Articles About Ketamine from Lori Calabrese, MD | The Ketamine Blog
Breakthrough anesthesia medicine proves life-changing for many who suffer from severe mood disorders.
In the last several years, a medicine began to emerge as a remarkable treatment for mood disorders. It was developed and FDA approved for anesthesia around 1970. Over 25 years later… it began to show its colossal hidden ability. What sort of ability? The power to relieve depression and other psychiatric disorders in a most dynamic way. Disorders like PTSD, bipolar depression, postpartum depression, addiction, social anxiety, and even eating disorders respond to this extraordinary treatment that involves a series of IV infusions. And perhaps the most remarkable of all, ketamine infusions can erase suicidal thinking in a few short hours. These articles about ketamine treatment are presented here to dispel stigma about psychiatric conditions and to give hope about treating them.
Early Testing was Cautious
Researchers tested it with trepidation 10-20 years ago. Then each study built upon the last. Their work revealed more insights about what actually causes depression, and how to treat it effectively. Never before has a medicine helped relieve symptoms in such a wide variety of people and their symptoms.
Researchers Still Learning All Ketamine Can Do
Ketamine works in multiple areas and systems of the brain. It improves the function of mechanisms that have been impaired by the stress of depression and anxiety. It helps the G proteins that pile up on lipid rafts in the cell membrane slide to off. This equips them so they can do their job enhancing signal transmission.
It also turns on the mRNA switch which in turn flips on DNA to build up brain-derived-neurotrophic-factor (BDNF).BDNF then causes synapse connections between neurons to proliferate in turbo mode, transforming and replenishing the connections between brain cells all around the brain, lighting it up with information, cognition, creativity, and insight.
There’s more that it accomplishes, like tamping down the cell bursting in the lateral habenula so you can experience the reward of pleasant moments. We don’t know what researchers haven’t discovered yet, but we look forward to hearing what’s next.
Ketamine Does More Than Bring Relief, It’s Transforming
The results of IV ketamine treatment are transformative.Those who have been weighted under a blanket of lethargic apathy and despair typically find they feel better and better after treatment. They often find they have the energy and motivation to dive into tasks they couldn’t face in recent memory.
More patients with treatment resistant conditions respond to ketamine than any other medicine available. It may sound odd, but the patients it helps the most are those who suffer the most from severe disorders. With continued research, neuroscience researchers and psychiatrists are learning methods of administration that help more and more patients enjoy a rapid and robust response,.
As a result, these individuals enjoy renewed hope. They express amazement at their energy for life and work, and an overall transformation in what they enjoy and are able to accomplish. They report a more balanced and joyful outlook, and the desire to rebuild and strengthen their relationships.
Ketamine is NOT for Everyone
With all the good IV ketamine treatment accomplishes, some people still don’t respond to it at all. The percentage of people who don’t respond is comparatively small, and we need to see more studies that can help explain why.
Why Ketamine Sometimes Doesn’t Work
There are others who have a significant response initially, then the response fades. One reason for that may be they have a deficiency of certain components in their blood. They may have a low folate level, or low testosterone, and some other deficiencies. In cases like this, sometimes replacing those nutrients helps that patient respond to ketamine treatment and experience resilience again. There are even cases where a patient’s blood levels are normal but the levels of certain components in their cerebral spinal fluid is low. By replacing that deficiency, the patient is able to enjoy a very positive and robust response to ketamine treatment.
Neuroscience is gaining knowledge by leaps and bounds in the 21st century. We hope to see more and more medicines that work as well as ketamine for those who have not yet been helped.
These articles about ketamine expand on those things we learn from neuroscience research in the labs, as well as those things we learn from research in our practice.
For years, ketamine clinics across the country have offered intravenous infusions as a fast-acting treatment for severe depression. But last week, the US Food and Drug Administration approved a version of ketamine, called esketamine, to do the same thing — so what’s the difference and what will this mean for newly interested patients?
Ketamine, sometimes known as the party drug Special K, is a compound made of two mirror-image molecules. It has long been approved as an anesthetic, isn’t covered by a patent, and is widely used — meaning it’s not going to make much money for a pharmaceutical company. So, Janssen patented the left part of the molecule, esketamine, and sent it through the FDA approval system as a potential cash cow called Spravato, legitimizing the use of ketamine for depression in the process.
“We deliver an off-label treatment that has the baggage of being known as a club drug,” says Steve Levine, the founder of Actify Neurotherapies, which runs 10 ketamine clinics around the country. “Now we’ve moved from ‘we deliver horse tranquilizer off-label’ to ‘we deliver FDA-approved Spravato’ and it’s just easier to talk to people about that.”
Still, FDA approval of esketamine for treating depression comes with plenty of caveats. The drug must be administered as a nasal spray, patients must be taking another antidepressant at the same time, and it can only be given to patients who have (unsuccessfully) tried two antidepressants before. Most notably, people won’t able to pick up Spravato at the local Rite Aid. Spravato will only be available in certified clinics.
Though Janssen, the maker of Spravato, has yet to officially announce what “certification” means, some psychiatrists have a head start on the process. Lori Calabrese, a psychiatrist who offers ketamine treatments at her clinic in Connecticut, is already certified because she contacted Janssen as soon as news of the approval went through. She had to go through a risk evaluation and mitigation strategy (REMS) program, which meant providing verification of all her medical licenses and showing that her clinic has been approved by the Drug Enforcement Administration for dispensing controlled substances. The next day, Calabrese was notified that she is cleared to administer Spravato. (A representative from Janssen was not available for comment.)
Doctors must order medication for a particular patient and pick it up at a specialty pharmacy. The patient will self-administer the nasal spray in the doctor’s office, stay in the office for two hours of monitoring, and then be taken home. The Spravato never leaves the facility. “It’s a very different kind of treatment model than anything we’ve seen in psychiatry before,” Calabrese adds. Janssen has told her that the first shipments of Spravato will be sent out on March 18th.
Plenty of excitement has greeted the Spravato news, but physicians caution that the requirement that it be taken nasally — instead of through IV, which is the typical method in clinics — may make it less effective. With an IV, all of the medicine is absorbed and the delivery is far more controlled, says Levine of Actify Neurotherapies. Though the nasal spray will help people who can’t (or don’t want to) take an IV, the process might be a little clunkier, especially because some of the drug might drift down people’s throats and it’s harder to control how much someone will get. There is also some evidence that nasal ketamine will be less effective than IV ketamine. Some studies have shown that more than 70 percent of those who try IV ketamine feel better; that number is closer to 45 percent for nasal ketamine.
It’s not cheap, either. Ketamine treatments usually cost a few hundred dollars per infusion, but the expense comes not from the generic drug, which is cheap, but from the doctors’ time and the clinic space. In contrast, just the Spravato drug alone can cost almost $900 per session, which would bring a monthly cost — at the recommended two sessions a week — to nearly $7,000, according to Stat News. The good news is that Spravato will be reimbursed at least partly by insurance, which will greatly increase access, says Bryan Clifton, chief medical officer of Kalypso Wellness Centers, another ketamine clinic. But as Calabrese points out, it’s going to be a challenge to figure out how much of the time and labor costs insurance will cover when the treatment alone is more expensive than the alternative, which already has those costs factored in.
For some, the approval of Spravato is more a story about the failures of the medical industry than great news about an exciting new treatment. “We’re very happy to see ketamine mainstream, but I’m distressed that this commodity medicine that’s so freely available got no interest until somebody could find a way to make more money from it,” says Steven Mandel, who runs Ketamine Clinics of Los Angeles. “It’s so thrilling to see this treatment endorsed publicly by mainstream institutions, but it’s one of the worst aspects of our medical system that this drug was scorned by all the big companies until they could find a way to get a piece of the action.”
Erik Messamore, a professor of psychiatry at Northeast Ohio Medical University, agrees. Messamore — who used to work with patients with treatment-resistant depression — wanted to administer ketamine for a patient, but was told that his insurance carrier would not protect him from liability because the drug was not FDA approved. We didn’t need esketamine, he argues. We needed channels for regular ketamine to be accepted in clinical practice. He maintains that instead of waiting for Janssen’s clinical trials, it would have been more helpful if the American Psychiatric Association, the National Institutes of Health, or another official board released guidelines that encouraged the use of ketamine for this kind of treatment.
That said, Messamore adds that if he were still working with severely depressed patients, he would absolutely offer Spravato. “I would be pressing my administration to get it offered to people as quickly as possible,” he says.
The newly approved drug, esketamine, is one half of the ketamine compound.
By Angela Chen@chengela Mar 11, 2019, 3:45pm EDTIllustration by Alex Castro/The Verge
For years, ketamine clinics across the country have offered intravenous infusions as a fast-acting treatment for severe depression. But last week, the US Food and Drug Administration approved a version of ketamine, called esketamine, to do the same thing — so what’s the difference and what will this mean for newly interested patients?
Ketamine, sometimes known as the party drug Special K, is a compound made of two mirror-image molecules. It has long been approved as an anesthetic, isn’t covered by a patent, and is widely used — meaning it’s not going to make much money for a pharmaceutical company. So, Janssen patented the left part of the molecule, esketamine, and sent it through the FDA approval system as a potential cash cow called Spravato, legitimizing the use of ketamine for depression in the process.
“We deliver an off-label treatment that has the baggage of being known as a club drug,” says Steve Levine, the founder of Actify Neurotherapies, which runs 10 ketamine clinics around the country. “Now we’ve moved from ‘we deliver horse tranquilizer off-label’ to ‘we deliver FDA-approved Spravato’ and it’s just easier to talk to people about that.”“THIS DRUG WAS SCORNED BY ALL THE BIG COMPANIES UNTIL THEY COULD FIND A WAY TO GET A PIECE OF THE ACTION”
Still, FDA approval of esketamine for treating depression comes with plenty of caveats. The drug must be administered as a nasal spray, patients must be taking another antidepressant at the same time, and it can only be given to patients who have (unsuccessfully) tried two antidepressants before. Most notably, people won’t able to pick up Spravato at the local Rite Aid. Spravato will only be available in certified clinics.
Though Janssen, the maker of Spravato, has yet to officially announce what “certification” means, some psychiatrists have a head start on the process. Lori Calabrese, a psychiatrist who offers ketamine treatments at her clinic in Connecticut, is already certified because she contacted Janssen as soon as news of the approval went through. She had to go through a risk evaluation and mitigation strategy (REMS) program, which meant providing verification of all her medical licenses and showing that her clinic has been approved by the Drug Enforcement Administration for dispensing controlled substances. The next day, Calabrese was notified that she is cleared to administer Spravato. (A representative from Janssen was not available for comment.)
Doctors must order medication for a particular patient and pick it up at a specialty pharmacy. The patient will self-administer the nasal spray in the doctor’s office, stay in the office for two hours of monitoring, and then be taken home. The Spravato never leaves the facility. “It’s a very different kind of treatment model than anything we’ve seen in psychiatry before,” Calabrese adds. Janssen has told her that the first shipments of Spravato will be sent out on March 18th.
Plenty of excitement has greeted the Spravato news, but physicians caution that the requirement that it be taken nasally — instead of through IV, which is the typical method in clinics — may make it less effective. With an IV, all of the medicine is absorbed and the delivery is far more controlled, says Levine of Actify Neurotherapies. Though the nasal spray will help people who can’t (or don’t want to) take an IV, the process might be a little clunkier, especially because some of the drug might drift down people’s throats and it’s harder to control how much someone will get. There is also some evidence that nasal ketamine will be less effective than IV ketamine. Some studies have shown that more than 70 percent of those who try IV ketamine feel better; that number is closer to 45 percent for nasal ketamine.
It’s not cheap, either. Ketamine treatments usually cost a few hundred dollars per infusion, but the expense comes not from the generic drug, which is cheap, but from the doctors’ time and the clinic space. In contrast, just the Spravato drug alone can cost almost $900 per session, which would bring a monthly cost — at the recommended two sessions a week —to nearly $7,000, according to Stat News. The good news is that Spravato will be reimbursed at least partly by insurance, which will greatly increase access, says Bryan Clifton, chief medical officer of Kalypso Wellness Centers, another ketamine clinic. But as Calabrese points out, it’s going to be a challenge to figure out how much of the time and labor costs insurance will cover when the treatment alone is more expensive than the alternative, which already has those costs factored in.
For some, the approval of Spravato is more a story about the failures of the medical industry than great news about an exciting new treatment. “We’re very happy to see ketamine mainstream, but I’m distressed that this commodity medicine that’s so freely available got no interest until somebody could find a way to make more money from it,” says Steven Mandel, who runs Ketamine Clinics of Los Angeles. “It’s so thrilling to see this treatment endorsed publicly by mainstream institutions, but it’s one of the worst aspects of our medical system that this drug was scorned by all the big companies until they could find a way to get a piece of the action.”
Erik Messamore, a professor of psychiatry at Northeast Ohio Medical University, agrees. Messamore — who used to work with patients with treatment-resistant depression — wanted to administer ketamine for a patient, but was told that his insurance carrier would not protect him from liability because the drug was not FDA approved. We didn’t need esketamine, he argues. We needed channels for regular ketamine to be accepted in clinical practice. He maintains that instead of waiting for Janssen’s clinical trials, it would have been more helpful if the American Psychiatric Association, the National Institutes of Health, or another official board released guidelines that encouraged the use of ketamine for this kind of treatment.
That said, Messamore adds that if he were still working with severely depressed patients, he would absolutely offer Spravato. “I would be pressing my administration to get it offered to people as quickly as possible,” he says.
Have you heard? In the “ketamine for depression” world we’re all a-buzz.
Esketamine nasal spray’s been added to our arsenal to fight refractory depression.
This is the first psychiatric medicine of its kind to win FDA approval. A medicine developed in a new brand new direction — glutamate modulation — to stimulate production of BDNF and to proliferate neurosynaptic branching and connection. It doesn’t just do some trivial thing. It repairs, and improves…and enriches.
Esketamine is the left-sided mirror image molecule — which in addition to the right-sided one makes up ketamine — and it may provide many of the same remarkable benefits of its parent, ketamine.
Because ketamine was approved by the FDA 50 years ago as a dissociative anesthetic, it’s generic, and not likely to be re-approved by the FDA for any other indication — like treatment resistant depression.
There was just no one to put the money into the expensive trials it takes to show efficacy and safety, despite the hundreds of scientific papers published about using ketamine for depression and other psychiatric conditions.
In 2006 (yes, 2006!), an important study revealed that ketamine was effective in treating depression.
Then, a few years ago, further research revealed that the temporary nature of ketamine’s antidepressant benefits could be extended by providing additional infusions.
And there were some doctors who began working with that data, and offered short series IV ketamine infusions over 2-3 weeks to help patients achieve, maintain, and extend their response and remission to ketamine. I was one of them.
Fast and Strong Antidepressant Medication
As revelations of IV ketamine’s rapid and robust antidepressant properties spread through journals, news outlets, and face-to -face discussions, a number of pharmaceutical companies set out to develop medicines that could act like ketamine and bring relief to more people… as well as win FDA approval.
Esketamine is the first medicine to accomplish this.
And there will be more to follow, for sure.
The days of relying on a monoamine hypothesis, and selective serotonin reuptake inhibitors (SRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are behind us.
This is not to say these medicines are obsolete. Roughly 30-60% of people who suffer from depression are effectively treated by the oral antidepressants that are already available.
But for the rest who haven’t been helped –many of whom have become increasingly hopeless or suicidal — a medicine has been needed that does work. One that’s covered by insurance to help more people.
So researchers in pharmaceutical companies got to work to find compounds that would fit the bill.
Esketamine FDA Approval Will Lead to More Effective Medicines for Mood Relief
Instead, we’re enjoying the widespread, rapid, and robust effectiveness glutamate modulators can give. You know, the ones that dampen activity in the lateral habenula, dramatically proliferate signaling structures, and move G proteins off their lipid rafts in cell membranes to enhance communication across the brain.
Janssen Pharmaceuticals
The happy news is that esketamine is expected to be covered by insurance, and insurance companies have already begun negotiating with Janssen to provide this coverage.
Here’s what this means for you: the medicine will be covered by insurance, and the doctor’s office visit to provide it should also be covered by insurance. Given that it’s a 2 hour office visit, we expect the insurance reimbursement for that will make a dramatic difference for people and allow more people to come in for treatment.
Considering Aetna provided some of the funding for esketamine (Spravato) FDA trials, it seems likely they’ll be one of the companies that provides coverage for esketamine treatment. (Aetna, are you listening?) Blue Cross and Blue Shield as well as United Healthcare seem to be already involved and negotiating coverage, too.
We think all of them should get on board, and quickly and generously cover the drug and the physician expertise required for the office administration and monitoring.
Treatment resistant depression is extensive, leads to disability and life years lost, and can lead to suicide. Insurance companies need to step up quickly.
They can and should do better for you and for your family.
Since esketamine FDA approval only took place less than a week ago, it’ll take few weeks for us to get it — Janssen and their partners are working to produce, package and ship it, working out the certification, registration, and patient safety monitoring details.
And it may take up to 6 months for some insurance companies to decide what and how much of the cost of the drug and the office visit they’ll cover.
So we’re in a holding pattern. Watching, waiting, and preparing.
The Particulars of Esketamine FDA Approval
Now — let’s talk about what esketamine is, and what it isn’t.
The popular belief that esketamine nasal spray is ketamine runs rampant. It’s a relative of ketamine, but it isn’t ketamine.
As we’ve talked about before, ketamine is a racemic compound consisting of 2 mirror image molecules, like holding your two palms together: one on the right and one on the left. R-ketamine. And S-ketamine. In the world of science, many terms have Latin origins. The word for “left” in Latin is sinistra. Hence, the left-side mirror image molecule is called S-ketamine.
So these molecules are now often called by the phonetic spelling of their prefix: arketamine (R-ketamine) and esketamine (S-ketamine.)
This is important in understanding a little bit about this treatment. Each molecule in the ketamine compound contains different properties, and they share some as well. For instance, we think the left is the more psychoactive molecule — and many think it is a better antidepressant than the right; other researchers disagree or say they don’t know.
We know how robust the combination is, because we see it in IV ketamine treatment.
But we’ll all learn together what esketamine nasal spray will be like in the real world with real patients.
Esketamine nasal spray has not yet undergone a head-to-head comparison with IV ketamine in any published study. But with time, we’ll see how it performs to help you get better.
Esketamine FDA Approval: Requirements For Treatment
You need to know that you can’t just be prescribed esketamine.
When esketamine nasal spray is prescribed for you for treatment resistant depression, you need to show you’ve taken two antidepressants that have failed. In both cases, you must have taken the medicine for an adequate time at an adequate dose. And you will have start taking a new antidepressant when you start esketamine. (No ifs, ands, or buts about it. )
First, your doctor will register you with a special patient safety monitoring program.
Second, esketamine must stay in your doctor’s office. You’ll have to have your treatment in your doctor’s office, biweekly at first, then weekly, and then every 1-2 weeks for maintenance treatment.
Third, plan to stay in the office for 2 hours following treatment — for monitoring, and to ensure the side effects have subsided. In addition, you won’t be permitted to drive until the next day after a full and restful sleep.
Esketamine Side Effects
The FDA warns us about the side effects possible with esketamine. While they’re concerned with seeing proof that a medicine works, their greater concern is safety.
So, even though we don’t anticipate a serious safety hazard with esketamine, to protect your safety, the FDA warns of the potential for short-term cognitive impairment, and stresses that you not drive a car or operate machinery the day of your treatment, and also that you avoid making major decisions. They say the side effects may impair your attention, judgment, thinking, reaction speed, and motor skills. So — be cautious.
Esketamine nasal spray is not for pregnant and nursing women.
There’s been no testing at this point for esketamine’s effects on fetuses in the womb or infants.
The esketamine FDA approval has ushered in a new era of depression and anxiety medicines. Watch for updates about other ketamine-related medicines. We’ll be talking about them more as they begin to emerge.
To learn more about receiving esketamine (Spravato) treatment, please contact us here, and we’ll add you to our waiting list. We’ll contact you to come in for a consult to see if this is for you as soon as we’re able to begin ordering it from our specialty pharmacy, and we’ll work with your current doctors and therapist to ensure you get the most out of your treatment.
We’re on the cutting edge of treatment, to give you an edge over depression and suicidal thoughts.
We offer both IV ketamine treatment and esketamine nasal spray. And that means there’s help ahead for you.
The U.S. Food and Drug Administration today approved Spravato (esketamine) nasal spray, in conjunction with an oral antidepressant, for the treatment of depression in adults who have tried other antidepressant medicines but have not benefited from them (treatment-resistant depression). Because of the risk of serious adverse outcomes resulting from sedation and dissociation caused by Spravato administration, and the potential for abuse and misuse of the drug, it is only available through a restricted distribution system, under a Risk Evaluation and Mitigation Strategy (REMS).
“There has been a long-standing need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition,” said Tiffany Farchione, M.D., acting director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research. “Controlled clinical trials that studied the safety and efficacy of this drug, along with careful review through the FDA’s drug approval process including a robust discussion with our external advisory committees, were important to our decision to approve this treatment. Because of safey concerns, the drug will only be available through a restricted distribution system and it must be administered in a certified medical office where the health care provider can monitor the patient.”
Patients with major depressive disorder who, despite trying at least two antidepressant treatments given at adequate doses for an adequate duration in the current episode, have not responded to treatment are considered to have treatment-resistant depression.
The Spravato labeling contains a Boxed Warning that cautions that patients are at risk for sedation and difficulty with attention, judgment and thinking (dissociation), abuse and misuse, and suicidal thoughts and behaviors after administration of the drug. Because of the risk of sedation and dissociation, patients must be monitored by a health care provider for at least two hours after receiving their Spravato dose. The REMS requires the prescriber and the patient to both sign a Patient Enrollment Form that clearly states that the patient understands they should make arrangements to safely leave the health care setting to get home and that the patient should not drive or use heavy machinery for the rest of the day on which they receved the drug. Additionally, Spravato must be dispensed with a patient Medication Guide that outlines the drug’s uses and risks. The patient self-administers Spravato nasal spray under the supervision of a health care provider in a certified doctor’s office or clinic, and the spray cannot be taken home. The health care provider will instruct the patient on how to operate the nasal spray device. During and after each use of the nasal spray device, the health care provider will check the patient and determine when the patient is ready to leave.
The efficacy of Spravato was evaluated in three short-term (four-week) clinical trials and one longer-term maintenance-of-effect trial. In the three short-term studies, patients were randomized to receive Spravato or a placebo nasal spray. In light of the serious nature of treatment-resistant depresison and the need for patients to receive some form of treatment, all patients in these studies started a new oral antidepressant at the time of randomization and the new antidepressant was continued throughout the trials. The primary efficacy measure was the change from baseline on a scale used to assess the severity of depressive symptoms. In one of the short-term studies, Spravato nasal spray demonstrated statistically significant effect compared to placebo on the severity of depression, and some effect was seen within two days. The two other short-term trials did not meet the pre-specified statistical tests for demonstrating effectiveness. In the longer-term maintenance-of-effect trial, patients in stable remission or with stable response who continued treatment with Spravato plus an oral antidepressant experienced a statistically significantly longer time to relapse of depressive symptoms than patients on placebo nasal spray plus an oral antidepressant.
The most common side effects experienced by patients treated with Spravato in the clinical trials were disassociation, dizziness, nausea, sedation, vertigo, decreased feeling or sensitivity (hypoesthesia), anxiety, lethargy, increased blood pressure, vomiting and feeling drunk.
Patients with unstable or poorly controlled hypertension or pre-existing aneurysmal vascular disorders may be at increased risk for adverse cardiovascular or cerebrovascular effects. Spravato may impair attention, judgment, thinking, reaction speed and motor skills. Patients should not drive or operate machinery until the next day after a restful sleep. Spravato may cause fetal harm and women of reproductive potential should consider pregnancy planning and prevention; women should not breastfeed while being treated.
Esketamine is the s-enantiomer of ketamine. Ketamine is a mixture of two enantiomers (mirror image molecules). This is the first FDA approval of esketamine for any use. The FDA approved ketamine (Ketalar) in 1970.
The FDA granted the approval of Spravato to Janssen Pharmaceuticals, Inc.
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
A cause and affect relationship that’s a recipe for profound misery…is there hope?
Jarrod turned over. The room was dark except for the light of the clock. 3:45AM glowed brightly in the darkness. Jarrod sighed heavily. It had been 5 hours since he turned off the light. Exhaustion weighed him down like lead.
He hadn’t slept more than an hour all week. Why does it have to be so hard to just get some rest?? Rage was growing in a slow boil in his chest… He was afraid of what he might do if something didn’t break this maddening cycle. Sometimes he wanted to explode from the frustration. Sometimes he wanted to give up and die.
Much of the time, just after he dropped off, an alarm of sorts sounded inside his head and woke him wide awake again…
What is life if it has to be spent like this?
Months. Years. A lifetime.
None of his medicines worked. None. He felt defeated just thinking about it.
He tried to count sheep. His mind wandered fretfully slamming him with accusations, fears, uncertainty…hopelessness. Despair.
Buuuuzzzzzzz !!!
5:30AM. His alarm. He only slept maybe an hour and a half.
There was no choice but to drag himself out of bed and force himself to face another day… he knew he just couldn’t go on like this much longer… in fact, he wouldn’t.
Life-Threatening Misery
It’s not hard to connect the dots between insomnia and suicide. If you’ve suffered from chronic insomnia, you know the wretchedness of staring at the ceiling and watching the hours tick by.
And the longer it goes on, the more you worry about how you’ll get through the next day on 4 hours of sleep…or three hours… then 2 hours. Well, an hour and a half.
Have you ever experienced unrelenting insomnia for several nights in a row? If you have, you know that just as you’re getting sleepy, hoping you’ll drop off, suddenly you wake with a start and realize you had fallen asleep and woke up only 3 minutes later! It makes you want to chew nails.
In fact, it’s so terrible that prisoners of war are forcibly prevented from sleep as a torture to break down their resolve.
It’s not hard to see that prolonged insomnia can lead someone to want to die. Nor is it far-fetched to consider that having a desire to stop living could keep you from sleeping.
So which comes first? Well, it’s hard to know.
Sleep Disturbance is Treatable
Researchers have found that insomnia is an independent risk factor for suicidal thoughts, but a factor that’s not etched in stone. Because this is something that can be changed. And when it is, it relieves its influence on suicidal behaviors.
Genetics can’t be changed. Environment is hard to change. But insomnia..? It can usually be treated.
In addition, research has shown that insomnia is a risk factor and predictor for depression.
And among both adolescents and adults, those who seek treatment for problems with sleep experience more severe forms of depression than those who are depressed without sleep disturbance.
Insomnia Is An Independent Culprit
Traditionally, there has been an assumption that insomnia was a symptom of depression, but further research shows that sleep disturbance symptoms are experienced most often before the onset of depression, and continue longer after depression symptoms are relieved.
So is it the first symptom of depression that shows up long before other symptoms..? And the last to go after depression is resolved? Or is it a separate disorder that commonly accompanies other disorders?
You and I both know that when you go without sleep, or without enough sleep, 2-3 days in a row, it’s natural to find you’re more irritable and less able to control your mood.
When someone goes without sleep 5 days…or 8 days… their mental state becomes impaired, as well as coordination, cognition, and judgment. Often, at some point, they’ll finally sleep. Maybe for a few hours, maybe longer. And once they’re able to fall asleep once and remain asleep a few hours, they may have more success for the next few nights with more restful sleep.
Then the cycle begins again.
The Link Between Insomnia and Suicide Can Lead to Death
One recent study found that dysfunctional neuroplasticity may be to blame for insomnia. And that dysfunction can drive not only insomnia but other severe symptoms that are truly unbearable for you.
The theory is that neuroplasticity is a major mechanism in the cause of depression.
Neuroplasticity is the way the brain adapts to changes in the environment and to various stimuli.
Since sleep promotes synaptic neuroplasticity and a healthy ability to adapt and change, the lack of sleep reduces your ability to do that. Synaptic plasticity is also reduced in major depressive disorder.
Now think about this:
As many as 50% of people diagnosed with psychiatric disorders are never helped by medicines or therapies. Because of this, there’s been a need for a novel and advanced treatment to bring relief to their symptoms, as well as to their suicidal thoughts.
So it stands to reason that ketamine treatment can relieve both depressionandinsomnia. In fact, in a separate action, it can also erase suicidal thoughts in an hour or so.
Insomnia and Suicide
Stubborn long-term insomnia that doesn’t respond to medicines or therapy is not uncommon at all. But it contributes to your illness in ways that are so dangerous, it’s important to find effective treatment.
Suicidal thoughts are also life-threatening, and the longer they continue, the greater the risk to your survival.
If medicines and therapies haven’t relieved these symptoms, you may be a candidate for ketamine treatment. Ketamine treatment can restore your neuroplasticity and erase suicidal thoughts within 4 hours or less. Then, after that, you may find you can finally sleep.
At Innovative Psychiatry, patients walk out restored every week. They find they can do things they couldn’t do before, work through inner turmoil that they were unable to before, build relationships they lacked the energy and resilience to build before.
They can build rewarding lives and relationships.
And you can enjoy these breakthroughs, too.
Call us. You owe it to yourself to give your life and yourself the best advantage.
Your child. Devastating diagnosis. Potentially fatal.
The very thought runs chills down your spine. Takes your breath away. You’re paralyzed.
We’ve talked in the past about PTSD, and how there are varied events that can cause it. The best known cause is active combat. But many different kinds of traumatic events can lead to post-traumatic-stress-disorder (PTSD). And PTSD in parents can have an enormous impact on every family member.
No way! She’s fine! She just has a cold!! She was running and playing just last week! There must be some mistake. A mixup in the lab? Are these people wrong? This can’t be real.
PTSD. Because of things like domestic abuse, fire, or assault, to name a few. But something we haven’t discussed is the trauma parents experience when their child is suddenly diagnosed with a catastrophic or life-threatening illness.
In fact, parents who endure this traumatic and often long-term struggle are often all but ignored in lieu of the more pressing issues. And their suffering, though hidden, may lead to a larger and wider disorder of their own.
In the case of an auto collision, both the parents and the children involved have been subjected to trauma. If a child is critically injured, the parent’s trauma doubles . And as victims themselves, the parents are likely to be recognized as people who are in need of special support as they heal and cope with their child’s injuries and prognosis.
But in the case of the sudden diagnosis of a life-threatening illness, the focus is on the ill child. And the parent is left to try to cope with shock, fear, anxiety… maybe depression…and probably denial, too.
PTSD in parents can be crippling.
Studies conducted about this type of situation have shown that the parents have certain needs above all others.
If Your Child is Diagnosed with a Life-Threatening Illness
First, you need to have clear and accurate information about your child’s condition and prognosis. You may or may not be ready to grasp what the doctor tells you the first time you hear it. For this reason you need to have the opportunity to see the doctor at least once a day if your child is in the hospital (or at least very frequently if he or she is not). If the prognosis is poor, you probably need several visits each day. There is just so much to take in.
Second, you need to have privacy to hear this information, to discuss decisions, ask questions, and to grieve.
Third, you need emotional support. You need your child’s doctor to be compassionate, to listen for a few minutes. You also probably need a specific staff member — a doctor, nurse, social worker, or someone else who really knows — help you consider options, and show they care.
Fourth, and this is specific to situations where the child dies, you need to be able to hold and comfort your child in the final hours of his or her life. There comes a point when heroics need to be set aside to make way for grief, comfort, and goodbyes.
By reading articles like this one, you can gain a clearer idea of parents’ needs if you or a loved one ever faces such a situation like this. And by becoming familiar with what those needs are, you can help another parent — or you will understand better what you need to ask for yourself.
A number of studies have followed parents at the bedside of a critically-ill child to learn more about their needs, as well as their psychological reactions to their child facing this scenario.
And it turns out that these parents are so deeply affected by this threat to their child’s life that they often suffer symptoms that are in line with the symptoms of PTSD.
So let’s say your child nearly drowned, or was badly burned, or developed meningitis, or was in ICU with the new diagnosis of Type 1 diabetes, your reactions would be similar in all these scenarios… intense and difficult to relieve.
Faced with the heartbreaking gravity of your child’s condition, you may be plunged into shock. Numbness. Dread.
It may be difficult for hospital staff or family to effectively communicate with you because of your state of mind. You may have to ask several times for your child’s doctor to reiterate the current status of your child’s condition…until you “get it.”
Because it’s not uncommon for a doctor to explain a poor prognosis for a child, and the parent to respond by saying, “So you’re saying she’ll be OK when she goes home?”
Why does this happen?
Because you’re in shock, and with it, denial. You’re human and “reality” as you know it has taken a sudden left turn. It may even have come to a crashing halt. You need time, support, privacy, and patience to catch up with what’s going on.
At the same time, while you’re going through all this, your child is also suffering. Your instincts are telling you that she needs you. That she needs your comfort. And you want to provide that with everything in your being.
But the accumulation of the astounding turn of events, the devastating prognosis, the enormous amount of information you’re trying to sort through and grasp…well all of it together can be tremendously overwhelming.
You may find the doctors will repeat the same things to you each time they see you — to be sure you grasp it all and can move forward with decisions.
Many parents in this situation may begin to show symptoms of post-traumatic-stress-disorder weeks or months after their child has recovered and is discharged from the hospital…or …after their child has died.
These may include things like numbness, as we mentioned before, as well as denial. You might find yourself going over and over in your mind the string of events that led to this.
They may also find they avoid being near places that remind them of their child’s traumatic illness, or speaking of anything that might remind them of the pain their child suffered.
And the nightmares. Reliving the experience in your sleep, trying to do something to prevent it. Or reliving it to the worst possible outcome.
The misery, the trembling, the weeping…the headaches, stomach upset, even ulcers. And anxiety that escalates to panic, with such a pounding, fast heart rate, you wonder if you’re going to die.
The initial shock of the diagnosis, and the intrusive medical treatments that follow — all may serve to drive you into a state of real PTSD.
How You Can Increase Your Resilience
Can you prepare for a crisis like this? As a parent, you probably would like to so you can be sure to function at your best in such a difficult time.
But, as we’ve talked about before, the impact all these stressors have on you is more determined by your own personal resilience, and less about your educational preparation for crisis in general.
So how do you develop resilience?
By adapting.
How do you look at crises? Do you feel the very fact that you’re faced with a crisis is traumatic? Do you perceive yourself as a victim who’s been singled out to suffer? Are you overwhelmed with the unfairness of it all?
This is important: There’s no wrong answer to these questions…only your answer. And what you learn from it.
When you look at life as a series of mountains to be climbed, and you’re ready for the challenge, you’re less likely to be overwhelmed by crises when they come. When a crisis brings out your toolbox of problem-solving methods, you’re most likely to adapt and resolve the crisis.
On the other hand…if you face each crisis you encounter in life as another problem to be resolved… Then you go into each crisis with a little extra strength, a bit more armor against the attack.
But if you view yourself as an innocent victim who didn’t deserve this difficulty, you’re more likely to be crushed by the situation. The key is in the way you think about yourself and the situation around you.
So while you can’t prepare yourself for every inevitability, you cantrain yourself to adapt and seek solutions to every obstacle in life. You can train yourself to recognize that life is full of challenges for everyone, and obstacles can be taken in stride.
Doing so over time may not make you immune to trauma during a life-threatening illness in your child, because a crisis of that magnitude can be overwhelming to anyone.
But it can help you feel more equipped to navigate those waters until the seas calm again.
We have patients at Innovative Psychiatry who fall into this category. And sometimes, the PTSD is stubborn, and difficult to relieve. PTSD in parents magnifies a family’s calamity.
In fact, some patients who’ve been un-helped by medication and therapy for PTSD, consider ketamine treatment and enjoy remarkable relief.
So understand that PTSD is not a failure to be resilient…or a failure of attitude. That’s just not the case. But sometimes those who work to remove the “victim” mentality from their outlook are less affected by a terrible life crisis than someone who has not done the same work in their thinking through therapy.
Our hope is that you’ll be as healthy and resilient as you can be, and that your life will be an ongoing opportunity to learn about yourself, and the world around you. Seek out the lessons in each experience. This will help you become adaptable and strong.
Because adaptability gives rise to the strength of resilience.
Trudging through life isn’t reserved for only the sick, the suffering, and the poverty-stricken. On some level, trudging is part of the routine of daily living for many. Certainly, it isn’t the sentence for every human. But why? Could the reason be hidden in the science of joy…?
Or is it because those privileged with wealth and fame are spared the drudgery of a mundane routine, bad weather, or a car that won’t start?
Let’s talk about the differences between those who trudge and those who dance through life. Is joy the result of near-perfect surroundings? Is it an abundance of happiness?
Or is joy the result of nurturing a garden in your psyche and soul that pays off in dividends of fragrance, beauty, patience, and the aromatic blossoming of inner joy?
For the last 4 weeks, we talked about ways to remodel the infrastructure of your mindset, your outlook, and your attitude. Our purpose has been to show you the potential for developing an atmosphere in your thought life that nurtures your remission after ketamine treatment, and gives you the rich soil you need to grow a healthy and peace-cultivating way of thinking.
Letting Go, Then Facing Your Truth, Sets You Free
When you let go of those things that you’ve held onto that have been obstacles to your wellbeing, you give yourself the gift of freedom from addictions, freedom from bitterness, freedom from rage that drives reactions inside you that can enslave you. You give yourself the gift of new options as you move forward in life.
Sometimes in the process of letting go of those things that have been destructive to your wellbeing, you find yourself against a wall that you don’t know how to penetrate. We talked about facing the truth about situations you haven’t wanted to face. You may have been defending yourself in your mind, and running active arguments through your mind to defend that thing you haven’t faced.
Then you can open yourself to the possibility that maybe you were actually wrong, or that you share the responsibility, and you can face and accept that. Telling that person you’ve been in conflict with that you know you were wrong, and asking forgiveness, can lift such a burden of shame and blame off you, and let you enjoy peace within yourself, and with others.
It doesn’t matter that you know their actions were terribly wrong and caused damage. That’s their responsibility. But you’ve evicted that guilt, resentment, and denial from your mind and heart. And the place it occupied is now filled with peace.
“Persisting” Leads to a Life of Peace and Kindness
Once you know you have nothing to prove, and you enjoy the relief and freedom that brings, you’re equipped to face the next item in your life that surfaces and go through that same process to find peace, once again.
You then learn that this is a way of life, and you can grow in peace and freedom by persisting in this process with each issue that arises within you.
You’re on a mission to set yourself free. And it’s working.
Then LOVE follows. Your process, your system for recovery, leads you to treat yourself with love, and that flows to others in kindness. Your former short-tempered, impatient, self-focused self becomes more focused on others and helping them find peace, too. And your personality begins to mold around the kindness that dominates in your interactions with others.
This process repeated over and over, reduces your stress and strengthens your resilience … and all those gut knots that had been your constant companions in life relax and dissipate…
And you begin to notice that joy bubbles up from within.
So let’s talk about the anatomy of that joy.
What Is the Science of Joy?
Is it about happiness? Well, joy can make you smile like happiness can, but it’s based on different things.
Happiness is centered on “happenstance” …or basically when circumstances align with what you want. Maybe you’ve worked hard for that job, and maybe you got the promotion. Or maybe you were able to buy a car, after having to rely on the bus for the last 3 years. And just maybe… that gorgeous woman you met online finally agreed to meet you for coffee.
All of these things are good. And they present themselves as solutions to one problem or another. But the problem with happiness is that it is limited to your circumstances being a certain way that pleases you.
Now, the problem with life is that circumstances may line up with your desires from time to time, but then they change, don’t they? Happenstance, as such, is fickle. One day everything is just like you want it, and the next, well your world has been turned upside down.
You got passed up for the promotion after all. Someone ran a stop sign and your new car is wrecked. That gorgeous woman turned out to be a liar and a witch.
If that upsets your happy outlook, then you’re only happy when things go your way.
So there has to be something that comes from a deeper place—something that remains stable no matter which way the wind blows or the direction your boat floats.
It needs to be something that emerges from deep inside you, even when times are hard, and tells you everything is going to be alright. Something that fuels optimism in a storm.
It’s joy. Joy transcends circumstances. And it’s not based on you getting what you want.
Hmmm……you’re saying. What’s this?
Joy In Your Heart In Tough Times
Remember how we talked about giving of ourselves and the kindness that naturally follows? Well, this is also where joy comes in. While happiness is based on circumstances, joy flourishes as a product of transcending those circumstances.
Let’s say that again:
The Science of Joy teaches you that joy flourishes as a product of transcending your circumstances.
In fact, joy comes from giving to someone to the point of your own personal sacrifice, and from seeing that person gain freedom and joy, too.
Joy also arises from your gratitude.
Researchers have found that humans tend to focus more on negative experiences than positive ones. Even though we may have many times more positive experiences in a given 24 hour period, it’s the negative one that can ruin our day. That is, if we let it.
One thing people tend to do is to miss the chance to focus on the things that are good in their lives. And … after awhile … they don’t notice them at all.
This is where the attitude of gratitude comes in. A compelling component in the science of joy. One study showed that people who make a list each morning of all the things they’re grateful for, are healthier physically and psychologically, more successful, and happier. They’re less materialistic and envious, and more generous in giving to others.
Happiness vs. Joy
What is the opposite of happiness? Unhappiness.
Hmmm.
What is the opposite of joy? Depression.
And what is a telltale sign that you’re in remission after ketamine treatment? Joy. And HOPE.
So it stands to reason that to maintain a joyous heart is to build a sort of insurance policy against depression. To rise in your aspirations higher than material gain, personal pleasure, or the attention that comes from achievement…well, it’s liberating. Then, to transcend your own desires, and rather reach beyond yourself to help someone else find fulfillment — that results in joy.
And because that joy is not dependent on you having what you want, it lasts.
And fuels your mind and heart with passion that motivates you to make the world a better place, one person at a time.
Mother Teresa and Your Family
Mother Teresa knew all about joy. She said, “Help one person at a time and start with the person nearest you…” and “..If you want to change the world, go home and love your family.”
For the most part, it’s safe to say that what you need is to be freed from making yourself happy. The science of joy, in a nutshell.
It might be interesting to write down all the things you think you want, and the stressors subtly associated with each one.
Like, the car payment you’d have to make every month, keeping it clean, paying for gasoline, changing the oil, paying for new tires, and the list goes on…
Then, think about the needs you see around you. Your parents? Maybe your spouse? Certainly your children…and maybe your neighbor or co-worker. Sometimes your presence is the greatest gift of all.
The science of joy includes simplifying your life. To free up your time and resources for a more rewarding way to live.
Sharing Your Joy
A researcher at Brigham Young University, Nathaniel Lambert, conducted a recent study that showed that when you share your positive experiences and the things you’re grateful for, it leads to heightened wellbeing, more energy, and better overall satisfaction in life.
Isn’t that amazing?? Practicing the very thing that supercharges your joy makes your life BETTER!!
When you take a step back and really think about all these aspects of joy, you gotta start to wonder if we all just need to make a major shift in what motivates us. Because when you’re motivated to please yourself, it leads to all sorts of obstacles to your peace.
But when you follow the path of joy, everything seems to fall into place.
And that’s the science of joy.
These are the keys to building an infrastructure to help your remission thrive… but if you haven’t received ketamine treatment yet, you may want to talk about it with us.
But the most exciting work with ketamine centers on using it to stop suicidal ideation. To stop suicidal thinking. And to avoid going to the ER. To avoid getting hospitalized. Put simply, to stop the suffering.
What a game changer.
And the remarkable thing about suicidal thinking is that ketamine can erase those thoughts fast – in less than an hour.
Reach out to us, or have your doctor get in touch with us. We love working with the doctors who already know you and take care of you so that we can create your best outcome.
If you think ketamine treatment might be right for you, call us. Let’s talk about whether you’re a candidate for ketamine treatment.
No other medication has offered such extraordinary outcomes to so many people. Our joy is helping you get better… really better.
(Reuters) – An advisory panel to the U.S. Food and Drug Administration on Tuesday voted in favor of Johnson & Johnson’s experimental nasal spray, which has a compound similar to often-abused ketamine, bringing the drug closer to approval.
The panel voted 14-2 in favor of the drug esketamine, developed to treat major depression in patients who have not benefited from at least two different therapies, saying its benefits outweighed the risks. One panel member abstained from voting.
Esketamine is a chemical mirror image of anesthetic ketamine, which is also abused as a recreational party drug and goes by the street nickname “Special K”.
“I think esketamine has the potential to be a game-changer in the treatment of depression … I use the term potential because the issues of cost and patient accessibility need to be addressed,” said Walter Dunn, who voted in favor of approval.
However, the panel members echoed concerns raised by FDA staffers on Friday regarding the increased risk of sedation, dissociation and higher blood pressure observed in the study.
The FDA recommended implementing a risk evaluation and mitigation strategy (REMS) program which included ensuring esketamine is only dispensed and administered under supervision.
“Ketamine is a nasty drug … should (J&J’s) drug get approved, I think a strong effort has to be given as part of REMS … so that patients really know what they are getting themselves into,” said Steven Meisel, another member who voted ‘yes’.
Major depressive disorder affects over 300 million people globally. About 30 percent to 40 percent of these patients fail to respond to first-line treatments such as antidepressants, most of which take at least four weeks to show effect.
However, depression is a tricky area of development. Patients in clinical trials often show a big placebo response, masking the efficacy of the drug being tested.
Currently, Eli Lilly and Co’s Symbyax is the only FDA-approved drug for treatment-resistant depression.
“There is a lot of potential for people that just want that quick fix. I really would be cautious,” said Kim Witczak, a panel member who voted ‘no’.
J&J’s esketamine, used in combination with a newly prescribed antidepressant, works by restoring the nerve cell connections in the brain, leading to an improvement in depression symptoms.
The FDA, although not mandated to follow the panel’s recommendation, is expected to announce its decision on esketamine by March 4.
With perseverance, you can build the life you want to live.
You’ve probably seen the photo of an old stone lighthouse in the storm, with overwhelming waves crashing against it and around it. It looks like it will surely be knocked down…but it’s not. Those waves go on year in and year out, decades upon decades, but it stands strong. It stands to give light to ships in the storm. Steadfast, it shines its light, no matter what.
This is persistence. Holding steadfast to the hope for better days, believing in the peace that will follow the storm, no matter how great the pressure… it endures.
Storms are a part of every life, and the risk of collapse is real. If there was no fear, no risk, the endurance would be unremarkable.
However, because the risk is real, there is great reward when you see the calm that follows the storm. And each storm that you survive prepares you to be stronger to withstand the next one.
Holding Steady in Chronic Illness and Abuse
Marti withstood storms. Life-threatening illness that came in waves and threatened to destroy her. An abusive partner who shifted from violent to repentant and back again, bringing her within an inch of her life. Repeatedly.
But each time, she nursed her wounds, and determined to try again.
Marty had contemplated or attempted suicide quite a few times in the 25 years she’d been depressed. Through those times Marty’s depression worsened and she wanted to die, but she kept holding on for a day when life might get better.
After her ketamine treatment, she discovered that she still had some of the perseverance she’d developed through those years of constant crisis. And, she learned about the importance of practicing endurance, self-control,letting go, and honesty with herself.
As the ketamine treatment continued to improve her outlook long after the infusions were over, she thought often about how to work on her “infrastructure” that she’d heard so much about.
How to increase her own determination to stand steady when some symptom returned, by knowing it would pass again like they’d come to do.
Or to keep putting one foot in front of the other when she lost her job and wanted to give up. …Or when she had 2 twelve-day hospitalizations the same month and she couldn’t see a time when she would be well.
Persistence – The Road to Resilience – May Be Enhanced by Ketamine
While she was undergoing ketamine treatment, she arranged with her therapist to have a session 24 hours after each infusion. It was clear she needed therapy to heal from the scars of that abusive relationship.
And she’d understood that there was something special about the 24 mark after the infusion that really helped the therapy to be more effective.
Marti found the neuroplasticity ketamine treatment had initiated allowed her to see through her faulty thinking in that relationship, so she could heal, and move forward in her life.
It encouraged her when she realized that each time she held steady through a period of emotionally swinging out of control, she felt stronger to do that the next time.
After awhile, she also worked at being kind to others in the wake of her symptoms subsiding post- infusion. The more times she stopped herself from over reacting toward someone, the easier it was the next time.
Each of these steps helped her peace to grow. She felt more serene, more confident in her ability to function in life. And in her healthier state, she found someone new who brought out the best in her, and supported her healing and restoration.
She’s now in full remission and kindness has again become the backdrop of her nature, though her assertive personality is still fully hers. She couldn’t have gained this ground without ketamine, but once she had its help, she made great strides that paid off in the reward of a fulfilling life.
Holding Steady Between Bipolar Episodes
Bernie withstood storms. Like Marty, he came close to succumbing to them. The frequent storms of bipolar depression made survival appear like an ugly life sentence, with no escape.
But, then his parents heard about ketamine treatment. They gave him articles to read …and the more he learned, the more he wanted it.
After the treatment, he felt relieved… but there were still symptoms some of the time. When symptoms did come up, he knew he needed to keep putting one foot in front of the other, and keep moving forward, because he could finally see hope.
He found that the reduced symptoms and his better frame of mind in between was making his life more “endurable” when the symptoms did rise up.
Persistence is believing in good days ahead when a storm is pounding down on you and your ship is breaking apart beneath your feet.
Persistence knows that no matter how overwhelming this moment…or this decade…seems to be, there will be a better day – a happier ending.
When you’re persistent, your mind is focused on the positiveoutcomeof the crushing circumstances you’re enduring, and you know that you don’t want obstacles like complaining or an attitude of defeat to prevent you from reaching that reward. So you look at the promise you see of what lies ahead, rather than focusing on or magnifying the circumstances you’re in.
And like Marty, each time you hold onto that promise and plod forward with determination, you gain more strength to do it again in an even worse storm. You get stronger.
The seeming foreverness of each bout with illness that never seemed to stop for years, and the seeming inevitability that the abuse would finally end her life, only bowed and gave way to her hope as she worked with the ketamine treatment to change her outlook.
And hope, as well as the ability to be resilient during storms, finally took root and stayed.
So persistence is a component of strength you can develop,nurture, and establish within yourself. Like a well-dug foundation it will hold you on course during the most threatening times of life.
Persistence is akin to perseverance.
Keep on keeping on…no matter how shrill the wind whistles. And no matter how long you pull your cap down over your head and bow into the freezing rain, you will endure. Because that persevering will hold firm in your mind the view on the other side of what’s going on, and it gives you the durability to emerge from the whole horror unscathed.
A bit wiser, a bit stronger, yes. But with a new confidence that drives away fear.
In time, you can arm yourself with that new confidence and the hard-earned wisdom that reminds you what it takes to survive, and build the future you find in the pot o’ gold on the other side.
One step at a time. With determination, and a new instinctive sense that it’s persistence that will keep you on the scene so you can enjoy the rewards that await you.
Because it’s persistence that helps you try again and again and again. Perseverance tells you to get back up after falling down, brush yourself off, figure out why you fell, and incorporate that new knowledge into your next try.
Stubborn Persistence is Required for Marriage to Survive
Do you notice older couples who are white haired, and take evening walks holding hands with their dog on a leash? Ever wonder how they stayed in love that long?
It wasn’t magic.
There is no 40-, 50-, 60-year marriage or more that lasted that long without persistence. No one knows how to make a marriage work on the wedding day.
Some may have a little more insight than others about getting along, or putting someone else’s interests ahead of their own.
In this generation of self-assertion and self-absorption, that’s all but a lost art. Still, it wasn’t an accident that two people with stooped posture and white hair feel like holding hands and enjoying each other’s company after so many decades of living together.
To enjoy their autumn years, they had to learn early about getting back up and trying again. They’ve most likely had times when they couldn’t stand each other and didn’t want to stay together even another day. But one of them, one time or another, probably stepped up with persistence and determined to build a bridge, forgive the other one, and ask for forgiveness, too.
Without that? They wouldn’t have made it to their next anniversary. And you can ask them…but I’d guess with confidence that they both have done that many times…and more times than they can count… they’ve each taken turns at playing that role, until they managed to get really good at it.
Over time they learned that persistence, road to resilience, has kept their marriage strong.
…And, eventually realized they were glad they were still together…to watch their children graduate from high school; to give away their daughters in marriage; and to welcome and play with their grandchildren and great grandchildren.
You’re Human, After All
Everyone falls down in their endeavors. But the persistent ones brush off and get back up and try again…and again… As many times as it takes as long as they live.
That kind of persistence leads to success, and resilience, and countless rewards.
Does a three-year-old play the violin like a maestro the first time he picks it up?
No.
He makes mistakes and gets frustrated. He wants to throw it away and forget it. But his mom, whose name is Persistence, sees that he picks it back up and tries again. And practices. Again and again… and over the years, the 3-year-old eventually lands 1st chair in high school… and later gets to decide if he’d like to accept that invitation to play in the Philadelphia Philharmonic.
What do you want to bet he’s now become so good at persistence, he knows how to apply it in countless areas of his life? As with the hare and the tortoise: slow and steady – consistently – wins the race.
Persistence.
Honestly? Without perseverance and persistence there’s not much you can accomplish in life. Because everyone falls down. Everyone gets discouraged at some point. Everyone fails at something. Abandoning the vision strikes the death blow to that endeavor.
However, with persistence there’s nothing you cannot do. The more you use it, the stronger it gets. Until persisting is part of who you are, and a tool you put to use in every project. And persistence gives way to resilience.
The character of a psychiatric disorder – the actual activity of it in the brain – wears down resilience, and flattens out persistence. If you’ve suffered from depression, social anxiety, PTSD, bipolar depression, or addiction, or suicidal thinking, you probably can’t imagine the resilience and persistence required to stand up after you’ve been down so long.
But that’s where ketamine comes in. Since at least a third of all people afflicted with these disorders experience no relief from prescribed medications,something more novel and advanced is required to bring relief. Ketamine treatment is the first treatment that has made an extraordinary difference for these patients.
And it’s such an advantage that another benefit of ketamine is its neuroplasticity that makes it easier for you to make changes in your mind that allow you adapt to your circumstances, reduce your stress, apply persistence, and build resilience.
If you’re even considering treatment with IV ketamine, or have recently received it, you know you have persistence and a good measure of grit.
You know what it’s been like…how you’ve been able to withstand the disappointment of one treatment after another — or one effort after another — not working. You already have some persistence working for you.
Ketamine delivers a one – two punch. First restoring connections in the signaling systems in the brain, and then providing neuroplasticity to help you make the changes in your outlook you want to put in place.
Because if you’ve been depressed, and now you feel better after ketamine treatment, you want to keep feeling better, right?
You want to do the work that will help you maintain a remission frame of mind. So you can continue growing, and press on with developing the life you want to live. The best way to do that is to remove the stressors in your life.
We do the work, too. We’re up at night, reading, refining, persisting in trying to identify the best treatment options that can get you back to your best self. We offer treatment when your symptoms persist, when your doctors have done all they can, when you’ve just gotten tired.
We’re here to help you win your battles… and in that process, persistence is priceless.
Be sure it’s your real self you’re showing. Because it is your real self that needs to be loved. Daphne Rose Kingma
It’s the most healing thing you can accomplish as you work through the changes in your thinking, your responses, your outlook and attitude about people and your world after ketamine treatment. As you build an infrastructure of peace and generosity…fix your inner life and learn to embrace the truth about yourself.
Self-doubt, self-defensiveness, and pretense eat away at your self-respect and love of yourself…and can lead to depression. But you want to reduce the stress in your life to help your wellbeing thrive.
How do you reduce the stress? By facing the truth that eats at you or that you hide from yourself.
What sort of truth..? Well, that you’re human, for starters. That you’re not always perfect in your responses to life’s stressors. And that there are plenty of things you can learn to make your life work better for you.
Things like humility, admitting your shortcomings, and asking for forgiveness, to name a few. To accept yourself as a learner in this life and not to expect yourself to know everything out of the gate.
Using Pride as a Shield of Protection
Pride drives many of us to present ourselves as infallible, until we realize that pride also shackles us from the fulfillment of intimacy in relationships.
Replacing pride with love can be scary. It can make you feel exposed and vulnerable until you get used to it. But doing so can transform your life and drive loneliness away.
Something we do as humans is to construct personas that we tell ourselves others will find more likable or respectable than who we really are. But a persona that you construct is always stilted. Unnatural.
Have you ever been around someone who’s utterly at home in his own skin? Isn’t he or she absolutely enjoyable and relaxing to be around? The reason they’re enjoyable and relaxing to be around is because they’ve found a certain degree of peace with who they are.
They accept themselves as they are so there’s no need for pretense. When someone is trying to prove themselves, it can make you uncomfortable. But when you sense they have nothing to prove, you subconsciously feel like you can relax.
At the same time, you get the sense that their mental health is pretty good.
It’s the exception to meet someone like that, rather than the rule. Most of us aren’t free of pretense, until we learn what we need to learn so we can bewho we are.
This shouldn’t be so hard. You know?
But we live in a world that feels dangerous and makes us think we have to protect ourselves. So we do. We build walls around ourselves. Thick, impenetrable armor to keep ourselves safe.
And we guard that armor, those walls, to stay safe. Then, if anything threatens to expose us under the armor, we get anxious and defend it. Don’t we?
So, after all that work, we’re reluctant to knock down those walls. We don’t feel safe without the armor.
And that’s why we have to learn to see what the walls and the armor are costing us. We have to see that they’re interrupting our social development and our opportunities for close, fulfilling relationships.
They also require that we remain vigilant, prepared to defend any attack on our security in the armor. So we can’t relax. We can’t let our guard down.
Fix Your Inner Life
You have to change the way you think. The way you respond to things.
You may need to get really honest with yourself. You may find you have to learn how to embrace the truth, and learn to accept yourself as human, fallible, and forgivable. When you do that, you may also feel more lovable.
And when you feel lovable…and LOVED… you’ll tend to find it much easier to generously love others.
Ok. I know it’s certainly easier said than done. It’s an uncomfortable process to look head-on at things in yourself you haven’t before. But, it leads to a very comfortable, confident, joyful way of living.
But, if you’ve had ketamine treatment, and feel much, much better, you sure want to stay better, right?
Well, one important aspect of staying better is to unravel the conflict you carry inside you that you may not even realize is there.
But…it IS there. And it interferes with the peace within you. So what can you do?
Embrace the truth about yourself.
Just like letting go of what you NEED to let go of, when you embrace truth about yourself it helps you relax with who you really are.
Accepting your shortcomings, and dropping that guard that says you’re flawless, admirable, or beyond reproach, helps you embrace the truth that you’re a real living fallible human worthy of giving and receiving love.
And there’s another plus: doing so will increase your self respect.
Sound pretty far out? What if you don’t know what you have inner conflict about? Or how to tell if your guard is up?
What if you’ve been presenting yourself the way you think people expect you to for so long you don’t remember what it was like to be yourself?
Scrutinizing Your Inner Self
Start with looking closely at that experience or event that scratches at your conscious memories. What are you telling yourself about it? What about it might be seen differently?
Pay attention to your inner voice…do you find yourself defending yourself over what happened? What could you be “hiding” from yourself?
It might be related to some sort of blame you place on another person… or something you’re hiding from yourself. Look deeper. Could you have caused the situation, even though you didn’t intend to? Is it possible you share responsibility for what happened?
And what happens when you look at the other person’s role with a heart of forgiveness and understanding? Can you see how the outcome might not have been his/her intent?
Then. Just say it. “It’s my responsibility that so-and-so happened. ” Or…share the responsibility… ” I share in the responsibility that so-and-so happened. I didn’t intend for it to go down the way it did. He/she probably didn’t intend it either. I’m human, and I was wrong. I handled the situation badly. I’m truly sorry, and I’ll really try to not do it again.” Then move on with the resolve to make good decisions and to treat others well going forward.
I Was Wrong
It’s very difficult sometimes to reach this point. But giving up the fight and accepting that you’re fallible can be so liberating. You THOUGHT it could destroy you, hence the long arduous combat in your mind.
But when you really see that you were wrong…you can accept that it happened. And the fight inside you…the defensive arguments in your head…begin to disappear and become quiet.
And that quiet is a deposit of peace into your inner self. Enjoy the reward of harmony you feel.
Then take what you’ve learned and apply it to the next situation that comes to mind…because another situation will. You’re human and fallible. And so is everyone you know.
Going forward, you may find you’re a little less judgmental, a bit less inhibited…and more and more relaxed. In that relaxed and peaceful state, it’s much easier to feel better.
With these things at work within you, you can accept yourself as human, and realize that through forgiveness of yourself you are more able to love and receive love. And that brings joy.
Remember, this discussion is NOT to say that if your remission fades away, it’s your fault.
At Innovative Psychiatry, we want to be a part of your recovery as you use your ketamine treatment to help you bring change in your thinking, your outlook on life, and your attitudes.
If you’re not in the habit, but have experienced joy from ketamine treatment, changes like we’ve talked about can help you continue to enjoy that joy, increasing love…and freedom from emotional pain.
