Lori Calabrese, MD

Category: Resilience

Articles About Resilience from Lori Calabrese, MD | The Ketamine Blog

What the dictionary says…

The dictionary definition of resilience is the capacity to recover quickly from difficulties; toughness.  It’s knowing how to cope and maintain an even keel in spite of setbacks, barriers, or limited resources. It has to do with emotional strength. We offer these articles about resilience to dispel stigma, and to show how you can gain resilience. In addition, to show how resilience has set itself as a key factor for determining that someone is doing well, and possibly even achieving remission from depression.

In this day and time, when IV ketamine has been helping so many achieve remission, it has become commonplace to judge outlook and frame of mind by the level of resilience. For some, even inklings of resilience indicate symptoms are dissipating.

What Resilience Does

The early twinkling of bits of resilience gives hope to someone suffering from depression that they may be improving.

Resilience is a quality, a factor, a tool, and a hope-instigator.

It’s also the ability to adapt to adversity …and to manage strong feelings and impulses.

When you’re depressed, a disappointment or hurt can set you back for weeks or months. You find you can’t recover because the pain of it just goes on and on mercilessly.

How IV Ketamine Treatment Can Restore Resilience

This is where IV ketamine treatment can transform your outlook. Resilience and initiative can return. Hope can take the place of despair. And resilience can introduce remission.

With the help of IV ketamine treatment, you can learn to change the way you see crises. Rather than viewing difficulties as insurmountable problems, you can learn to see them as challenges to be resolved.  You can look at your past experiences and learn from them then apply what you’ve learned as new challenges arise.

The Result of Developing Resilience

As you make steps in this direction, your self confidence can grow. Your belief in your ability to handle what comes into your life can become stronger.

We hope you’ll read these articles about resilience and see ways to grow it,  develop it, strengthen it, and maintain it. We also want to show how IV ketamine can kick start that process when a disorder has drained away your your ability to cope at all. 

  • Treating Mood Disorders: Is the Key Hidden in the CSF?

    Treating Mood Disorders: Is the Key Hidden in the CSF?

    No Wonder Treatment Resistance Has Been Such a Mystery! Clue: Look in the Cerebral Spinal Fluid!

    A man in his forties, Greg had never experienced life without depression. Treating mood disorders didn’t seem to be his psychiatrist’s forte. (Oh boy…) At least not in his case. Every accomplishment, every failure, struggled for expression beneath the darkness of that clinging lead blanket.

    People had always admired his quiet humility and unrelenting integrity.

    But they had no idea of the courage he required to face every single day. As a child, just to face each day of school…As a young man, to walk from his apartment to his car, and from his car into the building — to start another work day.

    Complex Disorders Make Things Worse

    Social anxiety filled him with self-doubt, self-consciousness, and dread. Agoraphobia made it incredibly difficult to walk out the door to face another day. To walk into a salon to get a haircut. Or to shop for groceries. 

    Family gatherings were impossible. He’d show up late, linger as long as he could bear, then quietly slip out to seek refuge in the safety of his car, and drive home to the quiet security of his apartment where his cat purred when she saw him.

    His family became accustomed to his disappearances. “Has anyone seen Greg?”

    “No..?” 

    “Well, I guess he went home…”  :::sighhhh:::

    His days filled with thoughts of ending his life, his nights with planning a suicide that would work.

    No one grasped the shame he felt that he couldn’t function like others he saw.

    Of course, he’d sought treatment. Prescriptions of Zoloft, Wellbutrin, and Lexapro tried his patience. Oh and then Effexor, Abilify… He hated taking the pills, but had had the highest hopes for relief that never came…

    Psychotherapy never seemed to make any difference. He’d seen a lot of therapists.

    In fact, it was worse than that. It was maddening… nothing that came up was new to him. It was boring and frustrating. And the effort required to go… to push through the dread and phobias to get there… just became too big a price to pay and he stopped going.

    He’d heard it said that there’s a difference between a good therapist and a great one. He hadn’t found a great one, apparently. Treating mood disorders came to seem like a cruel game to him.

    Decades of Complex Treatment Resistant Disorders

    In his twenties, he had beat all odds by starting and developing a consulting company. When he was in his thirties, with a long list of brilliant consultants on his payroll, and rivers of money streaming in, an episode of severe depression and crippling phobias threatened to bring his company to its knees. His mind shut down and he withdrew. It had been 15 years since he felt desperate enough to seek a psychiatrist’s care.

    So he tried once again.

    Once again, he took the latest antidepressant medicine…Cymbalta…for five miserable months. He tried to give it every chance. But his suicidal thoughts only increased. Depression, anxiety, and desperation made it nearly impossible to work, much less carry the load of generating new clients, advising his team, and keeping the payroll covered. 

    Then recently, he learned about IV ketamine for depression. He scoffed at the idea. As far as he was concerned, this was yet just another shiny new penny. Obviously, people clamored to get in on it. Articles that dismissed the validity of ketamine for depression drew him in. It was easier to find ammunition to protect himself from any more risk of disappointment …until something happened.

    His cousin had been severely depressed all her life, too. He’d heard that depression runs in families. But it happened that she went for IV ketamine treatment. It was a rocky process for her. Because of major stressors in her life, she had ups and downs. But eventually, she seemed to be better than he’d ever seen her.

    He was reluctant to ask questions. He didn’t want to be swept into the “ketamine frenzy.” He knew disappointment was a huge risk. But this was someone he knew well and trusted. And he wanted to know if he could get better.

    Ketamine Slashes Depression in More People When the Causes of Failure Are Explored

    She told him she didn’t experience it quite like others she’d heard about.

    Others who simply received six infusions and by the third were feeling great, caused her to have unrealistic expectations. She wanted a wow. But she had to just take it a step at a time.

    She didn’t improve until the 4th infusion, then felt better and better…almost great…until a terribly stressful bout in the hospital seemed to end the benefits she’d experienced with ketamine. The depression came back. So she’d go for another infusion… a “booster” she called it. And again she’d improve dramatically…

    Until another severe stressor, and she’d lose it again. This pattern had continued for a few infusions. She felt like she was on a see-saw.

    But finally, she began to improve every week. Still, she had a cloak of fatigue that colored her joy in shades of gray.

    She explored various supplements that might help, and found a “smart coffee” product that gave her the extra little spring and energy she needed, and just the right touch of mood enhancement, so she could enjoy her day. It bumped her just enough past the remarkable effects of ketamine, that she finally felt truly better. Soon after that, she realized she had achieved remission. She was bubbly. Her eyes sparkled. She sang spontaneously and laughed infectiously all the time.

    She could cope with difficulties like she hadn’t been able to before. Daily tasks became routine instead of insurmountable. Her hope for the future and what she could accomplish began to rise.

    Greg had watched her transformation. He knew how wonderful she felt now. Quietly, he secretly longed for the same.

    He scheduled a series of ketamine infusions with a local psychiatrist. After 6 infusions, he’d experienced a lifting of the depression and suicidal thoughts, but in less than a week those depressive symptoms — and the suicidal thoughts — began to creep back in.

    Then, he received another, with good then fleeting results, then another.

    His fear that he was so treatment resistant…and had been for so long…that he was beyond help…well, it engulfed him. It settled into his mind like stone and wouldn’t budge.

    He knew it. He decided he just couldn’t be helped.

    When Treating Mood Disorders Sometimes We Have to Fight and Not Let Go

    Then one day he read an article about neurometabolic abnormalities and how they can have such profound impact on the brain that depression can dominate mood.

    He remembered reading somewhere that treatment resistance in some cases can be overcome. One way is by treating underlying conditions like low testosterone, thyroid, and folate deficiencies. He’d dismissed it at the time, but now he asked his doctor to order these lab tests.

    The article he read focused on a study in the American Journal of Psychiatry.

    The study was initiated because of a particular young man who suffered with treatment refractory (same as treatment-resistant) depression for most of his life, as well as unrelenting suicidal thoughts and several suicide attempts.

    It was remarkable to Greg that the young man’s experience and symptoms were so parallel to his own.

    The authors of the study knew that treating mood disorders could be challenging, so they took their exploration of this man’s serum levels a step further. They performed a lumbar puncture to collect cerebral spinal fluid.

    They discovered his CSF (cerebral spinal fluid) levels were much lower than his serum levels. So even though it seemed that his serum levels of key hormones, nutrients, and metabolites were “normal” there were severe deficiencies in his brain.

    In particular, he had a severe deficiency of CSF tetrahydrobiopterin, a critical component you need to manufacture neurotransmitters like serotonin, dopamine, and norepinephrine in your body. After they treated him with sapropterin, a compound with a molecular structure very similar to tetrahydrobiopterin, their subject experienced a dramatic and long-lasting remission of his depression symptoms.

    Wow!

    Study Shows Surprising Results for Treatment Resistant Patients

    Because of this discovery, they conducted a study of 33 adolescents and young adults with treatment resistant depression who hadn’t responded to at least 3 trials of antidepressant medication, and 16 healthy control subjects for comparison. They created profiles of each of them using urine levels, serum levels, and CSF levels of a wide variety of metabolic compounds.

    They found that CSF metabolite levels were abnormal in 21 of those 33 subjects. The most common abnormality occurred in 12 of the 21 participants. In these, the serum levels were normal but the CSF level of 5-methyltetrahydrofolate (5-MTHF) was low.

    There was one patient in that group who had a low CSF level of 5-methyltetrahydrofolate (5-MTHF) as well as low CSF tetrahydrobiopterin.

    These patients were treated with folinic acid and the one who also had low CSF tetrahydrobiopterin was also treated with sapropterin. All of these patients showed improvement in depression symptoms as a result of treating these CSF deficiencies. 

    It’s important to note that the healthy control subjects had no CSF deficiencies.

    The conclusion the authors reached was that checking the CSF levels of metabolites produced a surprisingly large group of people who had normal serum levels but severe deficiencies in their CSF metabolites.

    So — they expect that examination of CSF metabolites can identify unexpectedly high percentages of treatment resistant patients who have treatable metabolic conditions. And treatment of those deficiencies just may resolve their depression symptoms.

    Until recent years, it wasn’t clear that treating mood disorders could be such a complex process, but that so many who have not been helped can be.

    Greg (whose name has been changed to protect his privacy) is currently undergoing treatment for his metabolic deficiency. We’ll talk about the results when he has completed treatment. Meanwhile, we applaud him for taking the emotional risk and making the effort to find solutions for his illness.

    Greg’s story is important to help us understand why we need to dig deeper and sometimes include specialists on our treatment team to find remission and resilience for our treatment resistant patients in every case that we can.

    The more we learn about all the factors that enter in to balanced wellbeing, the more avenues we can explore.

    In the past, psychiatry depended largely on observing a patient for signs of their illness, and listening to them describe how they felt. But as we advance further into the 21st century, we’re stockpiling more and more tools to help in the diagnosis and treatment of our patients.

    At Innovative Psychiatry, in treating mood disorders we encourage our patients to include specialists to explore their possible deficiencies and treat them. We work with the entire health team because often, it requires a team effort.

    After all, the goal of your recovery is our top priority.

    If anything about Greg’s story or this study sounds familiar to you, and if you’ve not found joy or resilience with other treatments, call us. We’re committed to provide the support you need to feel again, to enjoy life and relationships again. To live again.

    IV ketamine treatment combined with treatment of serum and CSF level deficiencies can restore your hope, your initiative, your motivation, and your creativity.

    Don’t sell yourself short. Let us help.

    To the bounding renewal of your very best self, 

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
    Lori Calabrese, M.D.
  • RESILIENCE! It’s the New Buzzword Among People with Mood and Anxiety Disorders

    RESILIENCE! It’s the New Buzzword Among People with Mood and Anxiety Disorders

    Reslience! it's the buzzword that people with psychiatric disorders are talking about.

    Too much screen time? Let yourself have 2 more minutes of it right now: because if you’ve been tooling around reading anything related to mood disorders or anxiety disorders, IV ketamine, and other advanced treatments, you’ve probably noticed that there’s buzz about resilience.

    Because of the world that has opened up since IV ketamine began treating depressed patients with its ability to create new branches and connections, the expectations of these patients have soared.

    No longer are patients satisfied to have a little relief from their depression. They’ve learned they can feel good. Feel “normal.” Enjoy participating in life the way others do.

    So now the question you hear on the internet isn’t this: “Will any medicine help me feel at least a little bit better…?”  No.. now it’s this: “Will this medicine help me feel resilient again?” Or “What can I do during this treatment to help it work… improve my chances of remission… develop more resilience?”

    Now before we go on, I want to clarify that no doctor can promise or guarantee remission of symptoms from disorders like depression, bipolar disorder, PTSD, addiction,social anxiety, or to promise or guarantee that suicidal thinking will go away. There just isn’t any medicine in psychiatry that helps 100% of people get well.

    Resilience! It's the Buzzword.
    But, even so, there are many people who’ve suffered for years, even decades, with these disorders who are now living lives they never dreamed possible. They’re painting, excelling at work, meeting the loves of their lives, enjoying their families, and contributing to their important relationships. They’re investing in hobbies, socializing with friends and family, and feeling good about themselves and their accomplishments.

    This doesn’t happen overnight, but resilience has freed them to invest in their lives, and provides the energy for things they could never do before.

    Resilience Protects You From Falling in the Ditch

    And when hard times come along, they have the resilience to grieve a bit, then brush themselves off and keep moving forward. This may be the most remarkable change of all.

    Resilience is the ability to adapt when a crisis comes along… to adapt to whatever the situation may be. To bounce back, recover, and move forward after an onslaught of difficulty.

    Since psychiatric mood and anxiety disorders often develop as a response to some degree, to something environmental or an upsetting/traumatic event, if you can adapt to that event or force in your environment, you can remove that response from your psyche.

    Adaptation is the way organisms throughout your world survive. When there’s a strong wind, if trees don’t bend under the wind they’ll be splintered and destroyed. But their ability to bend is their means of survival and the way they develop resilience.

    The same is true of you.

    If you have a continuous source of stress in your world, one that assaults your senses, emotions, or body, you can eventually be beaten down and weakened or destroyed by those assaults.

    But if you can find a way to bend like a tree does, to adjust yourself to accommodate those assaults, hurts, and winds of fury without being damaged, it will help you avoid being traumatized. And that’s how you’ll develop resilience.

    This brings up the story of a friend of mine. 

    Resilience! It's the new buzzword with patients who have been depressed.

    Jillian grew up in a small town in the midwest, and was a faithful member of a tiny congregation there. The pastor had served in her church for 40 years, and unwittingly preached a serious sermon every Sunday that reflected the smallness of his own tiny world in that tiny town.

    Jillian, like the rest of the church members, worked hard to live up to the expectations her pastor laid out in his sermons. Her town was small, her world was small, and those expectations left her view of life small, too.

    Culture Shock – From Small Town to Big City

    As she approached her thirtieth birthday, her husband broke the news to her. He’d been transferred to Chicago. 

    So they packed up their belongings, and moved into a pretty little apartment in that big, new city.  Her birthday was anything but a celebration. The traffic overwhelmed her … the variety of people she saw at the grocery store, the post office, and everywhere else were just so different than any she’d ever seen before.

    Hairstyles, clothing styles, and the way people just talked made her feel more like she was on another planet than just in a different city. She felt afraid to meet people or make friends. She was afraid she looked like a fool and she couldn’t imagine how you could trust anyone.

    This sad woman lacks resilience to bounce back after hardship.

    The more time she spent alone, the more isolated she felt. And the sadder she became. She was lonely. She missed the comfort of her home town.

    Her husband asked her often if she was making any friends. But she just told him that the people she ran into on the street weren’t “her kind of people” — and she felt safer alone.

    One day he arrived home from work and announced they’d been invited to dinner by one of his co-workers. She was excited to meet this co-worker and his wife. Surely they’d be a good match socially, too.

    The following Friday, Jillian and her husband drove to the address her husband pulled from his pocket. The front yard was alive with a variety of blooms that reminded her of English gardens she’d seen in books at the library. It was just beautiful.

    Jillian Adapts and Learns Resilience

    They knocked on the door — and it was opened by the strangest-lookingpeople she’d ever seen. She immediately wanted to go home, but her husband held her hand firmly as he warmly greeted the couple.

    Her husband’s co-worker had jet black hair that was shaved on the sides with a narrow path of hair from his forehead to his crown, pulled into a ponytail.  His wife had bright pink hair with spikes on top enhanced by a shag that softly fell on the left side of her head; the right side was shaved from her temple to her ear.

    Jillian’s alarm choked her. Then Cass, the pink-haired woman, spoke up and told her how glad she was to meet her. That most of her co-workers were middle- aged or nearing retirement, and she ached for friends her own age.

    When she spoke, Jillian began to relax. What a warm and genuine person, she thought. 

    “May I help you in the kitchen?”

    “Yes, I’d love the help!”

    So the two of them disappeared into the kitchen to finish up with dinner, and their husbands settled in to talk shop and about their hobbies outside of work.

    Jillian and Cass had so much more in common than she could have dreamed — and by the time they called the guys to sit down and eat, she had forgotten about the “strange” hairstyles.  She realized that her perspective of the world in her small town had apparently been pretty sheltered. And she was thankful she had found someone who could be a true friend.

    Resilience is Adapting to Your Situation, Which Helps You Bounce Back After Surprises, Disappointments, and Hardships

    The point is, that Jillian adapted. She was experiencing a stressful situation, and it was affecting her emotionally. Sadness was growing as well as isolation and loneliness. If she’d remained unwilling to bend, she might have eventually plunged into depression.

    Resilience gives this woman peace in the face of difficulty.
    But, after exposure to a stressor that felt threatening to her, she was instead willing to look beyond her distaste, and read the heart of a person who was ready and able to offer her real friendship. And many great adventures lay ahead as a result.

    Resilience! It’s the new buzzword for a reason. Beyond reduced depression symptoms, resilience protects your life from being interrupted by a trauma or disappointment.

    While this is an oversimplified example, it shows you how important it is to bend, rather than break. To change the way you think in a stressful situation so you can bounce back from disillusionment, disappointment, or betrayal.

    Resilience! It’s the New Buzzword for Adapting and Growing Stronger

    But, here’s the thing. Sometimes you face stressors that feel threatening to you when you don’t feel equipped to respond with resilience. In fact, sometimes you may not feel resilient at all.

    Sound familiar?

    Times when you’re drowning in depression or terrorized with PTSD. When you don’t have the energy to get out of bed, much less “bend with the wind.” What do you do then?

    Ketamine Treatment Enhances Resilience

    Well, that’s when you may need treatment. You need to get the help of your psychiatrist to get those symptoms under control. To empower resilience. And if the medications that have been prescribed for you haven’t helped, then you may need something more targeted, more potent.

    One medicine we use at Innovative Psychiatry for exactly this is IV ketamine treatment. We’re experts in ketamine treatment and we’ve offered it for years–way before most doctors–and most people–ever even heard about it.

    Resilience. It's the new buzzword among people who were depressed and now live in joy.

    You may need something like that to help you enjoy resilience and to make it stronger. Because from its vantage point, ketamine has a list of actions that can help you develop the resilience that will see you through stressors and losses that may come along in the future.

    Neuroplasticity Helps You Build Resilience

    Ketamine stimulates neuroplasticity, which is the ability of the cells in the brain to change and adapt. That neuroplasticity can enhance your psychotherapy, especially when your therapy is 24 hours after your infusion.

    It can also help you change your perspective of life and people. In doing that, it can help you learn how to “bend with the wind,” or whatever crosses your path. You can create and build up a level of resilience that empowers you to roll with the punches in life.

    Numerous studies have shown that the more often you adapt to small stressors in your life, the stronger you’ll be at adapting to big calamities. And the more you change your thinking to adapt to difficulty, the stronger your resilience can be.

    So, you can do things to strengthen your resilience…by choosing adaptive behaviors in smaller crises day by day.

    For example, you don’t have to succumb to the same old habits when something frustrates you, or makes you angry. With the help of ketamine stimulating your neuroplasticity, you can choose to think a different thought. Then practice it.

    I’m never going to get out of this job or this company. I’m doomed to a future of misery and mediocrity…

    You have the choice to accept that thought…or to grab the wheel and change its direction, like so:

    I’m not going to succumb to that thinking. I WILL excel at this job because I’m working hard to perform well. And I will be rewarded with promotions that will give me the resume that will promote me when I apply to new jobs. Bottom line, I’m not giving up..!

    You have choices when thoughts come to you, and when your choice is empowered by the neuroplasticity of IV ketamine treatment, you CAN overcome.

    Resilience helps you build a stronger remission of your symptoms... In fact, resilience is the reason so many people can undergo tremendous stressors, and bounce back.

    Resilience gives this woman peace in the face of difficulty.

    People like you, and those you love. Because resilience isn’t something you’re born with or NOT born with. Resilience is something you can develop with practice, determination, and persistence.

    That’s so important that I want to say it again: resilience is something that can be developed. You can develop it. And we can help you.

    We want you to live as the best YOU, you can be. And you can with the ability to adapt, and to apply resilience.

    Ketamine KRIYA Conference 2018
  • Persistence: The Road to Resilience Helps You Try, Try Again

    Persistence: The Road to Resilience Helps You Try, Try Again

    Persistence the road to resilience helps you get back up and try again when you fall.

    With perseverance, you can build the life you want to live.

    You’ve probably seen the photo of an old stone lighthouse in the storm, with overwhelming waves crashing against it and around it. It looks like it will surely be knocked down…but it’s not. Those waves go on year in and year out, decades upon decades, but it stands strong. It stands to give light to ships in the storm. Steadfast, it shines its light, no matter what.

    Persistence

    This is persistence. Holding steadfast to the hope for better days, believing in the peace that will follow the storm, no matter how great the pressure… it endures.

    Storms are a part of every life, and the risk of collapse is real. If there was no fear, no risk, the endurance would be unremarkable.

    However, because the risk is real, there is great reward when you see the calm that follows the storm. And each storm that you survive prepares you to be stronger to withstand the next one.

    Holding Steady in Chronic Illness and Abuse

    Marti withstood storms. Life-threatening illness that came in waves and threatened to destroy her. An abusive partner who shifted from violent to repentant and back again, bringing her within an inch of her life. Repeatedly.

    But each time, she nursed her wounds, and determined to try again.

    Marty had contemplated or attempted suicide quite a few times in the 25 years she’d been depressed. Through those times Marty’s depression worsened and she wanted to die, but she kept holding on for a day when life might get better.

    After her ketamine treatment, she discovered that she still had some of the perseverance she’d developed through those years of constant crisis. And, she learned about the importance of practicing endurance, self-control, letting go, and honesty with herself.

    As the ketamine treatment continued to improve her outlook long after the infusions were over, she thought often about how to work on her “infrastructure” that she’d heard so much about.

    How to increase her own determination to stand steady when some symptom returned, by knowing it would pass again like they’d come to do. 

    Or to keep putting one foot in front of the other when she lost her job and wanted to give up. …Or when she had 2 twelve-day hospitalizations the same month and she couldn’t see a time when she would be well.

    Persistence road to resilience provides determination, and strength.
    Persistence – The Road to Resilience – May Be Enhanced by Ketamine

    While she was undergoing ketamine treatment, she arranged with her therapist to have a session 24 hours after each infusion. It was clear she needed therapy to heal from the scars of that abusive relationship.

    And she’d understood that there was something special about the 24 mark after the infusion that really helped the therapy to be more effective.

    Marti found the neuroplasticity ketamine treatment had initiated allowed her to see through her faulty thinking in that relationship, so she could heal, and move forward in her life.

    It encouraged her when she realized that each time she held steady through a period of emotionally swinging out of control, she felt stronger to do that the next time.

    After awhile, she also worked at being kind to others in the wake of her symptoms subsiding post- infusion. The more times she stopped herself from over reacting toward someone, the easier it was the next time.

    Each of these steps helped her peace to grow. She felt more serene, more confident in her ability to function in life. And in her healthier state, she found someone new who brought out the best in her, and supported her healing and restoration.

    She’s now in full remission and kindness has again become the backdrop of her nature, though her assertive personality is still fully hers. She couldn’t have gained this ground without ketamine, but once she had its help, she made great strides that paid off in the reward of a fulfilling life.

    Holding Steady Between Bipolar Episodes

    Bernie withstood storms. Like Marty, he came close to succumbing to them. The frequent storms of bipolar depression made survival appear like an ugly life sentence, with no escape. 

    Persistence road to resilience leads to strength .

    But, then his parents heard about ketamine treatment. They gave him articles to read …and the more he learned, the more he wanted it. 

    After the treatment, he felt relieved… but there were still symptoms some of the time. When symptoms did come up, he knew he needed to keep putting one foot in front of the other, and keep moving forward, because he could finally see hope.

    He found that the reduced symptoms and his better frame of mind in between was making his life more “endurable” when the symptoms did rise up.

    Persistence is believing in good days ahead when a storm is pounding down on you and your ship is breaking apart beneath your feet.

    Persistence knows that no matter how overwhelming this moment…or this decade…seems to be, there will be a better day – a happier ending.

    When you’re persistent, your mind is focused on the positive outcome of the crushing circumstances you’re enduring, and you know that you don’t want obstacles like complaining or an attitude of defeat to prevent you from reaching that reward. So you look at the promise you see of what lies ahead, rather than focusing on or magnifying the circumstances you’re in.

    And like Marty, each time you hold onto that promise and plod forward with determination, you gain more strength to do it again in an even worse storm. You get stronger.

    The seeming foreverness of each bout with illness that never seemed to stop for years, and the seeming inevitability that the abuse would finally end her life, only bowed and gave way to her hope as she worked with the ketamine treatment to change her outlook.

    And hope, as well as the ability to be resilient during storms, finally took root and stayed.

    So persistence is a component of strength you can develop, nurture, and establish within yourself. Like a well-dug foundation it will hold you on course during the most threatening times of life. 

    Persistence is akin to perseverance.

    Keep on keeping on…no matter how shrill the wind whistles. And no matter how long you pull your cap down over your head and bow into the freezing rain, you will endure. Because that persevering will hold firm in your mind the view on the other side of what’s going on, and it gives you the durability to emerge from the whole horror unscathed. 

    A bit wiser, a bit stronger, yes. But with a new confidence that drives away fear.

    In time, you can arm yourself with that new confidence and the hard-earned wisdom that reminds you what it takes to survive, and build the future you find in the pot o’ gold on the other side.

    One step at a time. With determination, and a new instinctive sense that it’s persistence that will keep you on the scene so you can enjoy the rewards that await you.

    Because it’s persistence that helps you try again and again and again. Perseverance tells you to get back up after falling down, brush yourself off, figure out why you fell, and incorporate that new knowledge into your next try.

    Stubborn Persistence is Required for Marriage to Survive

    Do you notice older couples who are white haired, and take evening walks holding hands with their dog on a leash?  Ever wonder how they stayed in love that long?

    It wasn’t magic.

    Persistence

    There is no 40-, 50-, 60-year marriage or more that lasted that long without persistence. No one knows how to make a marriage work on the wedding day. 

    Some may have a little more insight than others about getting along, or putting someone else’s interests ahead of their own.

    In this generation of self-assertion and self-absorption, that’s all but a lost art. Still, it wasn’t an accident that two people with stooped posture and white hair feel like holding hands and enjoying each other’s company after so many decades of living together. 

    persistence

    To enjoy their autumn years, they had to learn early about getting back up and trying again. They’ve most likely had times when they couldn’t stand each other and didn’t want to stay together even another day. But one of them, one time or another, probably stepped up with persistence and determined to build a bridge, forgive the other one, and ask for forgiveness, too.

    Without that? They wouldn’t have made it to their next anniversary. And you can ask them…but I’d guess with confidence that they both have done that many times…and more times than they can count… they’ve each taken turns at playing that role, until they managed to get really good at it. 

    Over time they learned that persistence, road to resilience, has kept their marriage strong.

    …And, eventually realized they were glad they were still together…to watch their children graduate from high school; to give away their daughters in marriage; and to welcome and play with their grandchildren and great grandchildren. 

    You’re Human, After All

    Everyone falls down in their endeavors. But the persistent ones brush off and get back up and try again…and again…  As many times as it takes as long as they live.

    That kind of persistence leads to success, and resilience, and countless rewards.

    Does a three-year-old play the violin like a maestro the first time he picks it up?  

    No.

    persistence
    He makes mistakes and gets frustrated. He wants to throw it away and forget it.  But his mom, whose name is Persistence, sees that he picks it back up and tries again. And practices.  Again and again… and over the years, the 3-year-old eventually lands 1st chair in high school…  and later gets to decide if he’d like to accept that invitation to play in the Philadelphia Philharmonic.

    What do you want to bet he’s now become so good at persistence, he knows how to apply it in countless areas of his life? As with the hare and the tortoise: slow and steady – consistently – wins the race.

    Persistence.

    Honestly? Without perseverance and persistence there’s not much you can accomplish in life. Because everyone falls down. Everyone gets discouraged at some point. Everyone fails at something. Abandoning the vision strikes the death blow to that endeavor.

    However, with persistence there’s nothing you cannot do. The more you use it, the stronger it gets. Until persisting is part of who you are, and a tool you put to use in every project. And persistence gives way to resilience. 

    The character of a psychiatric disorder – the actual activity of it in the brain – wears down resilience, and flattens out persistence. If you’ve suffered from depression, social anxiety, PTSD, bipolar depression, or addiction, or suicidal thinking, you probably can’t imagine the resilience and persistence required to stand up after you’ve been down so long. 

    But that’s where ketamine comes in. Since at least a third of all people afflicted with these disorders experience no relief from prescribed medications, something more novel and advanced is required to bring relief. Ketamine treatment is the first treatment that has made an extraordinary difference for these patients.

    And it’s such an advantage that another benefit of ketamine is its neuroplasticity that makes it easier for you to make changes in your mind that allow you adapt to your circumstances, reduce your stress, apply persistence, and build resilience.

     If you’re even considering treatment with IV ketamine, or have recently received it, you know you have persistence and a good measure of grit.

    You know what it’s been like…how you’ve been able to withstand the disappointment of one treatment after another — or one effort after another — not working. You already have some persistence working for you.

    Ketamine delivers a one – two punch. First restoring connections in the signaling systems in the brain, and then providing neuroplasticity to help you make the changes in your outlook you want to put in place.

    Persistence road to resilience can be expedite hope.

    Because if you’ve been depressed, and now you feel better after ketamine treatment, you want to keep feeling better, right?

    You want to do the work that will help you maintain a remission frame of mind. So you can continue growing, and press on with developing the life you want to live. The best way to do that is to remove the stressors in your life. 

    We do the work, too.  We’re up at night, reading, refining, persisting in trying to identify the best treatment options that can get you back to your best self. We offer treatment when your symptoms persist, when your doctors have done all they can, when you’ve just gotten tired.  

    We’re here to help you win your battles… and in that process, persistence is priceless.

    Call us if we can help. 

    To the persistence of your best self, 

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
    Lori Calabrese, M.D.
  • Fix Your Inner Life: Embrace the Truth About Yourself

    Fix Your Inner Life: Embrace the Truth About Yourself

    Be sure it’s your real self you’re showing. Because it is your real self that needs to be loved.   Daphne Rose Kingma

    Fix your inner life: embrace the truth about yourself.

    It’s the most healing thing you can accomplish as you work through the changes in your thinking, your responses, your outlook and attitude about people and your world after ketamine treatment.  As you build an infrastructure of peace and generosity…fix your inner life and learn to embrace the truth about yourself. 

    Self-doubt, self-defensiveness, and pretense eat away at your self-respect and love of yourself…and can lead to depression. But you want to reduce the stress in your life to help your wellbeing thrive.

    How do you reduce the stress? By facing the truth that eats at you or that you hide from yourself.

    What sort of truth..? Well, that you’re human, for starters. That you’re not always perfect in your responses to life’s stressors. And that there are plenty of things you can learn to make your life work better for you.

    Things like humility, admitting your shortcomings, and asking for forgiveness, to name a few. To accept yourself as a learner in this life and not to expect yourself to know everything out of the gate.

    Fix your inner life: embrace the truth about yourself.

    Using Pride as a Shield of Protection

    Pride drives many of us to present ourselves as infallible, until we realize that pride also shackles us from the fulfillment of intimacy in relationships.

    Replacing pride with love can be scary. It can make you feel exposed and vulnerable until you get used to it. But doing so can transform your life and drive loneliness away.

    Something we do as humans is to construct personas that we tell ourselves others will find more likable or respectable than who we really are. But a persona that you construct is always stilted. Unnatural.  

    Have you ever been around someone who’s utterly at home in his own skin?  Isn’t he or she absolutely enjoyable and relaxing to be around?  The reason they’re enjoyable and relaxing to be around is because they’ve found a certain degree of peace with who they are.

    They accept themselves as they are so there’s no need for pretense. When someone is trying to prove themselves, it can make you uncomfortable. But when you sense they have nothing to prove, you subconsciously feel like you can relax.

    At the same time, you get the sense that their mental health is pretty good.

    It’s the exception to meet someone like that, rather than the rule. Most of us aren’t free of pretense, until we learn what we need to learn so we can be who we are.

    This shouldn’t be so hard. You know?

    But we live in a world that feels dangerous and makes us think we have to protect ourselves. So we do. We build walls around ourselves. Thick, impenetrable armor to keep ourselves safe.

    Fix your inner life: embrace the truth about yourself.

    And we guard that armor, those walls, to stay safe. Then, if anything threatens to expose us under the armor, we get anxious and defend it. Don’t we?

    So, after all that work, we’re reluctant to knock down those walls. We don’t feel safe without the armor.

    And that’s why we have to learn to see what the walls and the armor are costing us. We have to see that they’re interrupting our social development and our opportunities for close, fulfilling relationships.

    They also require that we remain vigilant, prepared to defend any attack on our security in the armor. So we can’t relax. We can’t let our guard down.

    Fix Your Inner Life

    You have to change the way you think. The way you respond to things.

    You may need to get really honest with yourself. You may find you have to learn how to embrace the truth, and learn to accept yourself as human, fallible, and forgivable. When you do that, you may also feel more lovable.

    And when you feel lovable…and LOVED… you’ll tend to find it much easier to generously love others.

    Ok. I know it’s certainly easier said than done. It’s an uncomfortable process to look head-on at things in yourself you haven’t before. But, it leads to a very comfortable, confident, joyful way of living.

    Ketamine Treatment Can Help You Achieve Remission

    This isn’t news. We’ve known this for years.

    But, if you’ve had ketamine treatment, and feel much, much better, you sure want to stay better, right?

    Well, one important aspect of staying better is to unravel the conflict you carry inside you that you may not even realize is there.

    But…it IS there. And it interferes with the peace within you. So what can you do?

    Fix your inner life: embrace the truth about yourself.

    Embrace the truth about yourself.

    Just like letting go of what you NEED to let go of, when you embrace truth about yourself it helps you relax with who you really are.

    Accepting your shortcomings, and dropping that guard that says you’re flawless, admirable, or beyond reproach, helps you embrace the truth that you’re a real living fallible human worthy of giving and receiving love.

    And there’s another plus: doing so will increase your self respect.

    Sound pretty far out? What if you don’t know what you have inner conflict about? Or how to tell if your guard is up?

    What if you’ve been presenting yourself the way you think people expect you to for so long you don’t remember what it was like to be yourself?

    Scrutinizing Your Inner Self

    Start with looking closely at that experience or event that scratches at your conscious memories. What are you telling yourself about it? What about it might be seen differently?

    Pay attention to your inner voice…do you find yourself defending yourself over what happened? What could you be “hiding” from yourself?

    It might be related to some sort of blame you place on another person… or something you’re hiding from yourself. Look deeper. Could you have caused the situation, even though you didn’t intend to? Is it possible you share responsibility for what happened?

    And what happens when you look at the other person’s role with a heart of forgiveness and understanding? Can you see how the outcome might not have been his/her intent?

    Then. Just say it. “It’s my responsibility that so-and-so happened. ” Or…share the responsibility… ” I share in the responsibility that so-and-so happened. I didn’t intend for it to go down the way it did. He/she probably didn’t intend it either. I’m human, and I was wrong. I handled the situation badly. I’m truly sorry, and I’ll really try to not do it again.” Then move on with the resolve to make good decisions and to treat others well going forward.

    I Was Wrong

    It’s very difficult sometimes to reach this point. But giving up the fight and accepting that you’re fallible can be so liberating. You THOUGHT it could destroy you, hence the long arduous combat in your mind.

    But when you really see that you were wrong…you can accept that it happened. And the fight inside you…the defensive arguments in your head…begin to disappear and become quiet.

    And that quiet is a deposit of peace into your inner self. Enjoy the reward of harmony you feel.

    Then take what you’ve learned and apply it to the next situation that comes to mind…because another situation will. You’re human and fallible. And so is everyone you know.

    Fix your inner life. Embrace the truth about yourself.
    Going forward, you may find you’re a little less judgmental, a bit less inhibited…and more and more relaxed.  In that relaxed and peaceful state, it’s much easier to feel better.

    With these things at work within you, you can accept yourself as human, and realize that through forgiveness of yourself you are more able to love and receive love. And that brings joy.

    Remember, this discussion is NOT to say that if your remission fades away, it’s your fault. 

    IT’S NOT.

    But since stress remodels and prunes the signaling circuitry in the brain, which can lead to depression and other disorders, it stands to reason that the more you can remove stress from your life, the better the environment is for remission to thrive.

    At Innovative Psychiatry, we want to be a part of your recovery as you use your ketamine treatment to help you bring change in your thinking, your outlook on life, and your attitudes.

    Everyone needs these changes, but not all understand how to make them.

    If you’re not in the habit, but have experienced joy from ketamine treatment, changes like we’ve talked about can help you continue to enjoy that joy, increasing love…and freedom from emotional pain.

    Can we stop suicide? Yes, with a series of IV ketamine infusions.

  • Want to Help Ketamine Remission Last? First Strengthen Your Personal Infrastructure

    Want to Help Ketamine Remission Last? First Strengthen Your Personal Infrastructure

    Help ketamine remission last but letting go of bitterness, possessions, and fear.

    In past posts, we’ve talked about remission by ketamine, the 50-year-old anesthesia medicine that stepped up to the plate in the last ten years or so… to bridge the gap in the treatment of an array of psychiatric disorders.

    And once you’ve achieved remission, you want to help ketamine remission last. You don’t want to return to your same old ways of reacting. Or to the same old stress and risk losing the ground you’ve gained.

    So let’s continue. We’ve talked about the growing body of evidence that demonstrates the extraordinary antidepressant effects of this medicine in numerous psychiatric disorders. Illnesses like severe treatment-resistant depression and bipolar depression. as well as its unparalleled impact on PTSD to arrest symptoms and restore peace to the traumatized individual.  

    In our own practice, Innovative Psychiatry, we’ve seen ketamine treatment make a dramatic difference with social anxiety, that cruel disorder that creates obstacles between you and financial success, self respect, meaningful relationships, and general fulfillment in life.

    Help ketamine remission last by building meaningful relationships.

    So that after ketamine treatment, you can effectively interview for the job you want. You can initiate and develop loving relationships. In fact, you can basically BE who you are and at your best. While you contribute to your team at work and your family and community, as well.  So you want to help ketamine remission last.

    But it doesn’t stop there. We’ve also seen ketamine treatment relieve OCD symptoms, providing the neuroplasticity for needed changes through therapy.

    And then there’s alcohol use disorder as well as crack and other addictions, which ketamine (as demonstrated through the work of Dakwar and others) helps you conquer by weakening or erasing cravings. 

    We’ve seen similar positive results in our own practice, though there have not yet been enough studies to validate this benefit across the board… yet.

    Then, possibly the most amazing of all is suicidal thinking…no matter what the cause that led to it… can be eradicated, often within an hour, and usually in less than four. We’ve seen extensive positive outcomes of this life-saving benefit in our office.

    Your Personal Infrastructure Seems to Play Some Role in Making or Breaking Your Remission

    Sometimes people achieve remission with ketamine treatment only to lose it after a few months as the stressors of life wear away at the repair work the treatment accomplished, and the remission is lost… or seems to be.

    Interestingly, because stress is such an important cause of the pruning of brain cell connections (synapses) it appears that sometimes when patients receive ketamine treatment while under severe stress, it seems to not work for them.

    Then, sometimes it happens that the patient finally begins to enjoy ketamine’s benefits after the stress is significantly reduced. This is something we’ve observed multiple times but lack the extensive research to back up… yet.

    So it’s important that we distinguish those benefits we see every week at Innovative Psychiatry from those that have already been validated by peer-reviewed research.

    It takes time for research to catch up with the widespread use of ketamine treatment. And it requires multiplied studies upon more studies to establish the reliability of any benefit.

    So let’s be clear that the benefits of ketamine treatment we’ve seen at Innovative Psychiatry have already been reported in research studies. But, not with the overwhelming stacked-up body of evidence that stands behind ketamine for depression. Not enough to proclaim them from the housetops without an explanation.

    Even so, it’s important that you know these things are happening, and we’re playing a waiting game for the research to catch up and explain what we’re seeing in practice.

    Meanwhile, while we wait, we want to let you know that we’re discussing what we’ve found works for our patients. And although we make the disclaimer that this is not individualized medical advice for you personally, we want to share the best of what we’re reading and actually doing. In the name of transparency. And in the name of hope.

    Help ketamine remission last by unburdening yourself of self consciousness.

    Now to recap…we were talking about how stress seems to undermine the benefits of ketamine…or at least it appears to. And there’s more to stress than meets the eye. Right?

    Sometimes the stress is inside our heads…like things aren’t going the way we wish they would, or something we hoped would last doesn’t, or maybe people aren’t doing what we think they should.

    Or we like the job but hate the commute and arrive at work ready to rip someone’s head off…or we hate the job and every day is miserable.

    …or we have friends who drive us crazy, use and abuse us, but we keep spending time with them.

    And that’s where “infrastructure’ comes in. You want to help ketamine remission last. And the rebuilding of your environment, your decision-making, your thinking patterns, and your responses to the challenging moments in life, is part of your personal infrastructure. All of that tries to return you to your former state before treatment…or can establish you in your new peaceful life of joy and productivity.

    It’s impossible to cover all those elements in one post, but we’ll attempt to show ways you can tackle certain elements that make up your inner and outer environment over time… here and in some posts to come.

    A Full Overhaul Of Your Life, Step by Step, Can Be the BEST Medicine

    Help ketamine remission last by overhauling your attitudes, expectations, and responses.

    And a good place to start is by taking a look at learning to let go. It’s completely normal and natural to assume that any depression or anxiety you have is the result of the behavior of others. That you just got worn down from it all.

    And there may be some truth in that. 

    But in exploring the causes, it may surprise you to learn that their behavior may not actually be the cause, as much as your reaction to their behavior that is.

    Now understand this. We’re not implying here in any sense that your lack of response to ketamine, or the loss of remission, is in any way your fault, or even within your control.

    But it’s important to understand that the best prescription for maintaining stability with remission includes maintaining health in those things in your life and environment that you can control.

    Things like your respect for yourself and for other people. Your persistence in pursuing peace in your life and relationships. The development of a kindness-centered approach to yourself and those in the world around you.

    …And the evaluation of your life and simplification of the burdens and demands it presents. Ensuring  you have the power to enjoy life’s simplest pleasures…which may include letting go of things that pull you down or hold you back.

    These are things that can help ketamine remission last.

    So let’s talk about a fundamental skill that can change your life…for the better.

    Letting Go

    When we talk about letting go, it’s not reserved to only one thing…such as letting go of a relationship. Since relationships can be so important in our lives, and the ending of them can be so painful, letting go of relationships that have died is high on the list.

    Help ketamine remission last by reducing relationship conflicts and replacing with harmony.

    But there are other issues in our lives that may present themselves as we consider letting go to reduce stress. 

    Such as letting go of being right in our discussions at work with our boss or co-workers, and in our discussions at home with those we love most, such as our spouse and kids.

    And what about letting go of fighting to get our way, when obstacles are thrown in our path? This may be akin to letting go of being right, but it has a personality all its own. 

    Possessions Can Shift from Useful Tools to… Jailer

    How about letting go of your pride in your possessions…?  For instance, let’s imagine a teenager sets his icy soft drink can on your dining room table…allowing condensation to mar its flawless finish? 

    What goes through your mind when you see it? Rage that a kid with no manners has caused your beloved heirloom table some damage…?  Fear that your spouse will hit the ceiling? Compassion for a young man who didn’t know better… so you pick up the can and set it on a coaster for him? 

    It’s ok to enjoy having nice things, but when the “thing” is higher on your priority list than the development and well-being of a person…well that “thing” is controlling you.

    Which do you value more: A 19th century mahogany table with a flawless finish that was handed down through your family over a hundred years….?   Or a tall and lanky boy who needs a haircut and a clean t-shirt ?

    If you’re honest with yourself, it really might be the table. But if that’s the case, maybe it will help you see the kinds of things you can work on, possibly with a therapist, to improve the infrastructure in your head.

    Because anger causes stress. And anger toward that kid is stress you don’t need. Compassion on the other hand doesn’t, and actually supports your remission frame of mind.

    Remember…you’re learning to nurture peace… in your head. And to do it means developing a response of gratitude, humility, and kindness.

    What If You Lost It All?

    Help ketamine remission last by shedding attachments to things and cherishing people you love.

    On the other hand, picture your belongings lost in a fire. No one’s fault, really. But it cost you every material thing you own.  How do you feel about that?  Sad?  Sure… all those memories and photos…but the house and belongings?

    This is a loss you’ll never fully recover from materially, but does it reach the core of who you are?

    Now.  Picture the phone call that makes the world STOP. Your spouse, your three children, and your only grandchild have been in a terrible car accident. No one survived.

    What do you feel? What does the furniture or sports car mean to you now?  

    My point here is that we have a way of putting people and things on a priority list… and that list can get all mixed up. But this scenario helps to show how those things we think are important lose their glow instantly when those at the core of our hearts are lost.

    And that being the case, putting ourselves through unnecessary stress to preserve things that pale in comparison to those we love… well, it’s a waste of valuable moments and energy when we think about what really matters to us.

    And therein lies the secret. Rather than wasting our lives by hurting people to preserve things, we find our life is best spent preserving the moments with those we love the most. 

    And the things…the houses, cars, antiques, reputation, recognition…none of these things can compete with the people we love the most.

    The Greedy Monkey

    You’ve heard the story of the monkey who is shown a jar of cookies.  A jar that has a small mouth. He sticks his hand in and grabs a cookie…but can’t pull his hand out unless he lets go of the cookie.  The opening just won’t accommodate anything larger than his open hand. 

    Because he won’t let the cookie go, he panics. Swinging the jar around in the air in a temper because it won’t give him the cookie, he finally smacks himself on the head with the jar and it hurts so much, he immediately lets go of the cookie to hold his head.

    Sound familiar… at all?  Is there anything in your life that’s pleasurable to you that you don’t want to let go?  And if circumstances prevent you from having it or keeping it…does it make you mad?

    If you have any marred tables or unyielding jars in your life, take a moment and breathe…  Think about what trying to protect and preserve that “thing” costs you.  Are your feelings on your cuff?  Do do you snap at people when its security is threatened?  Do you feel panic at the idea of it being removed from your life…?

    The Surprise Benefits of Letting Go

    The unexpected surprise you can discover by disengaging from “it” is that the angst of control that you’re powerless to perfect is replaced by a growing peace and relief.  And when you have succeeded in reaching that point, that same peace and relief is a signal that you’ve now added a brick to the foundation in your personal infrastructure.  

    Help ketamine remission last by showing kindness, sowing seeds of love, and nurturing peace.

    That thing, whether it’s your marriage, your shiny sports car, your child who’s supposed to fulfill your dreams….your house, the money you make in your job that prevents you from spending time with those who yearn for your attention…no matter what it is, has been holding you back and isn’t deserving of what it takes from you.

    Picture serenity in your life.  Peace.  What has been removed from the picture when you think of it?

    An alcoholic wife, an abusive screaming boyfriend, a job that you bring home and work on till you go to bed…? Maybe it’s more house than you can afford, so you’re driven to work three jobs to pay the bills. If it is, that house controls you.  

    Life is short. We get the most out of it when we can cherish every moment.  In your daydreams, when you wish for reprieve…what do you erase from your life in your mind’s eye to make room for hope?  Peace?  Love?  Enjoyment?

     Commit to Finding Ways to Let It Go

    First of all, in your mind and heart.

    This is one facet of the infrastructure in your life that you may need to confront and adjust to make room for remission. 

    It will be easier to explore these things after you’ve had ketamine treatments because of the neuroplasticity that results. The ability to think in new ways. To change, and make productive decisions for your life.

    So…to get there… you may want to consider ketamine treatment for severe and suffocating depression, your wracking and immobilizing bipolar depression, PTSD that injects traumatic reactions into your days…and your nights. 

    OCD that stands in the way of your achievements, and that social anxiety that has plagued and isolated you since you were a child.  And for suicidal thinking that threatens to snuff your life before you even have a chance to recover.

    Wanna Help Ketamine Remission Last?  You Can If You Strengthen Your Infrastructure

    Strengthening your infrastructure involves ferreting out burdens you can lift off yourself, like excess belongings, excess weight, whatever it is that requires your service and obligation…and prevents you from freely enjoying opportunities with those relationships that matter.

    Let it go. Help Ketamine Remission Last

    By giving your brain…your inner self…the most optimal environment for healing and growing possible.

    It means simplifying the grandness of your life… For you, it might mean living beneath your means so you can travel, write, or volunteer. Or shedding those friendships that demand your time but don’t contribute. It’s shedding the less meaningful to free up time and space for what’s ultimately important.

    For this person it may mean letting go of the bitterness he carries toward his ex-spouse for leaving him.  For another, it may mean selling the house to travel the country in an RV and stop and paint when the view is spectacular.

    And for someone else, it can mean retiring from the corporate job to teach underprivileged children, or to cook meals in a soup kitchen for the homeless.

    For you? Maybe it’s saying no to all those obligations that crowd your life so you have time to spend with those who adore you.

    Basically, it’s about pulling weeds in your life to help ketamine remission last, and to preserve your joy. To put the life ketamine helps you find to the very best use.

    You know what your strengths are…if you take time to think about it. Those special gifts you have ached to get out.

    No one can tell you what it is for you. But that’s the fun of exploring your own infrastructure to find your path for cherishing the moments of life, and enjoying your new found joy.  It’s a painful process that gives birth to fulfillment.  And along that path, you’ll find joy.

    Even though we don’t see everyone achieve remission with ketamine treatment, we do get to see that most do. And more and more physicians are learning better and better methods for administering ketamine for the best possible outcomes.

    Help ketamine remission last by preserving and cherishing moments with those you love.

    The result is that more physicians are reporting higher numbers and better outcomes. The field of ketamine for psychiatric disorders is growing as physicians and researchers collaborate and learn from each other.

    Meanwhile, researchers and physicians alike continue to discover more with hopes of bringing relief and remission to those who aren’t experiencing it now.

    If you suffer from symptoms that no medicine has helped, call us.  

    We’re here to help you experience life the way you’ve longed to live it. 

    To the liberating of your best self, 

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine


    Lori Calabrese, M.D.
  • Treatment of Psychiatric Disorders: 2019 Year of Promise

    Treatment of Psychiatric Disorders: 2019 Year of Promise

    Treatment of psychiatric disorders with ketamine brings remarkable results.

    Compounds and methods for treating severe psychiatric disorders are getting better and better…

    Charlie sank into a chair in utter discouragement, as she realized she had awakened again, after hoping as she went to sleep that this would be her last night. Her last time to breathe. Night after night she prayed to die in her sleep. Morning after morning she woke up again. Ugh.

    She felt betrayed by whatever cruel powers that be…that there seemed to be no compassion for her misery…and no escape.

    She dragged herself to the bathroom and turned on the shower. Instantly, she saw an image of herself hanging by a rope from the shower head.

    And she screamed.

    Then climbed into the bathtub and stood sobbing under the shower.

    Finally, she shampooed her hair, soaped up her body, rinsed, and turned off the water.

    There was nothing to do but go to work…AGAIN…and try to function…AGAIN… and hopefully not get fired, because of her poor performance.  Tears filled her eyes…

    Suicidal Thoughts Can Be Deadly

    Charlie is one of millions in the US who want to die as a result of depression.  Approximately a million people commit suicide each year, and many times that amount try but survive. And many times more than those get struggle with suicidal thoughts that keep coming back.

    Because relatively few tell anyone they’re thinking about or even considering suicide, it’s been impossible thus far to estimate the number.

    Treatment for psychiatric disorders can turn anguish into joy.

    They don’t want to die, they just don’t want to live with this kind of misery any more. Maybe you know someone like this… or you’ve felt like this yourself.

    You are the ones we want to reach, to help, and to treat so you can rebuild fulfilling and rewarding lives again.

    Ketamine Treatment Continues to be Misrepresented

    With all its talents — with all its extraordinary mechanisms of actions — IV ketamine treatment may need a good PR firm!

    When have you seen a safe, rapid, extraordinarily effective, life-saving treatment misrepresented, misunderstood, lambasted, and gossiped about more than ketamine? (Think about that for a minute.)

    I saw a comment in STAT magazine the other day that took the cake.

    There were lots of great comments, some more informed than others. But you do sort of expect that in a national publication. And… there was a lengthy comment–difficult to decipher–claiming ketamine was inherently dangerous.

    It was clear the individual didn’t know about the research and data. All the information that’s poured out around the globe about ketamine and related compounds for psychiatric disorders over the last 10-15 years.

    The commenter seemed to only be acquainted with its dangerous and highly abusable street form, Special K. And with the extremely high doses used on the streets… repeatedly over and over and often… he or she had seen the damage that abuse of ketamine can do.

    As a psychiatrist, I hate to see it represented that way, but I cherish free speech, and freedom of expression. I also cherish scientific advancement and use it — every day — to relieve suffering.

    Ketamine should definitely be administered under a psychiatrist’s close supervision, not self-dosed.

    Then … there are the articles by young residents and clinicians, aspiring academics, and others. Those who have little true experience with the medicine or the treatment. But they’ve jumped in to write reviews of the literature or opinion pieces about it.

    Treatment of psychiatric disorders gave this man his smile.

    The best way to learn about ketamine treatment for psychiatric disorders is to hear directly from experts who actually use it — with many, many patients — every day in their offices or research units to treat psychiatric conditions. In this case, from the neuroscience researchers and psychiatrists who have worked with it a long time.

    Because the truth is, the majority of physicians have read snippets about it here and there. They’re just now getting up to speed. And some have distorted ideas about it.

    An article in VeryWell Mind by Naveed Saleh, M.D., May 2018, made some erroneous statements about ketamine treatment for suicidal thinking.

    First, he claimed that ketamine is best absorbed through the intramuscular (IM) route, which is just simply false.

    Ketamine is 100% bioavailable only when it’s given by the intravenous (IV) route. In IV form it’s delivered straight to the brain tissues that so desperately need its benefits. IM and IN (nasal spray), lozenges, troches, and oral liquids are all less bioavailable.

    In addition, there are other problems with IM injections of ketamine that we’ve discussed and that are described in that Time Magazine article we talked about.

    He also made claimed that if ketamine is to be widely-used, it most likely will be as an adjunct to other medications. Another misunderstanding of his research. Because the evidence says…

    Ketamine Treatment Acts Independently of Other Medications

    While that may or may not be true, my vote is that it won’t need to be. Evidence shows it doesn’t depend on other medicines for its mechanism of action. It’s not dependent on other medications to create a “partial response” that it augments. It acts independently on its own merits.

    In fact, the most robust research is in patients where medication has FAILED — patients who have TRD, or treatment-resistant depression.

    The left half of the ketamine molecule, known as esketamine, is nearing completion in its FDA trials and IS being tested as an adjunct to other medicines, not as a primary or stand-alone treatment. It’s being packaged as an intranasal spray, and has had some serious setbacks while seeking FDA approval.

    It’s exciting to see what new glimpses researchers will find as they continue to study ketamine and other related compounds for treatment of suicidal thoughts, depression, bipolar depression, PTSD, OCD, social anxiety, and addictions. Maybe it will be a new action not yet identified, or maybe additional applications or conditions that could be responsive to this extraordinary treatment. 

    But the majority of patients who receive IV ketamine treatment report that other antidepressants or anxiolytics have failed, and, even if they walk in on antidepressants and mood stabilizers, they attribute their response and remission to ketamine treatment.

    Ketamine Treatment of Psychiatric Disorders…

    At Innovative Psychiatry, we see the majority of patients with severe treatment-resistant depression, bipolar depression, and suicidal thoughts. respond and achieve remission. They are real-life, real-world people just like you or people you know. Often, they don’t have just one thing or just one disorder — because psychiatric symptoms and disorders are complex and tend to run hand-in-hand.

    We call that complex psychiatric cormorbidity.

    Don’t let the term scare you.

    It just means that when we see patients with treatment-resistant depression — as in unipolar depression and bipolar depression — they often also have other things, too, like social anxiety, PTSD, OCD, and addictions.

    They’re often hopeless. Often suicidal.

    It’s one of the reasons we’re so interested in following the research in using ketamine to treat suicidal thoughts and these other psychiatric conditions — and one of the reasons I write about them so often and devote space to them here.

    Suicidal thinking can disappear within a few hours with IV ketamine treatment. Think about what that would be like for you … or someone you love.

    If you’d like to consider ketamine treatment, give us a call. We can talk it through.

    The Microbiome Has Been Underestimated

    The microbiome is the collection of genes included in the trillions of bacteria, fungi, and viruses that populate the gut along nerve pathways connecting your brain to the rest of your body. These microorganisms provide our immune system and all work together to help our minds and bodies function properly and in partnership.

    Treatment for psychiatric disorders includes feeding your microbiome.

    Another area psychiatry is advancing quickly forward is in its understanding of the importance of the microbiome and its effect on psychiatric illness.

    When the balance between good organisms is outweighed by “bad” organisms, we become sick in some way. This may be an upset stomach, a systemic virus, or a disorder like depression, to name a few. Restoring the balance of these systems in our gut can help restore our health.

    In fact, physicians have come to understand that sometimes the extensive use of antibiotics may destroy so much bacteria that the good bacteria that fights disease becomes depleted.

    The more we learn, the more we can refine this essential part of our bodies to support our emotional well-being, as well as fight inflammation throughout our bodies.

    But, we’re also learning it’s possible to overdo good organisms, too.  And other disease symptoms can begin if there are far too many of them. It’s a balanced eco-system we’re looking for…  We’ll be talking more about that soon.

    Plans Unfolding for the 2019 Year Ahead

    And we’re brimming at Innovative Psychiatry. (How’s that for 2019?) With new initiatives, new efforts, and exciting plans.

    We’re expanding our hours and our availability, and preparing to publish our outcomes peer-reviewed journals in the hope of adding to the growing body of evidence of ketamine treatment’s remarkable benefits for treating an array of psychiatric disorders. (I’ll keep you posted as that develops.)

    We hope to present our outcomes at more national and international conferences this year.

    On top of that, we’re adding some opportunities to help us get more help to more of our patients to finance the cost of their treatment, and help fight for insurance companies to reimburse patients for the cost of their treatment.

    Ketamine Treatment: Getting Better, Giving Back

    Another opportunity in the wings is a program we’re developing — the first in the country– that would allow us to help patients Get Better and Give Back to their communities with special volunteer opportunities. 

    This program can help patients who would not have access to treatment any other way.

    As we get all our irons in the fire scheduled and the details sorted out, we’ll update you so you’ll know what to watch for. G

    2019 promises to be a year of hope, and a year of gratitude and goodwill, as we see more people feeling better... and getting well… after years of struggling without solutions.

    We want to see progress made toward insurance companies covering ketamine infusions for psychiatric disorders. The medical billing code for ketamine infusions exist but it is usually rejected when it is linked to a psychiatric diagnosis. We continue to fight stigma and stigmatizing terms.

    Hope is on the horizon. It’s going to be a good year.

    If you battle depressive symptoms, or suicidal thoughts like Charlie, that haven’t gotten better, despite various medicines you’ve tried, please get in touch with us if you’re interested in ketamine treatment.

    It consists of several doses of IV ketamine, usually about 6, and sometimes a few more, over 2-3 weeks. Ketamine isn’t appropriate for all patients — and doesn’t work as well for some as it does for most of our patients — so it’s not for everyone.

    But we see such high percentages of response, we can say that most likely the chances are it will be a great help to you.

    Treatment of psychiatric disorders like ketamine brings unparalleled relief.

    Most of our patients find after a full series of infusions, they can do things they’ve procrastinated about for years, enjoy things they used to enjoy, take advantage of energy to work, create, and socialize they had found impossible, in many cases for years.  And build relationships and careers that are rewarding and satisfying.

    We look forward to talking with you, and helping you find your smile again.

    To the best YOU you can be in 2019,

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
    Lori Calabrese, M.D.

  • The Stigmatizing Term: Mentally Ill

    The Stigmatizing Term: Mentally Ill

    Young woman, called mentally ill, suffers from stigmatizing term: mentally ill, needs ketamine off-label treatment.Stigmatizing Term: Mentally Ill

    I used to think I was an expert in this stuff.  The stigma of it all.  Mental illness. 

    Man, I hate that phrase.  I don’t hate many things, but I hate that phrase. Always hated that phrase. Truly,  I think I hate every awful syllable of that phrase.  I never utter it.

    People who know me know this is true. 

    But most people–probably most of the patients that I treat–don’t know this about me.  It’s not something I share, and it’s never been something I broadcast.  I think most people assume that psychiatrists are experts in mental illness.

    Mental illness sounds like such a dirty word.

    Here’s what we psychiatrists are: experts in disorders of the brain… and the mind… and the spirit… and the body—disorders that go on to affect the brain… and the mind… and the spirit… and the body.  360 degrees. Experts in treating people who are full of shame.  Who are isolated, distanced from their families, cut off from their friends.  Cut off from their insurance, denied life insurance, denied disability insurance.  Experts in helping people who are stigmatized every day for what they have.  As though what they have reduces them to the thing itself.   

    Experts in the diagnosis and treatment of psychiatric disorders.

    Depression.  Bipolar Disorder.  Anxiety.  Panic. Obsessions.  Addictions.  Bulimia.  Trauma.

    There are illnesses, disorders, and diseases that affect your ability to walk, to digest food, or ability to function in the presence of others.  Sciatica, ulcerative colitis, panic disorder. But specifying an illness that affects your brain, your mind and spirit as separate or somehow different from all of the other problems we treat in medicine delegitimizes that illness.

    So let’s start there.

    We psychiatrists are not only experts in diagnosis and treatment, we are the stewards of our knowledge, and it behooves us to guide society’s perceptions about our field and the people we care for. To help our culture catch up to our science.

    You’ve heard someone say, “…it made me physically ill…” and it left a specific impression, right?  Spoken in those words, we assume she felt nauseous, and that because she felt “physically” ill, it was all the more intense, believable, legitimate.

    Our society struggles to find ways to legitimize illness, disease, or disorders caused by brain anomalies. People can handle discussing a brain tumor, a stroke, or multiple sclerosis, but when the symptoms affecting behavior, or moods, or thought processes don’t have a clear lesion that explains them, it seems to hit a proverbial nerve.

    The Dark Ages of the Brain Finally Ends

    It wasn’t until the last ten or fifteen years that researchers began finding out why those behaviors existed. And so, because of that absence of information, throughout the history of mankind, people who suffered with these disorders were ostracized, isolated, imprisoned, and dehumanized…or dismissed as “weak,” or “undisciplined.”Old woman in ancient asylum suffers alone, because psychiatric disorders were misunderstood, showing the stigmatizing term: mentally ill is no longer relevant.

    But that was then.

    This is now.

    Introducing: DNA, fMRI, BDNF, Amygdala, Hippocampus, et al…

    Now we know more in neuroscience than we’ve ever known before. We have functional MRIs, that show unmistakable changes in brain activity in those with specific disorders compared to those who don’t have them.

    We have 108 genetic DNA markers that are linked to schizophrenia and other illnesses.

    Certain brain structures differ in people with depression, bipolar disorder, and schizophrenia.

    We’ve found reduced levels of BDNF (brain derived neurotrophic factor), different genetic polymorphisms of key enzymes in the brain that affect how neurotransmitters are metabolized, and higher blood levels of certain inflammatory markers in different psychiatric illnesses.

    Now, in the 21st century, we have facts.

    Neuroscience is quickly becoming more and more proficient at understanding, describing, and measuring emotional shifts, behaviors, cognition, and emotion, through brain activity. No longer are behaviors and symptoms that weren’t understood by mankind in the past given fictitious explanations.

    When have you heard someone say, Joe is physically ill. . . when describing his cardiovascular disease?

    We might tell someone Joe had a massive MI because of blockages in 3 major vessels to his heart.

    Sound legitimate? 

    Of course.

    We describe illness and health events specifically and in some detail.

    Sarah was diagnosed with Type 2 diabetes.  She’s trying to lose weight, and feels nauseous when her blood sugar gets too low.

    Or…

    Jim was just diagnosed with Parkinson’s disease. No wonder he’s been shaking so much.

    Again, legitimate, right?

    What’s more, Parkinson’s is a neurological disorder…so we’re crossing the threshold into neuroscience and its disorders and illnesses.

    Call ‘Em Like We See ‘Em

    Let’s take it another step.

    My sister-in-law saw a doctor last week to understand her mood swings and extravagant spending the last few months. She was diagnosed with bipolar disorder. I think she and her husband are beginning to understand a lot of things she’s been doing that seemed out of character for her.

    Legitimate?  Absolutely.

    Young woman feeling relief and gratitude after ketamine treatment for depression, showing there's no place for the stigmatizing term: mentally ill.It’s as natural and valid to describe what a loved one is experiencing in their health as it is to describe their move to a new house, or the addition of a new baby.

    All of these scenarios speak of a health condition that brings challenge and impact to this person’s life, as well as his or her family.

    To isolate health issues sourced in the brain as ‘different’ is to alter the listener’s perception of their validity. Health is health. The well-being and function of the entire human body is a vital part of living well for every person.

    When any part of your health is compromised or impaired, your entire life can be affected.

    There is no difference in validity or impact in the case of illness in the gut, the kidneys, the liver, the heart, or the brain.

    And in each case, the physician is focused on finding treatment that improves the health and wellbeing of her patient.

    We’re at the end of the darkness related to psychiatric disorders.

    Stigma No More

    There’s no place for stigma.

    Brain tumors are not caused by guilt or bitterness, neurofibromatosis is not caused by criminal intentions, and bipolar disorder and PTSD are not caused by poor parental discipline or weakness.

    People get sick.

    And medical science and neuroscience want them to get better.  We want them to get better.

    Let’s leave stigmatizing talk and stigmatizing terms like “mentally ill” behind and move forward into greater understanding, support, and treatment to help each person in our world discover his or her best self.

    Call us to discuss your health and areas of unrest, and let’s explore how we can help with depression, PTSD, bipolar disorder, and anxiety. We can offer innovative treatment options like IV ketamine treatment and TMS  to improve your life, and help you feel much better.

    To the discovery of your best self,

    Lori Calabrese, MD

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Resilience: Adapting To Emerge as Your Best Self

    Resilience: Adapting To Emerge as Your Best Self

    A woman's hand reaching out for the possibilities that can come from her circumstances, and that's resilience.Do you know someone who can’t seem to go through difficulty without collapsing emotionally?  Whether the difficulty is a natural disaster, a broken relationship, or a financial loss…

    Some people can weather difficult storms with strength and resilience. Others become grief-stricken and shut down every time something disappointing happens.  Why is that?

    So what is resilience, anyway? 

    Resilience is the ability to absorb and then find a healthy way to adapt to what you’re faced with. 

    Attitude: Resilient or Victimized?

    A key to understanding and developing resilience, is attitude.  Or better said, perception. Those who look for ways to learn and grow in each difficulty presented to them, are the ones who are actively growing a bumper crop of resilience. It’s how you perceive the difficulty you face that makes the difference.

    Do you meet challenges on your own terms, believing the outcome is based on who you are and how you respond?

    Or…do you feel victimized by storms, fold up and lick your wounds when times are tough? Do you tend to see the glass half empty? If so, you may have a difficult time recovering from an adverse situation or experience.

    Resilience Takes Practice

    Anyone who goes through life with a proverbial halo over his head, never challenged, always rewarded, may or may not have the resilience he needs to draw from when times are tough.  Until you face hardship or difficulty, you never know how you’ll respond to it. 

    On the other hand, we also know we can train ourselves to be less resilient. if you’ve had challenges every step of the way, you have the best opportunity for displaying resilience, or else learning how to develop it. Because it’s in the presence of the storm that resilience is developed.

    Psychologists who conducted studies of children in extremely trying circumstances learned how they either succumbed to or surmounted their situation. Among the children, about 2/3 succumbed to their circumstances, losing their belief in themselves, and their hope for future achievements.

    But about 1/3 responded to their dire circumstances with determination and a belief that they were in control, that their outcome would be the result of their own decisions and actions.

    What they concluded is that the children who rose above their circumstances, who piloted their own journey through their personal storms, were those who did not view their difficulties as traumatic, but as just another difficulty to be overcome.  

    Trauma is How You Perceive It

    Only those who view difficulty as traumatic are, in fact, traumatized.

    What’s more, anyone can learn to view the difficulties they face in life in a resilient way. By learning to view an emotionally-charged experience as less emotional, and more factual, you can remove the traumatic association of it. Then, train your emotions to view it with less pain. By doing this, you can learn to regulate your emotions, and strengthen your resilience.

    On the other hand, we also know we can train ourselves to be less resilient. By exaggerating the emotional feelings tied to an experience, by thinking about it, talking about it, meditating on it, we can convince ourselves we’ve been traumatized. And that traumatized orientation will continue to follow us through life unless we set about to change it. We don’t even realize we’re doing this to ourselves.

    When you perceive a difficult situation as one that’s threatening, your own ability to face it and overcome it drains away. Conversely, view it as a challenge to be overcome, and your emotions remain strong and agile, adapting as you go and building inner strength along the way.

    This is what those resilient children discovered on their own.

    Some of them may have been fortunate to find a friend or relative who gave them support, as studies have shown that the most resilient of people are those who are closely connected to mentor or peer group support.

    David Brooks’ work on resilience in children has shown that the one thing that is found is children who develop resilience is the presence of a charismatic adult in the life of that child.

    Studies of military groups found those units with the strongest peer support and highest morale were the most adaptive in stress situations such as battle.

    Flexibility

    Graphic image shows all the indicators that say you can't do it, but then one emerges that says, I CAN DO IT! This is resilience.

    Flexibility is a core value for resilience. The ability to adapt to circumstances as you navigate through them, gives you the power to emerge successful.

    In the award-winning movie, Pursuit of Happyness, Chris Gardner (played by Will Smith) faced ever-increasing obstacles and hardships that would have crushed many to despair, as he sought a better life for himself and his son. But his flexibility in the face of those hardships, and his stubborn tenacity in holding to his belief he would overcome them was the reason he did.

    In one scene, he locked himself and his son in a public restroom to sleep in safety, then woke the next morning to continue his quest to get the career that would change his and his son’s destiny.

    For some, that one experience alone would have been seen as traumatic. And hope would have drained away. But for Chris, it was a means to accomplish what he had to do to achieve what he wanted to achieve. It was a bump on the road to success.

    Resilience is Learned

    And, remember, you can learn to adapt, to change the way you see the challenges and stressors, every day. Take a moment to look at your circumstances. Are they as damaging as you tell yourself they are? Can you look at them with an objective view and see ways to adapt your attitude to move forward?  If you can, you’re building your own crop of resilience, and paving the road to your own success. There’s no shame in realizing you have invited a traumatized view of an experience. We’ve all done it. The key is to change to become a happier person.

    You really are the captain of your fate in this life, as you strengthen your skill to ride the ups and downs in life that surround you.

    Look for ways to develop resilience in your own life daily. The opportunities are all around you. And if you don’t see where to start, you may benefit from our innovative approach and  advanced psychiatric services, such as TMS or IV Ketamine treatment.

    Contact us and let’s discuss your options. You really can feel better and live a rewarding life.

    To the growth of your best self,

    Lori Calabrese, MD

    Lori Calabrese, MD offers innovative psychiatric treatment

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