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.

ASKP Meeting Notes: The 2018 Inaugural Conference of the American Society of Ketamine Physicians
New Advances in Ketamine Treatment
2018 has been a good year. A very good year.

In this fall season of harvest and bounty which surrounds us outdoors, we find ourselves as ketamine physicians with wonderful gifts to work with: in our world of neuroscience and psychiatry, the soil is rich, the seeds have been planted, and hard work has been done – sometimes for years! – by experts who have paved the way, and brilliant emerging experts whose work and insights inspire us all.

I’m talking about the 2018 ASKP Meeting in Austin, TX.

Ya shoulda been there

It was the Inaugural Meeting of the American Society of Ketamine Physicians – hence, ASKP – and it was a conference that fueled excitement, embraced inquiry, acknowledged the need for temperance … and left all of us thirsting for more opportunities to work, study, collaborate, and publish.

I want to tell you about the meeting.

Especially if you or someone in your life suffers from a mood disorder. If you’ve been struggling for a terribly long time. If you’ve begun to think of yourself with symptoms that have become “treatment-resistant.” Sound familiar? Then dial in to learn about IV ketamine treatment advances.

What you learn may help you think outside the box you’ve found yourself in.

Hard Pruning Can Leave You Unable to Recover

As you know, it’s terrible to struggle to live your life when your confidence, your hope, your ability to think and perform, are all dulled, impaired…broken down.

Major depression, panic disorder, social anxiety, PTSD, OCD, bipolar disorder, addiction … the list goes on … all of these can make it nearly impossible to reach the goals you may have for your life.

You’ve probably seen your doctor and tried some different medicines, but if you’re not feeling better, you may be part of the large group of depressed or anxious people for whom conventional medications don’t work.

If you’ve heard of ketamine, you may know that it’s showing great promise for helping a majority of people who weren’t helped by antidepressants.

But, you may not have been able to find someone who administers ketamine treatment properly. Because until recently doctors have just been on their own offering ketamine the best way they know how.

Sometimes their methods don’t work very well.

So physicians who provide ketamine treatment are beginning to organize into groups to exchange their ideas, experiences, and discoveries, in hopes of solidifying some of the true “best practices” that provide the best outcomes for their patients.

An important organization that’s doing this is the American Society of Ketamine Physicians, or ASKP — and we just held our Inaugural Conference September 20-22, in Austin, TX.

Let me start by saying how grateful I am for the many opportunities to meet with other medical pioneers who are committed — like we are — to helping people who suffer with treatment resistant psychiatric disorders.

Conferences are a festival for the mind. Ideas spark, slides fly by, data positively crackles in the air — and so does good humor, agreeableness, collaboration, and humility. We are humbled by the pain our patients experience, and inspired by our colleagues to learn more, think critically, design carefully, proceed with integrity.

We are privileged to have ketamine in our toolbox and to be able to offer ketamine treatment to patients whose suffering has become unbearable.

ASKP is helping us do just that.

IV Ketamine Treatment Advances: Leaders

We were treated to a lineup of seminal leaders in the field. Steve Mandel, M.D., the President of ASKP and Ketamine Clinics of Los Angeles, James Murrough, M.D., of Mount Sinai and Sam Wilkinson, M.D., of Yale, Steve Levine, M.D., of Actify Neurotherapies, Carl Bonnett, M.D., of Klarisana in San Antonio who has been working with veterans for years treating depression, PTSD and pain; Rupert McShane, M.D., whom I met at KRIYA and Oxford, Raquel Bennett, Ph.D., the founder of KRIYA Institute and the KRIYA Conference, and Jason Wallach, Ph.D, of University of the Sciences, a brilliant synthetic chemist and expert on the pharmacology of ketamine and related novel NMDAR antagonists.

Dr. Mandel’s opening address caught everyone’s attention when he opened with statistics about suicide. He reported that 44,000 people die by suicide each year, and 25 times that number attempt to end their lives. There are more suicides among physicians than any other profession.

He stressed that there are so many people who need this medicine and not nearly enough doctors providing it — if for no other need than to help prevent suicide. But of course, we shouldn’t stop there.

He also pointed out that in his practice, he’s seeing more and more patients who have a delayed response, just as we see at Innovative Psychiatry.

Because of this, it’s so important that if you don’t feel better after your series of infusions, that you must not give up. You may be a late responder and we’re learning more about this all the time.

Extensive Research That Began During Residency

James Murrough, M.D., Ph.D., was next and he talked through the history of ketamine’s research for treating psychiatric disorders. He spoke of Carlos Zarate’s work in 2010 which was the first study in patients with treatment-resistant bipolar disorder.

He got involved in ketamine research as a resident in a study of 47 patients led by Sanjay Mathew, MD who, with Zarate, co-authored the book Ketamine for Treatment-Resistant Depression. It was a difficult study, and ketamine treatment was surrounded by skepticism at the time. (For some people, it still is.) But it was the largest number of patients studied clinically at that point.

Dr. Murrough did a beautiful, comprehensive review of the clinical literature on ketamine’s effectiveness. He and his team published a study in 2015 that demonstrated that ketamine’s effect is rapid and robust.

Then, studies accumulated that showed ketamine’s effect lasts longer when given in a series. (Which is why we give a series of 6 – 9 at Innovative Psychiatry.)

Groundbreaking studies…over and over and over.

Steven Levine, M.D., talked about what he’s learned through 30,000 ketamine infusions with 3000 patients over the past several years.

And he made the point that stress itself is a risk factor for relapse.

Raquel Bennett, Ph.D.

I don’t have room here to tell you enough about every presentation, but really quickly I want to tell you about Raquel Bennett’s presentation.

Raquel Bennett, Ph.D., spoke about the varied ways ketamine is used in psychotherapy and the importance of selecting patients appropriately for each type of treatment.

She also chaired a panel discussion with Eli Kolp, M.D., Robert Grant, M.D., and Jeff Becker, M.D., about their varied therapeutic approaches and their work with ketamine in psychotherapy.

Sandhya Prashad, M.D., spoke about the hallucinogenic potential of ketamine. While many physicians have been reluctant to delve into this aspect of ketamine, the dissociative symptoms patient experience are key to their improvement.

This wonderful gathering included research scientists, clinical researchers, full-practice physicians, and psychologists who explained their own discoveries for us to assimilate.

So many luminaries, so little time…

Rupert McShane, M.D.

Sam Wilkinson, M.D., explained the challenges of research and reviewed key studies. Rupert McShane, M.D, presented data on oral ketamine and abuse concerns. I first met Rupert at the KRIYA conference and he encouraged me to attend the Oxford International Conference on Ketamine for Psychiatric Disorders 2018 conference last March. He chaired the Oxford event, which was spectacular. He’s been generous with his mentorship in so many ways. Such a lovely man.

Rachel Dalthorpe, M.D., talked about hormonal factors in ketamine infusion treatment. She referred specifically to premenopausal women and proposed an ideal time during the menstrual cycle for scheduling follow up infusions. Such valuable information.

I was delighted to see so many of the luminaries there who have previously spoken at Kriya… like Jason Wallach, Jeff Becker, and Steve Levine … and from the Oxford Conference like Rupert McShane and Jenny Southgate … Such friends … and such a hall of fame!

Benjamin Keizer, Ph.D., talked about pain and the impact it has on the brain. Jennifer Southgate, Ph.D., spoke about her work with urothelium and bladder inflammation, and how ketamine can affect the bladder.

Ronald Hertz, M.D., explained his important work on the use of ketamine for treating severe and chronic pain…and CRPS. Randall Malchow, M.D., talked about his own studies treating pain. Jason Wallach, Ph.D., spoke on the pharmacodynamics of ketamine, expounding on the history of derivatives of PCP. He also discussed the difference between r-ketamine and s-ketamine. He is brilliant, engaging and makes chemistry fascinating.

Ketamine Advocacy Network Helps Physicians and Patients Alike

Finally, Dennis Hartman, who founded the Ketamine Advocacy Network, spoke about the extreme importance of patient advocacy. I was delighted to meet Kim Juroviesky. Kim hosts a Facebook group for ketamine patients, which is growing fast and helping so many.

The entire two days was chock-full of data, expert opinions and suggestions regarding clinical use of ketamine.

What an inauguration! Ketamine treatment is growing rapidly in use and in its positive effects. The more we can learn, the better able we are to effectively treat more patients with bright outcomes.

At Innovative Psychiatry, we administer ketamine and other treatments for treatment-resistant mood disorders. And we align our methods with best practices to help you achieve the most favorable outcome.

If you suffer from severe depression, social anxiety, bipolar disorder, PTSD, OCD, substance abuse disorder, and suicidal thinking, please call us.

And know that you don’t have to suffer with your symptoms. Let us help you find the life you want to live, and discover the best you, you can be.

To the reinvigorating of your best self,

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October 1, 2018
Dissociation: Is It Key to Ketamine’s Antidepressant Response?

That Floating Sensation May Predict Ketamine’s Healing At Work

Know anyone who’s depressed?

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

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

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

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

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

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

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

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

AMPA Gives You Power to Adapt and Develop Flexibility

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

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

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

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

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

Ketamine’s Antidepressant Response

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

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

Ketamine is a molecule that modulates the excitatory neurotransmitter glutamate.

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

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

You see where I’m going.

Care in Ketamine Administration Yields Better Results for You

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

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

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

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

Dissociation…and Ketamine’s Antidepressant Response

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

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

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

The Study:

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

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

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

And guess what?

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

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

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

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

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

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

Understanding Your Treatment and Your Healing

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

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

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

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

Now that’s a sweet spot!

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

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

There really is hope!

We Want You to Enjoy a Rewarding Life

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

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

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

To the reinvigoration of your best self,

Lori Calabrese, MD

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

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

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

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

Prolonged Years Fighting a Mood Disorder – Demoralizing

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

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

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

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

…You Have to Take the First Step

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

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

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

“May I ask your name?”

“James.”

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

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

“Not today you didn’t–you called!”

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

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

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

Why Ketamine Over Esketamine (Still Testing for FDA Approval)

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

Why Ketamine Over Esketamine?

The answer is rather logical.

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

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

This was my response:

“Thanks! Wow–these are great questions!

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

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

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

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

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

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

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

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

“Hmmm…

The More We Learn, The Better It Gets

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

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

“We see this every day in my office.

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

“Calling all neuroscientists!”

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

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

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

Outstanding Outcomes Emerging in Private Practice

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

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

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

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

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

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

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

Find out how much better you can feel.

To the reinvigorating of your best self,

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

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

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

Rapid-acting Antidepressants

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

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

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

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

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

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

They want more.

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

Or so they hope..?

Antidepressants that Work as Well as Ketamine Treatment

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

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

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

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

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

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

Seeking Ketamine Wannabes

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

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

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

How about this?

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

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

Rapid-Acting Antidepressants Help You Get Better Fast

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

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

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

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

Review of Literature Clarifies the Search

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

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

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

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

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

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

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

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

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

Times are changing and suffering is declining.

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

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

To the restoration of your best self,

Lori Calabrese, MD
August 13, 2018
The Truth About Bipolar II Disorder: How To Get Your Life Back

You Can Know if You Suffer From Bipolar II Disorder

and What You and Your Doctor Can Do About It

Clara is a 27-year-old artist whose talent has opened opportunities for her she never dreamed possible. She’s published books of her original poetry and children’s stories she wrote and illustrated herself. She paints watercolors of children playing amid lovely floral backgrounds … and sells them through a local gallery.

Clara’s light-hearted artistry belies her deeply analytical and moody personality. She says she paints the world the way she wishes it was, rather than the way she sees it.

She experiences long periods of sorrow…self-criticism…shame. Then sometimes, out of the blue, she’ll feel more normal again — and she’ll rush around to buy groceries, clean up her place, and have lunch with friends…until that brief “normal” period is replaced by that all-too-familiar sinking feeling again.

Clara was diagnosed with bipolar II disorder. Most of the time she labors under the leaded blanket of bipolar depression…and occasionally she’ll feel better for a few days. Her “hypomanic” periods are really just about what “normal” would be like for someone who wasn’t ill.

She can’t believe this isn’t just depression.

The Good Times Roll…and Then They Plunge…

Then, there’s Ben. He’s 33 and works in the IT department of a large hardware company. He’s been promoted regularly due to his innate ability to problem-solve software “puzzles.” Ben finds that there are periods when he’s particularly astute, and can work long hours relishing in the challenges before him. At these times, he gets by on little sleep — and feels fine with only 4-5 hours a night.

He loves to get with co-workers for a beer after 16 straight hours of fighting a problem together. He buys drinks for everyone, along with appetizers for the team. Then after a few hours of shut-eye, he’s ready to jump back in again.

However, those times come and go.

After a period of almost spectacular productivity, it’s as if someone blew out the candle. He begins to slow down…really slow down…more and more until it’s hard to rub two thoughts together. During these times he feels heavy, sluggish. He manages to go to work, but once there, he feels dull. And he chows down on chips, cookies, cokes, and pasta. Before long, he can no longer button his pants.

It’s so humiliating. His coworkers – the ones he bought rounds of drinks for 2 weeks ago – poke at him. Tease him. They really like him but don’t understand that he’s powerless to be different right now, and the aggressive ribbing just make his shame more intense.

He just wishes he could go to bed and sleep. He feels overwhelmed at his own failure. He’s convicted of his complete worthlessness.

His boss starts pushing, getting annoyed with his poor performance. Ben feels helpless. Powerless. And ashamed. Worthless.

Then, after a few months, just before his boss is about to lay him off, his energy comes back. Suddenly, he’s brilliant again, and in two weeks makes up for all the down time when he was so depressed.

Ben sees a psychiatrist for his condition, but the treatment hasn’t helped. The doctor diagnosed Ben with bipolar II disorder.

No One Understands: Their Lovable Friend Retreats in Pain

Kelsey is 29 and has a job as a lab tech in the community hospital. She’s fast and efficient in her job and loves it. She has a bright and sparkling personality most of the time. Her coworkers love socializing with her outside of work.

They all want to be her best friend.

But sometimes she withdraws…calls in sick for several days…and avoids answering the phone. She thinks she has the flu from all the aching in her back, arms, and legs. And being home in bed is a welcome relief from the pressures and chaos of the office. She needs rest, she tells herself, and she’ll be ok.

After a week of reprieve, she steels herself to face it all again, and is back at work on Monday morning. But she decides to see her doctor when she realizes she’s still not herself a week later.

After a thorough examination, and lots of questions, her family doctor tells her he believes she’s suffering from Major Depressive Disorder (or unipolar depression, as some call it), and prescribes an antidepressant to help her feel better.

The antidepressant is a SNRI (serotonin norepinephrine reuptake inhibitor) and he expects it to relieve the aching she experiences during these “down” times.

It takes a couple of months, but Kelsey does begin to feel better. She wakes up with more and more hope each day… feels less need to withdraw … and the aches and pains subside. Finally.

The Solution Becomes the Problem

But then something weird happens. About 5 weeks after beginning the SNRI, Kelsey notices herself talking more at work — and at social gatherings, too.

After she goes home she thinks back and realizes she did most of the talking herself…like a veritable Chatty Cathy. It’s embarrassing… what’s wrong with her? She dominated the entire evening! groan…

But she still has the energy for work again and that’s a great relief.

The next week, she deposits her paycheck, and goes shopping. First she decides on new sheets … then she thinks it would be nice to make all her linens match, so she chooses bright cheerful sheets, pillows, duvet cover, towels, bathmats.

The bag is humongous so she takes it to the car then goes back into the department store.

The store is having a sale, and it’s so exciting that she just happens to be there — what great deals! She spots dishes that match her bed and bath linens, then pots and pans.

On her way out she notices those shoes she’d seen in a haute couture magazine…and buys them! She works hard. This is her special reward.

Oh boy! she says to herself, How beautiful and cheerful my whole apartment will be with everything matching. She pulls out her debit card and pays for a full set of dishes complete with matching serving bowls and the matching set of cookware.

The clerk suggests she bring her car to the door so they can help her load it all up.

After loading, she calls a friend to meet her for lunch at the nearby Italian bistro, and off she goes feeling exhilarated.

Following a yummy lunch with her friend and lots of lively chatter, the waiter brings the check. Kelsey pulls out her debit card and offers it to the waiter. In short order the waiter returns.

“Ma’am, this card was declined… do you have another we can try?”

OH NO. In Kelsey’s enthusiasm, she didn’t think to subtract her purchases from her balance. She had spent her entire paycheck without even noticing.

She asks her friend to cover lunch with promises she would pay her right back. What choice did her friend have…? Kelsey knew her friend wouldn’t look at her the same way again. She was devastated…confused… her face flushed and she tried to hide it.

She also knew she should probably return all the stuff she bought. But she just didn’t want to.

What happened…?

Bipolar II Disorder Can Hide For Awhile

Sometimes, a person who’s diagnosed with unipolar depression can take an antidepressant … and manic symptoms emerge.

Kelsey’s relief from depression and physical pain led to a phenomenon that sometimes happens with persons who are depressed and take antidepressants.

Kelsey actually suffers from bipolar disorder, but was mistakenly diagnosed with unipolar depression and treated with an antidepressant because she had not had a manic episode at that point.

The antidepressant either triggered hypomania in Kelsey… or… this was her first hypomanic episode.

Either way, she unwittingly plunged into a crisis.

Bipolar III?

Many doctors call this Bipolar 3 Disorder, which isn’t a real diagnostic term…but more a nickname for the condition when someone with depression who’s never exhibited bipolar symptoms suddenly does upon beginning an antidepressant.

If you’re old enough, you may remember the popular talk show host, Jane Pauley from the Today Show. This was her experience. And in a televised interview, she referred to her condition as “bipolar III.”

Aside from labels, Kelsey needs to be watched carefully by her doctor who’ll cautiously treat the symptoms as they present themselves, evaluating her condition going forward. But that’s another article for another day.

Treatment for all the variations of mood disorders doesn’t line up in black and white categories, but in combinations and shades of gray and it’s important to find the one that best helps you personally.

Bipolar Disorder is a Spectrum Disorder

So, we’ve mentioned three people who share a bipolar diagnosis, but whose symptoms are not that much alike. The point is that bipolar disorder is a spectrum disorder and its diagnosis relies on the patient’s – and their family’s – observations and descriptions of symptoms.

When you suffer from bipolar I, the upswing symptoms tend to be more severe … harder to ignore…and the diagnosis is less difficult.

The distractibility is clear, the recklessness and impulsivity are OBVIOUS, the high energy and lack of sleep and grandiosity can slip quickly down a slippery slope. It’s mania through and through, and it can dig you into a hole, fast.

But bipolar II is more complicated to diagnose because your symptoms land in a variety of places on a symptom spectrum. And sometimes even the symptoms you expect to see aren’t really there… yet. And may never be.

The better you understand your symptoms and recognize them, the more you and your family can help your doctor arrive at the correct diagnosis and the best treatment for you.

How to Understand a Spectrum Disorder

In his book, Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder, Jim Phelps stresses the importance of gauging symptoms on a continuum, rather than checking them off an arbitrary list.

Because we’re human, and everyone has a little of something that can be a symptom in someone else.

You may know someone who has milder insomnia but somewhat pressured speech and …severe irritability. They tell you they have bipolar disorder. So you think that’s what bipolar looks like.

In your case, you may feel confident and clever at times, even at times engaging everyone at a dinner party. Still, behind closed doors you have periods of extreme agitation and impulsivity. Or maybe risky behaviors like spending sprees, speeding, or intense sexual behavior that isn’t your norm…?

It’s tempting to say things like, “Maria doesn’t have bipolar disorder. It must be something else causing her problems. Because my daughter has bipolar disorder, and Maria and my daughter don’t act the same way at all!”

Each Person is Unique – So Psychiatric Disorders Are Unique in Each Person

But the fact is that there aren’t absolutes, but rather varying degrees of various symptoms that interfere with a productive and fulfilling life. And that’s why we seek to treat these symptoms…because they interfere with your life and the way you want to live it.

At Innovative Psychiatry, we see people with bipolar disorder in all its varieties every day. And we work with you to help you feel better. Not to just improve, but to feel so much better you can finally live and enjoy the things that are important to you. You can build and strengthen your relationships. You can focus again to read what you want to read and do things you enjoy. And you can show up when and where you’re needed.

And if you’ve tried other treatments for your bipolar diagnosis that haven’t helped much at all, don’t give up. Chances are that ketamine treatment may be just what you need to feel balanced, motivated, and able to relax and enjoy the moments of your life.

The beauty of it in bipolar disorder is that it lifts depressive episodes quickly — so you can avoid the risks of switching into hypomania or mania that come with using an antidepressant for weeks … or months.

That is so worth it.

The Concept of Spectrum Disorders

We encourage you to read Dr. Phelps’ book to gain insights about your own condition. And some of my blogs. Try to understand the concept of a spectrum illness. Ask your doctor. Get a second opinion.

And if you’d like to see what life is like without phobias, panic attacks, social anxiety, bipolar depression, PTSD, OCD, and… worst of all… those thoughts of death and suicide, call us.

Because every person is different, and responds to medicines differently than every one else, there are no absolute guarantees. But given our success rate, chances are ketamine treatment can turn your life into one you enjoy living.

To the emerging of your best self,

Lori Calabrese, MD

July 23, 2018
Ketamine Treatment Enhances Creativity – Lori Calabrese, M.D.

Psychiatric Disorders and Creativity: Is there a link?

Think about it. Vincent Van Gogh. Virginia Woolf. Michelangelo. Beethoven. Robin Williams. Ernest Hemingway. Carrie Fisher. Anthony Bourdain.

Creative Genius.

There are hundreds, probably thousands more, who fit right in with this good company. Maybe you do, too.

Take John Nash, the Nobel prize-winning mathematician whose story is told in A Beautiful Mind.

Hallucinations, delusions, severe depression, fear, phobias, suicide… Psychiatric symptoms are all too familiar. But how often are they accompanied by creative thought, astounding accomplishments, and indescribable beauty…?

The simple answer to that question is probably more often than you think.

So what IS the connection between psychiatric disorders and creativity? Is there a link…?

A meta analysis by Christa L. Taylor, published in Perspectives of Psychological Science September 21, 2017, shows that researchers have used psychological tests, population surveys, and genetics to examine creativity in psychiatric illness, and vice versa. They’ve found measurably higher rates of creativity in people with bipolar disorder, as well as more cases of bipolar disorder in creative people.

Clearly, for every celebrity who’s been diagnosed with a psychiatric illness there are probably dozens who are pretty healthy and stable. (Although some would say that’s a bit hard to believe about Hollywood…!)

But doesn’t it appear so often that the really brilliant ones, spectacular performers in the arts, the math and sciences…seem to battle complicated symptoms …?

When you consider that the links researchers have found in visual arts, performing arts, politics, business, religion, literature, music, and science translate to exceptional people all around you in school, work, and everywhere in between, it’s worth another look.

Still, researchers have often found these connections in individuals with milder forms of bipolar disorder, such as bipolar II and cyclothymia. Their assumption was that the extreme mania of severe bipolar I disorder would interfere with creative thought.

On the other hand, we can’t ignore the great achievements of Beethoven, Winston Churchill, Abraham Lincoln, John Nash, Brian Wilson, Kurt Cobain, who all experienced severe forms of their disorders.

So here’s what’s interesting…

Psychiatric Disorders and Creativity: Clues in Your Genes

Bipolar disorder and schizophrenia actually share genetic origins with creativity. Interestingly enough, there are some symptoms of schizophrenia that are conducive to creative work. Isn’t that a surprise…?

So when someone has psychotic symptoms ….and is afraid to take medication to manage symptoms… you can sort of see where they’re coming from. But, it doesn’t mean we have to take an all-or-nothing perspective.

Burns Woodward, MD, in his article, Creativity and Psychiatric Illness: Finding the Sweet Spot, makes the point that if people who suffer with psychiatric disorders fear treatment because they don’t want to lose their creative thought, it’s important we listen to their perspective.

By listening, and collaborating in working with them, you can support their concerns and still encourage them to participate in a treatment plan that helps them function better and avoid hospitalization.

This is also good advice for families.

When families dig their heels in, convinced their loved one can’t make good decisions for themselves, the resistance on both ends of that battle usually leads to noncompliance.

But when the family finds a way to build harmony with their loved one’s concerns, treatment becomes a possibility. Their loved one can grow closer to cooperating with a treatment plan.

The Case of John Nash

Woodward also makes the point that in the case of John Nash, his fear of loss of creative thought led him to refuse medication. You can only wish he had had the chance to receive IV ketamine for depression. Ketamine treatment enhances creativity and it might have helped his courage with his antipsychotic medicines.

You see, it was only after he had received the Nobel Prize that he began $Psychiatric disorders and creativity seem to be linked, and sufferers worry that treatment will quell their creative thought.$ developing symptoms of schizophrenia.

His distracting delusions and hallucinations prevented him from the intense focus necessary to do more significant work until after he’d been hospitalized a third time. He finally agreed to medication to manage his symptoms. And you know what? John created his only noteworthy mathematical work while he was taking that medication.

True.

But What if Medication Doesn’t Help?

There are currently medications that help some people who suffer from every form of psychiatric disorder. Be it depression, social anxiety, panic disorder, bipolar disorder, PTSD, OCD, schizophrenia, eating disorders…

But there are so many who receive no relief whatsoever from these medications. And those are the ones we focus on at Innovative Psychiatry.

You are someone we want to help.

Innovative Psychiatry dedicates focus and resources to help you experience relief and hope if you suffer from treatment-resistant psychiatric symptoms.

Ketamine Treatment Enhances Creativity

I can tell you straight up that if you do, ketamine treatment doesn’t work for everyone. It just doesn’t, and we don’t know why at this point. We know every brain is different, just like every face is different. Your brain is uniquely yours.

But what I can say is that we’ve seen extraordinary outcomes in the majority of patients we treat. Ketamine treatment is more effective in more cases than any other medicine in our lifetime.

In the case of schizophrenia and schizoaffective disorder, ketamine is not the treatment of choice.

And yet, studies have found it to be very helpful in stopping suicidal thinking and relieving depression in patients with these disorders. Aziz Walid and his team published a case study in the Journal of Addiction Research and Therapy which demonstrated this.

So let’s talk about psychiatric disorders and creativity. If you’re afraid of medicating the disorder you live with because you’re afraid of losing your creative edge, be encouraged. Ketamine brings creativity back to life.

Ketamine treatment enhances creativity.

This is not an old-fashioned antidepressant that dampens your feelings, your emotions, or your creative thought.

Rather it renews, rejuvenates, and replenishes your creative pathways and signaling systems so you can think more, not less. Create new beauty, new prose, new ideas, and feel truly alive again.

So How Hard Is It To Find Ketamine??

Ok, so don’t get me wrong. Ketamine isn’t something you can pick up at the pharmacy. It’s a powerful medicine that should only be administered by a psychiatrist if it’s used to treat a psychiatric disorder.

What’s more, there are countless doctors providing it who really aren’t qualified to do so.

What Difference Does It Make…?

Because ketamine as an anesthetic is a medicine for anesthesiologists to administer to patients for anesthesia or for pain control.

But ketamine as a psychiatric treatment should be provided by seasoned psychiatrists deeply experienced in treating life-threatening psychiatric disorders as well as suicidal inclinations.

Psychiatrists equipped to provide ketamine are still rare. This treatment is best administered by an expert psychiatrist deeply skilled and experienced in treating psychiatric disorders with IV ketamine treatment. And here’s why.

Ketamine for psychiatric disorders is a treatment of delicate brain systems and should be infused with precision and insight physicians of other specialties don’t possess.

Skilled psychopharmacology as well as insight for personalized dose and rate of infusion are vital skills necessary in psychiatrists who provide ketamine treatment.

Physicians from other specialties lack the training to accomplish this well. Sometimes they’re impatient. Outside of their scope of practice. Unsure about coordinating psychiatric care. Or they’re so familiar with the drug itself that they don’t think they need sophisticated equipment to administer it.

A psychiatrist providing ketamine for various psychiatric disorders should utilize a precise infusion pump and monitoring equipment to ensure the most thorough and effective treatment experience.

At Innovative Psychiatry, we’re expressly equipped and proficient to provide you with treatment for your symptoms that other medications and treatments have failed to relieve.

We see a remarkably high remission rate among people who’ve come to believe that their symptoms are treatment-resistant.

If you’ve tried medications for your disorder that haven’t helped, and you’re afraid to try more medication — or sick of their side effects — we can help. Call us and let us help you find the creativity, initiative, motivation, and enjoyment you’ve been missing. Let us help you find the real you that’s been hidden for so long.

To the resurrection of your best self,

Lori Calabrese, M.D.

July 2, 2018
Outrageous Behavior: Mood or Personality??

Outrageous Behavior: Mood or Personality Disorder?

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

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

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

Hmmmm…

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

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

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

Outrageous Behavior: Mood or Personality…?

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

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

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

Scammer? …or maybe bipolar disorder..?

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

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

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

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

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

Is She Hysterical or Just Seeking Attention…?.

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

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

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

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

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

Unbelievable.

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

You Can Love Them… But Do Get Them Help

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

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

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

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

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

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

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

Outrageous Behavior – Mood or Personality?

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

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

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

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

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

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

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

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

Miss Jekyll or Mrs. Hyde…

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

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

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

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

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

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

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

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

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

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

What happened…?

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

But this is scary.

What do you do??

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

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

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

People with borderline personality disorder can sometimes appear like this.

Even people with substance abuse disorders can show these symptoms.

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

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

You’re not alone.

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

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

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

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

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

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

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

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

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

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

To the release of your best self,

Lori Calabrese, M.D.

April 30, 2018
21st Century Psychiatry: Neuroscience Discoveries Fight Stigma

Stigma: A Mark of Disgrace Based On Belief in Certain Assumptions That Have No Factual Basis

“He’s not depressed…he just needs to get up and get busy.”

“PTSD is just a fancy name for weakness. Get over it!!”

“Bipolar disorder? What an excuse for bad behavior! Get some discipline in your life and you’ll be fine.”

Sound familiar?

Comments like these are insulting, stigmatizing, and prejudicial. They hurt. And they have no basis in fact.

In this day and age, there is no excuse for them.

These are just some examples of the stigma expressed in hurtful words that serve to fuel shame in people who have depression, bipolar disorder, a trauma history, or who struggle with substance abuse.

Why Are Psychiatric Diagnoses So Hard for Some People to Accept?

Do you ever hear someone say, “Diabetes… ridiculous. Work harder and you won’t have trouble with blood sugar. I work hard and I don’t have diabetes!”

Or…

“Cardiovascular my foot! You’re fine. Get back to work.”

Probably not. Why is that?

Because there is no real stigma attached to malfunctions in the heart or the terrible sudden dysfunction in the pancreas of a child who develops Type I diabetes.

The more science learns about the human body, and its ailments, the more credibility those ailments have.

Why The Brain is Such a Target of Stigma

Except for one part of the body…. And that’s the brain.

Since ancient times, the intricate and complex functions of the brain have been steeped in mystery and wrapped in tales of fear, sorcery, and voodoo. All of this has contributed to the stigma that has hovered over people with psychiatric illnesses like a dark cloud of shame.

As recently as decades ago, patients admitted to psychiatric hospitals for behaviors their families didn’t understand were heavily drugged and incapacitated.

There is a population of individuals today who still stand by the opinions that reigned at that time…and they’re still influencing younger family members and friends with those erroneous views.

Stigma-busting Research

If you’ve faced stigma about your psychiatric symptoms from family, friends, or your job, we have some encouraging news for you. We both know that the expression of stigma is simply a sign of ignorance. Lack of up-to-date information underscores old and outdated beliefs. The best defense against stigma we see about psychiatric disorders is information — scientific information.

A recent study shows we can use a blood test to distinguish biomarkers in bipolar disorder that are different from those in schizophrenia. Investigators have also developed a blood test that could help doctors more quickly diagnose schizophrenia and other disorders.

This one detects certain types of inflammation and oxidative stress. Another test can differentiate 20 metabolites found in urine that distinguish schizophrenia and bipolar disorder.

Tests like these are building a foundation of what we would call biological proof for various psychiatric disorders — proof that they’re real, that there are underlying genetics for many and pathophysiology — how things go wrong — that is being worked out and understood in labs and universities and clinics around the world.

These are exciting times!

Neuroscience discoveries fight stigma .. .And the more we talk openly about the data points, the sooner we can dispose of the stigma.

HOPEFULLY.

If you know me, you know I abhor the term “mental illness” — a term that subtly suggests that psychiatric disorders are somehow different — maybe even less valid — compared to so-called “physical illness.”

This is just another way of perpetuating the myth… and the stigma… that psychiatric illness has less credibility.

The fact is, psychiatric disorders are just as physical as pancreatic disorders, or pulmonary disorders, or gastrointestinal. They’re just a lot more complex to see.

The brain is the most intricate, “multi-media” operating system in the human body. It is absolutely the “last frontier” in medicine. And it has as much credibility as any other body system…and is as real as Saturn or Jupiter…two planets we can see but can not yet touch.

And if you’ve suffered from severe psychiatric symptoms, you KNOW how terribly real and concrete they really are. Because psychiatric disorders can encompass your whole body.

Neuroscience Discoveries Fight Stigma

So here’s another piece of scientific discovery that rips yet more of the stigma-fied rug out from under uninformed individuals who make hurtful and ignorant comments.

Millions of people are living today who remember when psychiatric disorders were blamed on poor parenting or even demon-possession. Thankfully, we’ve made light years of progress since then through the dedicated work of neuroscience.

In a commentary on many studies, published February 2018 in Biological Psychiatry, the authors explained discoveries made by researchers about micro RNA (miRNA) and how it plays a role in either improving or exacerbating symptoms of psychiatric illness.

One finding showed that a certain type of miRNA could be found in tumors; another type was found throughout the body serving a variety of purposes.

miRNA-9 is found most abundantly in the brain, while miRNA-21 is abundant in a variety of tissues in the body. miRNAs can regulate a multitude of genes throughout the body.

And certain miRNAs regulate processes in the brain, like synapses and the replenishing of brain cells, or neurons. They estimate that 60% of all genes are regulated by at least one miRNA …and sometimes by many.

Tight and Multi-layered Gene Control

When multiple miRNAs regulate the same gene, it allows for regulation of many layers of processes and tight control of the protein “expression” of these genes. Genetic expression basically involves turning on the protein or RNA that the DNA creates to fulfill that gene’s blueprint.

This is how genes “express” themselves in the organism they are designed for. When something goes wrong in that process, it can lead to illness. In fact, improper expression of genes has been linked to pretty much every kind of illness or disorder across most of the body’s systems, such as cardiovascular, autoimmune, infectious, neurodegenerative, and psychiatric disorders.

So in the study of miRNA, researchers discovered that miR-137 regulates the maturing and differentiation of neurons, which has an impact on cognition and the physiology of the brain.

How about that?

miRNA and Neurogenesis

Another miRNA, miR-16 hinders the development and growth of neurons. Fluoxetine, an antidepressant, seems to decrease that hindering function, allowing more neurons to grow and thereby decrease depression.

Also, it seems to suggest that antidepressants that hinder or block the function of miR-16 increase growth of neurons in the hippocampus. Another plus!

And if fluoxetine can decrease those miRNA hindering functions, how much more so could IV ketamine treatment …right?

Neuroscience Discoveries Fight Stigma…

Well-meaning (but uninformed) adults in the ’60’s, ’70’s, and 80’s used to say “if mental illness is real, show me…where is it? Take a picture and show me!” These comments were even made by people in medicine. Shameful, really.

Stigma is such a terrible thing.

Well, the pictures are emerging. Concrete evidence is spreading.

And if you suffer with psychiatric symptoms…you don’t have to listen to those heartless comments anymore. There is a wealth of documented science that’s growing every day, every month, and every year.

Neuroscience Discoveries

I hear the things people say to my patients that cause deep hurt … that promote shame … that silence good hearts, and I’m struck by their courage to keep going. To fight stigma. To get well.

So, another point or two about miRNAs.

Various alterations, like the one accomplished by miRNAs to block the work of miR-16, have been linked to a number of psychiatric disorders. Researchers found this link in blood, postmortem brain tissue, and cerebral spinal fluid.

… And Another Discovery

Also, researchers have found that miR-132 is altered in the brain tissue of subjects in cases of schizophrenia and autism, and in the blood serum of subjects with major depressive disorder…as well as in animal models of depression and addiction.

Researchers think this may be due, in part at least, to the alteration of miR-132. Researchers suggest that this happens because of the role miRNA play in circadian rhythm or brain-derived-neurotrophic-factor (BDNF). We know (and love) BDNF. This protein has a clear role in mood regulation, cognition, and the growth of neurons.

Neuroscience Discoveries Fight Stigma

One last thought. This increasing knowledge about miRNA and how it can shape the causative factors of psychiatric disorders lays another row of bricks in the foundation of our understanding of the causes of different psychiatric conditions, and opens up new directions to improve treatment.

In addition, it’s further documentation that there are real cellular, biologic processes behind our diagnoses. And our treatments.

If stigma has intimidated you, take heart.

Neuroscience has your back.

Innovative Psychiatry Offers Advanced Treatment

And so do we. We see all forms of psychiatric illness here, and we work hard to find more effective ways to help you heal. At Innovative Psychiatry, we offer the most advanced and effective novel treatment options, like IV ketamine treatment and transcranial magnetic stimulation (TMS), along with medications, adjunctive help with nutrients like curcumin, and strategies to strengthen your microbiome.

To date, IV ketamine treatment rises above all other forms of treatment for many individuals who’ve been failed by traditional treatment.

If you suffer from depression, anxiety, cocaine or alcohol use disorders, PTSD, OCD, bipolar disorder, or suicidal thinking… and have not been helped by medications, call us. We’ll work together to determine the best treatment to help you live a productive, joy-filled life again. Build relationships again. Enjoy your favorite interests again.

To the restoration of your best self,

Lori Calabrese, M.D.

April 22, 2018
Functional Brain Connectivity: Vulnerability and Resilience in Siblings with Bipolar Disorder

Do You Wonder about Your Family?

Connor’s mom was diagnosed with bipolar disorder before Connor was born. He’s now an adult who was diagnosed with Bipolar I Disorder ten years ago. He has a brother and a sister, both grown, also. But his sibs, Todd and Della, have never experienced psychiatric symptoms, and feel healthy, balanced, and able to cope with the challenges of life. They don’t really understand why Connor has so many struggles.

(Healthy siblings often don’t.)

Sadie’s dad has Bipolar II Disorder and Sadie was diagnosed with Bipolar II during her second year of college. Her three brothers, James, Tim, and Hal, don’t experience symptoms of bipolar disorder … but they each have other things going on. James has been melancholy throughout his life, Tim has OCD (but refuses to deal with it), and Hal eventually was diagnosed with PTSD after a deployment in Iraq.

What’s going on in these two families?

Functional Brain Connectivity Affects Vulnerability and Resilience to Bipolar Disorder

Why is every child in one family plagued by brain dysfunctions that result in psychiatric disorders, while the other family has only one child with a psychiatric illness?

First of all, we don’t understand yet the full answer to that question. But as a result of extensive studies, neuroscientists understand more than they used to.

We’ve talked before about genetic markers and traumatic experiences.

But something else has emerged to give us more insight. The default mode network was discovered several years ago.

Learning about it helps us understand how neurons in the brain are connected.

Functional Brain Connectivity in the Default Mode Network (DMN)

So first, let’s talk about the default mode network (DMN). The DMN is a network of neurons that connect brain regions that are necessary for bringing up information about yourself and how you felt in certain experiences in the past, thinking about others with empathy, judging someone’s attitude, remembering the past and thinking about the future … all these skills depend on the default mode network.

When you focus on a task, whether it be writing a report, balancing your checkbook, or changing a tire, the DMN becomes quiet or de-activated.

That’s because your attention, concentration and focus is right there, right in the moment, honed in. And the DMN quiets to allow you to do your thing.

When that highly-focused task completes, the DMN activates again.

It’s at its peak when you’re wakefully resting. Not when you’re asleep.

Let’s say you’re “sittin’ on the dock of the bay, watching the tide roll away…”. In times like this, your DMN is in full throttle. Organizing, sorting memories, rebuilding the connections (synapses) while you’re daydreaming. Or while you’re meditating.

It’s a beautiful thing.

That is, if you’re brain is healthy.

Impaired Connections Play a Role in Bipolar Symptoms

Researchers know that in bipolar disorder connections like these don’t work properly. Sometimes the connections break down and don’t work at all.

Bipolar disorder and other psychiatric disorders affect the connectivity of some important networks, such as the default mode network, the sensorimotor network, and the central executive network.

When there’s an imbalance between the functions of the default mode network and the sensory motor network, the result is … chaos … and disconnect.

And the chaos that ensues really mirrors the chaos that happens in bipolar disorder. What happens on a brain level can be expressed in your real life. In a very direct way. It’s almost palpable.

Bipolar’s genetic link creates another piece in the puzzle. But researchers still work to understand the bridge from the genetic link to bipolar symptoms. We do know that siblings of a person with bipolar disorder are ten times more likely to also develop bipolar symptoms than someone who has no relatives with this disorder.

And yet, in spite of that statistic, a large number of relatives continue to be healthy and unaffected.

So why are some sibs able to “avoid” developing a disorder like bipolar, and others aren’t?

What Makes the Difference?

A team of researchers at the Icahn School of Medicine Mt.Sinai NY set out to learn more. They worked with a group of 78 people with bipolar disorder diagnoses. The team screened these participants to ensure they had not experienced an episode of mania or depression in 3 months. Then, they recruited 64 of their siblings — BUT ensured these siblings had NOT experienced bipolar symptoms. Finally, they added 41 healthy volunteers with no psychiatric disorders as a control group.

Using functional MRI scans, they collected data of the functional brain connectivity of bipolar patients, their unaffected siblings, and healthy volunteers to compare. They took the fMRIs during the resting state, when subjects were awake but not focusing on anything in particular. They wanted to first look at what the brain was doing when these folks were “sittin’ on the dock of the bay…”

Some aspects of brain region connectivity remained the same in all three groups. But they found changes in the default mode and sensorimotor networks. In bipolar disorder, the sensorimotor network doesn’t work smoothly. But rather it disrupts the processing of sensorimotor information in the brain. And creates chaos.

The authors of this study pointed out that recent studies have revealed reduced motor coordination, sensory integration, and selective attention in both bipolar patients and their unaffected siblings.

Increased Motor Impulsiveness with Impaired Functional Brain Connectivity

And in this current study, increased motor impulsiveness was associated with those who were diagnosed with bipolar disorder, as well as their siblings.

To simplify, the study demonstrates the cause of the kind of reduced GABAergic and glutamatergic receptors that coroners see in autopsies of people with bipolar disorder. The impaired neuroplasticity that results from the dysfunction of the DMN and sensorimotor network probably bears responsibility.

In other words, the broken down connections in these important networks in the brain may help explain the chaos of symptoms in bipolar disorder.

And, the study also confirmed the connection between default mode connectivity and resilience…or in this case, the ability to of the brain in certain individuals to NOT develop bipolar disorder.

Great Connectivity in the Default Mode Network = Resilience

So the better the connectivity in the default mode network, it appears, the more resilience that individual has, even if he’s related to someone with bipolar disorder.

And that introduces new ideas for developing novel ways of preventing bipolar disorder, or at least changing its course.

And both the default mode network as well as the sensorimotor network could possibly be made stronger and more resilient through interventions that enhance plasticity in those networks.

So that’s the lesson we learned from siblings who haven’t been affected by bipolar disorder. We learned that the adaptations that occur in some sibling brains perhaps could be explored and used to protect all relatives from this illness. And hopefully in the process, a similar method protects everyone from this disruptive and cruel illness.

Neuroplasticity. You’re going to be hearing a lot about it. You’re going to want it for yourself and your family.

Hope for the Future…and Hope for Now

There’s hope for the future to wipe out the suffering caused by bipolar disorder, PTSD, anxiety and thoughts about suicide.

But for now, we don’t have those developments. We’ve only just begun.

However, we STILL have hope. Hope for feeling better, being better, living better. And that’s through treatment that leaves others in the dust. In the years I’ve been in practice, I’ve treated patients with just about every conceivable psychiatric disorder, and have prescribed medications that target a kaleidoscope of symptoms. I still do.

But the most robust and extraordinary tool I’ve found for helping people to recover, build lives and relationships, and experience the joys of life, is IV ketamine treatment. Administered with the utmost care and precision to enhance it’s best effect on the delicate systems of the brain, I’ve been privileged – sometimes joyfully overwhelmed – at the numbers of people who have enjoyed real remission, joy, and relief.

If you’ve been dragging a severe psychiatric mood disorder around with you without real and lasting relief, call us.

Disorders like depression, general anxiety, social anxiety, PTSD, OCD, bipolar disorder and suicidal thoughts can be relieved…and quickly. This isn’t like those antidepressants that take weeks or months for you to feel the benefits.

We specialize in treatment-resistant psychiatric disorders. There aren’t many that ketamine treatment doesn’t conquer. We often say that ketamine treatment isn’t for everyone. And it’s not. But more than likely it could change your life for the better. Let’s find out.

To the blooming of your best self,

Lori Calabrese, M.D.

April 16, 2018
How Stress Takes Down the Best People…and What To Do About It

Heather was 38, and had had a series of extreme stressors over a period of several years. She was a giver at heart, always looking for ways to help — always trying to make the lives of people she knew easier or more fun.

But then her husband left her. It was the same old, tired story — an affair with her closest and dearest friend. But still … she was left with two enormous losses, and a crippling sense of betrayal about both of them.

She tried to function for the sake her of two children, Katie and Noah. One foot in front of the other. One day at a time.

Another Devastating Crisis

Three years later, Noah was hit by a school bus and rushed to the hospital. He had a concussion and his pelvis and femur were broken in so many places they gave her minimal hope he’d walk again. Weeks in the hospital, then months of rehab. Asking neighbors and family members to pick her daughter up at school, get her to piano lessons, grab dinner.

She was exhausted. And Noah was beginning to walk with a walker and just starting back to school when she got a phone call from her mother.

Another Overwhelming Tragedy

Her dad had died when she was 25 and her mom lived alone. Mom just found out she had an aggressive form of breast cancer. She’d been told to expect a year minimum of treatment then re-evaluation. But when her mom got so tired she couldn’t drive back and forth to chemo, there was nothing to do but have her mom stay with her. She’d probably be there through radiation, too. Heather asked her mom’s neighbors to look in on her house.

So a household of three greatly stressed people became a household of four extremely stressed people. Heather just held her chin up and set out to get through this, too. The idea of losing her mom when she was so young was terrifying.

She cooked, cleaned, ran the kids around. Made dinner. Went to work. Drove her mom to chemo. Did everything.

Stress Takes Down the Best People

Finally, 6 months later, her mom had to be admitted to the hospital. Her next door neighbor offered to take care of Katie and Noah for a few days. Thank goodness. But then … Heather didn’t get out of bed or out of her pj’s for three days … and she felt less and less like getting out of bed after that. She went through the motions of getting her kids to school and back home again … and feeding them when they were hungry. But she was numb. She was barely functioning.

Finally, darkness wrapped around her like a cold box, and she felt hollow. Numb. Adrift.

Someone from the church came to see her. When they saw how she looked, they could see she’d been through too much for too long. They went to work to take over the care of her mom, and took her to the hospital. Heather was admitted with severe Major Depressive Disorder.

Heather’s a giving, kind, and generous person. But chronic and repeating stress can take down the best people, and Heather was no exception. It brought her to her knees.

How Stress Brings Someone Like Heather to Her Knees

We’ve talked and talked about what stress does to your brain, and how it contributes to depression.

But let’s talk about why that happens.

Thanks to recent studies sponsored by Brain and Behavior Research Foundation, we’ve learned some things lately.

And I’m excited to share them with you.

It all makes so much sense when you get a peek inside the brain to see what happens.

MIcroglia Unwittingly Launch a Destructive Attack

There are immune cells in the brain, called microglia, that are responsible for defending against infection, among other things. One of the other things they do is help build and change the construction of neural connections in the brain.

Huge. And hugely important.

In this study, the research team, led by Ronald S. Duman, periodically caused laboratory mice to undergo stress-inducing conditions over a period of weeks. Then they evaluated the effects of this chronic stress on their brains.

It’s not surprising that the mice displayed symptoms of depression and anxiety. The team demonstrated that the neurons in the prefrontal cortex — which control your abilities to make decisions and function socially — react to the stressors.

Specifically, these brain cells signal the microglia to begin “remodeling” pyramidal neuronal circuits … which basically WEAKENS them. The outcome is that the synaptic connections between the neurons in the prefrontal cortex begin to break down. And too many of them are lost.

Sounds like Heather. Broken down. Lost.

Maybe that sounds like you.

How to Stop the Damage?

Then the team carried it another step.

When they blocked the neurons from signaling the microglia, the chronic stress the mice were subjected to did not affect their synapses in their prefrontal cortex so they did not become depressed.

The research team concluded that finding a way to block the neurons from signaling the microglia could be a way to treat anxiety and depression.

(It seems to me this could be a fantastic way to prevent anxiety and depression in those subjected to long term chronic stress, such as first responders, those with chronic illnesses, and more.)

You can imagine that if you undergo extreme stress over an extended period of time, that more and more of these connections will be lost due to microglia activity. And depression and its accompanying anxiety become more and more severe.

So what can be done about this deconstruction… these massive losses of synapses?

Restoration through an Extraordinary Medicine

Enter IV ketamine treatment, which has been shown to rapidly rebuild and proliferate these synapse connections that have been broken down by depression and anxiety … which are caused by stress and which create more stress of their own.

Remember that tiny doses of ketamine, administered properly, turns on mRNA to switch on DNA which turbo charges the brain-derived-neurotrophic-factors (BDNF) so the synapses grow, branch out, and proliferate creating a dense forestation of neuron connections.

And when all these neurons in the prefrontal cortex are tied together with a dense network of synapses, you come alive. Joy returns. Creativity blooms. Initiative and motivation billow.

This is what we can do about those lost synaptic connections.

Innovative Psychiatry Offers Expertly Administered Ketamine Infusions

We know that stress takes down the best people. You probably know someone like Heather who tries to help everyone, but eventually she’s the one who breaks down and needs help.

At Innovative Psychiatry, we see extraordinary, positive outcomes in treatment-resistant depression and bipolar depression, as well as in PTSD, OCD, social anxiety and suicidal thinking. That means that very ill people can get really, truly better. As in happy, upbeat, full of energy, initiative, and hope for the future.

You can feel like yourself again. With the energy to embrace each day, the hope to look forward to the future. You can enjoy an afternoon breeze, a beautiful ocean view, or the fragrance of a summer rose.

When was the last time that happened?

If you suffer from depression, anxiety, bipolar disorder, PTSD, OCD, social anxiety or suicidal thoughts, and medications haven’t helped, call us. We can help you leave psychiatric disorders behind, and live a fulfilling life.

Live as the best you you can be.

To the emerging of your very best self,

Lori Calabrese, M.D.

April 9, 2018