Category: Ketamine

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.

The Right Dose of Ketamine for You

Ketamine Treatment for Mood Disorders is NOT One-Size-Fits-All

Have you suffered from severe depression, suicidal thoughts, social anxiety… or PTSD, OCD, bipolar disorder, addiction… and the treatments your doctor prescribed didn’t help?

Did you reach out to a doctor who offers ketamine, or a ketamine clinic in your area, and find that it hardly helped?

It’s so disappointing.

To put your hope in a new treatment that seems like it could finally make a difference and give you your life back … only to find out it didn’t help any more than anything else you tried — well, that can be shattering. Devastating, really.

I have some thoughts –

It’s true that ketamine treatment doesn’t help everyone reach remission, but it does help most… Still, there may be reasons that it didn’t do as much for you as it could have done. That disappointment you feel just may be remedied…just possibly…. by more effective means of treatment.

Perhaps the provider who administered your ketamine treatments used a route that robs ketamine of its best opportunity to help you.

So here’s a question: Did you receive just a dose or two? Separated by, say, two weeks or more?

Ketamine has been studied long enough to show us that one initial infusion is just that: it’s the first step. And it needs to be followed by others if you’re looking for long-lasting benefits.

It’s been known for some time that the best way to overcome ketamine’s short duration is to stack several infusions together, every 2-3 days. And so far, the best results follow a series of 6 infusions. Over 2 weeks, and now 3. For others, they need 6-8 infusions, maybe even 9… over 3 weeks. And now the numbers start to rumble:

2,2,1,1

3 over 2 weeks

one a week for 4 weeks

two a week for 3 weeks

Geez, is this all just made up? Is there an evidence basis for how we dose and administer ketamine beyond replicating how we administer ECT, or beyond convenience — building a dosing schedule around your driving time, your spouse’s availability, or when you can get a ride? Is there a strong base of evidence for how much or how little to use?

This is where science becomes art. This is what the practice of medicine is.

With IV ketamine, a foundational series of infusions can set in motion changes in the brain structures and systems that can give you the best chance of remission.

For some patients, a few more treatments may be necessary for you to achieve remission…

In other cases, it may be necessary to refresh your remission and bolster it, a few times a year…or once or twice a year.

But in many cases, that remission may remain strong after the initial series — especially if you’re able to strengthen what I like to call the infrastructure of your life.

To reduce stressors by making positive changes.

To work with your therapist to develop productive thoughts and actions in response to daily challenges.

And you may need to receive those refresher infusions periodically while you work on these things.

Researchers are looking at why … and at how many, how often, how high, and how long. We don’t know all the answers yet.

Another consideration is the route your doctor used. Ketamine’s beneficial antidepressant effects are precisely delivered by IV infusion — but it has been delivered an an intramuscular injection, and it can be delivered by inhaler, or swallowed as a bitter liquid, or formulated in an oral lozenge (called a “troche.’)

And now, there are providers out there offering ketamine by “IM infusion.”

An “IM infusion” of ketamine is an oxymoron.

Ketamine was originally developed for anesthesia and to be administered straight into the bloodstream, where 100% of the medicine can reach the brain — where it does its work.

For treatment-resistant psychiatric disorders, we believe this route is especially important.

Any other route – IM (intramuscular), intranasal, oral, sublingual, involves obstacles to the medicine reaching your brain, and a doctor can only estimate the amount that actually reaches your brain. We talked about this in detail in March of 2017.

So…if you’re not getting the full dose of medicine but rather only 50% or even 30%…it’s not hard to see that ketamine could be being shackled from doing its best work. So important.

Why would you risk that?

And there’s another important detail that can rob you of your best results.

The Right Dose of Ketamine for YOU

Every person is unique, every body has its own history, and your brain is unique to you.

Yes, it’s true that a brain is a brain, but yours has its own precise, infinitesimal variations. The systems in your brain are uniquely yours. And this uniqueness must be addressed in your ketamine dose for you to experience the best possible results from your treatment.

This is why we have a personalized, individualized approach to medical care. To customize your treatment to fit you.

We talked about the importance of dose seven months ago, but something new has emerged on the scene. You need to hear about this.

You may have seen the press. A study focused on ketamine dosing (finally!) which revealed two strengths of IV ketamine that provide effective symptom relief in patients with treatment-resistant depression.

Now, keep in mind as we move through this study that the subjects in the study had treatment-resistant depression, specifically. But we know that ketamine is also effective in treating bipolar disorder, panic disorder, social anxiety, PTSD, OCD, addiction … and that it can stop suicidal thinking within just a few hours.

So keep these conditions in mind also as we look at what the researchers found.

Study Finds Two Doses of Ketamine Treatment That Provide Significant Relief of Symptoms

The study, published in Molecular Psychiatry in the October 2018 issue, was led by researchers at Massachusetts General Hospital, and identified 2 doses of IV ketamine that effectively reduced symptoms of treatment-resistant symptoms. Four were tested — two made the cut.

This study investigated 4 dosages of IV ketamine: 0.1mg/kg, 0.2mg/kg, 0.5mg/kg, and 1.0mg/kg.

Now we have a paper that confirms that doses under 0.5 mg/kg are not effective, so hopefully more focus can be devoted to dosages above 0.5 mg/kg.

Such as 0.6, 0.7 or 0.8mg/kg. And may even 1.1 mg/kg and 1.2 mg/kg, too.

Of course we want to use the smallest dose possible that achieves optimum results, but physicians don’t want to administer a dose so small that it can’t achieve relief. And certainly we shouldn’t be cavalier — and provide unnecessarily large doses — when we know that too much ketamine can cause damage.

At the tiny doses we use, however, there’s a wide safety margin.

So back to the study.

What Doses Worked?

The four dosage strengths were tested against an active placebo — which means a non-ketamine medicine that has similar side effects to ketamine. This helped to prevent the study subjects from being able to tell if they got ketamine or not.

The researchers accepted 99 adults with current diagnoses of treatment-resistant depression. These subjects were chosen across 6 different geographical regions, and were involved in the study at 6 different research centers: Massachusetts General Hospital, Baylor College of Medicine/Debakey VA Medical Center, Icahn School of Medicine at Mt. Sinai, Stanford University School of Medicine, University of Texas/Southwestern Medical Center, and Yale University.

A real hall of fame in research centers!

The 99 participants were divided randomly into 5 groups — a group for each dose and one for the active placebo group.

Each participant was assessed with a series of standard depression rating scales on the first day of the infusion study with a series of questions about their symptoms at that time — to established a baseline for each person.

Then they were assessed again on the second day, the third, the fifth, the seventh, the 14th, and 30th day after that infusion. Other assessment instruments determined their mood and suicidal thinking.

Because this was a study, the goal was to check which dose was most effective and lasted the longest. (It wasn’t designed to be a dose-titration study to help participants achieve remission.)

So they were only given one infusion.

Turned out the participants receiving ketamine enjoyed substantially higher symptom improvement the first 3 days according to the depression scale, than those who received the active placebo.

When they compared the 4 dosage groups, those who received the 0.5 mg/kg and 1 mg/kg were the only ones who showed significantly higher symptom relief. This symptom relief lasted 3 days then began to diminish. After 5 days, the antidepressant benefits were gone.

And Ketamine Treatment Research Continues

This is great information. And this study shows us that there needs to be more investigation of ketamine dosing — like maybe between 0.5 mg/kg and 1 mg/kg? Don’t you think?

It also gives us yet another reminder about why most ketamine experts administer a short series of ketamine infusions when you begin treatment. We don’t want your antidepressant benefits to decline, we want them to build. And right now the best evidence we have shows that it seems to require several infusions in a row.

If you’ve been struggling with a disorder that stubbornly resists treatment, or if you’ve had ketamine administered in a way that was less than ideal like we’ve mentioned here, give us a call. What’s important is that you achieve the very best possible relief from your symptoms.

Let’s put ketamine treatment on notice for your life. You need to enjoy living again.

You really can feel better, function better, live better. It’s possible for you to enjoy like you haven’t in years, and discover motivation and initiative to accomplish what’s important to you.

To the resurrection of your best self,

Lori Calabrese, MD

October 22, 2018
PTSD and Sexual Assault: Can Ketamine Treatment Offer Hope?

PTSD and Sexual Assault Are Pervasive and Unrelenting

She froze. Beads of perspiration broke out on her scalp…her eyes flashed wide. Terror gripped her and she prepared to fight off her attacker…

She waited. Held her breath. Seconds passed. Then a minute….so she quietly sucked in some air… and slowly — almost imperceptibly— looked into the bathroom mirror.

No one was behind her. She was alone… again. A string of curses flew out of her mouth. And then, again, she collapsed in sobs.

Those moments were so real. But they weren’t. Was she losing her mind..??! She just knew he was there ready to grab her…or worse.

Destined for Success

Joanne had worked hard to climb her way to leadership in her marketing firm. She was smart. And well-educated. And had that special savvy that generates millions for clients. She was director of her division, and proud of her accomplishments.

Bright-eyed, warm, and ambitious. Everyone around her wanted to be part of her inner circle…until it happened.

Rape: The Night She Couldn’t Forget

That weekend night was such a bad, bad night.

She remembers his voice. The sounds. Her fear. His smell. A backhanded slap across her face…a sickening thud when her head hit the floor…

She’d been raped. She’d heard that voice before. Thought she’d seen that face. On the elevator…? Where was it…?

He was gone…but her awareness of his presence filled her apartment for weeks… and then months. And the more time that passed, the worse her terror grew. The gripping fear he’d come back was there 24/7, especially at night.

She felt horrifically vulnerable.

A sitting duck.

Why PTSD Is So Hard

She found she was utterly unable to leave the apartment, take the elevator, or to step out into the sunlight and walk to her car. So she created and occupied a little fortress in her small apartment. What a joke.

What if he came back..? Just got in the elevator..??

Her friends tried to hover around her, and to never leave her alone.
Still, she couldn’t feel safe. But eventually she needed her place back to herself.

When she realized he worked in her building(!!) … it all came back. So she called the police and gave them a statement. But still…he could come back at any time…

And her torment persisted…

She felt alone in her prison of chilling terror. Her friends’ warm, caring efforts at comfort seemed unable to penetrate the icy cold cage that held her in its grip. The assault had shackled her; the PTSD she developed afterwards made sure she never forgot it.

Joanne’s illustrious career began to stall, as her ambitious and talented co-workers surged forward in her absence. Like sharks to blood, she thought.

She had the building supervisor install safety clamps on the windows and an extra lock on the door. But she couldn’t concentrate. Her mind wouldn’t work. She kept checking the locks…

The slightest sound…the ice maker initiating a cycle, a car backfiring in the street below…a man’s voice… launched her into all those same feelings from the night of the rape… magnifying the moment from a passing sound to an explosion of terror within her.

There Has to be Something That Can Be Done

Joanne reached out. She had reported it, had all the tests, was given the name of a counselor. She told her doctor she couldn’t sleep. Told her counselor she couldn’t think. Saw someone who prescribed Zoloft, then Paxil. Someone else who added prazosin, and then Abilify. The nightmares worsened, her anxiety skyrocketed. And she crumbled.

How Does PTSD Happen ?

PTSD can come from any sort of severe trauma. A car wreck, a mugging, a sexual assault, domestic violence, combat, a life-threatening illness…

But the terror, the loss of productivity, the sense of profound vulnerability, the grip of powerlessness, the unrelenting vigilance, the rage…

…and the nightmares…waking up in terror and not knowing if the paralyzing fear is reality or a dream.

The symptoms of PTSD can emerge no matter what event flipped the switch to a roaring ON.

Triggers, we call them. Anything that lights the fuse of flashback symptoms and the fight/flight urges along with symptoms like Joanne experienced: irritability, hyper-vigilance, withdrawal, night terrors, mood swings, lack of focus, guilt… and shame that she couldn’t protect herself.

No matter how much empathy you have, unless you’ve been in combat, you can’t really know what a combat veteran has seen.

Unless you’ve been repeatedly battered, you can’t know what a survivor of domestic abuse feels.

And unless you’ve been sexually assaulted, you can’t know what a survivor lives with in the days, weeks, months… and even YEARS that follow.

The changes can render you unrecognizable — even to yourself. Joanne’s confident and warm demeanor disappeared …and in its place was now irritability, short-tempered emotional outbursts, and criticism of everyone around her.

It became “normal” for her to shake… as if she had a constant case of the jitters… and she found it impossible to let down, relax, and enjoy anything.

Her relationships with her friends deteriorated over time.

As hard as they tried to understand, listen, support, and comfort her, Joanne’s harsh and unforgiving onslaughts against them wore down their confidence in her friendship, and her isolation slowly drove them away. They got tired of it. And tired of always helping her.

Knowing the damage she was causing, she’d sometimes cry herself to sleep. But most of the time, her preoccupation with impending danger filled her thoughts. She had no idea how to do any better than she was doing.

Her reactions seemed justified to her, and she lashed out if anyone questioned her.

But deep in her heart, Joanne knew that what had happened to her was slowly destroying her.

She’s didn’t want it to define her.

She picked up the phone.

Hope Quietly Bubbles Up

At the appointment, the psychiatrist took a full history to better understand Joanne’s condition.

She explained to Joanne that she was, in fact, suffering from PTSD, and for such a long time, that it had worn her down. Depression and chronic anxiety permeated her. And nothing had helped.

They discussed at length a variety of approaches for treatment, including the off-label use of IV ketamine infusions to rapidly treat PTSD, lift her depression, and restore Joanne’s ability to function in her daily life.

In spite of Joanne’s rage at her assailant, she wanted to get her life back. To be able to enjoy going out with friends again, attending dinner parties, and relaxing at home with her cat. To feel whole again.

She had her first ketamine infusion the following day.

Relief Builds in Cadence with the Treatment

After the first infusion, Joanne didn’t feel exactly great. But the doctor had prepared her to keep her expectations in check until the medicine had time to work.

She felt nauseous during the infusion, so the doctor added medicine to the IV to help her feel better, and she felt a bit dizzy afterwards. So the doctor treated her again for that. She did notice that the panic that always rose inside her when there was a trigger seemed less intense maybe…? Sort of blunted…?

Still, she wanted to get home as quickly as she could. The couple of hours she’d been away intensified her sense of vulnerability and she ached to get home and lock all those barricading latches on her door.

Then came the second infusion a couple days later, and she felt the slightest **ping** of relief for a fleeting moment. Nothing dramatic, but unmistakable. The air seemed a little clearer…and the sunshine on her shoulders gave her a mild, though transient, warmth.

Really? Or was this just a placebo effect? Was she trying too hard to talk herself into believing that this was working?

Then… after the third infusion… she noticed on the way home she was liking the drive. Watching people walk by on their way to lunch. The aromas wafting from the restaurants along the way… The verdant greens of the neighborhood parks.

Incapacity Yields to Triumph

With the fourth, fifth, and sixth infusions, she rapidly felt better …and better …and better. She called a friend to meet her for lunch after each of those infusions, and they took in some shopping afterwards.

Noticing the sparkle tickled by the sun on the colorful cars as they drove by. It occurred to her she hadn’t noticed colors in a long time. She remembered the world around her as being more like shades of grey. How neat.

Once home, she felt calm. She locked the door and the second deadbolt…but ignored the rest of the locks on the door.

Initiative Restored

“That’s plenty,” she told herself.

Next, she launched into laundry, vacuumed, dusted, and washed the dishes. As the apartment began to gleam, she took a look at her laptop…and set out to catch up on months of emails.

Day by day, she worked more and more from her laptop on a new campaign with her team. She hadn’t been this creative in such a long time. Then, two weeks after the last infusion, she called her boss about returning to the office.

Next, she invited her friends over for wine and cheese. They were wary when they arrived, but they came. She was worried that they’d gotten so tired of her that they’d just say no. She explained what had been going on with her through all the horror of the last months…and what had changed.

It meant the world to them that she was finally talking to them again… and opening the curtain to her previously closely-guarded thoughts.

Her animated descriptions of the last several months prepared the path to healing between them. And she had the capacity, once again, to really listen to what they experienced throughout the whole ordeal.

Rape is a Crime…Not a Mistake or Lapse of Judgment

Rape is a terrible crime, and an indelibly traumatic experience for the victim.

While it’s common to hear the diatribe about standing up for yourself (great advice) and rising above the trauma (easier said than done on the power of sheer will), if sexual assault has caused PTSD, healing often involves not only venting your rage, but reaching out for a treatment that actually works.

Your rage, indignation, and need for justice are justified.

You were robbed of something sacred and intensely personal.

But in the big picture, it’s important to get better and have the power to live again.

To create. Produce. Feel motivated and inspired. To love your family and friends. To be generous. And recover.

Living Again

At Innovative Psychiatry, we often see victims of rape and sexual assault who’ve developed PTSD. This traumatic and crippling condition can cause your life to crumble before your eyes. In addition, it can hold you hostage and keep you enslaved to your fear.

But, just as often, we have the privilege of watching a broken-hearted person with PTSD recover through the rapid and robust effects of IV ketamine treatment.

The same effective medicine that was used to float the young Thai boys through hours of their rescues from the caves earlier this year—

Ketamine has been used around the world in trauma and disasters. It has a 50-year track record of safety and effectiveness in people of all ages.

But it’s the off-label use of ketamine in psychiatry that’s been discovered to be so extraordinary for treatment of depression, PTSD, social anxiety, OCD, bipolar disorder, addiction, and suicidal thinking.

If you’ve been sexually assaulted, and you feel plagued by some of the symptoms in Joanne’s story, call us.

Your pain is real. And justified.

But you can recover from the pain and fear of that terrible assault.

And you can heal…and start to really live again.

To the healing of your best self,

Lori Calabrese, M.D.

October 8, 2018
ASKP Meeting Notes: The 2018 Inaugural Conference of the American Society of Ketamine Physicians
New Advances in Ketamine Treatment
2018 has been a good year. A very good year.

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

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

Ya shoulda been there

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

I want to tell you about the meeting.

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

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

Hard Pruning Can Leave You Unable to Recover

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

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

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

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

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

Sometimes their methods don’t work very well.

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

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

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

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

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

ASKP is helping us do just that.

IV Ketamine Treatment Advances: Leaders

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

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

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

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

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

Extensive Research That Began During Residency

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

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

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

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

Groundbreaking studies…over and over and over.

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

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

Raquel Bennett, Ph.D.

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

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

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

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

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

So many luminaries, so little time…

Rupert McShane, M.D.

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

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

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

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

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

Ketamine Advocacy Network Helps Physicians and Patients Alike

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

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

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

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

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

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

To the reinvigorating of your best self,

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

That Floating Sensation May Predict Ketamine’s Healing At Work

Know anyone who’s depressed?

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

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

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

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

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

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

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

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

AMPA Gives You Power to Adapt and Develop Flexibility

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

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

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

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

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

Ketamine’s Antidepressant Response

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

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

Ketamine is a molecule that modulates the excitatory neurotransmitter glutamate.

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

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

You see where I’m going.

Care in Ketamine Administration Yields Better Results for You

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

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

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

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

Dissociation…and Ketamine’s Antidepressant Response

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

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

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

The Study:

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

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

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

And guess what?

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

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

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

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

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

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

Understanding Your Treatment and Your Healing

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

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

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

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

Now that’s a sweet spot!

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

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

There really is hope!

We Want You to Enjoy a Rewarding Life

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

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

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

To the reinvigoration of your best self,

Lori Calabrese, MD

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

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

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

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

Prolonged Years Fighting a Mood Disorder – Demoralizing

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

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

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

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

…You Have to Take the First Step

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

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

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

“May I ask your name?”

“James.”

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

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

“Not today you didn’t–you called!”

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

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

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

Why Ketamine Over Esketamine (Still Testing for FDA Approval)

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

Why Ketamine Over Esketamine?

The answer is rather logical.

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

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

This was my response:

“Thanks! Wow–these are great questions!

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

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

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

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

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

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

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

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

“Hmmm…

The More We Learn, The Better It Gets

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

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

“We see this every day in my office.

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

“Calling all neuroscientists!”

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

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

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

Outstanding Outcomes Emerging in Private Practice

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

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

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

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

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

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

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

Find out how much better you can feel.

To the reinvigorating of your best self,

Lori Calabrese, M.D.
September 17, 2018
Biological Psychiatry Stamps Out Stigma and Old Wives’ Tales
When Your Loved One Needs Treatment –

The Stigma of Old Wives’ Tales Can Cause Crisis… or Tragedy…

A mother’s heart is broken when she finds her 19 year old son dead in his car…apparently from carbon monoxide poisoning. She knew he’d struggled for years, saying things like he wished he was dead…or about how he wanted to jump off a bridge.

She’d wanted to help him, wanted to relieve his sadness, but didn’t want to take him to a psychiatrist because of the stigma… she didn’t want him labeled.

Believing he’d grow out of it… she didn’t want him hampered in life by a psychiatric diagnosis. She had the best intentions…

Meanwhile, she signed him up for riding lessons at a nearby stable, tried to get him interested in basketball. Helped him participate in Boy Scouts.

All because she thought a new interest would captivate him and help him overcome his sadness, poor self-image, and low energy. He seemed to have no initiative, motivation, or courage to fight it off.

So she kept trying… unwittingly missing the fact that these very symptoms were the reason why he needed help… and lacked interest in much of anything…

Stigma About Psychiatric Illness Can Blind You to a Loved One’s Need

A middle-aged man watches his wife of 23 years from the corner of his eye. What’s happened to her? he thinks to himself.

She’d always been a highly-motivated, creative person who took pride in herself and her contributions to their family and the community. But now she seemed to have lost interest in her appearance and her family.

She was taking a lot of naps and had gotten behind on the laundry. In fact, he’d been running the washer and dryer in the evenings to just catch up, make things easier. Last week he started cooking meals because they’d gotten sick of carry-out.

What happened…? Had she gotten lazy…? Or was it something else…?

He tried to talk to her…to learn if something had happened to her friendships or if she needed more supplies for her hobbies… but she showed no interest in that subject.

The truth is, he was growing more and more concerned.

After mentioning this to a trusted friend at work, his friend suggested an appointment with a good psychiatrist might shed some light. He was shocked.

A psychiatrist???

“My wife may be bored…or maybe she has the flu. But she doesn’t need a psychiatrist…! That’s for nut cases!!”

His friend shrugged. “I went to one a couple years ago, and to tell you the truth, it really helped.”

Pshhhhhh. Psychiatrist. Ridiculous.

Or is it?

Neuroscience Research is Shining a Light in Darkness

Most of us realize that psychiatric disorders carry with them a stigma that’s sometimes associated with terms like, “nut jobs,” “looney tunes,” and “crazies.”

However. Not only do neuroscience and psychiatry know there’s a mountain of information about the brain and how it works that we don’t know yet, but society in general knows even less.

We’ve talked in past articles about the exciting things that are being discovered in neuroscience research, like G proteins on lipid rafts that must be slid off to play their role in signaling between parts of the brain.

And neuronal bursts in the lateral habenula that seem to accompany depression, and how ketamine can dampen those bursts, and by doing so, relieve depression.

We’ve talked about how siblings of someone with bipolar disorder are 10 times more likely to also develop the same disorder. But…we don’t know exactly why. Just pieces of it.

Biological Psychiatry Stamps Out Stigma by Helping Us Learn to See the Cause of Suffering

So, in terms of actively exploring and learning and developing treatment, you might say the brain is the last real frontier in the human body. Since psychiatric disorders still carry lots of stigma in society, it’s important to learn all we can about what actually causes them, and what can be done to relieve them.

It’s only been a few decades since “bad parenting” was considered the root of so many disorders, not to mention blame on the sufferer who was considered “weak.” It’s pretty commonly known now that these were fallacies.

An interview published last week in Psychiatric Times by two psychiatry residents with Carol Tamminga, MD, shed more light on the quest to get to the basis of the biology of these conditions.

Dr. Tamminga specializes in biological psychiatry and its effort to find neurobiologic reasons for disease through brain imaging, genetics, and circuits. With her team, she searches for biologic confirmation of DSM diagnoses like schizophrenia, bipolar disorder, and schizoaffective disorder.

But her research from that perspective didn’t really make the connections she thought it would. They had expected to find biomarkers for each diagnosis, but they weren’t there. So the team started over.

They had about 1000 participants with psychosis symptoms across 5 states, and 500 people who had none of these symptoms.

They tossed out the diagnoses and looked only at brain imaging, EEG brainwave analysis, eye tracking analysis, and cognition. And without information about diagnoses or signs and symptoms to influence their findings, they found these patients each fell into one of 3 clusters, based on these findings.

Here’s a rundown of the 3 groups:
- First – Biotype One: People who have low cognition, very low hyporeactive EEG, and the highest amount of gray matter of all the groups.
- Next – Biotype Two: Modestly low cognition, very high hyper-reactive EEG
- Finally – Biotype Three: The most interesting of all — “barely abnormal at all,” but just as severe psychosis as the other groups.
So they scratched their heads to try to understand why this group didn’t have the biologic features of the first two, although their psychosis was still very severe. And they discovered the common denominator was cannabis use during adolescence.

… What?

Stigma Is Born in Old Wives’ Tales

Obviously, there is lots to talk about and learn from their findings, but for this conversation let’s focus on the point that stigma is born in wives’ tales…it’s not based on fact. And many people — more than we realize — still believe the archaic views that were passed down to them from older family members about psychiatric illnesses.

So you can see where those wives’ tales came from, right…? They came from a time when neuroscience was as baffled by the brain’s behavior and disorders as anyone else … so there were theories …theories that are now being disproved because we have the technology to learn what’s really going on … piece by piece.

Since false theories have fueled so much of the stigma, and connected it to diagnoses, maybe it’s a good thing for research to pave the way to do without the diagnostic labels… eventually… and instead to replace them with biotypes. You think? And then, perhaps, treatment could be according to biotype … ?

Biological Psychiatry Stamps Out Stigma and Old Wives’ Tales

Let’s hope we can see a fresher perspective now…in ours. Because the whole purpose in knowing what’s causing the disorder — which is usually a combination of biologic conditions in the brain, environmental influences that can alter the expression of DNA (we call those “epigenetic factors”) and learned behavior that makes it worse — is to find out how to treat it. To bring relief.

And there lies the reason for both the fields of psychiatry and psychology.

At least, there are all sorts of new questions to answer.

At Innovative Psychiatry in South Windsor, CT, we seek answers every day for our patients who suffer from various psychiatric symptoms. We use the latest research to find solutions that will help you rediscover the best you can be.

And among those solutions, the most powerful and widespread that’s been discovered is ketamine treatment.

If you’ve suffered from severe depression that other treatments haven’t budged, as well as bipolar disorder, OCD, PTSD, social anxiety, panic disorder, or suicidal thinking, call us.

We provide ketamine treatment in the most therapeutic way that’s currently been found through neuroscientific research. And we stay closely connected to current research as it happens to be sure we’re providing every opportunity for you to make the best possible recovery.

Our goal is not to put a bandaid on your pain, but to help you achieve remission.

It’s true that not every patient we treat achieves remission. And we’re still learning from researchers as well as our own patients’ experiences to help more patients.

We see more remission with ketamine treatment than has ever been seen with any other psychiatric treatment. But for reasons we don’t yet understand, ketamine doesn’t seem to be for everyone.

But odds are it will help you feel better and function better than you have in a very long time.

If your psychiatrist doesn’t offer ketamine treatment, call us. We love working with your healthcare team to help you achieve the very best results for you.

Give yourself the opportunity to be the best you you’ve ever been.

To the rediscovery of your best self,

Lori Calabrese, M.D.
September 3, 2018
Marti’s Story: How Ketamine Smashes Treatment-Resistant Depression

Ketamine Can Eradicate Severe Depression

Do you know anyone who’s severely depressed?

I want you to meet Marti. If you’ve never experienced severe depression yourself, learning about Marti’s journey may give you a glimpse into what it’s like. And if you have…well…I hope Marti’s story helps you feel less alone…and helps you find hope for your future, too.

Marti was a sparkling preschooler, obviously intelligent, and full of charm and spunk. But the spark disappeared when she was about six years old. She was also diagnosed with Type 1 diabetes that same year…which only increased the stress in her young life.

In spite of the depression, she pushed through the best she could and performed well in school…receiving all sorts of academic awards. School was her refuge and solace. Even so, her immunity to infection was reduced by the diabetes and she seemed to get sick with every bug that floated through. That made things worse…and pushed her stress higher.

Family Crises Can Trigger Greater Severity in Symptoms

Then, when she was in 8th grade, her dad collapsed and had to go to the hospital by ambulance. Long QT syndrome they called it… basically a heart attack but he survived. However, he was in the hospital for 2 weeks…and because she was sick she couldn’t visit him. The helplessness of the diabetes, the constant double workload at school, her brothers’ illnesses, and her dad’s near death event, became the final straw.

A darkness began to build inside her beyond anything she’d known before. Her mind seemed to become numb…vacant… she seemed unable to think. Things like motivation, initiative…or even the energy to do anything… had disappeared. She felt lost, but that wasn’t all.

There were new fears. Fears of people, places, leaving the house, answering the telephone. School became an insurmountable mountain to climb. She began to hide under her bed for the school day so no one would know she didn’t go. She couldn’t go.

That was on the worst days. On the days she could muster the courage to get on the bus, she sat silently in class…looking at her desk. Holding onto her chair with all her might to keep herself from running out.

Classmates would watch her behavior and assume she was using drugs. They’d ask her…and she’d tell them no, horrified that she gave that impression.

Academics Suffer When Medications Fail

Her parents took her to regular visits with an acclaimed psychiatrist. After 18 months he was amazed she wasn’t doing any better. Concerned their intelligent and awarded student would not graduate from high school without close support, her parents took her out of school and homeschooled her during her senior year. She was able to make up the credits she’d lost and graduate, mostly due to the decreased stress of the public school atmosphere.

But…her condition worsened. She registered in a university hoping the new routine would help her improve. But it wasn’t that simple.

She had intermittent periods of working at school and making top grades, then falling back into the abyss of darkness that had become her constant prison. A good semester then a terrible semester. Finally, she was placed on academic suspension for a semester… and eventually dropped out.

Her doctor continued to increase her dosage, and change her medicines. But nothing really worked. She slogged along in the proverbial mud, losing her hope, her self respect, and adopting a new outlook that was angry, bitter, and critical… an outlook she called “realistic.”

These changes in her view of herself and others resulted in friendships with others who were also angry and despondent. The motivated and emotionally-healthy friends she’d had during her childhood and early teens all but disappeared.

Treatment-Resistant Depression Spreads DOOM

Marti wore “toughness” like an overcoat, and functioned well enough to be sullen and angry with her friends. Her social circle was a tough lot, but she tried her best to fit in with them.

Then she met “him.” He was handsome, weathered, and wore chains and black leather. Her epic bad boy.

Within 2 weeks, they’d had their first big fight.

Shattered by his dirty and cruel tactics, Marti realized she was in over her head. But she was determined to live up to the challenge. The verbal abuse and horrific scenes deteriorated to physical abuse, but just reminded her that she knew what it was to suffer. And he’d been alone without support, so she was determined to be that support and “help him heal.”

This pattern continued, with periodic breakups, apologies, and a patched-up relationship for two or three years. Marti’s depressed condition deprived her of the energy, the judgment, or the initiative to improve her situation. And she told herself magical stories about how her love and loyalty – no matter what he did – could heal his wounds…and they’d enjoy a happy life together forever.

So she trudged.

A Disordered Brain Obsesses on Death

And there were suicidal attempts. And interventions that saved her life. But if you know anything about depression, you know that suicidal thinking or attempting doesn’t stop because you want it to. Your disordered brain creates images of death and darkness…and compulsions… It’s the very opposite of a healthy, imaginative brain that creates beauty and joy.

Marti’s nightmares became a constant torment. Waking up in a cold sweat over and over in the same night, with visions of cruel and terrifying demons destroying her… and as soon as she fell asleep again they were back.

Insomnia kept her awake for 5 or 6 days at a time…she’d feel brittle, reactive, hysterical at the smallest provocation. Screaming and cursing when the dog barked or the doorbell rang. Her coordination was also brittle, so she’d accidentally break a glass or stub her toe and fly into a screaming, cursing rage.

The phobias increased. Marti loved photography and was given an all expense-paid trip to Thailand with a professional photography group who would help her learn more artistic techniques for her craft.

An Opportunity Becomes a Crisis

She’d acquired outstanding equipment for her photography business, but the depression made it nearly impossible for her to follow through on opportunities.

Meeting with clients, doing a shoot or a sitting, became too difficult to manage, as social anxiety, fear of failure, and agoraphobia stripped her of the confidence to follow through.

She boarded the plane to Thailand with her gear, and on a layover in Bangkok she suffered a gargantuan panic attack. She couldn’t think to find her luggage, her gear, or her phone. Finally, she called her family collect and asked them to help her get home. Knowing her fragile state, they readily complied.

Once home she slept for days as she recovered.

Her Own Worst Critic

Then the shame set in. How could she squander such a life-changing opportunity? How irresponsible could she be? She’d always hated herself, but now she LOATHED herself. How could she bear the disgust she felt for her inept failure?

You know, when you’re struggling, you need a best friend… and if no one else…you need to be your own best friend. But sadly, whenever life got hard, Marti would use that moment to beat herself down into a shriveled nub.

And that’s how it goes, isn’t it? When we feel awful, we tend to make it worse. And we usually need an intervention from outside ourselves to turn the disastrous tide.

A final year with “him” was packed with physical abuse and cruel unspeakable torment that resulted in injury for Marti in her spine, her pelvis, and her neck.

From Abuse of Herself to Assault by Someone Else

The stress of her life led to muscle cramping in her neck and shoulders that left her left shoulder 3 inches shorter than her right one. She was unable to move her upper body without extensive treatment.

But those wounds were just physical. It would be years before physical therapists and chiropractors could help her body recover from the damage.

Still, the worst was the emotional damage. The silent scars that held her in a vice of fear.

Chronic hospitalizations plagued her life as the multitude of terrible stressors triggered vomiting spells that lasted for days at a time. Every 5-10 minutes…around the clock.

And those vomiting spells threw her body’s pH out of whack…and triggered diabetic ketoacidosis…a potentially fatal condition that won’t correct itself without emergency medical intervention in an ICU.

Over. And over. And over.

Then, it got worse. The repeated diabetic ketoacidosis and the high blood sugars that accompanied it, caused damage to the nerves in her stomach.

Gastroparesis… a condition where the stomach’s ability to empty itself is paralyzed… led to deteriorating nutritional absorption. Basically, she was starving because her body couldn’t absorb nutrients.

Depression Can Kill and Must Be Stopped

It all began with depression. But depression is just the beginning… and when it’s severe, it can trigger a cascade of circumstances that can suffocate life.

One day late in the summer, on one of many days when “he” tried to kill her, she grabbed her shoes and keys and fled.

And she never went back.

In the aftermath of that day, she spent more and more time in the hospital intensive care unit. A year and a half later, she was transported to the ICU so often, she was in the hospital more than she was home. A lot more. And she knew she was dying…

She also knew she was losing her ability to see. What began as foggy-out-of-focus moments in the early fall, progressed to full blindness by Christmas.

A retina specialist was called in and she went for surgery the day she got out of the hospital. Within two days she was back in ICU…but the surgery had succeeded in repairing the retina in her right eye. Her left eye was not reparable. But it was a start.

Then, her doctors recommended she undergo surgery for a feeding tube placement in her intestine, and formula was pumped into her body through that tube 24/7. After another week in the hospital, she was beginning to improve. The vomiting stopped. And she began to feel a little stronger.

A Mysterious Joy Begins to Bubble Up

But there was something else. She was feeling better. In barely perceptible ways at first. But little by little, joy was growing. In spite of her intestinal feeding tube. In spite of her blindness. She had hope. And she didn’t know why.

She would wake in the morning, remember she was blind…and cry. She grieved the loss of her eyesight. And facing that each day was so difficult.

But then she would launch into the day with a spring in her step. Initiative to move past this disability and build a new life. She had not had initiative since she was in 8th grade. She’d not felt joy since she was in kindergarten. What was causing this?

Ketamine Smashes Treatment-Resistant Depression

She heard about ketamine treatment… and someone suggested she check her surgery record to see what anesthesia she’d been given in surgery… so she did.

When the surgery record arrived in the mail 10 days later, she was astounded to find out she’d been given ketamine as an anesthesia in surgery. Could that be why she was feeling so much better??

Marti danced across the room just to consider that ketamine might be the reason she was coping so much better, and enjoying so much again. She set out to learn all she could.

That first IV ketamine infusion in surgery restored her wellbeing for 7 months. Then she began to feel the old depression returning, the critical thoughts, the anger, the hopelessness…but for the first time since she was a little girl…she didn’t want to die anymore.

6 IV Ketamine Infusions + A Couple Booster Infusions

So she set out to find a way to pay for a series of 6 infusions, as she’d learned that stacking infusions would produce more lasting results.

Within a couple weeks, her parents were able to help her with the money for a treatment of 6 infusions over 2 weeks. She’d heard that ketamine was available IV, IM, or intranasally...but she’d been convinced that IV was the best route for ketamine’s full benefits.

After the first infusion she felt no better…but that night her mother noticed she was folding clothes…for the first time in four years. Initiative.

Then, after the second infusion she thought she had a glimmer of hope. A lifting of pressure…of the weight that had been crushing her. Decreasing anxiety and diminishing sadness…she could tell she felt a bit lighter.

After the third infusion, she laughed a little, and talked a bit more freely… And from there her outlook grew better and brighter day by day through the last 3 infusions and over the next few weeks.

A few months later she’d been hospitalized more times (and with the intense stress of severe illness) she started “sinking” again…and called her doctor for a booster infusion of ketamine. She’d heard that sometimes that’s necessary. And she was glad she got it… it helped.

But four months later she needed yet another. Even so, that infusion of IV ketamine has held her remission steady for a long time.

She’s learning Braille, training to work, and excited about the life that’s ahead. She’s 32, in love with a wonderful guy who stood by her through the illnesses and surgeries, and life is working for her now on an exciting new level.

Marti believes in herself now and in her potential. And she’s eager to contribute to the lives of others. She’s joined the board of a non-profit blindness advocacy group. She has new friends who also have bright outlooks on life. Who are also productive and contribute to the community and to each other.

By the way, remember those terrifying nightmares that plagued her? They’re gone. Her dreams are bright and beautiful now…or at worst a little frustrating. The terrors that beat her up through all her nights for so many years are gone.

It All Began With Depression

And a co-existing illness. But treating the illness didn’t resolve the depression. Ketamine treatment did.

Marti feels transformed. Her family says she’s finally the person she was when she was 3 years old, before the assault of life hit. Her cleverness, wit, spunk, and joy for life has returned.

Marti is one of those people for whom the 6-infusion ketamine protocol wasn’t enough. She had researched extensively to understand how ketamine treatment ought to work and what to watch for. She also understood that to stay better required building a stronger infrastructure that would support her remission from depression.

And she actively worked to put that in place, through friendships, attitudes, and improved health. Active cooperation with her team of doctors, and doing the work in her outlook about her career and her relationships all helped strengthen that infrastructure.

And today, she’s in full remission. She sings every morning, dances a jig of her own design when she thinks no one is looking. Her life is full of promise.

She’s attracted to upbeat, healthy-minded people, and she loves herself. She enjoys life in a way she’s never been able to, and marvels at the frame of mind that held her captive 25 years.

Severe Depression Affects Every Aspect of Life

For those who have never experienced major depressive disorder in its severity, the fallout in Marti’s life may seem outlandish.

But Marti’s story demonstrates how all-encompassing and dangerous depression can be.

And why ketamine treatment is the golden child in psychiatric treatment these days. There’s no other treatment available that is as effective, potent, and all-encompassing for restoring life, hope, motivation, initiative, and a bright outlook to this degree.

At Innovative Psychiatry we’ve watched thousands of patients with treatment-resistant disorders follow the path Marti has in full remission.

Relief from social anxiety, depression, panic disorder, PTSD, OCD, bipolar disorder, addiction, substance use disorder, and suicidal thinking.

(Did I mention ketamine can stop suicidal thinking in 4 hours or less?)

If you suffer from severe depression that other treatments haven’t helped, call us. We can help you rediscover the life you’ve lost, just like Marti did. You, too, can enjoy remission from the crippling throes of mood disorders.

Give yourself the opportunity to live again, or even for the first time, and develop a fulfilling and productive life. Because you can.

To the restoration of your best self,

Lori Calabrese, MD

August 27, 2018
IV Ketamine Can Treat Adolescent Depression

Ketamine Treatment Shows It’s Effectiveness with Treatment-Resistant Adolescent Depression

For generations, teenagers have struggled with depression, and treatment has been only moderately effective. We need to treat adolescent depression urgently. Failed grades, lost schooling due to poor attendance, interrupted social development, broken dreams…

Pressures of Achievements

A young woman who had excelled in high school, was senior class president, a drum major for the marching band, and had great SATs wanted to be an ophthalmologist and headed out of state for college.

Hard-working and self-disciplined, she held a job to help pay her expenses, got involved in campus politics, and began trying her hand at a few new freedoms. A little under age drinking led to a lot more, and the pressures of college and work eventually pushed her to consider suicide. Before long she was diagnosed with major depressive disorder and suicidal ideation.

Her doctor prescribed medications for her depression, but nothing changed. Time passed without improvement.

She had to take a leave of absence from school. Just getting out of bed and going to class had become insurmountable.

But ketamine can treat adolescent depression.

Coping Mechanisms That Isolate Teens

A young man had “wowed” his way through grade school and junior high. He’d been invited to a magnet school focused on science and technology for his high school years. After winning a pile of awards for his debate team, as well as in math and science competitions, he couldn’t continue.

The agoraphobia and social anxiety that plagued him in restaurants and barber shops finally conquered his courage. He refused to go in to get haircut ever again. It was just too crippling…too stifling. So his hair grew and grew until it reached his waist over the ensuing years. He always wore a long dark tweed coat his grandfather had given him. He felt safer inside that coat.

But he drew attention, too. When he walked into a pharmacy security personnel shadowed him until he left…assuming he carried weaponry under that coat. But he wasn’t a threat. He was suffering from major depression and phobias and coping the best he knew how.

He’d tried a variety of medicines his doctor prescribed, but he continued to get worse. It colored his outlook about everything.

Depression in Teens: About More Than Attitude

Adolescent depression is a serious illness that interrupts a young person’s normal social, mental, and academic development. It colors the way he or she sees the world, and the people in it.

In adolescents, the prefrontal cortex is not yet fully developed, due to their age. This portion of the brain makes judgments, considers consequences and outcomes, controls impulses and emotions, and helps people understand each other.

So without this development already in place, a teen is more likely to make dangerous decisions on the spur of the moment, overlook the cost of his actions, and react to people and situations without a balanced understanding of the results.

When you add depression to this mix, and the impaired outlook that goes with it, a teen with untreated depression can cost himself and others failed goals, injury, and painful consequences.

For these reasons, depressed adolescents need treatment options that work. And ketamine is a remarkable option to treat adolescent depression.

When Treatment Fails, Better Options are Paramount

As many as 40% of depressed teens are not helped by the first round of treatment, and only half respond to the second round. We’ve talked before about how failed treatment affects teens with bipolar disorder, and how each successive attempt at treatment lowers the likelihood of a therapeutic response with traditional medications.

But the same is true with major depression in teens.

Studies demonstrate that these young developing brains need protection from the ravages of severe disorders to avoid serious consequences.

Effective treatment for adolescent depression that restores the brain to healthy function is vital.

Because of the critical cost of untreated disorders, researchers have delved into the quest for novel and potent treatments that do restore a teen’s brain to normal function. That bring remission. (And remember, we consider a disorder “untreated” even when current treatment isn’t working.)

Since ketamine in small doses has been receiving such recognition for its effectiveness with children and adults in treatment of depression, anxiety, bipolar disorder, PTSD, OCD, and suicidal thinking, some researchers surmised it should be effective with teens, too.

In Search of Effective Treatment

In a study published this month in the Journal of Child and Adolescent Psychopharmacology, a research team led by Kathryn Cullen, MD set out to gather more information about the use of ketamine to treat depression in adolescents. And they made some important points upon completion of the study.

They provided 6 ketamine infusions spread over 2 weeks to 13 adolescents who suffered from treatment-resistant depression. Initially, they based dosage on the ideal body weight for the participant’s age. None of the participants responded to the first infusion, so they changed their strategy. Dosing was then based on actual body weight … and guess what?

Obese participants received doses according to their body weight and experienced a solid response with the higher dose.

This demonstrates the importance of personalizing the dose to achieve remission.

Another important point is that prior studies indicated that pediatric patients require a higher dose than adults to achieve a dissociative state, which is an important aspect of ketamine treatment.

The same seemed to hold true with these adolescents, which may indicate that adolescents respond to ketamine treatment more like children than adults.

Understanding that key point can help psychiatrists in personalizing dosing for adolescents they treat.

Cullen’s research team concluded that ketamine treatment may be a significant option for relieving treatment-resistant depression in adolescents. And that psychiatrists need more research to determine ideal dosing for this age group.

Just to make an observation … and let you in on a secret. In the world of neuroscience, researchers make exceptionally cautious statements about their findings. They may sound a bit underwhelmed. But they aren’t. When a researcher says that a treatment may be effective for a given population, it’s akin to your neighbor setting off 30 minutes of fireworks!

Here at Innovative Psychiatry we treat adolescents regularly who suffer from treatment-resistant depression, and watch them emerge from ketamine treatment with joy, restored resilience, energy to be creative, motivation to achieve, and enjoyment of their relationships.

If your teenager suffers from major depressive disorder, and traditional treatments haven’t helped, call us.

The sooner your child is treated, and his brain development is restored to its best function, the more he or she can continue to grow into the healthy and resilient adult he or she is meant to be.

To the restoration of your best self,

Lori Calabrese, MD

August 20, 2018
Rapid-Acting Antidepressants Help You Get Better FAST
Smash Treatment-Resistant Mood Disorders with Rapid-Acting Antidepressants: Like Ketamine Treatment

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

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

Rapid-acting Antidepressants

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

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

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

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

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

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

They want more.

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

Or so they hope..?

Antidepressants that Work as Well as Ketamine Treatment

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

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

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

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

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

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

Seeking Ketamine Wannabes

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

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

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

How about this?

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

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

Rapid-Acting Antidepressants Help You Get Better Fast

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

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

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

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

Review of Literature Clarifies the Search

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

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

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

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

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

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

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

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

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

Times are changing and suffering is declining.

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

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

To the restoration of your best self,

Lori Calabrese, MD
August 13, 2018
Learning Emotional Regulation Skills Can Prevent Relapse
Emotional Regulation in Mood Disorders

Can be Improved !!

Ketamine Treatment and Psychotherapy

“Cassie..?”

“Yes, Mom?”

“Sam called … says he can’t come over because he has to go to the mall with his mom …”

“WHAAAAATT??? That CREEP!!”

The freshly opened Coke can in Cassie’s hand flew at the door like a bullet and exploded into a hole just above the door facing … carbonation spewing everywhere.

“Cassie…. it was his mother’s decision…” But before her mom got the words out, Cassie had crashed through the front door and was gone.

Ever reacted to disappointment the way Cassie did? Know anyone who has?

Adapting or Stressing Out?

There’s a whole cascade of adaptations or maladaptations that occur in a moment of disappointment or frustration … or hurt. The things that go through your mind, the decisions you make in the split second after the moment and beyond, determine how an event will affect your life.

If you choose healthy ways to look at the event, and to respond, your mood will reflect that you have the skills to adapt, and roll with the punches. Learning emotional regulation skills can make the difference.

When you choose maladaptive thoughts that are self-destructive and create more conflict, you lay another brick in the foundation within yourself for an eventual diagnosis of depression.

In many psychiatric disorders, impaired emotional regulation (or emotional dysregulation) is a common characteristic. For most of us, it’s not that hard to see that some people with certain disorders — like, say, bipolar disorder — may have a hard time regulating and controlling their emotions.

There are other disorders where this may happen, too. Like PTSD, panic disorder, and depression.

A child affected by a disorder like depression or bipolar disorder often has difficulty developing his emotion-managing skills. Add to that certain conditions that also interfere, like alexithymia, for instance … and it’s all that much harder.

Emotion Regulation and Alexithymia

Alexithymia is a term coined in 1972 by Peter Sifneos, introducing to psychiatry the condition of a person who can’t identify or describe their emotions. Since emotion is felt physically … if you can’t feel it… it must be awfully hard to articulate.

In your case, maybe you don’t feel emotions or find it hard to put them in words … or maybe you do feel them.

If so, your condition can be just as difficult for you as it is for someone who experiences alexithymia, because both can put you in awkward, even embarrassing, situations.

Society Maintains Certain Expectations of Us All

Emotion self-regulation is the ability to respond to whatever is going on at the moment in a way that’s socially “tolerable” … but also flexible to fit the circumstances. For instance, so you can either react spontaneously or … if the situation requires it … delay your response til a more appropriate time and manner.

The ability to self-regulate your emotions is a complex stack of dominoes. A thousand different things stimulate in you a potential response or reaction…every single day.

If you don’t develop the ability to manage your reactions — in other words, if you don’t find out how to respond to a given situation in an appropriate way — your inappropriate reactions can isolate you from jobs, relationships, and fulfillment. People may see you as someone who doesn’t fit in.

The Behavior Police

Society imposes pressure on everyone to adapt to behaviors it considers in line with a civilized community. And people can be cruel as they police the boundaries to ensure everyone “behaves.”

If you’re able to develop an intuitive understanding of those boundaries as you grow through childhood, and if you can implement the “acceptable” behaviors in various situations, it will help you in every situation as you grow through adulthood.

However, as we mentioned before, some people are unable to do this adapting. And you may find yourself reacting forcefully and loudly in situations where you feel strong emotion.

Learning Emotional Regulation Skills Can Be Difficult

On the one hand, this difficulty regulating and adapting emotions to the situation is important, but what can you do if you just can’t? Furthermore, what happens if you never learn how…? Or never get better enough to learn…?

So here’s the thing.

It’s tough to learn how to redirect and adapt your responses to situations you’ve found upsetting in the past…especially when you’re in the heat of it. So treating the disorder and minimizing the pressure you feel to react is a solid first step.

It’s Easier to Learn Emotional Regulation Skills Without Symptoms

With medications that drastically reduce symptoms, you’re in a better position to actually use therapy that can help you develop skills to respond differently to circumstances that you’ve reacted to in the past.

Therapy that helps you learn to problem solve rather than erupt, and handle circumstances instead of brooding or avoiding those situations altogether can be far more effective if your emotions aren’t in overdrive.

Because, according to studies, when you can’t modulate your emotions, it does seem to set you up for relapse of your disorder. To stay healthy, you need to learn to think healthy. This underpins that infrastructure within you to sustain mental and emotional health.

Poor Emotional Regulation Leads to Relapse

Researchers in Norway published a meta-analysis of studies on emotional modulation in May of this year in Frontiers in Psychology. The report analyzed 72 studies involving 3371 participants with major depression or those in remission from depression, and 5094 healthy controls.

Huge numbers.

They studied the way the participants managed their emotions through difficult and stressful experiences.

Then, they found that when they compared the way the healthy people (who’d never been depressed) responded the way those with major depression and those in remission responded, the healthy people had constructive, self-loving ways of responding and those with depression had more self-destructive ways of responding.

These researchers also found that the more “maladaptive” a person’s response to difficulty or conflict, the more likely that person will become depressed.

Conversely, the more healthy and constructive a person is in adapting to stressful situations, the less likely he will be depressed.

So poor ability to respond to difficulty and conflict correlates to likelihood of depression. And learning emotional regulation skills can prevent depression relapse.

And there’s more…

3 Factors Influence Emotion Regulation in Depression Remission

They found there are factors that influence how well someone with depression in remission can regulate his or her emotions:
- Age when the illness began
- Anxiety disorder that accompanies the depression
- How long the disorder has been in remission
Clearly more study is needed. We need to understand healthy adaptive means of emotion regulation. And we need to learn how to help depressed patients even when their disorder is in remission. We want to help them develop healthier responses. And by doing that, prevent relapse.

How many times do people stop psychotherapy — or stop their meds — as soon as they feel better? How many times have you?

Also, they urged more study of alexithymia in patients with remission so that they can understand how it impacts their ability to learn healthier responses.

How Ketamine Treatment Can Help

And keep in mind, if you’ve been treated for these disorders and you have not achieved remission, you may be a candidate for ketamine treatment. No other treatment has been as effective in as many treatment-resistant cases.

As we said before, it’s not easy to unlearn old habits and learn new ones in the way you think about and respond to painful or frustrating situations. If you’re in pain yourself, and the structures in your brain are broken and worn down from the stress of a mood disorder, this is especially true.

Remission can empower you to build a healthier inner thought life that sustains remission when you do achieve it.

At Innovative Psychiatry, we see people achieve remission through ketamine treatment every week. We’d love to work with you to help you build a healthier, more rewarding life.

Give yourself the chance to be well.

If you’ve suffered with a mood disorder and other medicines and treatments haven’t helped much or at all, call us at 860.648.9755. Let us help you achieve remission and a more meaningful life.

To the development of your best self,

Lori Calabrese, MD
August 6, 2018