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.

IV Ketamine: Doing What Prozac Can’t

Excitement about IV Ketamine

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

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

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

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

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

What Would You Do?

His answer?

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

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

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

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

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

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

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

More Questions

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

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

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

Most Promising Since Prozac

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

IV Ketamine: Doing what Prozac Can’t

No new medication for depression since Prozac!!!

So just a quick review: Prozac emerged in the 1980’s and was the first of a “new class” of depression drugs targeting serotonin, one of the neurotransmitters.

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

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

Period.

IV Ketamine – Doing What Prozac Can’t

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

They’re as excited as we are at the possibility of creating a whole new class of more effective drugs for depression.

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

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

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

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

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

Until recently, our patients with treatment-resistant mood disorders weren’t getting better.

Now they are.

IV Ketamine is Changing – and Saving – Lives

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

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

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

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

You can feel better.

Much, much better.

To the release of your best self,

Lori Calabrese, M.D.

March 22, 2017
JAMA Psychiatry Weighs In: The “Ketamine for Depression” Buzz
JAMA: “Ketamine for Depression” Buzz

The mental health community is all a-buzz about IV ketamine for treating depression and other psychiatric disorders, and for good reason. For the first time, people who’ve been treated without success for years are experiencing relief and enjoying their lives.

For anyone who has suffered from psychiatric disorders without relief for a prolonged time, the possibility of a breakthrough treatment that actually works can mean the difference between life or death. Or utter misery vs. hope. Most folks would go for hope … wouldn’t you?

This anesthetic-turned-street-drug has returned to the scene to restore its reputation by providing a remarkably successful, and fast, reversal of depression in patients who’ve not experienced relief in a very long time– some of them for decades.

In addition, these infusions in single doses or in a series of doses, reverse suicidal thinking, often within hours, if not before the IV infusion is even completed. Now that’s lifesaving.

What’s more, suicidal thoughts disappear immediately in many cases, whether the depression is relieved or not.

So yes, some of us in the psychiatry community are excited about what IV ketamine can do.

Psychiatrists Containing Enthusiasm

But … we know we have to contain ourselves, and maintain a scientific approach to this “off-label” use of the anesthetic ketamine. So we read the research, keep up with the published studies, and pore over the data to be sure our enthusiasm doesn’t get ahead of us.

We talk to each other endlessly, scour the journals, go to conferences, stay up late, stay at the office late, pull together every shred of published research, every letter to the editor, every blog and YouTube video.

Then, we watch TED talks. And we tweet, we message, we write. And we see dozens of people every day who are depressed. Sick of it. Suicidal. We offer many treatments. And we offer hope. Some of us offer off-label treatment with IV ketamine. And some of us have seen hundreds of ketamine patients, and administered nearly 1000 infusions. (That’s us.) We’re in the trenches. Deep.

Now comes this timely release to further illuminate the path for psychiatrists who are moving forward to help their patients with this breakthrough treatment.

So what does the APA (American Psychiatric Association) and JAMA Psychiatry (Journal of the American Medical Association Psychiatry) have to say about this unexpected surprise that treats psychiatric disorders?

In the March 1, 2017 issue of JAMA Psychiatry online, a consensus statement was released by the American Psychiatric Association (APA) Council of Research Task Force on Novel Biomarkers and Treatments regarding the off-label use of ketamine in the treatment of mood and other psychiatric disorders. The best and brightest are on that Task Force.

The Task Force made the point that there is compelling evidence that IV ketamine has the ability to provide rapid and robust antidepressant effects in patients with mood disorders who had previously displayed resistance to treatment.

Limited “Ketamine for Depression” Data

They acknowledged the sample sizes were small in these studies. And use of low dose ketamine for psychiatric disorders has increased at such a rapid rate that there’s a lot we still don’t know.

So, one point they made is that there’s limited data. The strongest data about the use of ketamine in the treatment of psychiatric disorders is for the treatment of major depressive episodes where there are no psychotic features.

Their concern was that even in the case of major depression, some of data that was evaluated had been collected from only the first week following one dose of ketamine treatment.

Again, limited studies, limited number of patients, limited information about outcomes, side effects, impact of long-term use.

Still, we know that anesthesiologists have been using this drug for decades and have found it to be quite safe in controlled settings. But the APA Task Force’s statement isn’t intended to decrease the use of ketamine in treating psychiatric disorders. But instead to highlight where we are and the most critical things to consider for keeping its use safe while research on ketamine proceeds.

Criteria for Ketamine Treatment

So, initially, the Consensus Statement recommends we take several steps when we see a patient to help determine if ketamine treatment might be appropriate for him or her. They include:
- Performing a comprehensive evaluation to determine that the patient meets appropriate diagnostic criteria for depression
- Ensuring the patient has completed adequate courses of FDA-approved antidepressants before considering ketamine
- Thoroughly reviewing the psychiatric and medical history as well as the patient’s potential risk factors for ketamine treatment
- Carefully evaluating any history of substance abuse, including baseline urine toxicology screens
In addition, they said the physician should thoroughly discuss ketamine treatment with the patient before use. The possible benefits of it, as well as the possible risks associated with its use for any given patient. This empowers the patient to make a truly informed decision about whether the benefits are greater than the risks. Of course — that makes sense. It’s the very basis of collaborative treatment in medicine and the basis of informed consent. Then, like with any medical procedure, we should obtain written consent before beginning the infusion.

Precautions with Ketamine

Next, in terms of specifics, spikes in blood pressure sometimes occur with ketamine infusions, so patients receiving ketamine therapy ought to be in a facility setting where we can manage any unexpected medical incident.

Even so, ketamine is considered “reasonably safe” at the recommended dosage of 0.5mg/kg over 40 minutes.

Because of ketamine’s natural action, patients experience dissociative effects that should pass momentarily. Or some may have short-lived vivid experiences of heightened perceptions, or intense ideas or memories.

Understandably, patients who experience effects like this may react with behaviors unlike their usual personality. So, physicians must be prepared to treat episodes of that nature. Which is why we want to see ketamine administered in specially prepared clinical settings, instead of at home.

Suicide Prevention

Also, as effective as ketamine is with suicidal thinking, there’s still the risk that the self-destructive thoughts or plans won’t lift for some patients. So it’s vital that physicians evaluate their patients after ketamine treatment before discharging them home.

Overall, psychiatrists must form a comprehensive plan for managing the patient’s depression along with needed followups. Ketamine is a highly effective drug to be incorporated into the overall treatment and management of depression.

The APA Task Force strongly advised that psychiatrists develop a standard operating procedure for administration of ketamine.

At the very minimum, it should incorporate these points:
- Signed informed consent and pre-procedure evaluation
- Baseline assessment of vital signs: blood pressure, heart rate, O2 saturation
- Continual evaluation of patient’s mental and physiologic status throughout the infusion
- Management of side effects that may occur during the treatment
Studies are lacking to evaluate the efficacy of long-term use of ketamine treatment for depression.

The most useful data to date indicate that infusions given up to twice a week and within four weeks are effective. Patients should be monitored with a rating instrument to assess changes in mood.

Avoid Abuse or Dependence

The Task Force also recommends that dosing of ketamine be discontinued if infusions can’t be reduced to one per week.

The committee members agreed that ketamine is an incredibly promising treatment but must be used with standards that ensure the highest level of safety.

Ketamine is the most abused drug in Asia. So the widespread use of it in the US – for therapeutic purposes – must be surrounded in safeguards to avoid the advent of abuse or dependence, in spite of its benefits.

JAMA: Ketamine for Depression – The Buzz

All in all, the buzz is that ketamine is the most promising new treatment to date for depression. The data is limited, it’s true. There’s much to be explored. But, we’re working rapidly to pull together all of the available evidence and all of the best practice recommendations as we proceed. This treatment is bringing hope where there was very little before.

We’re thrilled to be on the forefront, and we’ve developed our protocols for IV ketamine very carefully. Not only to set the bar for the standard of practice in our field but to exceed the standard.

At Innovative Psychiatry, our protocols comply with the recommendations of APA Council of Research Task Force on Novel Biomarkers and Treatments published in JAMA Psychiatry. But, we go above and beyond those. We educate you. Then, provide you with the research articles that we read ourselves. And ensure that we offer IV ketamine infusions as a psychiatric treatment — not simply as a medical procedure.

To that end, we work with you and your physicians and therapists for the best possible results. And we pull out every stop to help you feel better and enjoy life again when nothing else has helped.

Call for an appointment, and let’s work together to help you rediscover your best self.

To your emerging best self,

Lori Calabrese, MD
March 9, 2017
Ketamine IV, IM, or IN for Depression: Which is Best? (Does It Matter?)
Why do we always talk about IV ketamine for treatment-resistant depression, rather than just ketamine? Can’t we give it any old way…ketamine IV, IM, or IN for depression?

Why is it so important that it be given as an intravenous infusion, rather than as an intramuscular injection or an intranasal spray?

Ketamine IV, IM, or IN for Depression

Like lots of medications, ketamine can be given in a variety of ways. But are they all advantageous to you?

We don’t think so.

Not all physicians insist upon IV administration of ketamine, if they offer ketamine as a treatment for psychiatric disorders at all. But at Innovative Psychiatry, this is the only way we provide this medication.

We’re finicky. We’re perfectionists. We want to make sure we know the exact dose your brain receives so that we make sure you get the absolute best possible results from your treatment.

Did I say that right? Exact. Absolute. Best. That’s what intravenous ketamine offers as an advantage over any other method. It makes your best – or getting back to your best self – possible.

This is where we start swimming with sharks. And this is where the research and the experience and the opinions about what to do and how to do it get interesting.

Bioavailability

What’s bioavailability anyway??

It’s the amount of medication that your body is actually able to use. Not how much you’re given, but how much your body sees and can use.

So … it means the active portion that reaches your blood stream and that can actually be useful to you. The portion that treats what’s bothering you. The rest is altered, digested, excreted, or otherwise discarded by your body.

Make sense?

Why IV Ketamine?

OK. Basically, we want to be sure we know the exact dosage you receive, so we can know you’ll get the very best results. And intravenous infusion is the ONLY route where 100% of the ketamine you are given is 100% available to your body and 100% able to get to your brain. Which is exactly where it needs to be.

So how can we predict the exact dosage your brain will see?

Well, with an IV infusion, your ketamine dose is determined by your body weight that day and calculated down to a tenth of a milligram. Then it’s mixed with saline and slowly “infused” directly into your blood stream the same way that fluid is given to someone who’s dehydrated. (We love the word infusion — as in “infused with hope.”)

With an IV infusion, there are no obstacles preventing that perfect entry into your bloodstream and on to your brain. Anesthesiologists have known this for decades. Ketamine was designed to be given IV.

Why Intranasal Ketamine Is Unpredictable

But that’s not the case for other routes, which do present obstacles to the drug before it reaches the blood stream. I’ll show you what I mean.

When ketamine is given as an intranasal spray, it has to pass through your mucous membranes to reach your bloodstream. So first, it has to be suspended perfectly and evenly in a mist, and then the mist has to evenly saturate the mucous membranes of your nostril. And — it has to land high enough to not drip out your nose so that you don’t lose it and straight enough not to not run down the back of your throat. On top of that, it must be well-aimed enough to not get wasted on plain air and gentle enough to not get sneezed back out.

If that weren’t tricky enough, in addition to that, the ketamine spray delivers a mist that gives a concentrated dose over just a very few brief seconds of contact with mucous membranes, and just minutes of contact with critical and delicate brain systems … systems that need time to change for the better.

It’s just a bit too iffy …  whereas intravenous infusions are slow and precise and we can calculate, predict, and control. They allow very slow, controlled exposure of critical pathways to a medicine that stimulates neuronal growth and rearborization.

IM Ketamine: The Problems with Timing and Side Effects

In the case of intramuscular, or IM injections, ketamine must enter the muscle then find its way to the blood vessels and be absorbed.

Because the muscles contain dense blood vessels, a large portion of the drug makes it to the blood stream, but not all. There’s no way to determine how much time it will take the ketamine to leach out of the muscle, or how much of it will leach out, and reach your bloodstream so it can reach your brain.

From the time it’s injected, it depends on the circulation in that muscle and the condition of that muscle in terms of fitness.

To put it simply, your guess is as good as mine as to the total amount that makes it to the bloodstream and the rate at which it reaches the tissues in the brain to effect the changes we want to see.

Once again…way too iffy.

For ketamine, you need a route that ensures that ketamine reaches its target effectively, and you need a dose that will deliver the precise amount your brain needs to receive the optimum benefit from it. You also need it to reach the brain in a slow, controlled way. It needs to work, not frighten.

Because that’s another problem we’ll talk about in a bit. SIde effects … they just can’t be controlled once the medicine is in the muscle.

Bioavailability Comparison

Take a look at the differences in bioavailability of ketamine through these different routes:

Intravenous   100%

Intramuscular approximately 93%

Intranasal approximately 45%

Sublingual approximately 19-50%

Approximately?? For your brain??

As you can see, a range of 19-50%, as seen with sublingual use, is just far too uncertain. And approximating the dose, as seen with IM and intranasal ketamine, especially when we’re seeing numbers as low as 45%, just isn’t the best way to ensure solid, safe, predictable benefits.

Exquisite IV Ketamine

But when the ideal low dose of ketamine is precisely measured and administered directly into your bloodstream by an intravenous infusion, you get the benefit of all its anxiety-smashing, depression-relieving qualities in full measure.

There is none lost through dripping, sneezing, swallowing, digestion — or sloppy spraying or poor coordination. There’s just nothing getting in the way.

It’s a beautiful thing.

Add to that the fact that IV ketamine has been used in anesthesia since the early 1960’s. It’s backed by decades of data confirming its bioavailability, safety, and tolerability.

Effectiveness

Now think about this:

When you take ibuprofen for a headache, how long do you expect to wait to experience relief? 30 minutes? 45?

Have you ever been given an IV medication in the hospital? If so, you know that you start to feel relief pretty quickly. It can be a lifesaver when you really need it.

That’s because medications given by IV are available to the body so quickly … faster than any other route. There’s some benefit almost immediately, and it continues until you feel better and better as the medication circulates. With IV ketamine, the benefits keep growing.

Another factor is that the physician should give ketamine at a controlled rate. This is to create certain conditions in the brain to trigger a waterfall of actions…like the proverbial falling dominoes… that relieve the symptoms of the psychiatric disorders we’re treating.

Ketamine Research

Ketamine for depression has been a topic of scientific and clinical study for some time. The best research on ketamine over the past few years for the treatment of suicidal thoughts, depression, bipolar depression, PTSD, and OCD has used very precise IV infusion protocols.

It’s IV ketamine which–over and over–has been so startlingly effective. Intranasal sprays are being studied now, and one pharmaceutical company is sponsoring studies on a version of a ketamine spray it wants to turn into a brand-name patent, but there’s just not enough research on the spray technology, effective dose, or protocol for administering it to know what’s effective. One spray or two? one nostril or two? how strong? exactly how much? and how often? every 10 minutes? or every 15? why not every day? twice a week?

And intramuscular ketamine injections–forget about it. They can be such a nightmare of erratic absorption and side effects that can persist for hours that there’s no clear way to judge what dose might be effective or tolerable for you.

But by giving ketamine IV, we’re able to give
- - the most precise dose (recalculated to a tenth of a milligram each time you lose or gain a pound)
- - the most precise rate (calculated down to the minute using sophisticated infusion pumps)
- a drug your body can utilize 100%
We create optimum conditions. You experience the most benefits in the fastest way possible. It’s a win-win.

Safety

Two words: Side effects and drug abuse. (OK, so it’s 4 words.)

We associate ketamine with potential side effects, no matter how it’s given. This is the case with the majority of medicines. But the range and severity and duration of those side effects vary tremendously depending on whether ketamine is given IV, IM or intranasally.

Keeping an Eye on Side Effects – Just in Case…

In an outpatient office setting, low dose IV ketamine infusions can be administered in a beautiful, comfortable environment. High tech. Soft touch. Low lights and warm blankies (our patients love this!) with all of the medical monitoring and all of the important safeguards in place. Not the least of which is having a psychiatrist and infusion nurse right there to address any possible side effects.

In case of side effects, the psychiatrist can stop the infusion within seconds.Then she can administer a small dose of medication to treat the problem. Within minutes after the infusion, you can be ready for tea, snacks, conversation, and the ride home.

This isn’t true with intramuscular ketamine. In this case the full dose is administered in about a minute instead of slowly over 45, and there is no way to stop or slow the absorption once it’s already been injected into the muscle. And if strong dissociative side effects occur, as they often do with IM, the continued absorption of ketamine from the muscle can’t be interrupted– and the nightmare can last for hours. In one report, patients were kept lying down for at least 4 hours after an IM injection of ketamine for depression…just for monitoring.

If you use an intranasal spray mist at home, you administer it to yourself. There is no physician right there to address side effects.

Preventing Abuse

Unfortunately, ketamine has been shanghai’d by those seeking illicit experiences. It’s not just necessary, it’s critical to guard the way it’s distributed. It’s a shame, but a fact of life in the world we live in.

Think about this: If patients have ketamine available as a nasal spray for “as needed” use, what’s the risk? Clearly, if ketamine spray is available at home, there’s a much higher risk of outright abuse, sharing, or sale on the street.

It’s just so clear: right now, IV ketamine infusions are the best and most reliable approach we have. They allow precision dosing, instant responsiveness by the physician, almost-instant control of any potential side effects, and no risk of drug abuse or sharing in the community. .

At Innovative Psychiatry, we provide ketamine exclusively by IV infusion because it’s the best method for providing rapid, maximum benefits in the safest environment for you.

If you have not experienced relief from antidepressants, or if you’re tired of trying one thing after another, give us a call and let’s work together to evaluate what might be more effective for you.

To the recovery of your best self,

Lori Calabrese, M.D.
March 2, 2017
How Ketamine Turbo Boosts Brain Compost to Improve Your Mood
In a recent post, we talked about the impact of Brain Derived Neurotrophic Factor (BDNF) on the prolific development of neuronal synapses, or nerve connections, in the brain. BDNF is like a rich, organic compost that spurs dense growth. And we talked about how IV ketamine turbo boosts brain compost and multiplies the connections in your brain that improve your mood and sense of well-being.

Ketamine Turbo Boosts Brain Compost to Improve Your Mood

We described how BDNF creates an environment like “compost” for increasing these synapses to upgrade communication throughout the brain. It stimulates neurons to grow and branch out, and it increases the complexity and density of these branches. It’s like stimulating little saplings to develop into strong, complex riotous oak trees. BDNF increases the density of the forest and the density of the forest canopy. When the synapses are weakened, thinning out, and breaking down in the brain, depression and suffering is usually involved, one way or another.

So, if you want to clear out your darkened mood, then you need to clear out weak and broken down synapses. Replace them with healthy neurons loaded with abundant branches, which are called dendrites, and loads of connections, called synapses.

You’ll need to take a proverbial rototiller to your “brain garden” and clean out the deadwood, weeds, and broken roots. Mix in new soil, fertilizer, mulch, and compost, and let new tender neurons begin to leaf out.

That heavily “treed” neuronal forest will just naturally bring bright thought patterns and stimulation, just like all that new soil, mulch, and fertilizer would bring new growth and beauty in a garden. Because brain derived neurotrophic factor – BDNF – “brain compost” – improves your mood by providing a rich growth environment for your neurons and synapses. The more healthy synapses your have in your brain, the better you will feel.

BDNF on Steroids

In that previous post, we also featured the extraordinary result of IV ketamine on our “brain garden,” and that rich “compost” seemed to multiply the BDNF like gangbusters… which fostered remarkable multiplication of synapse connections…as if in a fast-motion animated cartoon.

That rich and deep synapse vegetation results in a high-speed and dramatic improvement in exchange of information throughout the brain:
- - improving cognition
- - relieving depression
- - removing thoughts of suicide
  - and equipping the brain to ‘reset’ itself with brighter and better thought processes, mental and emotional hygiene, the adoption of exercise, and more productivity going forward.
Since BDNF helps neurons and their connections grow, like fertilizer helps plants do the same, they become stronger and healthier. But even more dramatic is the appearance of new branches that that emerge, proliferate, and multiply, especially in the hippocampus and pre-frontal cortex.

Picture a bean plant you gently cover with fertile soil. You add a little water and set it in the sun. When you wake up the next morning, you hope and expect to see a tender shoot already poking through the earth…right?

We do, too. But we try to be patient, and give it several days, at least.

Take a Look at Your Beanstalk, Jack!

IV ketamine treatment is so powerful in its effect on BDNF that it’s as if your brain wakes up and within days you begin to have a dense forest growing where that little bean plant was.

BDNF obviously contributes dramatically to the “landscape” of the brain, and IV ketamine gives it a turbo boost.

But then, does that change as time goes by?

Ramshackle, Rundown Garden

We’ve made the point that IV ketamine puts BDNF on steroids — increasing the density and complexity of neuronal branching in the brain and increasing the number of connections between one cell and another.

But what happens to someone who’s depressed and has been stressed for a long time? Then BDNF is depleted, the dendrite branches get severely pruned back, the synapses break down, and and the hippocampus shrivels.

That’s a serious state, and a perfect description of what it’s like in the brain of someone with chronic depression. What it’s like in your brain if you’re chronically depressed.

It feels like a wasteland.

IV ketamine treatment can change that.

IV ketamine infusions work in a number of different ways, but the most striking thing they do is increase the rich compost of BDNF–to proliferate neurons, leaf out dendrites, increase synaptic connections, and re-establish a rich network of communication in your brain that can return you to your best self.

In some people, a series of IV ketamine infusions will return their “brain garden” to its optimal state … and they may not need further infusions.

But others may find after a time that they feel depression or other symptoms returning — their neurons and synapses have dwindled and shriveled again — and they need a new infusion to breathe new life into their garden of connections.

It’s Individual…One Size Doesn’t Fit All

No one knows in advance what will be needed, but to find a way to bring their brain to life is such a rejuvenating joy that most are beyond delighted to tap into this wonderful opportunity for energy, connection, and hope. For new growth.

And how about you?

How is your brain garden?

Is it prolific with verdant life and freshness?

Or does it need a turbo boost?

Unlike your bean garden, we can actually test your DNA to help determine the likelihood that you’ll benefit from IV ketamine.

Come join us to learn about you, and what can help you be the best YOU you can be. Contact us so we can give you a thorough evaluation. It’s the kindest thing you can do for yourself.

To restoring you to your best self,

Lori Calabrese, MD
February 23, 2017
IV Ketamine Infusions Restore Your Power to Enjoy

IV Ketamine Infusions Restore

Jacob couldn’t remember the last time he was really at his best self. He’d struggled from day to day since he was about 4. Getting out of bed, getting dressed, and going to school, from first grade through high school… every day had been awful and just exhausting. As he got out of the car for school each day, he’d look at his mom with pain in his eyes–and then drag himself into school, throughout his day, and through the night.

His parents didn’t know how to help. They talked with him and tried to do things that would cheer him up. But his inner pain seemed suffocating, and they felt helpless.

One day when he was 14, they found him on the floor behind the sofa, wedged against the wall in a fetal position.

He just disconnected…ran out of the energy to endure any longer…from the dead emptiness inside. The anxiety. All of it.

He thought about how to end his life every day. Some days he was obsessed with visual images of that final act.

Treatment-Resistant Depression

His doctor prescribed an SSRI, an SNRI, and then different combinations of medications, but none of them worked. Not really.

Eventually he refused to take any more, or attend any more therapy sessions.

School was something he just endured, or avoided, until he graduated.

College was a roller coaster–and life had been too hard for too long. He was exhausted. Isolated. Disinterested. And he eventually dropped out.

A Drug Called Ketamine

Then he read an article online about a drug called ketamine that was helping people recover from severe depression.

And he started looking for more information about it–studies, information, and just about anything he could find about this anesthesia-turned-club-drug-turned-antidepressant.

He found a few interesting articles, a few sensational titles, a lot of talk…and fascinating research that had been going on for years on using IV ketamine infusions to restore life for people with severe depression.

Who knew?

Was it possible there was a treatment for crippling depression and anxiety that could work when nothing else did?

His parents were pretty skeptical. They looked for hard science, research studies he could participate in, or a doctor he could see who knew something about this kind of treatment.

Turns out it’s pretty hard to find a psychiatrist who gets the devastation of depression and anxiety and hopelessness. One who can sift through the complexities, discuss the risks and benefits of all of the available treatment options, in order to provide the best possible options for someone whose symptoms just haven’t gone away.

Jacob’s first infusion of ketamine was extraordinary. The terrible heaviness that had weighed him down since he was four lifted for the first time about half way through the infusion.

And when his parents met up with him, they saw a lightness in his expression that they hadn’t seen in years. His treatments continued…his symptoms faded.

He had missed most of his childhood, and he spent most of his young adulthood wanting to die. But when IV ketamine infusions restored his ability to enjoy and experience beauty in life, it changed everything. He couldn’t believe it, but he actually wanted to live now. And was so glad he could.

How Effective Are IV Ketamine Infusions?

Before we go on, it’s important we point out that ketamine infusions don’t work for everyone. Every one’s brain is different. Everyone’s needs are different. And for some people, IV ketamine infusions don’t work.

But we see a lot of Jacobs.

Because IV ketamine infusion therapy does produce remarkable results in 80% of patients who have suffered with treatment-resistant depression, and the terrible, persistent depressive episodes in bipolar disorder, and for large numbers of patients with unrelenting anxiety disorders.

What is it about ketamine that delivers such dramatic, fast results? How does it affect your brain that it causes this wonderful, fresh relief…?

First, let’s talk about growth factors. The brain has its own special growth factor, called BDNF–brain-derived neurotrophic factor. That growth factor is like really rich, earthy compost. And we think that one of the really remarkable things about ketamine is that it turns on signals and opens up pathways so that the brain begins to manufacture and release more BDNF.

This is kind of radical news.

Most people don’t know that the brain continues to grow new cells all throughout life–and when there is rich compost, these cells, called neurons, grow new branches, and form more and more connections.

The Role of Glutamate

Glutamate is the most prolific neurotransmitter in the body. It operates throughout higher levels of the brain, so it’s especially effective in a widespread and quick proliferation of synapses. It causes them to branch like trees in fast motion, creating a virtual forest producing abundant relief, especially in a part of the brain called the mPFC (the medial prefrontal cortex).

Some neurotransmitters bring a calming balance to the brain and mood, others bring a stimulated excited balance. Serotonin is one of the calming ones… Glutamate is one that excites the neurons.

Because glutamate is so prolific and widespread, when it’s stimulated to increase, the impact on mood is fast to take hold and spread.

Now, when uptake of glutamate from the synapses is disturbed or blocked, you experience less of the feelings of reward…like for instance the enjoyment of a sunrise, or the fragrance of a rose. This impaired ability to “enjoy” is a symptom of depression.

However, and this is great news, when glutamate is released, there’s a prolific blooming and branching of synapses, which quickly connect different parts of the brain to each other. It’s almost like watching a film in fast motion as the synapses branch into more and more neural connections. The result is a rapid improvement in communication between networks of cells in the brain. And your ability to feel good quickly improves.

So how to get glutamate to be released??

Enter IV ketamine.

Ketamine Stimulates Budding New Branches in Brain Cells

Low dose IV ketamine infusions cause a burst of glutamate.

Those bursts of glutamate trigger the branching of dendrites (the branches on the tree) and the budding of bunches of synapse communication junctions, and in a short time, you feel better and better.

So how does it do that? We think that IV ketamine infusions cause bursts of glutamate that very quickly stimulate AMPA receptors, which activate calcium channels, which lead to the release of BDNF (good compost), which turns on the mTOR pathway, which — voila! — increases protein synthesis right in the brain. Neurons are made of protein. So dendrites branch. Synapses form.

New growth. New connections. Not just in the structure of your brain but in the very fabric of your life.

Psychiatrists get really excited about these things. You should get super excited, too. Geez.

Think of a brain cell like a tree in springtime that explodes with the stretching and unfurling of new branches, new growth, new buds, all stretching towards the sun. That’s what happens. If you have been so tied up in knots, wound up with tension and anxiety, and deadened to the joy of life…you can feel your shoulders relax for the first time in years.

Second, a study by the National Institute of Mental Health in August of 2015, revealed that ketamine reduces suicidal thoughts, as an independent and parallel benefit to the antidepressant effect it provides. And studies at Yale, Oxford, NIMH, Houston’s Baylor College of Medicine and New York’s Mount Sinai School of Medicine provided overwhelming evidence of the remarkable effectiveness ketamine demonstrates against treatment-resistant depression.

How?

Because of glutamate, and the richness of BDNF, and the fast-growing synapses branching out on neurons throughout the prefrontal cortex, causing relief to bloom along with them.

Breakthrough Innovative Treatment

Isn’t this amazing?

If you’ve suffered from depression, or bipolar depression…or crippling anxiety, you KNOW how amazing this is.

You’ve known the desperation, misery, and despair.

Maybe you’ve forgotten what it’s like to feel good, or even to feel ok.

You’ve lost touch with enjoying yourself.

But all that can change now.

Now you can feel good in ways you’ve forgotten.

Find your love of music, or art, or reading.

You can feel again.

Because of glutamate.

Because of flourishing synapses.

And because of ketamine.

Let us help.

Call us for a thorough evaluation so we can discuss innovative treatment options for you. IV ketamine infusions restore your ability to enjoy your life, and we’ll help you with whatever it takes to accomplish that.

To the emerging of your best self,

Lori Calabrese, MD

February 1, 2017
Ketamine Off-Label = New Hope

Ketamine Off-Label

Talk about ketamine off-label and it’s hard not to get a raised eyebrow or two. The one-eyebrow raise is the curious, skeptical, quizzical, or disapproving look when someone hears about IV ketamine infusions for depression, just before she takes a deep breath and then dismisses it. But the two-eyebrow raise is another matter entirely.

What Hope Feels Like

The two-eyebrow raise happens in men and women—or their spouses, parents, or adult children–when they see first-hand what hope feels like. When the veil lifts, when the suicidal thoughts stop, when the anxiety falls away. It is the sign of disbelief… but another kind of disbelief—not the one-eyebrow kind. The kind of disbelief that shouts out amazement. And hope.

There’s a face cream out there somewhere called Hope in a Jar. IV Ketamine is like that—it’s in a vial, a sort of tiny, nondescript little glass jar. And it offers hope for the relief of suffering to people with unrelenting depression…and anxiety…and suicidal thinking. Symptoms that have lasted for months, or sometimes years on end.

Ketamine is nothing new. It’s been around for more than 50 years as one of the safest and most widely used medicines in anesthesia. In the OR, in the ER, in pediatrics, on the battlefield, and around the world, even in the most primitive medical settings. But for almost as long, it’s been stolen and used illegally at extremely high doses as a recreational drug for the “out of body” experience that people report.

“Special K”

Because of that, when researchers discovered several years ago that ketamine has surprising effectiveness against depression, it was hard to break through the credibility problem ketamine unfortunately acquired under its name, “Special K,” the street drug.

In fact, almost every headline in the press about ketamine tries to grab your attention with something sensational: “Street Drug” “Party Drug” “Special K”.

How about grabbing your attention with this: Hope. Relief. Resilience.

To someone with depression, anxiety, or PTSD that won’t stop, hope is new. And even though ketamine isn’t new, the way we’re using it is completely new, and fresh, and offers a way out of despair for people who have just given up on feeling better.

Research studies using ketamine have exploded, and demonstrate that low doses of intravenous (IV) ketamine provide remarkable anti-depressive benefits.

In fact, it goes way beyond “benefits.” In a mountain of cases, IV ketamine off-label provides remission from depression and anxiety in people who can’t remember a time when they weren’t depressed… as well as suicidal.

And get this: in most cases, those who’ve been suicidal feel relief within an hour or two. This is remarkable and unheard of before in an anti-depressant, since before now anti-depressants have required weeks or months to provide full benefits.

But there’s a problem.

A problem…?

How can there be a problem with a medication that brings relief and even remission from depression and anxiety for a huge percentage of people who’ve not received relief from other antidepressants?

It sounds more like a miracle than a problem…!

The answer is simple.

Off-Label Ketamine Use

While the FDA has approved ketamine for use in anesthesia, it hasn’t been approved by the FDA for use as an antidepressant.

Is ketamine the only drug that’s used for off-label purposes?

Absolutely not.

Other Medications Used Off-Label

When the FDA approves a drug for a given purpose, the drug is approved for use. Physicians begin to prescribe it for that indication but are free to use their expertise and best judgment to prescribe it in other circumstances, too. And it’s not unusual for “side effects” to emerge that are so beneficial that the drug is prescribed for the side effect more often than it’s prescribed for its original use. In fact, 20% of the prescriptions written these days are for off-label uses.

Surprising, isn’t it?

One example of drugs commonly used off-label is beta blockers. These medications are approved by the FDA to control blood pressure, but cardiologists know they’re also very effective and widely accepted as standard medications in the treatment of heart failure, too.

Psychiatrists prescribe them for performance anxiety, stage fright, to treat tremor and restlessness, and sometimes to reduce aggression.

Even though they haven’t been approved by the FDA for those uses, they’re widely accepted and prescribed as the optimum treatment for entirely different problems than the ones they’re approved for.

Another example is the drug trazodone, which is approved for use as an antidepressant, but is usually prescribed off-label for sleep. Also, amitriptyline, approved as an antidepressant but prescribed off-label to prevent migraines, to treat nerve pain, and to improve motility.

Or metformin, a diabetes drug which is prescribed off-label to reduce food scavenging and promote weight loss.

So, many drugs are prescribed for off-label uses at some point. Some are so widely used for the off-label use their original purpose is all but abandoned.

Risks With Off-Label Use

That’s not to say there are no risks in prescribing medication off-label.

There are.

Plenty of risks exist for both the patient and the physician. Risks always accompany our looking outside the box. And occasionally a drug is used off-label and, because there hasn’t been enough testing, tragic outcomes result in the drug being removed from the market.

But that’s a very, very low risk for ketamine. Anesthesiologists have been using ketamine for decades in much, much higher doses than the the doses studied to treat depression and anxiety. This is not an untested drug. It’s safe, with minimal side effects that dissipate in minutes.

IV Ketamine infusions used off-label for depression require fractional dosages of ketamine compared to other uses, with minimal side effects that wear off in minutes. And the results are extraordinary.

Safe, FAST, and So Effective

People who’ve suffered throughout their lives with depression so severe they’re looking for an exit, are experiencing restored lives from the lifting of depression. They feel relief and renewed creativity that improves almost daily throughout their initial IV infusion course.

These most critically depressed patients often experience relief from suicidal thoughts within the first hour or two after their first IV ketamine infusion.

You’ve heard that traditional antidepressants–SSRIs, or selective serotonin reuptake inhibitors and others–work through the monoaminergic system on specific neurotransmitters.

But we’ve moved way beyond talking about monoamine neurotransmitters in psychiatry.

We talk about inflammatory cascades across the blood-brain barrier. New signalling systems. Dendritic branching and synaptic density. Neural networks.

New lingo. New news. New hope.

Ketamine works to bring balance to the body’s glutamate signaling system, a different system that hasn’t been addressed before in depression treatment. Ketamine works in a startling and effective way: it stimulates mRNA through the mTOR pathway to remodel neurons.

Wait. Say that again.

Ketamine turns on DNA to actually stimulate the growth and branching of neurons and to create more dense connections between them. It can literally stimulate the remodeling of neuronal trees and improve neuronal rearborization.

English, please.

Ok, here we go: IV ketamine infusions flip the DNA switch to “ON” to help neurons regrow the branches and connections that have been pruned away by stress.

This is extraordinary.

It’s so exciting that we should be throwing ourselves into studying it further, waking up early, reading voraciously, giving TED talks.

And low-dose ketamine infusions do several other nifty things that we’ll talk about in future posts. Things like bringing into balance the body’s glutamate signaling system–a different system that hasn’t been addressed before in depression treatment.

So addressing that imbalance ignites a whole new hope for depressed patients.

A New Approach

This alternative approach to treating depression and anxiety has so many benefits. It works fast, often within an hour. And continues to relieve depression through the weeks of treatment. Those treatments can provide depression and anxiety relief that lasts for weeks or months, or perhaps much longer.

As far as safety, there hasn’t been extensive testing for the long term effects of ketamine off-label use in depression. But there’s still the data from decades of ketamine use for anesthesia. As an anesthesia medication, the doses are much much higher, and it’s a safe drug with minimal, time-limited side effects.

Some people achieve remission after one treatment. But most need a short series of IV ketamine infusions over about 2 weeks to achieve remission—and still others need a bit longer. There are those who need maintenance doses to keep their depression at bay . Still, for those who are helped, this off-label treatment is a life-saver.

It’s hope. Pure and simple. And exhilarating.

Ketamine: Life Saving Innovation

So, it’s true this use of ketamine off-label hasn’t been through the scrutiny of the FDA’s approval gauntlet. Even so, the literature has shown striking benefit to severely depressed patients who have not received effective treatment in the past.

If your results from your depression and anxiety medication have been unsatisfactory, consider exploring a breakthrough option. Please do call for an appointment.

We’ll learn so much about you and the factors that can help predict your response to IV ketamine infusions through a thorough evaluation.

I look forward to meeting you.

To restoring you to your best self,

Lori Calabrese, MD

January 26, 2017
When Depression Medications Don’t Help

Treatment-resistant depression

When you’re depressed and taking an antidepressant, it may seem like it takes forever for it to work. While therapy, in addition to medication, can help… it may not be enough if you’re experiencing treatment-resistant depression. Some people find after many months with a medication that there’s no relief. If that’s the case, we can offer options that can make a dramatic difference. In addition to traditional antidepressant medications, there are new treatment options available.

1. Ketamine

Ketamine is an innovative, off-label treatment of depression, which has created a wave of scientific interest and excitement in psychiatry and is administered intravenously. Unlike traditional antidepressant medication, ketamine acts quickly and has few side effects. Many patients find that ketamine is a much better option when traditional medications don’t work for them.

Most patients find that their mood improves within hours of treatment instead of weeks or months. For those with major depressive disorder (MDD) or those contemplating suicide, fast treatment is crucial.

2. TMS

Transcranial magnetic stimulation (TMS) is another alternative to the treatment of depression. This is a non-invasive procedure that uses magnetic fields to stimulate the nerve cells in the brain and can lead to response and remission even when other treatments haven’t been effective.

During treatment, magnetic pulses are delivered to the specific section of your brain in charge of controlling your mood. It may activate regions of your brain that have been inactive due to depression, which improve your depression symptoms and allows you feel better.

Being depressed can take its toll on your life in many different ways. If you think you’re medication isn’t working, there is hope, and we are here to help you. IV ketamine and TMS may work even when other strategies don’t. To learn more, or to schedule an appointment, please contact our office at 860.648.9755.

To getting you back to your best self,
Lori Calabrese, MD

November 10, 2016
IV Ketamine Therapy for Postpartum Depression

Postpartum depression affects 1 in 7 women and can last for months if not treated. The symptoms of pervasive depressed mood, feelings of inadequacy and being overwhelmed are often accompanied by anxiety, irritability, inability to sleep despite exhaustion, inconsistent appetite, and intense isolation and guilt about experiencing these symptoms during what should be a joyful time. Some women have thoughts of harming themselves or intrusive thoughts of intentionally or unintentionally harming the baby.

Treatment for postpartum depression includes support for the mother and baby, omega 3 fatty acids, bright light therapy, and acupuncture. Data on the effectiveness of these is limited, but some women have found them helpful. Multiple studies have found that postpartum depression responds to psychotherapy and to traditional antidepressant medications. However, psychotherapy can take weeks or months to help ease symptoms; antidepressants often take weeks to work and are transmitted to the baby if the mom is breastfeeding.

Breastfeeding mothers with postpartum depression often agonize about whether or not to use antidepressants to treat their symptoms because they often don’t want to expose the baby to medication and don’t want to stop nursing in order to take a daily medication. Yet they need rapid and effective relief–for their own health and the health and development of their babies. Multiple studies show that untreated postpartum depression affects mother-baby interactions and are associated with lower cognitive functioning and adverse emotional development in the baby. In these instances, IV Ketamine Therapy for Postpartum Depression can help.

Explore IV Ketamine Therapy for Postpartum Depression Safely and Affordably

If you have postpartum depression or know someone who does, IV ketamine can treat it within hours without requiring that you stop breastfeeding.

IV ketamine is an extremely rapid, effective treatment for depression and 75-80% of patients respond quickly and dramatically to very low dose IV infusions. Although more research needs to be done, this makes IV ketamine therapy an exciting treatment option for postpartum depression, where getting better quickly is what every mom hopes for, and where restoring the health of the mother positively impacts the whole family. Mood, negativity, hopelessness, anxiety and distractibility can improve within hours, and hopelessness and suicidal thoughts can evaporate. A series of low dose infusions over about 2 weeks can result in dramatic and complete remission of symptoms.

Most women experience a mild floating feeling during the 45 minute infusion and lightheadedness, which clears within about 10 minutes. Although other side effects are possible, they are rare, and have not occurred in our postpartum patients. We are careful to discuss and review these in depth with our patients, as well as the breadth of research that supports the use of IV ketamine in the treatment of depression.

We Prioritize IV Ketamine Therapy for Postpartum Depression with Flexible Scheduling

We offer IV ketamine infusions, called IV Ketamine Therapy, for depression and for postpartum depression, and we make it a priority to see postpartum moms. We offer flexible scheduling in the late afternoon and evenings so that a breastfeeding mom can come in for her treatment and resume breastfeeding when the medication has cleared from her system so that her baby is not exposed to it. We carefully calculate the time that it takes for ketamine to clear and work with our patients to plan breastfeeding or pumping around their treatments.

This is dramatic and life-changing for new moms and their families and can be easily added to support, non-pharmacologic approaches and psychotherapy for the most robust and sustained result.

If you or a loved one would like to learn more about IV Ketamine Therapy for Postpartum Depression, please reach out to our office. We are here to help restore you back to your best self.

To getting you back to your best self,
Lori Calabrese, MD

September 18, 2016
Is IV Ketamine Therapy the Future of Depression Treatments?

Each year, millions of Americans are diagnosed with major depression. Not all of them will seek treatment, and roughly 40% of those who do will not respond to antidepressants.

Fortunately, there’s an alternative to Treatment-Resistant Depression – IV Ketamine Therapy

Ketamine is administered at a low dose by IV infusion, and it works quickly. Many patients feel the benefits within hours. Although it is not FDA approved for the treatment of depression, several studies have shown it to be safe and effective when used as an IV infusion in low doses.

It’s not uncommon for doctors to go “off-label” in prescribing medications. That means they prescribe medications to treat conditions research has demonstrated the medication is effective for. The medication might not have been approved for that use, but the FDA often approves a given medication only once. Once it is approved for use, research and experience sometimes reveals other uses for the medication.

Scientific studies have shown that even a low dose of ketamine administered IV can dramatically improve depressive symptoms. Symptoms like suicidal thoughts, loss of pleasure or interest in things, and decreased concentration tend to respond quickly. In fact, the rapid response to IV ketamine infusions can be life saving. Studies have shown that a single dose of IV ketamine often dramatically reduce suicidal thoughts.

Patients with Depression Respond to IV Ketamine Therapy when Nothing Else Appears to be Working

Low self-esteem, impaired sleep and appetite, overeating, decreased sexual desire, and other depressive symptoms also improve rapidly. With IV ketamine treatment, patients who’ve been unable to escape depression have a better chance. By putting lifestyle changes into place that help keep depression in remission, they can life more rewarding lives.

It’s important to note that Ketamine is not a miracle drug. Although it’s effective for the majority of patients, it doesn’t always work for everyone. As we know, the treatment of depression is complex and the best outcomes occur when treatment is comprehensive and tailored to each patient individually.

If you’ve been battling depression and feel as though traditional antidepressants aren’t working, it may be time to consider IV Ketamine infusions.

For more information or to schedule an appointment, please contact my office today.

To getting you back to your best self,
Lori Calabrese, MD

July 1, 2016
Ketamine Reduces OCD Symptoms

Obsessive-compulsive disorder is a psychiatric disorder that causes repetitive behaviors, intrusive thoughts, and fear. The traditional treatment for OCD has been cognitive behavior therapy, drug therapy, or a combination. But Ketamine has shown promise in reducing OCD symptoms. The theory that ketamine reduces OCD has been studied and continues to be backed up by ongoing research.

Ketamine Reduces OCD Quickly and Affordably

A recent study was presented to the American Psychological Association (APA) during the annual meeting showing promising results of ketamine therapy to reduce OCD symptoms. This study included 10 unmedicated patients with OCD who were each given an infusion of 0.5mg of ketamine and 0.5mg of saline randomly.

During the first week, half of the patients responded to treatment. The patients who received ketamine in the first infusion were evaluated two weeks later; 40% responded to treatment.

Ketamine Reduces OCD in 40% of Patients who Were Studied

The theory is that ketamine infusions work through the glutamate system to rapidly decrease the symptoms of OCD. More research is necessary to fully understand the sustained effect of ketamine in the treatment of OCD. However, this study has shown promising results for future OCD treatment.

Call My Office to Hear More about How Ketamine Reduces OCD

To getting you back to your best self,
Lori Calabrese, MD

May 26, 2016