to help this woman get better.

    If you’re deeply affected by severe symptoms of depression and anxiety, we can help.  Call and arrange an appointment.

    Ketamine isn’t for everyone. Of course not. It doesn’t help everyone. But even among those who aren’t helped initially… sometimes there are those who get a delayed response and in a few months reach remission quite by surprise. 

    And even though we can’t promise everyone they’ll reach remission, the truth is that a very large percentage do.

    As we’ve said before, ketamine is the most rapid and effective treatment for depression that we’ve seen in our lifetime … and really … ever.

    We’re constantly learning ways to help more people benefit and get better. And chances are…you’ll experience the most remarkable transformation you could have imagined.

    Our Results

    At Innovative Psychiatry, we see people with these symptoms and disorders get better every week with ketamine treatment. Our results are extraordinary, and our remission rate is very high. Call for an appointment and let’s talk.

    Ketamine works in some different areas of the brain in different ways than traditional medicines you might have tried that didn’t work for you. Your life really can improve dramatically.

    Find out what this remarkable treatment can do for you.

    Ketamine KRIYA Conference 2018
  • Bipolar Disorder and Hypersexuality: Symptom or Excuse?

    Bipolar Disorder and Hypersexuality: Symptom or Excuse?

    Bipolar disorder and hypersexuality can cause teens to participate in high risk sexual behavior.

    Most misunderstood symptom of bipolar disorder that divides families, shames sufferers, and hurts those who love them… BEGS to be treated before damage is done.

    It was 1am. Deftly, he slid the window open and quietly climbed into the room. In a moment his clothes were off and he was under the covers. 14-year-old Jillian whispered, “What took you so long?”

    Bernie, who was 15, whispered, “My parents took forever to go to bed. I’m so glad you’re still awake, and so glad you didn’t scream when I opened the window!”

    “Bernie, you should go home. What if my parents check on me..?”

    “Don’t worry, Jillz.  They’ll never know I’m here. Everything’s ok.”

    Then, he moved above her in the dark, and began to kiss her…

    Shocking, even horrifying for parents. But when a teenager has bipolar disorder, parental structure and rules aren’t enough to dampen overwhelming urges. 

    And sadly, the teenager begins to develop a reputation for making trouble before he even knows who he is.

    Emotionally charged…?  You bet.

    Damaging labels? Oh yes. 

    Challenging for parents to respond productively? More than words can say…

    But an early teenager usually doesn’t have the mental/emotional equipment, no matter how balanced he may be, to manage such compelling, overwhelming impulses and urges.

    You try it with the same circumstances. 

    Add to that a disordered early teenager smack in the middle of puberty who also is suffering from bipolar disorder where the upswings presents with hypersexuality…?

    And sadly, sometimes these kids who don’t know how to handle the urges can’t imagine having the forethought of contraception… and somebody  is likely to get pregnant. Disaster compounds upon crisis, critical illness, and parents are hit with it all at once.

    Then, think about this scenario…

    Is It Betrayal…?  Or a Symptom??

    Dahlia was diagnosed with bipolar disorder when she was 12… and she’d had quite a few episodes of mania over the years.  Now she was nearly 30, and had been married for years.

    As the pits and darkness…the isolation and emptiness…of depression began to dissipate, and she was beginning to see the light of day again…she noticed something new rising up.  At first she thought it was just the relief of feeling better…but as it slowly grew in intensity she couldn’t ignore it anymore.

    Bipolar disorder and hypersexuality leads to high risk sexual encounters.

    Arousal.

    For awhile, she and her husband were having delightful “private times” together. It was the best bedroom fun they’d ever had. She felt on top of the world. And she felt more and more charming, more clever. She laughed easily, chattered with sparkle…and she began to think she must be the most entertaining person in the world.

    But as her twinkle and charm ballooned, so did her capacity for arousal. And her efforts to satiate her desire just weren’t enough.  Not in the bedroom, not with her husband…whom she loved with all her heart…not as the “belle of the ball” when entertaining at home or at the holiday cocktail party at her work.

    It wasn’t long before she was aroused at work, during lunch, in meetings with co-workers…  Not knowing what to do about it, she’d excuse herself and go to the restroom.

    Finally late one night while her husband was asleep…she found one of those “hookup” websites she’d heard about and signed up. Wild, right? Within minutes…someone contacted her.

    She never intended to act on it. And never intended to be unfaithful to her sweet and supportive husband. She had reached the point that her ears were ringing from the constant arousal…and she reached out to find release…relief.

    And hated herself immediately.  

    Her husband was devastated. So were her friends. So she called her psychiatrist who adjusted her medications to help bring her back into balance.  Then professional counseling, with her heartbroken husband, to help them heal and put boundaries and safe guards in place to ward off the triggers.

    Think This Sounds Like an Excuse for Bad Behavior?

    So many behaviors of people with bipolar disorder seem like poor self-control. Which it is…and that’s the point.

    We don’t judge a person who has no legs for not walking. A person with severe bipolar disorder is missing his self-control, his judgment, and his ability to weigh consequences as if he was missing his “legs.”
    Bipolar disorder and hypersexuality can drive you to display risky and embarrassing behavior.

    So, let’s start by acknowledging yes, this condition can be emotionally-charged for loved ones.

    Hypersexuality…sounds rather scientific…doesn’t it..? If you didn’t know better, you might think it was caused by a virus…like diarrhea or rhinitis might be…  But if you heard this condition was afflicting your spouse or child, the SEX part of it would probably catch your attention pretty quick!

    And yes…symptoms can also result in betrayal.

    But there’s a difference between virus symptoms and bipolar disorder symptoms… when someone with bipolar disorder acts on hypersexuality, people can get hurt, disasters can happen, friendships can be broken, and marriages betrayed.

    How can a symptom hurt anyone besides the person who’s ill?

    Because hypersexuality usually involves someone else…or multiple “someone elses.”

    Hypersexuality is when someone has an intensely increased, overwhelmingly strong, desire for sex.

    And in bipolar disorder, it can accompany mania. It’s not a part of that person’s character. It’s caused by the disorder in their brain.

    Here’s another definition: Any compulsive sexual behavior that interferes with normal living and causes severe stress on the family, friends, loved ones, and one’s work environment.

    You might say, well why didn’t he/she resist the urges?

    Try this: Picture yourself inhaling a bowl of black pepper through your nose..  Now…don’t sneeze. 

    Like with a sneeze, it’s difficult to resist an overwhelming urge.

    What causes hypersexuality in people who suffer from bipolar disorder?

    In a review of the literature published in Cureus in Oct 2015, Kenneth Blum and his team wrote that the nucleus accumbens (located within the ventral striatum, not far from the amygdala) controls behaviors evoked by incentive stimuli. 

    Bipolar disorder and hypersexuality is associated with mania but can be treated by ketamine treatment.
    More simply, when you do something knowing there’ll be a reward for it, this structure mandates your behavior. So think of things like eating, drinking, and sex.

    They make the point that an imperative rule of positive reinforcement is that the response increases in magnitude and strength if it’s followed by reward.

    So whatever you do that gives you a sexual reward, you’re likely to do more often and with more intensity to get more reward.

    For someone who suffers from severe bipolar disorder with hypersexuality, the sexual reward is worth seeking with massive passion. And when you take into account the impulsivity that goes with bipolar disorder, considering consequences in advance of action is just too big an order.

    In her article in EverydayHealth on hypersexuality and bipolar disorder, Diana Rodriguez points out that an increased interest in sex isn’t of itself a problem. But, when the “heightened sense of sexuality” is paired with bipolar manic symptoms like impulsivity, risk-taking, and poor judgment, the resulting behavior can be damaging to far too many aspects of your life.

    So what can you do?

    First, call your psychiatrist. She can help bring your symptoms under control with medication. When your symptoms are controlled, the urges will most likely dissipate.

    Second, therapy and counseling for you and your loved ones. Information is power. Communicate with your loved ones about this symptom, and build a plan with your therapist for treating the sexual arousal when it shows up again.

    You need to break the mania, and hope you come in for a smooth landing.  Without falling through the floor and into another depressive episode

    But What If You Fall Through the Floor?

    Sometimes what happens when mania breaks is a depression so deep and unrelenting that nothing can lift it. If that’s where you are, you may want to consider a novel advanced treatment that’s demonstrated it can help in the majority of cases that weren’t relieved by other medicines.  IV ketamine treatment.

    Since bipolar depression can include agitation and a sense of worthlessness, it’s important to effectively treat it before you have suicidal thoughts or immediately after they start. Those who suffer with untreated bipolar disorder have a high risk for suicidal thoughts.

    Thankfully, ketamine for suicidal thoughts is one of the best and most rapid treatments we have for suicidal thinking. It can stop suicidal thoughts in 4 hours … and usually far less.

    Ketamine treatment shows extraordinary effectiveness in relieving bipolar disorder symptoms.

    So…maybe you’re asking yourself, How do I find the most skilled treatment with ketamine from a psychiatrist near me?

    At Innovative Psychiatry in South Windsor, CT ketamine for depression, bipolar depression, and other mood disorders can help patients with terrible depressive symptoms who haven’t been helped by any other medicines or treatments.

    Ketamine is so effective with depression.  Although it doesn’t work for everyone, in most cases it does, like gangbusters.

    Bipolar disorder and hypersexuality can be treated and you can achieve remission with ketamine treatment.

    If you suffer from severe bipolar disorder, and have been failed by other medicines and treatments offered you, it doesn’t help to think that you’re “treatment-resistant.” You just need something that works in a better way.

    Think about ketamine treatment — administered with skill, insight, and psychiatric expertise to ensure the best possible outcome for you.

    Bipolar disorder can be one of the most devastating psychiatric disorders, and can cause extensive damage in your life, until it’s treated. But you can get your life back and enjoy it again. You don’t have to be driven by the symptoms you experience or suffer with shame from the damage they’ve caused.

    Call us, and let us help you find the life you long to live.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

    To the reinvigoration of your best self, 

    Lori Calabrese, M.D.

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