Lori Calabrese, MD

Category: Depression

Articles about Depression by Lori Calabrese, MD | The Ketamine Blog

The World Health Organization asserts that depression causes more disability worldwide than any other illness. In addition to standing alone as a disabling disorder, it also worsens other illnesses from diabetes, liver disease, heart disease, and brain injuries. We present these articles about depression to show the many ways this disorder is expressed, ways to treat it, and to dispel stigma caused by lack of information.

Causes

Depression and stress create a self-defeating cycle. Prolonged stress prunes the synapses, the dendrites attached to them, and the dendritic spines, reducing the network necessary for optimal signaling in the brain. Consequently, thinking slows and outlook darkens. In addition, creativity all but disappears. Depression follows this process, imposing yet more stress on the these all-important signaling structures.

Other structures in the brain enter the process. These structures in turn malfunction and make the symptoms worse. The lateral habenula, the amygdala, the thalamus, and the hippocampus each play a role in depression. By the same token, depression impacts them, too.

Treatment

Only about a third of people who suffer with depression find relief with traditional antidepressants. These medicines increase neurotransmitters in the brain and eventually increase neuron growth. But the actions of these medicines delay the process and these patients improve slowly. Sometimes, if the first trial with a medication doesn’t help, a different one or combination can help another one third or so of those who didn’t feel better after the first trial. Unfortunately, 33% of people suffering from depression find no relief from these medications. Until recently, they were left with little or no hope of relief for the rest of their lives.

Benefits of Ketamine Treatment

However, ketamine treatment is a novel and advanced treatment that has changed the prognosis for those treatment-resistant patients. Ketamine switches the mRNA to “On” which turns on the DNA to turboboost the brain-derived-neurotrophic-factor (BDNF) that proliferates neuronal growth along with synapses, dendrites, and dendritic spines which play such a vital role in improving signaling throughout the brain.

Another benefit of ketamine is how rapidly it causes the G proteins to slide off the lipid rafts in the cell membrane. This allows them to get back to work enhancing signals. It also causes the cell bursting in the lateral habenula to be dampened. Another process that allows you to experience a sense of reward – and feel better – when something good happens. Basically, ketamine treatment goes to work to help you feel better fast.

Then you enjoy clearer thinking and more creativity. Also a rewarding and upbeat outlook filled with light and joy. Add to that the improved initiative, increased motivation, and hope that makes life worth living again. This remarkable outcome occurs in 65-70% of treatment-resistant patients in general, and much more than that when the treatment is highly personalized. And the results are rapid and robust. Extraordinary.

As you read these articles about depression, keep in mind that there is always hope. Researchers continue to work to find more aspects ketamine’s effects on the brain that can impact the outcome.

  • Ketamine's Healing: Does Depression Run in Families?

    Ketamine's Healing: Does Depression Run in Families?

    • Depressed girl is unresponsive to nagging father -does depression runs families.

    Does depression run families?

    I didn’t ask if it runs in families. Does it run your family?

    Well, let me ask you this. Do you love someone who’s depressed … ?

    I mean really depressed.  Someone who’s been withdrawn, listless, drained, and nervous for months — or years… Maybe you hear how they wish they could die.  Maybe you hear that often.

    Have you helped your son, daughter, or spouse get to the doctor for treatment?  It was hard for them to even just get out of bed, I bet. Really hard.

    They grumbled … maybe slung harsh words at the obstacle of waking up, of getting out of bed. If they did, you probably felt annoyed with the abusive language, but you also knew their struggle was gargantuan. And you knew better than to say anything.

    At the doctor, maybe you listened as they described how they felt. If they even let you in. They probably didn’t have much to say. Too shut down … or too angry.

    When Treatment Doesn’t Help

    After years of doctor visits, years of trying new medications one after the other … then 2 or 3 in combination … maybe none helped very much or for very long. Years of watching her — or him — stop taking meds because “they don’t work anyway.” You’ve likely fought your own despair about ever finding any real help for them.

    You’ve probably wondered just how long one person can endure such hopelessness. And, if you’re human, you may have even secretly wished there was somewhere you could go for a vacation from it just to get away for a little while. But you put that secret thought aside, because what’s most important is finding relief for your son or your daughter or your spouse … or your sister … or your Mom.

    Depression is a Problem of the Family – Not Just the Patient

    You’ve watched phobias take over. Fear of answering the phone. Of going outside. Fear of driving and fear of crowded places. Even fear of eating.

    It’s one thing to watch someone you love in pain for a day or a week.  But when the years come and go and you’d give Father tries to comfort his daughter. He knows that depression is a family problem.anything to see her enjoy herself, even for a little while … it becomes terribly hard to bear. Or to take her to dinner for her birthday and see that frozen look of dread in her face.

    Searching the World for Someone Who Can Help

    So you’ve researched, asked doctors and friends, read articles, scanned the internet, to find that one program, residential treatment, or miracle drug that could lift the lead blanket from the life of this one you love so much.

    But…after a while, they all seem the same.  Nothing seems to make a difference.

    Then, you dig deeper.  You see her desperation, and you worry about suicide risk, so you pull out the stops.  She doesn’t want to hear about any more promises, so you subtly take sugar out of her diet…and dyes… plus salt…  and add a plethora of nutrients like folate, vitamins, and anything else you read on the web. 

    Breakthrough Possibilities

    You learn about new medications that are creating breakthroughs for others.  But she says, “NO.” She’s jaded, has lost her confidence in treatment. She’s sullen and disillusioned. She’s tired.

    Then one day, you’re sitting in the doctor’s waiting room with her, and you pick up a magazine. It says something about ketamine…for depression…

    Hmmmm. Ketamine.  Why does that ring a bell…?  You think you’ve heard about it in the context of surgery. What was that? Something that helped a patient breathe…?  No… You read the article…and your head explodes.

    An anesthetic…?  A street drug…?  What on earth.

    You get online and find out there have been all sorts of articles and studies written about this for years but you never noticed them. But now with determination, you start Googling.

    Researching the Breakthrough

    The scientific articles are too hard to understand, but you discover articles written about the science. In everyday language. You read and take notes.  Read and take notes. Read more and take more notes.

    And it dawns on you this is something you haven’t tried. And instead of just a third of patients finding some sort of help, you’re reading about 75-80% of patients not just getting help, but getting better.  Symptom free. Really better.

    (***If you’re reading this, and you haven’t shared the yoke with a beloved spouse or child who’s, this all may sound ludicrous to you. “…Hey, aren’t you just a little over-invested there…?”)

    Depression is a problem of the family…

    A serious chronic disease impacts the entire family. It’s not only the ill person who suffers. The symptoms affect Little boy hugs his depressed dad. Does depression run families?everyone. Family gatherings are overshadowed by your family member’s reluctance to enter in, or to leave the house. Everyone carries the ache of this one’s suffering sadness. Everyone feels helpless — powerless — to offer relief.

    Mood Disorders – Serious, Crippling Illnesses

    Depression, specifically Major Depressive Disorder, is not a bad attitude, or laziness. It’s an illness caused by changes in brain structures and function. And depression is just one mood disorder. There are so many others just as crippling. OCD, PTSD, bipolar disorder, other anxiety disorders…

    About 1/3 of depressed people are successfully treated by traditional antidepressants. For them, depression is treatable, and they’re able to live their lives in a meaningful way.

    For another 1/3 who weren’t helped by their first round of antidepressants, a new medication or a combination “cocktail” of meds turns out to be effective.

    But what about that other one-third? 

    The World Health Organization estimates 350  million people worldwide are depressed. That means 116 million people in the world are suffering all the pain of depression along with the anxiety that accompanies it, without help or relief. That’s more than 3 times the population of Tokyo, the largest city on earth. And for every person in that list, a family suffers with him.

    Their loved one remains weighted by the lead blanket of depression and anxiety.  Phobias, withdrawl, poor functioning socially and professionally, and despair.  And their risk for suicide grows with every month, every year, they continue to suffer.

    Until now.

    Ketamine Relieves the Family by Making the Patient Better

    Now there is, for the first time in the history of psychiatry, a medication that can stop suicidal thoughts within hours.  Since suicidal thinking — and planning — often create an emergent situation needing life-saving intervention, time is of the essence. 

    And it’s safe.

    Ketamine  hydrochloride is a compound that was FDA-approved for anesthesia in 1964. It’s proven itself to be an Child sits alone listless, depressed.effective and useful anesthesia medication for surgery and for managing pain in emergency situations for 50 years. Ketamine has also demonstrated its safety when used in appropriate doses for children, adolescents, and adults.

    It was even included in the List of Essential Medications by the World Health Organization.

    It’s demonstrated its safety as an anesthetic in all age groups for 50 years. In the last 15 years it has also emerged as an extraordinary drug for stopping suicidal thinking, and in treating many forms of depression and anxiety.  Specifically, treatment-resistant mood disorders.

    Ketamine has been proving itself in laboratories, studies, and private practices across the US and around the world as a rapid and robust antidepressant, when used in the tiny doses required for treatment of mood disorders.

    WARNING: Use of Ketamine to Self-Medicate is DANGEROUS

    While it’s true that ketamine, known on the street as Special K, has been abused and passed on the street as a hallucinogenic way to get high, the doses people in the drug scene use for tripping are much, much higher than the dose administered by psychiatrists in precise therapeutic infusions. 

    And those who abuse ketamine on the street use large doses, massive doses…and way, way too often. And…they can suffer serious side effects in the form of damage to their bodies that are irreversible. Like bleeding ulcers inside the bladder, kidney failure. Death.

    Depression is a problem of the family, not just the patient.

    We know that families need relief along with their loved one who suffers.

    If you and your family have been prisoners in the war against major depression and anxiety, ketamine treatment for your family member can restore the rest of your family.

    Ketamine Relieves Stress in the Family Caused by Psychiatric Mood Disorders

    At Innovative Psychiatry, we’re dedicated to finding treatment for the sickest of the sick. Those who’ve trudged andDad playing with kids after ketamine treatment. Does depression run families? bowed under the tyranny of psychiatric mood disorders. While we can’t accept more patients who need general psychiatric care, (we’re full!), we do want to talk to you if you’ve tried two or more medications or treatment combinations without success.

    If treatment has been failing you up till now, call us. Helping people like you is our specialty.

    Let’s schedule an appointment to determine whether you’re a good candidate for ketamine. While ketamine isn’t for everyone, it’s remarkably effective for 80% of people who have been failed by other traditional treatments.

    And chances are it could be just what you need to restore your life — so you can enjoy meaning, productivity, and relationships you haven’t been able to for a long time.

    To the emergence of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

     

  • Who Should Provide IV Ketamine as Treatment for Depression?

    Who Should Provide IV Ketamine as Treatment for Depression?

    Should anesthesiologists give IV ketamine as treatment for depression.If This is What You Picture When You Imagine IV Ketamine Treatment for Depression, Think AGAIN!!

    And nix that image. Because we’re going to talk about who should provide IV ketamine as treatment for depression.

    Ketamine treatment is getting more and more attention in the press as a paradigm shifter for effective treatment for psychiatric mood disorders. And more and more medical professionals are opening offices to offer ketamine treatment for depression, and for pain management. Of course, more availability of ketamine treatment means more relief for more sufferers.

    Which is a good thing … right?

    Well, yes, but it raises some serious questions.

    Ketamine Isn’t for Everyone

    Like, for instance, is ketamine treatment for everyone?  And the answer to that is “No.” Not everyone will respond to it when it’s used for psychiatric mood disorders.

    But there are clinical factors and genetic tests that doctors can use to predict more accurately whether you’re likely to respond to ketamine treatment for depression.

    And another question: Is providing ketamine treatment for depression similar to providing ketamine treatment for pain? Is this something any medical doctor can easily do?  After all, it’s just a simple medication like any other, right?

    The answer to that isn’t exactly straight forward. First of all, the question includes an assumption that any medical doctor can easily prescribe any medication … even for specialized needs.

    Legally, this is true. Ethically and practically, it’s not.

    And while he may be able to prescribe a drug legally as a medical doctor…is he deeply versed enough in the nuances of the patient’s response to the drug and the drug’s potential side effects…as well as the patient’s potential reaction to those side effects and what to do about them….? 

    Is it really the best decision for a doctor to treat a condition he/she isn’t fully knowledgable about?

    Should an internist treat your periodontal disease? 

    An internist is expected to recognize and treat pretty much anything going on with your body…after all, he’s well-versed in inflammation and infections, and knows all about antibiotics. But his wide scope prevents him from having a specialist’s focused knowledge and deep experience with specialized aspects of your body, like your gums, for instance. So, you go to a dentist, and your dentist may send you to a periodontist for your gums…if you need it…a specialist’s specialist.

    Do All Psychiatrists Treat All Psychiatric Conditions?

    Well, let’s consider the nuances of psychiatry. There is a wide range of psychiatric disorders, including behavior disorders, mood disorders, personality disorders, cognitive disorders, developmental disorders, addictive disorders, and more — including all kinds of treatment modalities and several different kinds of psychotherapies we use — and most psychiatrists are not experts at everything.

    Of course not.

    Most of us gravitate naturally to our interests, and the best of us align our work with our own best selves — we choose the age range, the population, the conditions that fascinate us and tug at our hearts…the modalities that align with the way our own brains work and the way we interact. Some of us are researchers. Some of us are in the trenches. We play to our strengths. 

    We all should.

    Now, back to IV ketamine treatment.

    Anesthesiologists Use Ketamine in Surgery

    It’s understandable that anesthesiologists would be pretty comfortable treating patients with IV ketamine Who should provide and monitor IV ketamine Treatment for depression.since they’ve been using ketamine in surgery and emergency settings throughout their career.

    They’re also at ease sitting and monitoring a patient throughout the infusion treatment, because that’s what they do.

    Some medical doctors might get a bit antsy during that whole process, but it’s just second nature to an anesthesiologist.

    And, it’s true there are certainly plenty of anesthesiologists offering IV ketamine treatment for psychiatric mood disorders. They’re highly skilled in starting IVs, familiar with ketamine, and excellent in handling emergencies in the ER and in the OR.

    An anesthesiologist’s education and training is all about life support during critical moments in surgery. And these specialists know physiology like nobody’s business.

    But…

    Who Should Provide IV Ketamine as Treatment for Depression?

    When it comes to evaluating a psychiatric patient as a candidate for off-label use of IV ketamine treatment for treatment-resistant depression or other mood or anxiety disorders, there’s a great deal to manage. The role of ketamine used as an adjunct with complex medications and psychotherapy, for instance.

    Plus, the patients’ response to the drug and how to treat therm in their specific state of mind, whatever it is,  that emerges during treatment… All within the context of their baseline psychiatric symptoms and vulnerabilities.

    Anesthesiologists just aren’t trained for that.

    The same is true of nurses, even those in advanced practice.

    It’s my belief that the use of ketamine in the treatment of psychiatric disorders is something that is best done by psychiatrists who are thoroughly familiar with IV ketamine treatment.
    And here’s why.

    Because the things that this treatment requires — assessment of the patient and of the psychiatric response (not just the physiologic response), dose adjustment, management of fear, management of expectations… this is all psychiatric expertise. In addition, the family and their overall involvement (or lack of involvement) in the patient’s suffering… It requires we curate the experience, integrate it with psychotherapy, coordinate it within the context of the patient’s medical problems and with the professionals treating them. All these things are without a doubt what WE do and what our entire specialty is about.

    We deal with suicidal patients all day long and every night and weekend–anesthesiologists don’t and, understandably, don’t want to. But many, if not most, patients who receive IV ketamine treatment are not only no strangers to suicide, but in fact are so plagued by such thoughts their lives sometimes hang in the balance. Even to survive till the end of the infusion.

    Those tormenting thoughts just seem to creep in even when you’re not looking for them, and bring a presence to the ketamine room that stuns everyone involved.  That is, until  ketamine stops the suicidal thinking independently… and even if the depression doesn’t stop immediately… but lifts more slowly. A well-informed psychiatrist needs to be present to walk each patient through every scenario, especially when the outcome is a surprise.

    So, again, who should provide IV ketamine as treatment for depression? Definitely, not just anybody. Preferably a psychiatrist deeply experienced and educated in the nuances of ketamine treatment in psychiatric patients.

    Just as internists are not specialists in all areas of illness, not all psychiatrists are versed in the use of ketamine for psychiatric mood disorders.

    So What Kind of Psychiatrist Steps Out to Offer IV Ketamine Treatment?

    The ones who are really comfortable with medicine, and adjusting, adapting, and combining it for therapeutic outcomes. The ones who also have a strong identity as a physician first, and who are already experts in psychopharmacology.

    These psychiatrists are accustomed to a model of consultation and collaboration. And they like to work collaboratively with other psychiatrists, therapists, PCP’s, and families.

    This is no place for lone riders.

    These are the ones who know what it’s like when you’re the most suicidal of the suicidal, and who will stand with you and not be afraid. Those who understand that something transformative happens during an infusion. And that the specific experience of the infusion itself matters if there’s to be healing.

    We are grateful to the anesthesiologists who brought ketamine out of the OR and into the office.  

    But the psychiatric care of our most fragile, desperate, and ill patients — with multiple tangled psychiatric disorders, complex histories of polypharmacy and treatment failures, excruciating trauma, and concurrent medical problems — demands the finest life-saving that we have to offer, by psychiatrists. Nothing less.

    We continue forward to learn all we can from our patients and the dedicated neuroscientists who Who should provide Iv ketamine as treatment for depression in someone like this man?continue to explore the actions of this remarkable drug. As they explore, we continue to see our treatment-resistant patients enjoy extraordinary responses in 80% of cases.

    If you’ve suffered from treatment-resistant mood disorders and have tried multiple treatments without success, we get it. Innovative Psychiatry is a practice that specializes in helping people who have not found help before. People who have been to other psychiatrists and were failed by traditional treatments. People who are running low on hope.

    Innovative Psychiatry is into hope renewal. Through groundbreaking use of medications and treatments, we’re helping people like you live again. Enjoy life again. Please call us to schedule an appointment. We’ll evaluate whether you’re a likely candidate. There really is hope.

    To the release of your very best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Why Doesn’t My Doctor Provide Ketamine as Treatment for Depression?

    Why Doesn’t My Doctor Provide Ketamine as Treatment for Depression?

    This man has hope after asking why doesn't my doctor provide ketamine as treatment for depression.

    Why Doesn’t My Doctor Provide Ketamine as Treatment for Depression?

    It’s all over the news. Even the recent TIME magazine cover story. Ketamine as treatment for depression is blowing the doors off traditional treatments for psychiatric mood disorders.  Have you heard?

    Studies are piling up that demonstrate ketamine’s remarkable effectiveness. It’s making people who suffer better.  Not just “feel” better, but physiologically better.

    You know…  it’s really amazing when your brain is repaired and functioning well, how many aspects of your health and well-being improve. When you feel better and your outlook improves, you begin to see other aspects of well-being bloom.

    Things like initiative, motivation, resilience. We know it’s true that depression compromises the immune system. And we also know a healthy, balanced outlook strengthens it. You feel like eating healthier. You don’t get sick as often, and can be more physically active. Which in turn improves cardiovascular and respiratory function. And that activity improves stamina.

    Depression and anxiety sap stamina. Remission restores it.

    At this point, the drug therapy winning the most kudos for reversing depression and anxiety that isn’t helped by Soldier with PTSD asks why doesn't my doctor provide ketamine as treatment for depression?traditional antidepressants is ketamine treatment. In my practice, we see a consistent response of 80% among those who’ve tried other medications without relief.

    Ketamine is not specifically FDA-approved for the treatment of depression or other psychiatric disorders. And because it’s no longer brand name, it’s unlikely that any drug company will spend the colossal money required to gain FDA approval. But here’s the thing.

    It works.

    And it’s safe.

    Ketamine has been used safely in adults and for children for more than fifty years.

    In fact, it holds a solid position on the international list of drugs needed by the Red Cross for emergencies and disasters around the world.

    It’s up to a physician’s discretion whether to prescribe a drug for an off-label use. And ketamine for depression is an off-label use of the drug.

    Off-Label Use of FDA-Approved Drugs Can Provide Solutions

    When doctors prescribe a drug for an “off-label” use, they do it prudently and inform themselves in advance about the drug’s benefits for this off-label purpose.

    Neurontin, for example, was FDA-approved for epilepsy, but was found remarkably effective off-label for nerve pain and then got approved for it.  It’s also effective off-label for anxiety and in alcohol detox.

    Prazosin is FDA-approved for high blood pressure, but is often prescribed off-label to treat nightmares that accompany PTSD.

    Propranolol is FDA-approved for treatment of high blood pressure and angina pectoris, or chest pain.  However, it’s been found very effective off-label in treating performance anxiety. So a student whose mind freezes in a testing situation can be calm and perform on a test with mental clarity after a single dose.

    Cymbalta is FDA-approved for depression but doctors found it to be so effective for fibromyalgia in their depressed patients while Lilly still had it under patent that Lilly got it approved for fibromyalgia.  And then spread the word.

    So you can see that prescribing off-label is not only medically acceptable — and common — but can lead to safe and effective breakthroughs.

    For ketamine, which is FDA-approved as an anesthetic, studies by neuroscientists have demonstrated it is effective Young woman asked why doesn't my doctor provide ketamine as treatment for depression?for relieving depression by at least four different actions across the brain.  And clinical results have underscored the same.

    Thousands of patients around the US have been treated with ketamine for psychiatric mood disorders at a 75-80% response rate.

    Well with all this … why doesn’t my doctor provide ketamine treatment for depression, you ask?

    Well, the answer is multi-faceted.

    Any Emerging New Treatment Requires In-depth Study

    For one thing, doctors don’t prescribe something they haven’t investigated. There are more than 1200 scientific papers about ketamine to digest and evaluate. With their very busy schedules, how do physicians access all that information efficiently?

    There’s a plethora of scientific articles that range from basic science to clinical studies and that describe ketamine’s actions. And then there are the peer-reviewed studies, metanalyses, and opinion papers throughout the world literature on ketamine use in psychiatry that summarize current findings. Thousands of papers, tens of thousands of pages, and neuroscientists all over the globe are studying it.

    But there is no drug company promoting it. There are no glossy brochures. Or drug reps with samples and sound-bites. Not even slick TV ads to make you clamor and ask your doctor for it. No easy ad campaigns. Nothing like that.

    You need nights and weekends. LOTS of nights and weekends. Tons of hours. Academic privileges to access the journal articles or the willingness to purchase them one by one. All this extensive information isn’t prepared in a format that’s easily absorbed. The whole process can be daunting.

    Complete Paradigm Shift for Psychiatrists to Offer a “Procedure” in the Office

    Most psychiatrists haven’t done a procedure since residency. So it’s a horse of a different color to think about “treatment” as involving procedures other than the clinical work of talking, evaluating, providing psychotherapy, and writing a prescription for medication.

    Many still consider ketamine an “experimental” drug. They don’t feel ready to invest the necessary time, money, space, staff and other adjustments required to offer a treatment and a procedure that requires thinking outside the box.  Again, they need access to extensive information to move past their doubts and make those adjustments. But … an easily assimilated form of that information isn’t being generated for them.

    Add to that the state and federal regulations regarding obtaining, storing, and administering controlled substances and OSHA regulations regarding safety and hazardous waste. What psychiatrist has ever had to deal with hazardous waste…?

    It’s like starting a practice within a practice, with each side having its own requirements, staff, problems, demands, equipment, furnishings, regulations, reports, oversight, and on and on. It’s a gargantuan undertaking.

    Caution About Trying a New Drug

    In addition, there’s the issue of off-label use. Most doctors use some drugs off – label. But each time they make a decision to do that, they want to be assured of safety.

    Ketamine requires space — for storage and equipment — and room for patients and the people they bring with them to drive them home — and special equipment for safe handling and safety monitoring. Most psychiatrists don’t know where to get it, how to start, how to monitor patients appropriately and safely and for how long. There is no manual or how-to book. Many don’t have the staff. Some don’t even have an answering service or a receptionist.

    Beyond that, and despite the growing body of evidence, some doctors just feel cautious. They’re reluctant to try something new before all the potential obstacles have been removed and the effectiveness and safety statistics are well-established.

    This is why a task force made up of some of the best and the brightest minds in neuroscience and psychiatry issued a consensus statement regarding the off-label use of ketamine for depression. Led by Gerard Sanacora, M.D. for the American Psychiatric Association, they published their experience about its use and its remarkable results,. And issued suggestions for appropriate screening, monitoring, and safety.

    IV Ketamine Treatment Is Costly 

    Why is that?  Because ketamine itself is kind of cheap.

    But psychiatrists who do offer IV ketamine treatment take on responsibility and big expenses to provide it safely. Since the preferred route of administration at this point is intravenous infusion, or IV, extra safeguards have to be put in place.

    Things like space, equipment, regulations for handling, storing and disposing of controlled substances are required. Add to that the extensive policies and procedures for all of this. Plus new staff, DEA compliance, hazardous waste disposal, nursing staff salaries, equipment for continuous monitoring of vital signs.

    Think about this. Many psychiatrists don’t even have an answering service. Or office staff.

    SO … what drives us, the ones who take it all on?

    Ketamine treatment is saving lives.

    Doctors Make Up Their Own Minds About Ketamine – In Their Own Time

    Of course we do. Some are willing to reach out and try something they haven’t tried before, to find solutions for their patients who suffer.  Others worry about the data, and the risks of lawsuit for potential reactions to a drug they don’t fully understand. Still others prefer to wait until more drugs are developed that mimic the action of ketamine, and that can be FDA approved on their own merit.

    Meanwhile, the cost for that caution? Unnecessary loss of life. Ketamine demonstrates its ability to not only provide relief for psychiatric mood disorders, but also its tandem and separate action to rapidly erase suicidal thinking that saves lives in emergency situations in clinics and doctor offices around the world.

    While traditional antidepressants reduce suicidal thinking within 9-12 weeks, many patients at riskAs a doctor you can provide ketamine as treatment for depression and lend a helping hand to at-risk patients. of suicide can’t wait that long. Ketamine acts to erase those thoughts within 4 hours…and many times in only 45 minutes.

    Dr. Stephen Hyde, an Australian psychiatrist, says that once those new drugs are developed and approved by the FDA – a many-years-long process – there will still be no data about long term side effects until 20 or 30 more years have passed. Sooo….how many lives will be lost in the meantime? Ketamine is available now.

    His suggestion: Why not use it now for those who won’t live that long without effective treatment, and compile data now about long term use?

    Some of us believe that’s the best choice.

    Sanacora, the lead in the APA consensus statement, expressed it this way. In an interview with NPR news that followed the publishing of the task force consensus statement he said:

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

    We offer Ketamine as Treatment for Depression, When It’s a Good Match for You

    I hope that more and more psychiatrists learn about ketamine, and choose to stretch their capabilities even farther than they have. That in following the guidelines of the APA task force, they’ll help more people achieve rewarding lives through ketamine treatment.

    In the meantime, in my practice, I offer everything I possibly can that can safely bring relief to patients whose lives are passing in misery…or torment…or are about to end in suicide.

    At Innovative Psychiatry, 80% of our patients respond well who’ve been failed by traditional Reach out for help from a doctor who does provide ketamine as treatment for depression.treatments. And for the other 20% we continue to pursue solutions, and apply a combination of treatments to bring them relief. We never stop. We live to see you well.

    If you suffer from psychiatric mood disorders such as major depression, anxiety disorders, PTSD, OCD, bipolar depression, or a similar illness, and traditional antidepressants have failed you, call us.  Schedule an appointment to determine if ketamine treatment is right for you.

    We look for genetic markers and other signs that indicate if you’re likely to respond and benefit from ketamine, and determine the best treatment plan for you.

    Ketamine treatment is not for everyone, but it could be just right for your recovery, renewal, and restoration.

    To the emerging of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Breaking News: Another Way IV Ketamine SMASHES Depression

    Breaking News: Another Way IV Ketamine SMASHES Depression

    Another way IV ketamine smashes depression is by moving g proteins off lipid rafts in cell membrane.Another way IV Ketamine SMASHES depression

    Sometimes news is so hot it sizzles.

    It lures you away from whatever you’re into.  It captivates you.  And then — just face it — you think to yourself, with admiration, OMG.  You say to yourself … whoever came up with that is brilliant. They nailed it.

    Well, Mark Rasenik and his group from the University of Illinois Chicago College of Medicine nailed it.  They presented absolutely breathtaking work in May at the SBP meeting — the Society of Biological Psychiatry.  It’s the meeting where research is presented that is just so brilliantly conceived and executed that it’s mind-blowing.

    Rasenik’s work is like that.

    He and his group came in from left field with their brilliant discovery of a new way ketamine works which just might explain how and why it can begin to lift depressive symptoms in minutes.

    Understand ketamine’s talents, then get creative

    The goal was to learn what happens on a molecular level that causes IV ketamine’s fast depression relief.  Because, of course, someone wants to design a drug just as effective as ketamine but without its side effects. This is the ever-loving quest for new drugs that wannabe like ketamine.  

    Now, we’ve talked before about how IV ketamine acts on synapses to stimulate them to grow, branch out, and flourish — multiplying the numbers of connections between neurons that send signals deep into the brain. We’ve also talked about neuroplasticity, and how it’s key to this process that causes the brain to change.

    As new synaptic connections are built, and greater communication between brain cells develops, the brain gains the ability to see things in a different perspective, and your outlook becomes brighter and healthier. IV ketamine can jump start that process. Wait. No. It can turbo-charge it.

    How to Get Those G’s Back to Work

    So Rasenik and his team found that “g proteins” were packed on “lipid rafts” in the cell membrane with people G proteins on lipid rafts are moved off the raft shows another way IV ketamine smashes depression.who are depressed. In addition, their brain cell signaling is stifled, which may be the cause of that numbness depressed people experience.

    If this is you, listen up.  Numbness is no joke.

    They’ve demonstrated that when SSRI antidepressants are used, they move g proteins from lipid rafts (I love that visual…like the G’s are languidly floating on a raft in the pool…taking time off being lazy) very gradually, and back into WORK mode. Which is how SSRI’s help some people who are depressed — but it takes weeks or months for relief.

    You see, G proteins produce cyclic AMP, which is vital for the nerve cells to properly send their signals.

    And, Rasenick and his team noted that the movement of the G proteins under the influence of SSRI antidepressants, was gradual … over a period of several days.

    So, let’s take a breath here.

    The Many Talents of IV Ketamine

    We’ve talked about how IV ketamine stimulates neurons to flourish, grow branches, and become prolific with healthy connections for sending signals throughout the brain, especially into the deep brain structures like the hippocampus.

    Now, Dr. Rasenick and his team have discovered that IV ketamine also gathers up the tools the nerve cells need so they actually can send signals throughout this new and bountiful network of connections, or synapses.

    Those unemployed g proteins that were hanging out on the rafts, are pulled off the rafts and put to work to equip the brain cells to do their job.

    And they work fast.

    Remember how it takes several days for the g proteins to move off the rafts with an SSRI? Well, with IV ketamine, it happens in 15 minutes!!

    So … do you see why ketamine acts so fast to remove suicidal thinking and depression?Young man is relaxed as he benefits from yet another way IV ketamine smashes depression.

    I’m telling you, the more we know about IV ketamine, the more hope explodes with all of its potential.

    Letting Go of OLD Ideas

    There’s been a belief for years that ketamine’s one action was to block NMDA receptors.  (Boy, does that seem like the dark ages now!) But ketamine is the only drug that blocks NMDA receptors AND moves g proteins off lipid rafts. It’s a double whammy, a one-two punch!

    Once again, ketamine shows its highly targeted prowess in its assault on depression and its potential for assault on other psychiatric disorders.

    In addition, ketamine and other compounds like it, improve glutamate levels, which SSRIs really don’t touch. When the processing of glutamate doesn’t function properly, that also contributes to depression.

    So…wait a minute…that’s three actions ketamine uses to turn depression on its ear!

    Oh, and the fourth:  it turns on mRNA … to turn on DNA … to make more BDNF (Brain Derived Neurotrophic Factor) so that neurons grow new branches.

    The Four Ways.  Four different ways that ketamine smashes depression.  This has brought a level of excitement into psychiatry like nothing else.

    Someone should write a book.

    A full 80% of those who are treated with IV ketamine infusions in our Relieved and relaxed lady shows another way IV ketamine smashes depression.office respond, and many of those achieve complete remission of their symptoms. But, I’ve said before that it isn’t for everyone.  If it’s not for you, we have other treatments like TMS to help you get better.

    If you have symptoms of depression (chronic, recurrent, bipolar, postpartum),  PTSD, and treatment-resistant OCD and have not been helped by anti-depressants, call or email us to arrange an appointment for a consultation. We’ll thoroughly check you out, and analyze what we learn, to determine the treatment most likely to truly help you feel better. I don’t mean to reduce your current symptoms, but to actually get well.

    We’re Innovative Psychiatry.  (Um, you’d have to be to translate lipid rafts and g proteins into treatment that works in your office … )  And we’ll work with you to find the best steps that will help you get well and live the life you want to live.

    To the discovery of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Mom’s Nurturing: Your Cooing Nourishes Newborn Neuron Growth

    Mom’s Nurturing: Your Cooing Nourishes Newborn Neuron Growth

    Mom's closeness to baby nourishes newborn neuron growth.

    Mother’s Week

    Did you enjoy Mother’s Day?  Maybe you celebrated the day, or maybe it was a weekend whirlwind, but I’m hoping the people in your world have been celebrating the moms they love and appreciate all week long!

    If you’re a mom, you know what  mean. No gesture is too small. But even if you’re not a mom, I hope you’ve been celebrating and enjoying the moms around you. You know why…?  Because showing appreciation enhances your own life, as much as it does the one you appreciate.

    Mother’s Love

    Now then . . . if you’re a new mom, I’m going to take a wild guess and assume you’re pretty exhausted. But in spite of it, I hope you’re peeking through your bleary eyes and feeling enthralled at the wonder that is your precious newborn.

    She has your nose, you can see that. And maybe her daddy’s chin?  Her hands are a new version of your mom’s…and her ears…well, they look like your brother-in-law’s, but in the tiniest, sweetest form… The more you study her sweet little face, the more you fall in love with her.

    You want to do everything you can to make her life wonderful, warm, secure, and full of love. You want her to have the best nutrition so she can grow and develop to her best potential.  You’ve looked for the safest car seat, the best pediatrician, the softest fabric books, the smartest toys already, right?  

    There’s so much to think about.  SO much to worry about.

    Do you get a pang sometimes, feel inadequate to be the mom she needs you to be? Even wonder if you can live up to her needs as she grows…?  It’s completely natural to second guess yourself, in fact, most mothers do at some point. And to sometimes judge yourself harshly — too harshly — as if there were a thousand ways that you’re too poor or too busy or too scatter-brained to be the mom your baby needs you to be.

    Oh Mama, we gotta talk.

    Good news . . . for good moms

    Here’s the good news.Mom plays and hugs baby because nourishes newborn neuron growth.

    With all the things you want to provide her…the best nutrition, the best opportunities, best schools, best tutoring, best tennis coaching, best, best, best…there’s something you’re already doing that’s such a huge benefit to her, so life changing . . . and it’s almost effortless.

    Something that makes all the difference in her future. And you don’t need more money or more time or more focus to do it. It happens when you hold her, carry her, feed her . . . just spend time with her . . .

    It’s your presence that’s worth gold to her.

    Mom’s presence nourishes newborn neuron growth

    You see…Your PRESENCE is actually helping her get smarter.  Can you imagine such a thing?  When she’s with you, snuggled in bed nursing, or in her stroller on a walk to the park, or in her papoose carrier on your chest or back…your presence stimulates the growth of brain cells…it actually speeds up production, and sparks connections, and makes her little brain so much more powerful.

    Isn’t that just thrilling? No one can do for her what you do. Your nurturing nourishes neuron growth in your baby. Stimulates her brain to make more connections through brain cells.

    In fact, there’s scientific research that proves it.

    Neuroscientists at NYU have made some startling discoveries. It turns out a mom who’s engaged and nurturing her infant can apparently have a remarkable effect on her baby’s brain development.

    The study showed that when the baby is in mom’s presence, the signaling production of brain cells, or neurons, in her baby’s brain increases remarkably. 

    When they’re separated, the brain activity becomes erratic, and brain cell production slows down to a crawl. How about that?

    So, apparently mom’s nurturing presence helps regulate and control electrical signaling in a positive way that nourishes newborn neuron growth.  Isn’t that wonderful? 

    Mom's coos nourishes newborn neuron growth.Your cooing helps her build her language

    So…when you’re with your infant, stimulating those neurons to grow and flourish…just by being there… what do you do with her, besides feed her and change her diapers?

    Well, that comes pretty naturally, too. 

    You pick her up and cuddle her, or lift her in the air…kiss her face… and make happy, loving noises…

    Bet you talk to her all the time, right? Make cooing sounds? Repeat her noises with your own?

    So… why do you do that . . . do you know?

    I mean, she can’t talk back, right? She doesn’t talk yet, does she?  Or rather, she doesn’t seem to. So why do you talk to her…?  And what is that irrational feeling you have that she is actually listening…?  Responding…?

    Well, it’s not irrational. And here’s why.

    Your maternal intuition tells you to coo to your baby… to mimic her noises and joy … and when you do, you’re helping her build language.

    University of Washington study shows the link between cooing and language

    A team of researchers at the University of Washington studied the sounds we make to our babies and how it affects them. They labeled the sounds we make “motherese”… all those goos and gaas that are annoying to non-parents (who just don’t get it) but are such a delight to your baby.

    And the beauty is, they’re a vital part of the learning process for your baby to build language. So your presence is helping her rapidly develop more brain cells to learn with, and your baby sounds help her to put together the puzzle of language.

    No matter who you are, no matter where you’re from, no matter what language you speak, if you have a baby, you intuitively know how to slip into a secret language that babies understand.

    When you make exaggerated, clear vocal sounds to your baby, it helps her distinguish language from other sounds. This study found that by the time a baby reaches 7 months of age, she can tell the difference between language sounds and other sounds. And by 11 months, she can tell the difference between her native language and other languages.

    She’s an amazing baby. 

    Follow your instincts by cuddling and cooing

    There’s lots more to talk about here, about the parental and baby sounds and the role they play in building language, but the point is, you don’t have to worry about expensive clothes, Mom's presence nourishes newborn neuron growth.fancy schools, and exclusive camps. In fact, this is one place where no worries is a blessed relief.  By just being there, holding and nuzzling your baby, feeding and changing her, and cooing and talking with her back and forth, you’re giving her an excellent start in life…

    …by building her neuron development, her capacity to learn, and her ability to develop the power to speak with language that others can understand.

    Just by being a loving mom.  How incredible.

    I’m a mom, too. A mother of four, and I, too, want to celebrate all the wonderful moms who simply love spending time with their children. And who by doing so, are giving them a great start on their own journey in life.

    We at Innovative Psychiatry honor moms everywhere this week, and every week.

    If you’re a mom, or a dad, and struggle with emotions that interfere with your desire or ability to be the kind of mom or dad you want to be, please get in touch with us for a consultation. Sometimes things go differently than we expected. And when that happens, we need support. And hope.

    Don’t give up on finding your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Does Your Teen Exhibit Signs of Bipolar Disorder?

    Does Your Teen Exhibit Signs of Bipolar Disorder?

    Teen playing in surf after treatment because teen exhibit signs of bipolar disorder.Can You See It?

    Teenagers can be so unbelievably moody.  Well … a far more palatable word for it is reactive. 

    Overreactive (like yelling that brings the house down), intensely reactive (meltdowns that go on for hours, leave a hole in the drywall, or tear the room apart), egregiously reactive (with threats to jump off the roof, open a vein, down some pills), and . . . insufferably nonplussed. Apathetic. Unmotivated. Just downright bored.  

    Is this what kids are like now? Is this what your kid is like?  (or Is this what you were like?)  Is this what everybody else’s kid is like?

    How do you know if what you’re seeing at home falls within the norm . . . or points to something bigger?  

    Like bipolar disorder.  Does your teen exhibit signs of bipolar disorder? Signs that should point you in the direction of help.  How can you tell the difference between adolescent drama and an agitated mania or mixed episode?

    If you’ve never seen it before, how will you know?

    Bipolar disorder isn’t diagnosed on the basis of a single symptom.  Or a single episode of rage.  Or an impulsive (regretful) moment.

    Not ever.

    But if you wonder about the changes you’ve seen in your teen’s behavior and state of mind — and what parent doesn’t wonder what’s normal anymore? — then sit up straight, because this is probably the most important reading you will ever do.  It could save her life. 

    At first, it isn’t that easy to differentiate between a teen who’s reacting to frustration and a teen experiencing a bipolar manic episode.

    This distraught teen exhibits signs of bipolar disorder.

    Both are intense.

    But are unpleasant.

    And helping a teen grow up through the volatile reactions of adolescence, the moments of intimidation from challenging responsibilities, the sorrow of a spurned young love … can seem to mimic parenting a teen through bipolar disorder.

    However, they bear no resemblance, as surprising at that sounds.

    But if you’re the parent, how do you know?

    Does Your Teen Exhibit Signs of Bipolar Disorder?

    There are specific symptoms of bipolar disorder that go beyond your teen’s angry outburst. Symptoms that together paint a picture of an overall debilitating condition.

    To make it easier to put this picture together… to see if there are symptoms compelling enough for your child to be evaluated by a psychiatrist … there are some helpful and well-known mnemonics that can help you know what to look for. (A mnemonic is just a way to remember something that’s really important.) 

    First, the manic symptoms to watch for… DIG FAST.

    There’s just about nothing else that can dig you into a hole faster than being a little, or a lot, manic. That means having intensely happy, angry or wildly swinging moods with several of the following at the same time:

    Distractibility —

    jumping from one thing to another to another, without getting anything done, and just leaving a mess

    Injudiciousness —

    poor judgement with reckless behavior

    Grandiosity —

    that can start with feeling that you are just surrounded by idiots, that nobody really gets you or your vision, and it gets worse from there

    Fast thoughts —

    thoughts that fly through your head so fast it’s dizzying, sometimes with speech so fast it’s hard to interrupt

    Appetite for risk —

    fun, food, alcohol, gambling, drugs, sex, spending — it seems like whatever you do, you want more of, and risks you might never take are now opportunities you can’t wait to jump right into

    Sleep needs diminish —

    you can get by with very little sleep over days or weeks

    Thoughts become increasingly disorganized —

    and you can become hard to follow

    Next, the depression symptoms that emerge in very low and incredibly empty states…SIG:E CAPS

    Sleep changes:

    with difficulty falling asleep or staying asleep, waking up too early, or wanting to sleep all day — or a mix of these

    Interest loss:

    loss of interest in things that used to interest you

    Guilt /worthlessness:

    brooding about all the mistakes you’ve made, how you’ve messed up, feeling ashamed of yourself, feeling worthless

    Energy loss:

    lack of energy, fatigue, listlessness

    Cognition / Concentration:

    poor concentration, cloudy thinking, inability to make decisions, forgetfulness
    Teen exhibits signs of bipolar disorder.

    Appetite loss:

    a loss of appetite for life, pleasure, food, and the things you used to enjoy

    Psychomotor changes:

    variable agitation when anxiety is high, or just dragging when lethargy is pervasive

    Suicidal/death preoccupation

    passive thoughts of death as a relief, intrusive thoughts of killing yourself, deliberate planning for suicide, impulsive suicide attempts

    If you’re wondering what SIG:E CAPS means, it comes from the prescription pad your doctor uses. The term SIG: is printed on the pad and that’s where he writes the directions for taking the prescription.

    It stands for a Latin word, signetur, which means “write on the label.” Since lethargy, or loss of energy, is such a strong symptom in the diagnosis of depression, E stands for energy, or the need to write a prescription for Energy in the form of an antidepressant. And CAPS refers to those capsules that will help the patient feel better.  We used to think that antidepressants could be energy capsules — or should be energy capsules — and although we’re more sophisticated in our thinking of what antidepressants do and how they act, SIG: E CAPS sticks.

    Sort of silly, isn’t it?  But like all mnemonics, using relevant letters like this helps us, and the patient, remember the most prominent symptoms of depression and the depression in bipolar disorder.

    So, does your teen exhibit signs that could indicate bipolar disorder? These tools, DIG FAST and SIG:E CAPS will give you a starting place to examine your teen’s frame of mind and behavior. And the earlier this potentially devastating illness is diagnosed, the earlier treatment can begin, and the more likely your son or daughter can feel better, function better, and live a more rewarding life.

    Of course, psychiatric diagnosis and formulation is much more complex than simple observation, tallying checklists or counting up checkboxes. There’s a host of other symptoms, syndromes, disorders, developmental issues, and character traits that make teasing this apart an art as well as a science. That’s where we come in.

    The Danger of Untreated Bipolar Disorder

    Here’s something else to consider. When an adult over 30 is diagnosed with depression, they often have a frame of reference as to what life can be like. They have a compass, so to speak, from their memories of happier, healthier times.

    On the other hand, when young teens are diagnosed, they quickly lose sight of happier times, of what it’s like to feel good. To be fully functional. That shortened perspective can be so dangerous as it feeds their despondency, and suffocates their hope when asking themselves, “why live?”

    The pressure to find rapid and effective treatments for depression in teenagers continues to rise. Pressure to reduce the negative changes in their brains that will impact who they become as they mature. And also, the pressure to find treatments to ease the hopelessness during the years when impulsivity is strong, and most dangerous.

    IV Ketamine for Teen Depression

    One study at the University of Minnesota is currently accepting candidates to test the effectiveness of ketamine in adolescents who’ve suffered from treatment-resistant depression. The 3-year study began in 2014, and takes a look at the neurobiological mechanisms that make ketamine work — at an age where getting well can change the whole trajectory of your life for the better.

    This is extraordinary.

    They’re studying teens and how low doses of ketamine affect their depression. Change the course of their lives.  Save their lives.Teen girl can enjoy the beauty and quiet peace of a quiet evening because of IV ketamine

    So it’s exciting to think that IV ketamine for unipolar and bipolar depression doesn’t have to be reserved just for adults.

    The study will be completed this year, so conclusions are pending. But we’re hoping the conclusions will reveal ketamine is an effective drug that provides fast, safe relief for treatment-resistant depression and bipolar disorder, as well as other mood disorders in teenagers, too.

    This is critically important because for many people who suffer with unipolar and bipolar depression, their symptoms began during adolescence … somewhere between the ages of 12 and 20.

    Suicide-Driven Thinking

    What’s more, during the teen years, the outcomes of serious major depressive disorder or bipolar depression can be devastating … even deadly. Suicidal ideation is sometimes the only trigger needed for a teen to make an irreversible decision.

    And here’s why.

    During the years before the prefrontal cortex has completed its development – usually in the mid-twenties – the risk of impulsive Manic girl fights with friend so this teen exhibits signs of bipolar disorder.reactions to emotional pain are very high.

    So to find a way to stop the suicidal drive that causes so many lives to be cut short is simply but profoundly life-saving.

    And IV ketamine’s specialty is to erase suicidal thinking and hopelessness … fast. We’re talking in less than 4 hours.

    There’s more to be learned about treating adolescents with IV ketamine.

    But consider this. With everything that teens face in terms of the risk of life-long depression or bipolar disorder, as well as their elevated risk of acting on suicidal impulses, the sooner we aggressively study and support widespread adolescent treatment, the better.

    Ok, that was a mouthful. I’m just saying that we need dramatically improved treatments for depressed teens and those with bipolar disorder. Their developing brains make rash decisions at times. Their susceptibility to treatment is at its peak when they’re young. And their risk of suicide makes this a terribly urgent need.

    Meanwhile, we continue to seek every possible  treatment to achieve the greatest possible relief for our adolescent and adult patients at Innovative Psychiatry. We evaluate each patient with a proverbial “fine tooth comb” to design the most effective and customized treatment possible.

    Contact us for an appointment so we can learn more about you and provide the help so you, or your teen, can be restored to your very best self.

    When you’re at ease, balanced, and resilient, you can perform at your best, love at your best, and achieve at your best. In short, you can enjoy your life and look forward to your future. What a beautiful thing.

    To the restoration of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • IV Ketamine + Neuroplasticity = Relief, Relaxation, and Relishing Life

    IV Ketamine + Neuroplasticity = Relief, Relaxation, and Relishing Life

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

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

    And there’s more.

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

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

    They diminish in size and number … and thin out.

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

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

    IV Ketamine + Neuroplasticity

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

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

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

    The brain remodels itself.  Your brain remodels itself.

    This spectacular image of a neuron shows the rich prolific regeneration of neurons and synapses with IV ketamine + neuroplasticity.

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

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

    Wow.  

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

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

    Growing Your Brain Structure Garden

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

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

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

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

    depressed man needs the relief from treatment with IV ketamine + neuroplasticity

    So here’s the point.

    Ketamine’s Rapid Action

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

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

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

    Let the Sunshine In

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

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

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

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

    Joining forces with you to discover your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Ketamine Wannabe Drugs … of the Future

    Ketamine Wannabe Drugs … of the Future

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

    It’s happening with ketamine.  

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

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

    But there’s more to talk about.

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

    Think of it like this:

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

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

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

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

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

    Ketamine Wannabe Drugs

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

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

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

    Esketamine

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

    Teenage depressed girl needs ketamine wannabe drug treatment for treatment resistant depression.The Food and Drug Administration has awarded “breakthrough” status to esketamine to zoom its advancement through to approval with less interference from various obstacles and the usual red tape that slows everything down.

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

    Rapastinel

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

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

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

    AV-101

    Still another pharmaceutical company in San Francisco is working to create a small molecule drug that possesses all the good traits of ketamine without its potential dissociative side effects: VistaGen Therapeutics.Young couple enjoys a picnic in the country after ketamine wannabe drug treatment for treatment resistant mood disorders.

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

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

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

    A New Frontier – Ketamine and Ketamine Wannabe Drugs

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

    Image shows the dramatic brightness of a brain lit up by ketamine wannabe drug treatment, and the darkness in the depressed brain without it.And one day this miraculous breakthrough medication – ketamine – may become obsolete like so many cornerstone discoveries of the past.

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

    One last thought…

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

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

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

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

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

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

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

    To the emerging of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • IV Ketamine and Treatment-Resistant Mood Disorders

    IV Ketamine and Treatment-Resistant Mood Disorders

    This man feels good after treatment for PTSD because of IV ketamine and treatment-resistant mood disorders.

    IV Ketamine and Treatment-Resistant Mood Disorders

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

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

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

    Such sensitivity, such beauty for the world to enjoy.

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

    Bipolar disorder.

    Tragedy Without IV Ketamine

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

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

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

    Listless depressed mother is not responding to crying baby because of postpartum depression. Needs treatment with IV Ketamine and Treatment-Resistant Mood Disorders

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

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

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

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

    IV Ketamine and Treatment-Resistant Mood Disorders

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

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

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

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

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

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

    The trauma of active combat can result in mood disorders. But IV ketamine can help.

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

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

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

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

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

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

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

    Too many.

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

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

    Mom with postpartum depression can now show daughter affection because IV ketamine and treatment-resistant mood disorders.

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

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

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

    Relief and Solutions are RISING

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

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

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

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

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

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

    Power to enjoy.

    To the power for finding your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • IV Ketamine: Doing What Prozac Can’t

    IV Ketamine: Doing What Prozac Can’t

    Man on top of mountains spreads arms in relief - IV ketamine doing what prozac can't.Excitement about IV Ketamine

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

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

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

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

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

    What Would You Do?

    His answer?

    “If you have patients that are likely to seriously injure themselves or kill themselves within a short period of time, and they’ve tried the standard Man with treatment-resistant depression needs IV ketamine doing what prozac can't.treatments, how do you not offer this treatment?” he says.

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

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

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

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

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

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

    More Questions

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

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

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

    Most Promising Since Prozac

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

    IV Ketamine: Doing what Prozac Can’t

    No new medication for depression since Prozac!!!

    Treatment -resistant depression is relieved for this lady after IV ketamine doing what prozac can't.So just a quick review: Prozac emerged in the 1980’s and was the first of a “new class” of depression drugs targeting serotonin, one of the neurotransmitters.

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

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

    Period.

    IV Ketamine – Doing What Prozac Can’t

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

    They’re as excited as we are at the possibility of creating a whole new class of more effective drugs for depression.Young man in orange hat lounges in the sun, reflecting over the years he spent in the dark with depression- IV Ketamine Doing what Prozac can't.

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

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

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

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

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

    Until recently, our patients with treatment-resistant mood disorders weren’t getting better.Lady cries with treatment-resistant mood disorders, needs IV ketamine doing what prozac can't.

    Now they are.

    IV Ketamine is Changing – and Saving – Lives

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

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

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

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

    You can feel better.

    Much, much better.

    To the release of your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

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