Lori Calabrese, MD

Category: Suicidal Thoughts

Articles About Suicidal Thoughts by Lori Calabrese, MD | The Ketamine Blog

We offer the following articles about suicidal thoughts to reduce the hype and stigma that seem to accompany the tragedy of suicide and those who consider it. We hope to show how changes in brain circuitry and structures lead to the torment of these thoughts, and as a result an individual can make attempts on his own life because he succumbs to those painful images and thought patterns.

Suicidal Thoughts Are Caused by a Variety of Disorders and Reactions

Suicide is not selfish, as some claim, any more than kidney failure is selfish. It’s part of a disease process that creates a cycle the individual is trapped within.

Suicidal thoughts can accompany a variety of psychiatric disorders. In fact, they can torment people who have never been diagnosed with a disorder at all. Sometimes changes can happen slowly over time in response to a significant life event that takes the joy out of life for an individual.  And that state can progress to thoughts of death.

The loss of someone near and dear, or other types of losses can also contribute. Sometimes a personal failure is behind the action.

In other cases, a person may suffer for a prolonged period of time from a diagnosis, or multiple disorders, that bring feelings of depression, despair, and despondency.  When this happens, in some cases mental images of death, or thoughts of dying, or even plans for dying can begin.

Of all of those who admit to thinking about death and dying, and those who think those thoughts but don’t talk about them, there is a smaller percentage of people who actually follow through.

But that’s not to say that there aren’t far too many suicides.

Suicide is the Second Leading Cause of Death in 15-29 Year Olds

And it doesn’t just happen in developed countries. Globally, 79% of suicides occur in lower and middle income countries.

And think about this: The greatest risk factor for suicide is a previous attempt.

The archaic idea that an unsuccessful suicide attempt is just a cry for attention is an idea that can eventually lead to tragedy.

Here’s the point.

Talk of suicide should always be taken seriously. We don’t know for sure who among this group will follow through and who won’t. But these thoughts put any person at risk who experiences them.

Suicidal Thoughts and Actions Are a Product of a Mind Out of Order

Unfortunately there are far too many who end their lives. But thanks to IV ketamine treatment, that number is decreasing.

What I’ve seen in my own practice is that IV ketamine can end those thoughts in an afternoon. That buys time for the individual to safely participate in therapy and build a more solid personal infrastructure for remission.

In fact, the use of IV ketamine for suicidal thoughts can prevent trips to the ER for suicidal attempts and prevent hospitalizations, as well.

It’s for this reason I offer IV ketamine to stop suicidal thoughts and save lives. Lives of people who can go on to enjoy love, productivity, and fulfillment.

As you read these articles about suicidal thoughts, I hope they’ll broaden your perspective about how widely thoughts like this are experienced, and how important it is to stop them so your loved one can heal.

  • Johnson & Johnson’s nasal spray for depression wins FDA panel backing

    Johnson & Johnson’s nasal spray for depression wins FDA panel backing

    (Reuters) – An advisory panel to the U.S. Food and Drug Administration on Tuesday voted in favor of Johnson & Johnson’s experimental nasal spray, which has a compound similar to often-abused ketamine, bringing the drug closer to approval.

    The panel voted 14-2 in favor of the drug esketamine, developed to treat major depression in patients who have not benefited from at least two different therapies, saying its benefits outweighed the risks. One panel member abstained from voting.

    Esketamine is a chemical mirror image of anesthetic ketamine, which is also abused as a recreational party drug and goes by the street nickname “Special K”.

    “I think esketamine has the potential to be a game-changer in the treatment of depression … I use the term potential because the issues of cost and patient accessibility need to be addressed,” said Walter Dunn, who voted in favor of approval.

    However, the panel members echoed concerns raised by FDA staffers on Friday regarding the increased risk of sedation, dissociation and higher blood pressure observed in the study.

    The FDA recommended implementing a risk evaluation and mitigation strategy (REMS) program which included ensuring esketamine is only dispensed and administered under supervision.

    “Ketamine is a nasty drug … should (J&J’s) drug get approved, I think a strong effort has to be given as part of REMS … so that patients really know what they are getting themselves into,” said Steven Meisel, another member who voted ‘yes’.

    Major depressive disorder affects over 300 million people globally. About 30 percent to 40 percent of these patients fail to respond to first-line treatments such as antidepressants, most of which take at least four weeks to show effect.

    However, depression is a tricky area of development. Patients in clinical trials often show a big placebo response, masking the efficacy of the drug being tested.

    Currently, Eli Lilly and Co’s Symbyax is the only FDA-approved drug for treatment-resistant depression.

    “There is a lot of potential for people that just want that quick fix. I really would be cautious,” said Kim Witczak, a panel member who voted ‘no’.

    J&J’s esketamine, used in combination with a newly prescribed antidepressant, works by restoring the nerve cell connections in the brain, leading to an improvement in depression symptoms.

    The FDA, although not mandated to follow the panel’s recommendation, is expected to announce its decision on esketamine by March 4.

  • NYT asks: Can We Stop Suicides? Here’s Our Response

    NYT asks: Can We Stop Suicides? Here’s Our Response

    Can we stop suicide? Yes, IV ketamine is saving lives daily.

    An article published this past Friday, Nov. 30, 2018, in the New York Times Opinion section, asks about a possible remedy for suicidal thinking. Well researched, but not quite well enough. Keep reading…

    Author Moises Velasquez-Manoff explored the notion that maybe…just maybe…we can quell the epidemic rate of suicide. He points out that the suicide rate keeps rising, and according to the Centers for Disease Control and Prevention, suicide is now the 10th leading cause of death. After nearly two decades of growing statistics, suicide seems to be higher than it’s ever been. 

    Tragically, medicines to quell that tide have not kept up with the death statistics and doctors have been increasingly helpless to save a life in time.

    Until now. As research and clinical use of ketamine has increased, thousands of suicidal patients have been saved, giving them time to participate in therapy and other treatments so they can heal and rebuild fulfilling lives. 

    Best Mainstream Article on Ketamine to Date

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

    Kudos to Mr. Velasquez-Manoff for his thorough research about ketamine and its effectiveness in treating suicide. All too often, articles in national publications provide a narrow, myopic view of ketamine and what it can do. 

    These articles have sometimes misrepresented the potential of this medicine because of a lack of thorough research. While there’s more to the story, which we’ll talk about, there’s lots of good information here for you to read and pass on to your friends and family.

    So…Can We Stop Suicide? 

    Let’s take a stroll through this NYT article, and talk about the truths and the half truths in the quest for what matters.

    NYT: Using ketamine to treat depression and suicidality is somewhat controversial. Numerous small studies suggest that it holds great promise, but it’s only now being tested in placebo-controlled trials with hundreds of patients. 

    Dr. Calabrese: It’s true that it’s been controversial. Like with many controversies, those who make the effort to find and read the research results for themselves quickly understand the value and significance of this drug. Too many listen to hearsay and scuttlebutt and form erroneous opinions… 

    “Ketamine will never get approved for this,” or “There are too many dangers with ketamine,” they say ….  cautious? skeptical? negative Nellies?

    We hear their voices loud and long. But clearly, in real-world psychiatry, this is a medication that is revolutionizing outpatient practice.

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

    In all fairness, there is plenty we don’t — and can’t — know. Not yet. IV ketamine treating for treatment-resistant depression (TRD)  — and other psychiatric disorders —  has only been in moderately wide use for a few years. And it will be years before we really know the long-term consequences of single and repeat infusions, even with these tiny doses. Of course. That’s what long-term means.

    And we want to know long-term physiologic effects from low-dose repeated ketamine infusions or maintenance treatment — on the bladder, particularly.

    What about long-term impact on quality of life? Let’s talk about that. Since ketamine infusions for TRD use a much, much smaller dose than is ever used in anesthesia, and since we have 50 years of surgeries to go on, it seems pretty unlikely that a short sequence of a few tiny doses of ketamine will have any more negative impact on an individual’s quality of life than their severe treatment-resistant depression did.

    What we hear — and what my colleagues around the country hear –is that ketamine treatment can be transformative. 

    At the same time, the idea that it’s only now being tested in placebo-controlled trials is only true if the author is referring to this decade. Early trials at the beginning of this century were purely investigative to see what ketamine could do.

    We’ve said all along, ketamine isn’t for everyone.

    Still, its effectiveness is extraordinary especially for those who are most severely ill, and at highest risk for suicide.

    In the last few years, trials that were launched even earlier have finally gotten published. It takes time to conceptualize a study, and get it approved by the ethics committees and reviews boards that do these things. Then to  recruit exactly the right patients if you’re a major academic center,  collect, and analyze the data… we’re talking about a lot of time. 

    But even with that said, placebo-controlled trials have flourished in the last few years, as witnessed at the International Conference on Ketamine and Other Compounds for Psychiatric Disorders 2018, where researchers came from across the globe to present their findings. And more roll off the presses each month.

    NYT: Now, scientists think that they may have found one — an old anesthetic called ketamine that, at low doses, can halt suicidal thoughts almost immediately.

    Can we stop suicide? Yes with ketamine treatment.

    Dr. Calabrese: Yes! Isn’t that great news? In the last 50 years, there has been nothing that could stop suicidal thinking in 4 hours or less — sometimes within the first hour.

    And the beauty is that IV ketamine treatment doesn’t just make the suicidal thoughts easier to bear, it erases them.

    I wish it happened this way with every patient, but we still haven’t found a medicine that works the same way on everyone. Even so, psychiatry has never seen a medicine do this so quickly, so clearly, and so effectively in so many patients.

    NYT: After her suicide attempt, Louise’s psychiatrist suggested she try ketamine. She agreed, and received an infusion intravenously. Within hours, her sense of well-being improved. The hospital discharged her. Back home, she discovered that going to the market was no longer a “herculean task.” Getting her car washed wasn’t an insurmountable chore. “Life was better,” she said. “Life was doable.”

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

    Dr. Calabrese: I love that the author included Louise’s story. Her description is characteristic of the descriptions I hear from my patients after ketamine treatment begins to take hold. And note that her response was hours after one infusion, not a series. Then the hospital discharged her.

    A single ketamine infusion can provide a wonderful respite from the heavy lead blanket that is depression, the emptiness and vacancy of feeling, the darkness and despondency…for a few days, or a week, or maybe even 2 weeks.

    But we know that one infusion fades.  Pretty much everybody knows that. 

    If your doctor provides you with only one ketamine infusion, it’s almost cruel…it whets your appetite for how life could be…only for it to be snatched away again in a week or two.

    This is the reason “ketamine treatment” has come to mean a series of  IV infusions at tiny doses over 2-3 weeks. It’s the repetition of infusions close together that seems to stack the benefits and overcome the temporary nature of a single infusion.

    What we’re feverishly all working to find out is: exactly how many infusions? 6? 8? Should the dose be based on real body weight or ideal body weight? Some ask if it should be based on body weight at all or just fixed like they’re doing with esketamine. Should the series be all one dose? or should the dose increase? how fast and how high? is there a best dose? 

    Research has not answered these questions yet.

    In our practice, we are sticklers for data, and we collect (and are about to publish) our outcomes.  We’ve already presented them at conferences in Europe and in the U.S.

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

    Here’s a clinical pearl: dose titration is important, and many physicians and nurses don’t titrate the dose to achieve the best response.

    This practice is often the cause for patients to believe ketamine doesn’t work for them. Not in every case, but far too often.

    Seek out a psychiatrist who is up-to-date.

    There seems to be so much misinformation circulating, and  disappointed patients could possibly avoid disappointment if they — and their doctors — had access to more up-to-date information. Doctors only know the up-to-date information if they take the time to search it out.

    NYT: The drug seems to address a longstanding problem in emergency psychiatry. Sedation and physical restraint aside, doctors have few ways to quickly stop suicidal ideation, or thoughts of killing oneself. The current crop of anti-depressants can take weeks and sometimes months to work, if they work at all. They may also, paradoxically, increase suicidality in some patients. Talk therapy takes time to help as well (assuming it does).

    Dr. Calabrese: This is a paradox to be sure. The antidepressants prescribed to treat depression can sometimes actually increase suicidal thoughts and actions as a side effect in some people. Confusing and discouraging if you’re suffering without solutions. And they’re slow to work.  Even lithium and clozapine — clear anti-suicide champions — are slow to work.

    Imagine what rapid relief would feel like.  Quick relief from suicidal thoughts — whether you’re an adult or an adolescent or even a child — can give you time to do the work to scaffold things into your everyday life that can keep you well.

    One infusion can give you relief. Several can cement remission. Not for just hours or a day or a few weeks or a month. For many patients, remission gives them the time and space to make changes that keep their symptoms at bay.

    Imagine that instead of sitting in an ER or on an inpatient unit somewhere.

    NYT: Dr. Michael Grunebaum, a Columbia psychiatrist who studies ketamine, thinks the drug should no longer be relegated to a last-line treatment. “It makes sense that it move up in the treatment algorithm in E.R.s and inpatient units,” he told me. (Although if emergency rooms everywhere began offering ketamine, it could create new problems, he adds. As has occurred with opioids, people might claim to be suicidal when, in reality, they’re trying to get high.)

    Dr. Calabrese: There’s an important point we need to make here. When a psychiatrist provides ketamine in the safest, most therapeutic way, the psychiatrist manages the dose and rate and the therapeutic experience so that the biological changes that ketamine induces — dendritic branching and synaptic proliferation — can be optimized. One of the indicators of this during the infusion is the degree of dissociation. With an infusion (as opposed to IM or intranasal or oral use), this can be very carefully controlled. And the responsibility for controlling the access, and the infusion experience lies with the doctor. This is not about getting high.

    Because people have used ketamine abusively in clubs and on the street, the massive doses they use in those settings — and repeat far too often — can provoke frightening hallucinations.  Some people crave that, and use more and more.

    If you use ketamine on the street you may think you “get” ketamine treatment…what it’s like… and that it’s likely all about the “trip.” But, that’s a street culture thing. That’s not the science of medicine that heals depression and anxiety and erases suicidal thoughts.

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

    But when psychiatrists provide this medicine with skill and deep expertise, titrating the dose and the number of infusions, working synergistically with the rest of the patient’s medications and clinicians, it’s neither dangerous nor addictive. 

    The goal is remission, not ketamine ad infinitum.

    When a patient needs a new dose every month, ad infinitum, that patient likely didn’t achieve remission in the first place. 

    We want remission for you.  We want you to get better, get going, and give back.

    All in all, we loved Moises Velasquez-Manoff’s article. And glad we’ve had this opportunity to set the record straight.

    It’s refreshing to read a journalistic article about ketamine treatment for mood disorders that’s as close to accurate as this one.

    The question was, “Can we stop suicide?” And the answer is a resounding YES, most of the time, if you let us know you need the help.

    It’s wonderful when journalists help spread the word about novel and advanced treatments that relieve severe symptoms like suicidal thinking. The goal is to find relief and remission from the suffering. And new hope that you take with you into your future.

    At Innovative Psychiatry we see patients every week who experience renewed joy, purpose in life, creativity, motivation, and initiative after a full course of ketamine treatment. And those who have the best results are often the ones who had the most severe symptoms.

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

    Even if no other medicine or treatment has helped you before, even if your doctor told you there was nothing more they could do to help you, even if you’ve been sick for decades, you are  not hopeless.

    So take hope.

    So many people with a story like yours have gotten better with ketamine treatment.

    If you have lost hope, call us.

    Find out what it’s like to feel alive, hopeful, and able to to build a new life. Chances are we can help you live again… and enjoy the little things in life like you haven’t in what may seem like a lifetime. 

    We want to help you get well.

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


  • Fuel Hope With Gratefulness All Year Round

    Fuel Hope With Gratefulness All Year Round

    Fuel hope with gratefulness this season.

    Surprising Results Can Follow Counterintuitive Choices

    Thank you.

    Such sweet words.

    Here in the US, we’re just ending a four-day celebration we call Thanksgiving weekend. True, the official day for Thanksgiving is the fourth Thursday of November each year — but it’s also true that most families spend the entire four day weekend continuing to celebrate, spend time together, and enjoy this holiday set aside for gratefulness.

    Plus, you probably know that “the holidays,” starting with Thanksgiving and lasting through New Year’s Day, is a difficult time for some people. Yet many others actually enjoy all the festivities, sharing, eating, and laughing that goes with good times together.

    Whether you’re a celebrator or an abstainer from these gatherings, there are some things we can talk about to improve these days for the grievers, and improve sensitivity for the revelers.

    Thanksgiving was first conceived by the Pilgrims after their original successful harvest in the New World. 

    That doesn’t mean it was their first harvest, but rather the first time it was successful and there was food to eat. There’s nothing like starvation to inspire gratitude for food.

    They called it their harvest festival. 

    George Washington made a proclamation that Thanksgiving should be celebrated in 1789, and it was sporadically celebrated. However, Thomas Jefferson chose not to celebrate the observance, so the day of gratefulness tended to be hit and miss until 1863. 

    In the midst of the Civil war, Abraham Lincoln declared Thanksgiving be observed as a federal holiday on the fourth Thursday of November … and that has continued to this day.

    Fuel hope with gratefulness for family.

    It might strike you as odd that President Lincoln started a federal holiday observation when the country was at war with itself, when families were torn apart by sons, fathers, and grandfathers marching off to to battle…

    Homes and farms were burned. Families were seeing more funerals than birthdays. 

    Does that sound like a time to be thankful…?

    Can you imagine the uproar? 

    “Have you heard what he’s done now???  He’s declared thankfulness as a national holiday, of all things!!”

    “I’m not surprised…after all, seeing as how we do have SO MUCH to be thankful for right now… I’m so sick of  this war and this administration!  I’ve lost my farm!  How will I feed my family?!!

    …and on and on it might have gone.

    Doesn’t sound all that different from what we hear today, does it?

    Counterintuitive Declaration in the Middle of the Chaos

    Is it possible he had a higher purpose than just creating confusion in the midst of the terrible war?

    We do know that he had an abiding faith. He seemed to understand that choosing thankfulness can inspire better decisions and better outcomes. Thinking of others inspires generosity…and his nation needed generous hearts from top to bottom if it were to heal.

    Some of the most liberating principles of life have been around for hundreds of years and dozens of generations. And sometimes they’re hard to grasp because they’re locked in counterintuitive thinking.

    Oprah Winfrey put it this way:

    “Be thankful for what you have; you’ll end up having more. If you concentrate on what you don’t have, you will never, ever have enough.” — Oprah Winfrey

    And therein lies the secret. The secret of justice and unity that President Lincoln reached for, the secret of poverty vs. abundance that Oprah warned about, the benefit that we all receive when we take the time to focus on everything and everyone in our life that’s good.

    The Secret of Gratefulness.

    “At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” –Albert Schweitzer

    Albert Schweitzer may not be a familiar name to anyone under the age of 50. But, he won a Nobel Peace Prize in 1952 for his extensive work in Africa in an area now known as Gabon, near the Republic of the Congo.

    He had studied extensively in theology and medicine, and as a newlywed set out with his bride to live in this place where sickness and suffering were crushing the people. Over the course of his life he built an enormous hospital complex to treat the thousands who came to him for help.

    He wasn’t perfect — and even embraced perspectives that would offend us now in our modern culture — but he gave what he had from who he was and helped make life better for thousands. 

    It’s no mystery why he might have felt his “light go out” from time to time. His work was demanding and unrelenting in a place where hardships abounded.

    But he understood gratitude.

    Do you ever feel as though your light is going out…and you need it rekindled? Me, too. In fact, most of us can say that words of encouragement spoken at the right time can help to turn us around.

    Beloved 20th Century Actress Doris Day has seen it all.  She knows the value in that counterintuitive assertion of gratefulness. In her own words:

    “Gratitude is riches. Complaint is poverty.”

    Fuel hope with gratefulness.

    On her way to becoming a dance star, her car collided with a train. Her injuries took a serious toll that permanently ended her dancing career. But, rather than give up, she turned to singing under the training of a voice coach. She soon made movies that were wildly popular in the mid 1900’s … and her fans assumed her life was perfect.

    But behind the sweetheart-girl-next-door image she presented to the public… was a victim  of domestic abuse, a history of 4 marriages, the widow of the only man she loved, loss of her fortune, and complete exhaustion.

    But she, too, understands gratitude in the face of adversity.

    As humans we may envy what another has that we don’t. Wealth, charm, health, fame…but focusing on what we don’t have does nothing to improve our situation.

    Turning a laser beam of attention on our envy of another person only fuels a raging fire of jealousy inside us. And we grow more bitter and focused inward. It isolates us and doesn’t improve anything.

    On the other hand, being grateful for the gifts, the benefits, the talents we do have, empowers us to make those gift, talents, and benefits bigger, brighter, and more abundant.

    Helen Keller said that she cried that she had no shoes, until she met a man who had no feet.

    Helen Keller, if you’re not familiar with her, was blind, deaf, and mute… so you can see her metaphor about the lack of shoes…

    “Necessity is the mother of invention,” they say. So her gratitude for having feet led her to find ways to serve mankind, and especially others who were blind, deaf, or mute… or all three.

    Miss Keller knew there was no place in her life for self pity.

    She came to understand gratitude at a young age.

    During World War II, as able-bodied men went to war, and women and children were left behind, women who’d never considered such a thing went to work for wages.  It was a time of hardship. But, rather than complain, these women put on their work shoes and headed for the factories. 

    Many of us had grandmothers and great grandmothers who worked in the factories to make bombs, aircraft, trucks, and other tools needed to fight the war.

    Fuel hope with gratefulness.

    Is it any wonder that gratefulness and the can-do attitude that was required to rise above those difficulties led to a song in the last year of the war that strengthened that frame of mind? :

    You have to accentuate the positive, 

    Eliminate the negative, 

    And latch on to the affirmative, 

    But don’t mess with Mr. In-Between.

    Comical?  Maybe so…but you get the message.

    Like we saw with the man with no shoes, there is always something to be grateful for. And gratitude has a way of propelling you above the circumstances you wish would change, so you can see the bigger picture. 

    Gratefulness transforms your perspective.

    And when that happens, you’re no longer a victim, but rather on top of your circumstances. The circumstance may not change the way you want it to, but your improved outlook can give you power over it.

    No one is without flaws, and no one’s life is perfect. But each of us can contribute to the lives of others in some way, and in the process gain the freedom to overcome our own struggles on some level.

    Psychiatric disorders can render you emotionally paralyzed… trapped inside inertia, fatigue, and despair. And as you know, there are other types of paralysis. If you’ve experienced this, you may be able to relate to Jon Morrow.

    Jon Morrow is a wildly successful blogger whose body is paralyzed by Spinal Muscular Dystrophy.  He can move nothing except his eyes and lips. Helpless?  Well, he was for awhile. But he has pushed through from a point of inertia and despair to doing what he could do…until he learned to drive traffic to his blogs and has achieved the status of the most widely read blogger in the world.

    He has generated more than 200 million views of his blogs and earned $50 million as a result.  

    A spoiled rich kid?  Not in the least. This guy was facing the end of his life because of his need for healthcare, and no money to pay for it.  His story is hugely inspiring. If he can accomplish his dreams…anyone can.

    And Jon understands gratefulness.

    Look for his blog Unstoppable.me. It will give you a shot in the arm to choose and express gratefulness and overcome adversity.

    Gratefulness is liberating, empowering, and humbling… all at the same time. 

    Fuel hope with gratefulness

    So now that the Thanksgiving 2018 holiday weekend is behind us…let’s not lose sight of the lessons we’ve learned together as we venture through the rest of the winter holiday season and into the new fledgling year 2019.

    With gratefulness you can turn on the light in someone in your world, and illuminate your own heart at the same time.

    Still, if you’re suffering under the weight of a psychiatric disorder that hasn’t yielded to any medicine you and your doctor have tried, there is something more you can do as you focus on gratitude in your life.

    Ketamine treatment is a series of IV infusions that have demonstrated in thousands of cases an extraordinary capacity for relieving depression and anxiety in the vast majority of those who have not been helped by anything else.

    From severe treatment-resistant depression, bipolar depression, and suicidal thinking, to social anxiety, PTSD, OCD, and addictions, ketamine has the remarkable ability to rebuild signaling structures and systems along with regulating a wide variety of puzzle pieces in the brain that make up the sense of wellbeing, joy, motivation, and initiative you long for.

    Fuel hope with gratefulness.

    At Innovative Psychiatry, we’re big believers in joy. Happiness. And gratitude. We offer help and we offer hope — with new treatments that can turn things around for you.

    Call us. We want you to experience relief and the ability to build a rewarding life you enjoy… and to revive and renew the relationships in your life that are important to you.

    With gratitude for the opportunity to share my thoughts with you this year, I want to wish you a warm and heartfelt joyous season of holidays. 

    To the renewal of your best self,

    Lori Calabrese, M.D.
    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
  • Ketamine KRIYA Conference 2018

    Ketamine KRIYA Conference 2018

    KRIYA!!

    Ketamine KRIYA Conference 2018-Dawn of a new field.

    The most phenomenal ketamine conference to date!  

    Last weekend I attended and presented at the ketamine KRIYA Conference 2018 in San Francisco. This conference emerged as the most dynamic gathering of front-line ketamine practitioners I’ve ever experienced.

    And what an event!

    The ketamine KRIYA Conference 2018 was extraordinarily different than any other research or clinical conference I’ve attended. It’s clear that the realm of ketamine treatment for psychiatric disorders is growing wider and deeper. 

    There was a true spirit of inquiry, extraordinarily open collaboration, and presentations of risks, failures, and triumphs. Sheer transparency. Openly exposed vulnerabilities. A clear admission of the limitations of what we know. The latest information about clinical uses of ketamine in psychiatry. 

    The insider news.

    What happened when Raquel put all of it — and all of us — together?

    Palpable energy instantly exploded!

    During the presentations — which were riveting. As we met for coffee. Chatted on the beautiful conference grounds, sprawled out over the steps, snugged down into comfy couches, talked over creative and inventive lunches, inhaled coffee (for some of us, all throughout the day!) — there was the sense that we needed to learn from each other as fast as we could. So … we shared Ubers and Lyfts and dinner tabs. 

    We came from all over the country … and from as far away as Russia.

    We’re serious about this.

    And what a weekend! We learned so much from each speaker and each other. We talked about our data, our practices, our experiences, what we’ve learned. What we still don’t know.

    Ketamine KRIYA Conference 2018 helped this man reach light in his life.

    Soooo many different backgrounds, so many different approaches providing patient care, so much desire to reduce suffering in our patients.

    Founded by Raquel Bennett, Ph.D., KRIYA is the Ketamine Research Institute and it is devoted to understanding the use of therapeutic ketamine in psychiatry and psychotherapy.

    I must give a shout out to Raquel Bennett.

    In such a few short years, she single-handedly founded, organized and grew KRIYA, an organization devoted to helping people heal and live fuller lives through safe, legal, and effective ketamine treatment. She is originator of the first international ketamine conference — KRIYA’s first conference, in 2015 — on the therapeutic use of ketamine.

    Raquel has earned our respect, appreciation, and applause for the enormously hard work of bringing together experts who work with therapeutic ketamine in very different ways, using different routes, for different therapeutic purposes, in all aspects of psychiatry and psychotherapy, as well as in chronic pain and hospice.

    Ketamine is a visionary medicine.

    But Raquel Bennett, Ph.D, is a visionary.  

    Fantastic speakers, wonderful food, and gorgeous (read: non-hotel) settings gave all of us opportunities to pick the brain of someone nearby. We shared, we ate, we discussed, we listened. And at the end, we kept talking until they put away the chairs, and turned out the lights … until we each left for the airport. And then checked in and kept going.

    Meet me in Terminal 2. I’m at Starbucks. Find us in the International Terminal.  We’re sitting in the food court.

    Until one by one, each had to break away to catch a plane.

     … You haven’t seen anything til you’ve seen the excitement that comes from connection.

    Many thanks to Raquel and her incredibly talented, organized and generous team for making this all possible.

    Ketamine KRIYA Conference Founder Raquel Bennett.
    Raquel Bennet, Psy.D.

    Though our backgrounds are different, and our methods varied, it was clear that we share the same passion: to help reduce suffering from psychiatric symptoms and physical pain.

    Next, let me say, I can’t possibly share it all with you here — there were 30 different speakers over 2 days, fascinating and varied discussion panels, and a lively sharing of experiences and ideas that kept us on our toes till the wee hours.

    This conference was thrilling.

    Thrilling.

    I attended KRIYA last year.  But there has been so much growth, so much more research, so many new frontiers since then … that this gathering really can’t compare.

    These 30 speakers ran the full gamut of experience with using therapeutic ketamine in psychiatry — different practice settings, different studies, varied doses, varied routes of administration, varied preparation. Varied goals.

    This was no room for small or closed minds.

    We ALL learned and grew during those two days.

    Raquel Bennett opened to set the stage for this smorgasbord of ideas. 

    She said, “We are witnessing the birth of a new field.”  She spoke about how ketamine was developed for anesthesiology and has served that field well. But the therapeutic use of ketamine has birthed a new field of ketamine in psychiatry.

    Ketamine KRIYA Conference 2018 demonstrates the difference between anesthetic ketamine and psychiatric ketamine.

    And she emphasized that the two are as different as apples and toast.

    One way they’re different is in the goals of treatment. For anesthesiologists, ketamine has been used for managing consciousness or sedation and addressing physical pain. In psychiatry, the goal of treatment is all about treating psychiatric symptoms and managing psychiatric distress.

    The second difference is in training and areas of expertise, diagnostic skills, and managing emergencies, and she described the differences between anesthesiologists and psychiatrists. Anesthesiologists are best at managing surgical emergencies, interventional pain procedures and life support.  But psychiatrists are experts in diagnosing psychiatric conditions and managing psychiatrist emergencies.

    The third difference is in the type of patient who presents for treatment.   In psychiatry, our patients need a lot of contact, a high degree of emotional safety, and a great deal of emotional support and reassurance. Things we’re deeply attuned to by our psychiatric training.

    She also talked about the differences in routes of administration as well as the dose used  for each type of patient to reach the individual goals of sedation vs. relief of psychiatric symptoms.

    Add to that the amount of preparation required in each field. An anesthesiologist can walk into the surgical area, say hello to his patient, and tell him to count backwards from 12. 

    However, psychiatrists and psychologists offering ketamine treatment invest in substantial and detailed preparation of the patient before beginning ketamine treatment — to prepare for the treatment itself, the treatment experience, and how to metabolize or make sense of the treatment experience. 

    And the preparation involves not only  a thorough history of symptoms, treatment course, previous medication and treatment failures, but also a thorough developmental and social history. 

    Our education and training centers on entering into an ongoing therapeutic relationship with our patients and the critical understanding and provision of a safe, therapeutic frame to do the deep work we do.

    These two fields are two different animals. 

    Dr. Bennet encouraged everyone to learn from everyone else, in effect, to “cross pollinate” these fields and help each other to improve in clinical practice.

    Then she described the use of ketamine in psychotherapy as a “lubricant” for psychotherapeutic work. 

    Several of the speakers described this method in their practices.  This is called ketamine-assisted psychotherapy, or ketamine-facilitated psychotherapy.

    Ketamine KRIYA Conference 2018 demonstrated what ketamine treatment can do.

    And she went a step further, to describe the use of therapeutic ketamine in psychotherapy as a tool for deep spiritual exploration. This is where the goal of treatment is not symptom relief per se, but personal growth, self-knowledge, or transcendent exploration.

    All in all, she encouraged matching the treatment to the individual patient, recognizing our responsibility to learn more about varied strategies and to share our findings within our field.

    Speakers were diverse and fascinating. If you’ve been keeping up with progress in the field of psychiatric ketamine treatment, some of these names are sure to jump out at you:

    Will Van Derveer, M.D., Wesley Rylan, M.D., Scott Shannon, M.D., Michael Stanger, M.D., Jeffrey Becker, M.D., Jason Wallach, Ph.D., Dan Engle, M.D., Lori Calabrese, M.D., John Krystal, M.D., Phil Wolfson, M.D., Jeff Guss, M.D., Elias Dakwar, M.D., George Greer, M.D., Evgeny Krupitsky, M.D., Patrick Sullivan, D.O., and Jennifer Winegarden, D.O.

    And we had some lively and fascinating panelists, including Gary Bravo, M.D., Alison McInnes, M.D., Steven Levine, M.D., Steve Best, M.D., Veronica Gold, M.F.T., Greg Wells, Ph.D., Bob Grant, M.D., Genesee Herzberg, Psy.D., Jessica Katzman, Psy.D., Jennifer Dore, M.D., Julie Megler, P.N.P., Steven Levine, M.D., Steve Best, M.D.,  Sandhya Prashad, M.D., Steve Mandel, M.D., and me.

    Oh yes, I mentioned I also presented my own data, and am excited to tell you more about that…

    But… that will have to wait for another day … Without question, our fledgling new psychiatric field has turned a corner.

    Ketamine KRIYA Conference 2018. 

    We’ll never forget this one. We can only hope they keep getting better…if that’s possible.

    As exciting as this wealth of information may be, if you’re suffering from depression, bipolar depression, PTSD, OCD, social anxiety, substance use disorders…and even suicidal thinking, don’t wait. Call us. 

    Thankfully, if your symptoms are mild, there are a host of antidepressants and other medicines and treatments that can hopefully help you.

    Ketamine is at its best for those who are severely suffering. 

    Ketamine KRIYA Conference 2018 educated psychiatrists to help this woman get better.

    If you’re deeply affected by severe symptoms of depression and anxiety, we can help.  Call and arrange an appointment.

    Ketamine isn’t for everyone. Of course not. It doesn’t help everyone. But even among those who aren’t helped initially… sometimes there are those who get a delayed response and in a few months reach remission quite by surprise. 

    And even though we can’t promise everyone they’ll reach remission, the truth is that a very large percentage do.

    As we’ve said before, ketamine is the most rapid and effective treatment for depression that we’ve seen in our lifetime … and really … ever.

    We’re constantly learning ways to help more people benefit and get better. And chances are…you’ll experience the most remarkable transformation you could have imagined.

    Our Results

    At Innovative Psychiatry, we see people with these symptoms and disorders get better every week with ketamine treatment. Our results are extraordinary, and our remission rate is very high. Call for an appointment and let’s talk.

    Ketamine works in some different areas of the brain in different ways than traditional medicines you might have tried that didn’t work for you. Your life really can improve dramatically.

    Find out what this remarkable treatment can do for you.

    Ketamine KRIYA Conference 2018
  • So You Want to Buy Esketamine Nasal Spray… Really??

    So You Want to Buy Esketamine Nasal Spray… Really??

    Is It the Hype…?  Or Is There Something about Esketamine You Really Want…?

    Ok,  you’ve been wishing for a remedy for your distress with this mood disorder.  I get it. Something that will do more than take the edge off, but instead will really help you feel good again. You’ve heard about ketamine treatment, but having to go to an office and undergo IVs 6 times sounds just a bit daunting..? Then you heard about esketamine nasal spray, and that it’s close to receiving FDA approval. And it’s a nasal spray! How easy is that??

    What’s more, you’ve looked on the internet and its cost will probably be a great deal less than a series of IV ketamine infusions in a doctor’s office because you should be able to administer it yourself..? What a perfect alternative! …or is it?

    So your excitement is building that hope is around the corner…within a few short months…or maybe even weeks…?

    But wait…

    Take a breath…ok?  Of course, it’s possible…but…

    Just a couple weeks ago, Janssen (a company under Johnson & Johnson’s umbrella) announced that things haven’t been going all that well with their testing. 

    Well, they didn’t exactly say it like that.

    You know that it takes a ginormous amount of testing to get FDA approval on a drug. And all that testing costs lots of money.

    When a pharma company pours years of resources into R&D (research and development), they hope the compound they’ve made will do what it’s designed to do, what it’s supposed to do. But they’re taking the risk it may not.

    And they have lots of investors to please.

    It’s a bit early to make judgments about esketamine nasal spray. Janssen has had some good trial results, but some weren’t that convincing at all.

    Back in May, they made an announcement that even though they’d had both promising and disappointing results with esketamine nasal spray, they weren’t discouraged about its potential. They were determined to continue the trials.

    Esketamine doesn't help social anxiety for this mean but ketamine can make him well.

    Of course, investors want to see a return on their investment. Insignificant or conflicting results won’t butter their bread, if you know what I mean. 

    Then, after announcing September 4, 2018, that they were applying for a New Drug Application (NDA) for esketamine, a few weeks later they announced that esketamine failed yet another study in their Phase III trials.

    They said esketamine nasal spray had failed to meet its primary end point in this study…to lower the depression scale for these subjects significantly from the level they were at the beginning by 4 weeks after the esketamine doses began.

    Frustrating for Janssen.

    So much money, so much work, in laboratories across the globe.

    So, let’s take a closer look at Janssen’s quest for FDA approval of esketamine.

    It’s easy to understand that even as they made the announcement that esketamine had failed this study, they continued to point out all the tests it has passed. Reminding investors that a disappointment is no reason to throw the baby out with the bath water. (At least, they hope that won’t happen.)

    When they filed the NDA on September 4, it was based on 5 Phase III studies of esketamine in treating people with treatment-resistant depression: 3 short term studies, one “withdrawal maintenance of effect” study, and one long-term study.

    The long term study was aimed at establishing the safety of esketamine use up to 52 weeks, and it found that esketamine is generally well tolerated. Not that surprising, since ketamine is well-tolerated in controlled, small doses.

    HUGE Disappointment for Janssen

    But this most recent study, where results were announced September 21, 2018, showed esketamine nasal spray failed to meet a primary end point. It did not have a statistically significant positive effect in reducing depression symptoms in the subjects. Janssen is quick to say however, that even though the response didn’t meet the goal it was intended to meet… the numbers still support the use of esketamine combined with an antidepressant.

    Esketamine failed to relieve depression in this woman, but ketamine helps her achieve remission.

    Really…?? How is that?

    You get the feeling Janssen tries to do damage control in  each of its press releases…. Pay attention to the good stuff…and minimize the bad. (There seems to be a lot of that going around.)

    Still, look at this: The trial investigated esketamine plus an antidepressant at two different doses, 84mg and 56mg. The plan was to test both doses.

    However, the larger dose didn’t shake out better than placebo! So obviously there was no point in testing the lower dose.

    What a blow for Janssen. 

    I’ve not made it a secret that I’m skeptical of esketamine nasal spray. But, I’ll concede for now that the jury is still out as psychiatrists and researchers evaluate all of the results coming in from all of the clinical trials. 

    We’ve got a medicine with IV ketamine treatment that works — and more and more basic science, translational, and clinical research supports this. But look at all the cards stacked against esketamine.

    And…if the goal is to have a nasal spray form that’s more affordable, comfortable, and accessible to more people, that’s understandable.  We get it. (Even if that nasal spray form would make it easy to hide, easy to share, and easy to abuse. Those risks are formidable risks that need to be addressed.)

    But why use just esketamine when ketamine works so well?

    You know why.

    Because of money.  Ketamine can’t be patented after 50 years of use. Esketamine can be, if they can just get it to work…even half as well.

    To take this a step further let’s look at the problem that happened in May.

    May 2018 Press Release More of the Same

    So in May, Janssen made another announcement. That it had just completed 2 studies in its Phase III trials. In one of the two studies, they announced that in a group of subjects 65 or older, esketamine nasal spray had failed to show statistically significant findings. (Yep, just like it did in this most recent study.)

    Esketamine nasal spray isn't working like ketamine would for this worried man.

    So…wait…Does that mean 2 out of 5 studies failed to show any significant advantage over a placebo…?

    Now let’s be clear.

    In all of these studies, Janssen is investigating esketamine nasal spray  in conjunction with an antidepressant in comparison to an “active” placebo compound delivered by nasal spray along with an antidepressant.

    So, even with esketamine bolstered by an antidepressant like Lexapro, Cymbalta, Zoloft, or Effexor… esketamine showed no statistically significant beneficial response in patients with treatment-resistant depression. Even at the highest dose they tested.

    Reasons Why Esketamine May Fall Far Short of IV Ketamine Treatment

    1. It’s NOT ketamine!  Esketamine is only the left-facing form of ketamine . Ketamine consists of right- and left- facing forms and esketamine is the left-facing.  So with esketamine, some of the beneficial aspects of having both available may be missing. We’d love to think esketamine is the important one, and that maybe it does all the work, right? But…maybe not. 

    2. Traditional SRIs and SNRIs have not helped a full third of people suffering psychiatric disorders…so why would adding these partially effective medications help esketamine do a better job??

    3. It’s a nasal spray, for goodness’ sake. Let’s talk about that.

    Problems with Esketamine Nasal Spray

    We’ve talked before about the differences in various routes of administration with ketamine.

    Esketamine nasal spray doesn't work as well as ketamine for this man with high anxiety.

    A huge factor is bioavailability.  You know, the amount of medicine that actually reaches your brain to treat it. Everything else is digested, or somehow altered, or bound by proteins, or otherwise eliminated by your body … which does you no good at all.

    We give ketamine by IV, so it can go straight into the blood stream and straight to your brain where it’s needed to treat the problem. Virtually 100% of the ketamine we infuse into your blood stream goes exactly where it’s needed. And because the brain’s structures and systems are so very delicate,  we want to be very precise about how much reaches it and how fast.

    With a precise infusion pump and IV access, we can control those factors exactly. There are no obstacles that prevent ketamine from reaching the systems in the brain in the amount we want, at the rate we want. And we can slow it, and we can stop it at any time.

    But what is it about a nasal spray?

    In the case of a nasal spray, there are all sorts of variables.

    It has to be absorbed through mucous membranes to find its way into your bloodstream. 

    So picture this: 

    • It has to emit a spray that’s a perfectly suspended and evenly concentrated mist to saturate your mucous membranes—that are hopefully healthy enough and not bogged down by inflammation from allergies or a cold to absorb it properly.  (It wouldn’t be a good thing if some days you can’t absorb your medication because you’ve got a cold.)
    • When you spray it into your nostril, it has to be aimed just right…high enough that it won’t drip right back out your nose and straight enough that it will be absorbed before it runs down the back of your throat and into your stomach to be digested — where it’s bioavailability will drop even further.
    • It has to be sprayed so carefully that none is wasted in the air and gently enough that it isn’t sneezed right back out.

    Then add to all this, that once sprayed, there are only a few seconds for absorption to bring change to the critical and delicate brain systems…the ones vital to you getting better. 

    With IV ketamine, there are at least 40 minutes that ketamine is being continuously infused into the blood stream reaching the brain at a precise dose and rate.  40 minutes vs. a few seconds!

    Esketamine nasal spray has been in the news all this year…and last year too.

    Anytime Janssen has an announcement to make about esketamine we want to hear it.

    Even if it’s disappointing. Not meeting a primary endpoint on its large major Phase III trial for approval?  HUGELY disappointing. Shocking, really.

    Esketamine nasal spray didn't help her, but with ketamine treatment she's in full remission.

    So, while we wait, we’re so thankful we do have ketamine treatment. It doesn’t work perfectly and it doesn’t work for everyone. But when it does, it can save lives by stopping suicidal thinking in 4 hours or less. It can bring relief and remission to those who suffer the most with severe depression, bipolar disorder, social anxiety, PTSD, OCD, substance abuse disorders… It works fast.

    And extremely well, better than anything we’ve ever seen.

    At Innovative Psychiatry we see so many patients who get better every day.  Not just 50% better, but completely better. We see them achieve remission, and they go on to enjoy life as the best they’ve ever been.

    They’re creative again, motivated, full of initiative …and hope. With lives that have meaning. And they’re glad to be alive.

    So if you’ve invested your hope in esketamine nasal spray, don’t let disappointing news stories push you to give up.  

    There’s still all kinds of hope available that we’ve never had before. It just isn’t in esketamine nasal spray.

    At least not yet.

    But ketamine is still going full steam ahead helping many patients who thought they were treatment-resistant turn around… heal… and be restored.

    To enjoy their lives fully.

    If you suffer from treatment-resistant depression, and the problems that often go along with it, call us.

    We’re all about helping you reconnect with the best you you can be.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

    To the restoring of your best self,

    Lori Calabrese, M.D.

  • ASKP Meeting Notes: The 2018 Inaugural Conference of the American Society of Ketamine Physicians

    ASKP Meeting Notes: The 2018 Inaugural Conference of the American Society of Ketamine Physicians

    New Advances in Ketamine Treatment

    • Ketamine Treatment Advances help you to relax and enjoy again.

    2018 has been a good year. A very good year.

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

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

    Ya shoulda been there

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

    I want to tell you about the meeting.

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

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

    Hard Pruning Can Leave You Unable to Recover

    Ketamine treatment advances help more people escape depression.

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

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

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

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

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

    Sometimes their methods don’t work very well.

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

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

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

    Ketamine treatment advances lead to more remissions.

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

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

    ASKP is helping us do just that. 

    IV Ketamine Treatment Advances: Leaders

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

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

    Ketamine treatment advances can transform depression to joy.

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

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

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

    Extensive Research That Began During Residency

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

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

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

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

    Groundbreaking studies…over and over and over. 

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

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

    Raquel Bennett, Ph.D.

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

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

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

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

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

    So many luminaries, so little time…

    Rupert McShane, M.D.

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

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

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

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

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

    Ketamine Advocacy Network Helps Physicians and Patients Alike

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

    Ketamine treatment advances help you perform in your job.

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

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

    IV ketamine treatment advances help you transform.

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

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

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

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the reinvigorating of your best self,

    [line][line]

  • Dissociation: Is It Key to Ketamine’s Antidepressant Response?

    Dissociation: Is It Key to Ketamine’s Antidepressant Response?

    Ketamine's antidepressant effects may be predicted by dissociative experiences.That Floating Sensation May Predict Ketamine’s Healing At Work

    Know anyone who’s depressed?

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

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

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

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

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

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

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

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

    AMPA Gives You Power to Adapt and Develop Flexibility

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

    In other words, it’s the AMPA receptors that are behind the synaptic plasticity, Ketamine's antidepressant response may be predicted by dissociation.which means they empower the connections between brain cells to grow and flourish and move signals around the brain much more rapidly.

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

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

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

    Ketamine’s Antidepressant Response

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

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

    Ketamine is a molecule that modulates the excitatory neurotransmitter glutamate.

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

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

    You see where I’m going.

    Care in Ketamine Administration Yields Better Results for You

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

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

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

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

    Dissociation…and Ketamine’s Antidepressant Response

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

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

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

    The Study:

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

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

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

    And guess what?

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

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

    The antidepressant effect was strongest at Day 7, not 3-4 hoursKetamine's antidepressant response may be predicted by dissociation. after or a day later.
    You Can’t Know Without Testing – There’s So Much to Learn

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

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

    Understanding Your Treatment and Your Healing

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

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

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

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

    Now that’s a sweet spot!

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

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

    There really is hope!

    We Want You to Enjoy a Rewarding Life

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

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

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

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the reinvigoration of your best self,

    Lori Calabrese, MD

     

     

  • Why Ketamine Over Esketamine? It Works and It’s Available NOW

    Why Ketamine Over Esketamine? It Works and It’s Available NOW

    Why ketamine over esketamine? Because it's twice as effective.Treatment for Psychiatric Mood Disorders Has Been Quietly Waiting To Do Its Magic for 50 Years

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

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

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

    Prolonged Years Fighting a Mood Disorder – Demoralizing

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

    His productivity and accomplishments tanked during these times, and co-Why ketamine over esketamine? Because it's twice as effective.workers made insensitive and cruel remarks.

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

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

    …You Have to Take the First Step

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

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

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

    “May I ask your name?”

    “James.”

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

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

    “Not today you didn’t–you called!”

    When James arrived at the office, it was his Hail Mary last ditch effort. He sat Why Ketamine Over Esketamine? It works and it's available now.down in the waiting room and spotted beautiful binders with The Ketamine Library on the front.

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

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

    Why Ketamine Over Esketamine  (Still Testing for FDA Approval)

    As esketamine nears completion of its FDA trials, and crawls closer to the Why ketamine over esketamine? Because it's twice as effective.coveted approval status, people all over the US who suffer from mood disorders are clamoring for more information.

    Why Ketamine Over Esketamine?

    The answer is rather logical.

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

    Someone said he had been excited about esketamine, but as he understands more about it, his enthusiasm is waning. So he asked:

      • What is an AMPA receptor?
      • Is it a part of the NMDA receptor, or a separate thing itself?
    • And is it possible that there could be a synergistic effect of ketamine (Dextro + Levo) combined — meaning is it necessary to have both halves of the ketamine molecule to get the full benefits when ketamine is used for depression and other psychiatric disorders?

    Why Ketamine Over Esketamine? Because It Works…and It’s Available NOW

    This was my response:

    “Thanks! Wow–these are great questions!

    “There are 3 kinds of glutamate receptors: NMDA receptors, Why ketamine over esketamine? Maybe because it's twice as effective.AMPA receptors, and kainate receptors. (Each kind has variants.) So AMPA receptors are just one of the 3 kinds of glutamate receptor and they’re different from NMDA receptors. They exist independently of NMDA receptors but they can be on the same cells next to NMDA receptors–and they often are.

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

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

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

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

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

    “Then, the numbers can increase rapidly, dramatically, and can stay high. Why ketamine over esketamine? Maybe because it's twice as effective.This helps create quick responsiveness, flexibility, growth and change….and it can be for the long-term.

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

    “Hmmm…

    The More We Learn, The Better It Gets

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

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

    “We see this every day in my office.

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

    “Calling all neuroscientists!”

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

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

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

    Outstanding Outcomes Emerging in Private Practice

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

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

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

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

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

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

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

    Find out how much better you can feel. 

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the reinvigorating of your best self,

    Lori Calabrese, M.D.

  • Rapid-Acting Antidepressants Help You Get Better FAST

    Rapid-Acting Antidepressants Help You Get Better FAST

    Rapid-acting antidepressants like ketamine can restore dark emptiness to joy.Smash Treatment-Resistant Mood Disorders with Rapid-Acting Antidepressants: Like Ketamine Treatment

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

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

    Rapid-acting Antidepressants

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

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

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

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

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

    Still, knowing what ketamine treatment can do for major depression, Rapid-acting antidepressants like ketamine treatment restore inner joy.postpartum depression, social anxiety, bipolar disorder, PTSD, OCD, and suicidal thinking isn’t enough for neuroscience researchers.

    They want more.

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

    Or so they hope..?

    Antidepressants that Work as Well as Ketamine Treatment

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

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

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

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

    Why? Because when patients with severe disorders are inundated Rapid-acting antidepressants like ketamine treatment bring relief to despair.with thoughts of suicide, if those thoughts can’t be eradicated quickly, the risk of death is high.

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

    Seeking Ketamine Wannabes

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

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

    Compounds like:

    • Antagonists of metabotropic (mGlu) 2/3 receptors
    • Negative allosteric modulators of α5-containing GABA A receptors
    • Psychedelic compounds like psilocybin

    I know…I know… sounds like Greek.

    How about this?

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

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

    Rapid-Acting Antidepressants Help You Get Better Fast

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

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

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

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

    Review of Literature Clarifies the Search

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

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

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

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

    So let’s look again at the up and coming compounds and medicines in the running to potentially supply the benefits that ketamine is now providing:

    • Ketamine — still at the top
    • Esketamine (developed by Jansen, a division of Johnson & Johnson)
    • Rapastinel (developed by Allergan)

    It’s probably fair to say that in the next few years we’ll be bombardedRapid-acting antidepressants bring hope in darkness for those with treatment-resistant mood disorders. with many new medicines that operate quickly to treat mood disorders. But that’s the way of progress.

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

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

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

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

    Times are changing and suffering is declining.

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

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

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the restoration of your best self,

    Lori Calabrese, MD

     

  • The Heartbreak of Suicide: You and Ketamine Can Help

    The Heartbreak of Suicide: You and Ketamine Can Help

    Traditional depression treatment fails until ketamine.The Heartbreak of Suicide – What Can We Do?

    Each day last week,122 people in the United States took their lives by suicide.  We want to talk about Kate Spade … and you. And how the heartbreak of suicide is stealing our loved ones. And what we can do to change that.

    By now, most of us have read that Kate Spade died by suicide this past week. This is too important to ignore as if it’s just another news story. Yes, Kate Spade was an icon and many have cherished her distinctive purses, bags, and wallets.

    But this isn’t about her products. This is about her.

    And others who suffer like she did.The heartbreak of suicide: you and ketamine can prevent it in the people you love.

    Quietly. In silence… and despair.

    All sorts of reports have swept through the news without sensitivity to Kate Spade and her family. A note published publicly by her husband expressed his horror that a note allegedly by Kate to her daughter was published by sensationalistic news media without his consent.

    Traditional Depression Treatment Fails Sometimes…Then What?

    The bottom line is that when suffering from a psychiatric disorder ends in death by suicide, the public considers that death the business of mankind in general… regardless of the suffering of the family.

    It turns out, Kate suffered from depression and anxiety for the last six years before her death. She was engaged in intense psychiatric care regularly. But she wasn’t getting better.

    Her family and close friends wanted to help, tried to help, but she probably reached the point that just talking about her struggles wasn’t changing anything… maybe she laughed it off when her best friend expressed concern. Maybe she looked fine. Sounded fine.

    Psychiatric Disorders Can Be Hard on Relationships

    She and her husband lived in separate apartments the last 10 months, but near each other so their daughter could easily go back and forth between them. The three of them continued to share meals, and vacations.

    Kate and her husband Andy had been together for 35 years and the love between them was strong… enduring. But Andy says now they just needed a break to work out their problems…divorce was never considered.

    If you’ve known severe depression and anxiety, you know that the depression can be suffocating…The heartbreak of suicide: you and ketamine can prevent it in the people you love.the anxiety crippling. And for some, as the depression worsens, the anxiety becomes more intense.

    The longer depression goes untreated, the more likely it seems that phobias, panic attacks, and other forms of anxiety can emerge that can leave you feeling unable to function in your life like you used to.

    People like to speculate. They’ll tell you maybe it’s not depression. Maybe it’s bipolar disorder. 

    Kate’s husband has been adamant that she suffered from depression and anxiety for the last six years, and that she’d been in psychiatric treatment for the last five.

    And that’s the tragedy.

    When you know you’re suffering from a psychiatric disorder, and your doctor provides the best treatment he knows to offer, what if it doesn’t help?

    What do you do?

    The Heartbreak of Suicide

    For decades, this has been the situation with up to 50% of patients suffering with depression. They take medications year in and year out. But they don’t work…or maybe they don’t work well enough. So they try to keep going through their routine until they just can’t anymore. At some point they occasionally mention death… or dying…or funerals…

    And they try and try to buck up, keep enduring…until they just can’t anymore.

    Their thoughts fill with the idea of relief that would follow the end of life. They resist as long as they can. Sometimes, they succumb.

    And someone finds them, after it’s too late to help.

    For all of our lifetime, when medications and therapy didn’t make a real difference for a suffering person, doctors have sometimes just said, “I’ve done all I know to do.” It sounds so horrible. Like that’s it. There’s nothing else.

    Others suggest trying yet another and another new medication or therapy. When hope just keeps being deferred indefinitely…well, we get heartsick…and can give up.

    There’s Hope That Rises Above Traditional Treatment

    But here’s the tragedy for Kate Spade, and others like her.

    We’ve never had ketamine treatment before the last several years. But we have it now. She suffered for 6 years without relief.

    What about you? Untreated depression and anxiety can slowly erode your relationships, your confidence, and your hope.

    Does your doctor know about the effectiveness of ketamine treatment, or how to provide it with the best, most effective methods…? 

    She had made a fortune with her Kate Spade brand in partnership with her husband over the years. So she didn’t miss her chance for effective treatment because of cost. She had the resources to pay for the best treatment.

    We see people like her all the time here at Innovative Psychiatry. People at the top of their game who suffer from an array of psychiatric disorders … and need treatment so they can continue contributing to their world, engaging with their families, enjoying their lives.

    We can wish Kate had known about ketamine treatment. We can wish her life had been restored, her relationships with family and friends strengthened because she had the energy to invest in and build them again. Because she no longer feared that openness would harm her brand.

    But for Kate Spade, sadly it’s too late for that.

    Still, stop and think.

    So Many Suffer in Silence Until They Can’t Stand It Another Day

    How many people across the US died by suicide last week…? 122 each day. One of them happened Friday, when beloved celebrity chef Anthony Bourdain also died this way. How many more…?

    We have to ask how many of those deaths could The heartbreak of suicide: you and ketamine can help.have been prevented if everyone knew about ketamine’s effective treatment that takes the pain away?

    How many people in our world still don’t know that treatment actually IS available that can give them their lives back…restore their joy, their motivation, their well-being? That can stop suicidal thinking.  Quickly.

    We can work together to share this reality with everyone we know so no one else has to die without hope.

    We must work together to help people who suffer like Kate suffered find help. And hope. We must talk about psychiatric symptoms without shame. As freely as we talk about back pain, migraines, cancer.

    If a friend talks about death…about dying…even off the cuff…even laughing about it…

    What do you think?

    Oh, weird… wonder why she’s talking about this right now…embarrassing…

    I hope not.

    But the stigma is right there. Along with shame. The heartbreak of suicide: you and ketamine can help.

    What if I’m overreacting..?

    Overreacting to a possible call for help is not life-threatening….but ignoring the situation just may be.

    You can reach out. You can confide in your friend about something you’ve been through that was embarrassing. Lower the wall.  You can ask if there’s anything you can do. You can share things you’ve read, like this blog for instance.

    Brain and Behavior Institute published this statement by Dr. Jeffrey Borenstein on Friday:

    “If you are concerned about a loved one, you should express your concern. Some people have the misconception that asking a person about suicide will increase the risk, but in reality asking does not increase the risk of suicide, but can save a life.”

    And you can provide your friend with the Suicide Hotline and encourage her to call you or call this number if she ever feels serious about it:

    If you or someone you know is in crisis, call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.

    Ketamine treatment can stop suicidal thinking in 4 hours or less. Tell your friends and loved ones.

    Ketamine Treatment Ends Suicidal Thinking in 4 Hours or Less!

    The heartbreak of suicide can be prevented.

    It’s true that ketamine treatment isn’t for everyone…but it’s effective for most, and even some of those who seem to not respond at first have a delayed response…and are living their lives with joy several months later. Ketamine is so remarkable, it deserves a chance to show you what it can do.

    And you deserve the chance to experience the rapid and robust action of ketamine in your brain, relieving your symptoms.

    If you suffer from a psychiatric disorder, or if you know someone who does, read the articles linked to The heartbreak of suicide: you and ketamine can help.this one and inform yourself. It’s no longer necessary to suffer under the burden of a seemingly untreatable disorder.

    At Innovative Psychiatry, we offer a variety of novel, advanced options to reach the source of your disorder and help you get better. We’re not interested in treatment that just takes the edge off…

    When you’re in pain, you’re in pain. A little reduction in symptoms really doesn’t help that much. You need to feel good. You need to feel well.

    Please call us. Let us help you get better.

    May the husband and daughter of Kate Spade, as well as her family and friends, be comforted and find peace. Our hearts weep for you.

    And if you find your thoughts filled with images of death and dying…call us. We can help lift this terrible burden from you to help you rebuild a happier, more fulfilling life.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the healing and restoration of your best self,

    Lori Calabrese, MD

error: Content is protected !!