Lori Calabrese, MD

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

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

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

Rapid-acting Antidepressants

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

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

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

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

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

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

They want more.

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

Or so they hope..?

Antidepressants that Work as Well as Ketamine Treatment

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

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

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

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

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

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

Seeking Ketamine Wannabes

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

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

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

How about this?

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

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

Rapid-Acting Antidepressants Help You Get Better Fast

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

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

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

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

Review of Literature Clarifies the Search

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

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

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

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

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

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

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

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

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

Times are changing and suffering is declining.

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

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

To the restoration of your best self,

Lori Calabrese, MD
August 13, 2018
Scientists test ketamine on CHILDREN with treatment-resistant depression – and say the drug cleared up their symptoms in two weeks
- Ketamine has been shown to work much faster, with effects that last much longer, than current antidepressants (SSRIs)
- 40% of teens do not respond to their first round of SSRIs, lowering their chance of achieving remission
- Recently, ketamine has gained traction as an alternative to antidepressants
- The University of Michigan researchers say their study is proof that ketamine can be safely given to children
Children with depression who did not respond to pills have finally seen results after receiving an IV drip of ketamine, according to a new study.

Thirteen teenagers aged 12 to 18 received infusions of the illegal drug, which was first created as a horse tranquilizer, over the course of two weeks.

By the end, five of them (38 percent) were deemed to be in remission.

The authors of the study, done by the University of Michigan, say it is proof that ketamine can be safely administered to children – a question that researchers have been racing to answer as the drug gains traction as a more effective alternative to antidepressants.

Ketamine’s rise has come amid a soaring demand for alternative to antidepressants.

The rate of children and teenagers diagnosed with depression is steadily climbing year on year. Most are prescribed SSRIs, highly addictive antidepressants, which carry excruciating side effects when coming off them.

However, around 40 percent of teenagers do not respond to the first type of drug their doctor suggests to try, so they have to try another one. And if that doesn’t work, they try another – and so on, until they find their Goldilocks pill.

In theory, these drugs are to be used as a short-term measure as patients work towards remission, rather than spending a lifetime on medication.

However, studies show that the thousands of patients who go through this cycle of trial and error are far less likely to ever achieve remission.

Although ketamine itself can be addictive, the idea of administering small doses of it in transfusions is in vogue in mental health research at the moment – partly because it works so quickly.

The drug activates the part of the brain that regulates emotions, and promotes neural plasticity – the ability of the brain to change and adapt in response to experience.

What’s more, it works much faster than SSRIs, and appears to last longer to move congestion in the brain that may be hampering the patient’s freedom of thought and feeling.

It’s widely agreed that patients with depression appear to have dampened connections between certain neurons, caused by a build-up of proteins on top of cell membranes.

In healthy brains, cell membranes are free and open to receive signals. In patients with depression, an overwhelming amount of G proteins pile up on top of lipid rafts – kind of like lids which sit on top of cell membranes.

This pile-up prevents free movement.

SSRIs help to shift these G proteins off the lipid rafts, unblocking congestion, within about an hour.

Ketamine does the same, but in 15 minutes – and studies have found the effects to last much longer.

‘The field is excited about a potential new agent for adolescents with treatment resistant depression. We look forward to additional studies of ketamine to validate this treatment,’ says Dr Harold S. Koplewicz, Editor in Chief of the Journal of Child and Adolescent.

[Read the Full Article Here]
August 6, 2018
JCAP: Ketamine has potential therapeutic role in adolescents with treatment-resistant depression

New Rochelle, NY, August 1, 2018–A new study has shown a significant average decrease in the Children’s Depression Rating Scale (42.5%) among adolescents with treatment-resistant depression (TRD) who were treated with intravenous ketamine. The study, which demonstrated the tolerability and potential role of ketamine as a treatment option for adolescents with TRD, is published in Journal of Child and Adolescent Psychopharmacology, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Child and Adolescent Psychopharmacology website.

The article entitled “Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An Open-Label Study” was coauthored by Kathryn Cullen, MD, University of Minnesota Medical School, Minneapolis, and a team of researchers from University of Minnesota, Hennepin County Medical Center (Minneapolis, MN), and Mayo Clinic (Rochester, MN).

The study participants were young adults aged 12-18 years who had failed two previous trials of antidepressants. They received six ketamine infusions over 2 weeks. The treatment was well tolerated. Based on the Children’s Depression Rating Scale scores, 38% of participants met the criteria for clinical response and remission.

“The field is excited about a potential new agent for adolescents with treatment resistant depression. We look forward to additional studies of ketamine to validate this treatment,” says Harold S. Koplewicz, MD, Editor in Chief of the Journal of Child and Adolescent Psychopharmacology and President of the Child Mind Institute in New York.

About the Journal

Journal of Child and Adolescent Psychopharmacology is an authoritative peer-reviewed journal published bimonthly in print and online. The Journal is dedicated to child and adolescent psychiatry and behavioral pediatrics, covering clinical and biological aspects of child and adolescent psychopharmacology and developmental neurobiology. Complete tables of content and a sample issue may be viewed on the Journal of Child and Adolescent Psychopharmacology website.

About the Publisher

Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Cyberpsychology, Behavior, and Social Networking, Games for Health Journal, and Violence and Gender. Its biotechnology trade magazine, GEN (Genetic Engineering & Biotechnology News), was the first in its field and is today the industry’s most widely read publication worldwide. A complete list of the firm’s 80 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.

August 6, 2018
Learning Emotional Regulation Skills Can Prevent Relapse
Emotional Regulation in Mood Disorders

Can be Improved !!

Ketamine Treatment and Psychotherapy

“Cassie..?”

“Yes, Mom?”

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

“WHAAAAATT??? That CREEP!!”

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

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

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

Adapting or Stressing Out?

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

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

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

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

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

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

Emotion Regulation and Alexithymia

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

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

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

Society Maintains Certain Expectations of Us All

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

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

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

The Behavior Police

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

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

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

Learning Emotional Regulation Skills Can Be Difficult

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

So here’s the thing.

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

It’s Easier to Learn Emotional Regulation Skills Without Symptoms

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

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

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

Poor Emotional Regulation Leads to Relapse

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

Huge numbers.

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

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

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

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

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

And there’s more…

3 Factors Influence Emotion Regulation in Depression Remission

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

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

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

How Ketamine Treatment Can Help

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

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

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

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

Give yourself the chance to be well.

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

To the development of your best self,

Lori Calabrese, MD
August 6, 2018
Ketamine Shows Promise as Treatment for Adolescents with Depression

Young people suffering from treatment-resistant depression (TRD) showed a significant reduction of their symptoms after being administered ketamine injections, according to a study published in the Journal of Child and Adolescent Psychopharmacology.

Researchers from the University of Minnesota (UM) and the nonprofit Mayo Clinic found that ketamine caused an average decrease of 42 percent on the Children’s Depression Rating Scale(CDRS)—the most widely used rating scale in research trials for assessing the severity of depression and change in depressive symptoms among adolescents.

Ketamine is perhaps best known for being a popular recreational drug and a useful medical anesthetic, but a growing body of research is indicating that the compound could be an effective treatment for depression. Several recent studies have shown that even a single dose in adults can lead to rapid reductions in depressive symptoms. However, relatively little research has been conducted into ketamine’s antidepressant effects in adolescents.

“Adolescence is a very important time for studying depression, first because depression often starts during these years, and second because it is an important time for brain development,” Kathryn Cullen, from the Department of Psychiatry at UM, told Newsweek.

“When adolescent depression persists without successful treatment, it can interfere with achieving important developmental milestones. Finding the right treatment is critical to allow the restoration of healthy brain development and prevent negative outcomes like chronic depression, disability and suicide.”

Unfortunately, about 40 percent of adolescents do not respond to their first intervention and only half of nonresponders respond to the second treatment, according to the researchers.

“Standard antidepressant treatments do not work for everyone and take weeks to months to take effect, a time period when patients are at risk for continued suffering and suicide attempts,” Cullen said. “The field is in need of new treatment options. Ketamine has a very different mechanism of action than standard treatments.”

See All Of The Best Photos Of The Week In These Slideshows

The latest study involved 13 young people ages 12 to 18 who had failed two previous trials of antidepressants. During a two-week period, the researchers gave them six ketamine infusions.

They found that the treatment was well tolerated, with the participants showing an average decrease in CDRS scores of 42.5 percent. Five of the participants met the criteria for clinical response and remission. Of these, three were still in remission after six weeks, while the remaining two relapsed within two weeks.

According to the scientists, the results demonstrate the potential role for ketamine in treating adolescents with TRD. However, they note that the study was limited by its small sample size, so future research will be needed to confirm these results.

“The purpose of our study was to investigate the effects of ketamine for TRD in younger patients for whom this indication for ketamine administration is not well studied,” Mark Roback, a professor of pediatrics at the University of Minnesota, told Newsweek.

“I think our results show promise for this population, however this study is just a beginning. The study serves to point out the need for further, rigorous, study designed to answer the many questions that remain about ketamine for TRD, such as optimal dosing and route of administration, dosing interval and treatment length, and long-term effects—just to name a few.”

A teenager suffers from depression in this stock photo. Adolescents experiencing treatment-resistant depression (TRD) showed a significant reduction in their symptoms after being administered ketamine injections, according to a study.ISTOCK

James Stone, a clinical senior lecturer from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, who was not involved in the study, told Newsweek that there is “a lot of potential for the use of ketamine as a second or third line antidepressant where other treatments have failed.”

“Although ketamine is potentially a huge breakthrough in the treatment of depression, we still don’t know about the long-term safety, or about how to keep people well from depression without requiring regular ketamine dosing,” Stone added. “Further studies are needed to address these questions.”

This article has been updated to include additional comment from Kathryn Cullen.

[Read the Full Article and Watch the Video HERE]

August 3, 2018
True Recovery From Trauma and How to Find Restoration

Trauma: Don’t Beat Yourself Up – Allow Your Loved Ones to Lift You UP

Have you been through something traumatic …? Maybe you’re a combat veteran, a first responder, or a victim of severe domestic abuse. It might have been a car wreck, or the unexpected sudden loss of someone you love. Fixed beliefs you form about that traumatic experience can insulate you from working through the scars you feel. If you tell yourself you “shouldn’t” be reacting to the incident, it keeps sitting deep inside you…haunting…but not healing.

Truth be told, you were traumatized. By rape. Infidelity. Fire. Hurricane.

What matters is that it traumatized you.

No one but you knows what has shaken you to your core. And continues to keep you shaken. But no one needs to. This was your experience. And YOU need to heal.

People are individuals and don’t react the same to the same stimulus. One combat veteran finishes his tour and goes back home, gets a job, and proceeds to build his “after-combat life.”

It’s not that he’s not shaken. But his reaction to all that happened may not have shattered him like the next guy. People go through divorce. One ex-wife gets thoroughly angry and surges forward like a steam engine to overcome the heartbreak she feels about her husband’s infidelity. But another one may be so shattered, so disillusioned she can’t work, can’t function, and trembles or vomits when she sees her errant ex-husband or drives by their favorite restaurant.

Sometimes It’s Appropriate to Let Yourself Feel Loss

But then, there’s another reaction. This is you if you’re the abandoned spouse who’s so empathic toward others and their pain that when you’re in pain you just try to ignore your sorrow when you see others who seem to be suffering more.

Sadly, you validate the pain and sorrow of others, and dismiss your own. The result is that you can’t validate your own grief like you would for someone else to help them heal. Sound familiar…?

Hey, Loss is Traumatic: It’s Not a Competition

If a woman loses her husband in a car wreck, and watched him die, she has reason to be heartbroken and deeply shaken. The fact that another woman lost her infant child in a sweeping illness does not trump the widow’s pain.

Both woman have lost a treasured loved one through horrifying circumstances. Both women felt helpless. There is no measuring stick to compare the loss of a husband with loss of a child. Both losses are terrible, and life-altering. In both cases, the women hurt terribly. Both were traumatic.

And both women need support, kindness, a listening ear, and patience. Both may certainly need counseling at some point to help them restore their desire to live and go forward. They’re not in any sort of contest with each other.

In fact, they’re each faced with shock and grief. And people do have to find their way through these very difficult times of life. Often they come through such times as a natural process. Other times it requires treatment.

But either way, the loss is devastating. And each person who suffers terrible loss is justified to feel traumatized…to grieve. To be supported. And to recover.

Let’s look at another perspective.

When a Traumatized Person Who’s Evaluated For PTSD, Is Not Given that Diagnosis…

Does it mean he or she wasn’t traumatized…? Or that the shock or pain of it wasn’t that serious?

NO.

There are certain criteria required for a PTSD diagnosis. Every person is different and responds to painful or traumatic experiences individually. Your pain, loss, grief, and trauma are real and valid.

Don’t let a label or diagnosis invalidate what you’re going through.

Some people, after a deeply traumatic experience, are actually diagnosed with PTSD. Most aren’t. What’s more, there can be other diagnoses after you endure something like this. If it’s not PTSD, it may be depression, or it might be panic disorder, or substance abuse, or an eating disorder.

Or…it might be that you’re sorting through all the complicated effects of grief, shock, and pain that can accompany a traumatic event or experience. To achieve true recovery from trauma requires that you be honest with yourself, as well as patient.

Let’s set labels aside.

If you’re suffering, that’s all anyone needs to know. And your suffering is valid. As time goes by, after a few years, if you’re still suffering the same symptoms you suffered immediately after the event…or even during the event …. then it might be time to see a psychiatrist to find out how to help you move forward.

Because a life-altering event isn’t something you just get over. It’s a part of who you become…every major life event is. But if the way you feel about it is preventing you from living your life and productively contributing to your job or hobbies you enjoy, it may be that an intervention can help you get your life back.

True Recovery From Trauma

Mental and emotional health isn’t defined by a lack of difficulty or upheaval, but by the skills you learn as you live to cope and recover from those challenges and difficulties that happen.

Resilience … takes time to develop.

And…even if your ability to cope needs a little nudge or a leg-up, you’re still learning and building your life skills. And you’ll continue.

The Secret of the Phoenix

There will be fires and wars in life. Betrayals and shocks. But if your goal is to learn to rise from the ashes, you’ll likely gain strength and resilience through the processes you endure, and the storms you weather.

Even so, if you find that the results of trauma in your life have interfered dramatically in your ability to move forward — whether you have PTSD, general anxiety disorder, panic disorder, severe depression, bipolar disorder, substance use disorder, and especially if you have suicidal thoughts — call us.

At Innovative Psychiatry we specialize in helping people who haven’t gotten better with other treatments.

And the most powerful tool we’ve found among the novel, advanced treatments we offer is ketamine treatment. Sometimes in the process of grief, or in processing trauma, you can get sort of stuck, unable to progress forward into a healthier place. Ketamine treatment has proven over 50 years its safety with adults and children.

The extraordinary actions of ketamine treatment can rebuild the structures in your brain that stress and trauma break down. It’s like it restores your tool box so you can rebuild your life. And it can be a huge help in your true recovery from trauma.

Learn about how to choose the best ketamine clinic, or best psychiatrist who offers ketamine treatment, and be your own best advocate. You deserve to live well and enjoy a restored life.

To the restoration of your best self,

Lori Calabrese, MD

July 30, 2018
The Truth About Bipolar II Disorder: How To Get Your Life Back

You Can Know if You Suffer From Bipolar II Disorder

and What You and Your Doctor Can Do About It

Clara is a 27-year-old artist whose talent has opened opportunities for her she never dreamed possible. She’s published books of her original poetry and children’s stories she wrote and illustrated herself. She paints watercolors of children playing amid lovely floral backgrounds … and sells them through a local gallery.

Clara’s light-hearted artistry belies her deeply analytical and moody personality. She says she paints the world the way she wishes it was, rather than the way she sees it.

She experiences long periods of sorrow…self-criticism…shame. Then sometimes, out of the blue, she’ll feel more normal again — and she’ll rush around to buy groceries, clean up her place, and have lunch with friends…until that brief “normal” period is replaced by that all-too-familiar sinking feeling again.

Clara was diagnosed with bipolar II disorder. Most of the time she labors under the leaded blanket of bipolar depression…and occasionally she’ll feel better for a few days. Her “hypomanic” periods are really just about what “normal” would be like for someone who wasn’t ill.

She can’t believe this isn’t just depression.

The Good Times Roll…and Then They Plunge…

Then, there’s Ben. He’s 33 and works in the IT department of a large hardware company. He’s been promoted regularly due to his innate ability to problem-solve software “puzzles.” Ben finds that there are periods when he’s particularly astute, and can work long hours relishing in the challenges before him. At these times, he gets by on little sleep — and feels fine with only 4-5 hours a night.

He loves to get with co-workers for a beer after 16 straight hours of fighting a problem together. He buys drinks for everyone, along with appetizers for the team. Then after a few hours of shut-eye, he’s ready to jump back in again.

However, those times come and go.

After a period of almost spectacular productivity, it’s as if someone blew out the candle. He begins to slow down…really slow down…more and more until it’s hard to rub two thoughts together. During these times he feels heavy, sluggish. He manages to go to work, but once there, he feels dull. And he chows down on chips, cookies, cokes, and pasta. Before long, he can no longer button his pants.

It’s so humiliating. His coworkers – the ones he bought rounds of drinks for 2 weeks ago – poke at him. Tease him. They really like him but don’t understand that he’s powerless to be different right now, and the aggressive ribbing just make his shame more intense.

He just wishes he could go to bed and sleep. He feels overwhelmed at his own failure. He’s convicted of his complete worthlessness.

His boss starts pushing, getting annoyed with his poor performance. Ben feels helpless. Powerless. And ashamed. Worthless.

Then, after a few months, just before his boss is about to lay him off, his energy comes back. Suddenly, he’s brilliant again, and in two weeks makes up for all the down time when he was so depressed.

Ben sees a psychiatrist for his condition, but the treatment hasn’t helped. The doctor diagnosed Ben with bipolar II disorder.

No One Understands: Their Lovable Friend Retreats in Pain

Kelsey is 29 and has a job as a lab tech in the community hospital. She’s fast and efficient in her job and loves it. She has a bright and sparkling personality most of the time. Her coworkers love socializing with her outside of work.

They all want to be her best friend.

But sometimes she withdraws…calls in sick for several days…and avoids answering the phone. She thinks she has the flu from all the aching in her back, arms, and legs. And being home in bed is a welcome relief from the pressures and chaos of the office. She needs rest, she tells herself, and she’ll be ok.

After a week of reprieve, she steels herself to face it all again, and is back at work on Monday morning. But she decides to see her doctor when she realizes she’s still not herself a week later.

After a thorough examination, and lots of questions, her family doctor tells her he believes she’s suffering from Major Depressive Disorder (or unipolar depression, as some call it), and prescribes an antidepressant to help her feel better.

The antidepressant is a SNRI (serotonin norepinephrine reuptake inhibitor) and he expects it to relieve the aching she experiences during these “down” times.

It takes a couple of months, but Kelsey does begin to feel better. She wakes up with more and more hope each day… feels less need to withdraw … and the aches and pains subside. Finally.

The Solution Becomes the Problem

But then something weird happens. About 5 weeks after beginning the SNRI, Kelsey notices herself talking more at work — and at social gatherings, too.

After she goes home she thinks back and realizes she did most of the talking herself…like a veritable Chatty Cathy. It’s embarrassing… what’s wrong with her? She dominated the entire evening! groan…

But she still has the energy for work again and that’s a great relief.

The next week, she deposits her paycheck, and goes shopping. First she decides on new sheets … then she thinks it would be nice to make all her linens match, so she chooses bright cheerful sheets, pillows, duvet cover, towels, bathmats.

The bag is humongous so she takes it to the car then goes back into the department store.

The store is having a sale, and it’s so exciting that she just happens to be there — what great deals! She spots dishes that match her bed and bath linens, then pots and pans.

On her way out she notices those shoes she’d seen in a haute couture magazine…and buys them! She works hard. This is her special reward.

Oh boy! she says to herself, How beautiful and cheerful my whole apartment will be with everything matching. She pulls out her debit card and pays for a full set of dishes complete with matching serving bowls and the matching set of cookware.

The clerk suggests she bring her car to the door so they can help her load it all up.

After loading, she calls a friend to meet her for lunch at the nearby Italian bistro, and off she goes feeling exhilarated.

Following a yummy lunch with her friend and lots of lively chatter, the waiter brings the check. Kelsey pulls out her debit card and offers it to the waiter. In short order the waiter returns.

“Ma’am, this card was declined… do you have another we can try?”

OH NO. In Kelsey’s enthusiasm, she didn’t think to subtract her purchases from her balance. She had spent her entire paycheck without even noticing.

She asks her friend to cover lunch with promises she would pay her right back. What choice did her friend have…? Kelsey knew her friend wouldn’t look at her the same way again. She was devastated…confused… her face flushed and she tried to hide it.

She also knew she should probably return all the stuff she bought. But she just didn’t want to.

What happened…?

Bipolar II Disorder Can Hide For Awhile

Sometimes, a person who’s diagnosed with unipolar depression can take an antidepressant … and manic symptoms emerge.

Kelsey’s relief from depression and physical pain led to a phenomenon that sometimes happens with persons who are depressed and take antidepressants.

Kelsey actually suffers from bipolar disorder, but was mistakenly diagnosed with unipolar depression and treated with an antidepressant because she had not had a manic episode at that point.

The antidepressant either triggered hypomania in Kelsey… or… this was her first hypomanic episode.

Either way, she unwittingly plunged into a crisis.

Bipolar III?

Many doctors call this Bipolar 3 Disorder, which isn’t a real diagnostic term…but more a nickname for the condition when someone with depression who’s never exhibited bipolar symptoms suddenly does upon beginning an antidepressant.

If you’re old enough, you may remember the popular talk show host, Jane Pauley from the Today Show. This was her experience. And in a televised interview, she referred to her condition as “bipolar III.”

Aside from labels, Kelsey needs to be watched carefully by her doctor who’ll cautiously treat the symptoms as they present themselves, evaluating her condition going forward. But that’s another article for another day.

Treatment for all the variations of mood disorders doesn’t line up in black and white categories, but in combinations and shades of gray and it’s important to find the one that best helps you personally.

Bipolar Disorder is a Spectrum Disorder

So, we’ve mentioned three people who share a bipolar diagnosis, but whose symptoms are not that much alike. The point is that bipolar disorder is a spectrum disorder and its diagnosis relies on the patient’s – and their family’s – observations and descriptions of symptoms.

When you suffer from bipolar I, the upswing symptoms tend to be more severe … harder to ignore…and the diagnosis is less difficult.

The distractibility is clear, the recklessness and impulsivity are OBVIOUS, the high energy and lack of sleep and grandiosity can slip quickly down a slippery slope. It’s mania through and through, and it can dig you into a hole, fast.

But bipolar II is more complicated to diagnose because your symptoms land in a variety of places on a symptom spectrum. And sometimes even the symptoms you expect to see aren’t really there… yet. And may never be.

The better you understand your symptoms and recognize them, the more you and your family can help your doctor arrive at the correct diagnosis and the best treatment for you.

How to Understand a Spectrum Disorder

In his book, Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder, Jim Phelps stresses the importance of gauging symptoms on a continuum, rather than checking them off an arbitrary list.

Because we’re human, and everyone has a little of something that can be a symptom in someone else.

You may know someone who has milder insomnia but somewhat pressured speech and …severe irritability. They tell you they have bipolar disorder. So you think that’s what bipolar looks like.

In your case, you may feel confident and clever at times, even at times engaging everyone at a dinner party. Still, behind closed doors you have periods of extreme agitation and impulsivity. Or maybe risky behaviors like spending sprees, speeding, or intense sexual behavior that isn’t your norm…?

It’s tempting to say things like, “Maria doesn’t have bipolar disorder. It must be something else causing her problems. Because my daughter has bipolar disorder, and Maria and my daughter don’t act the same way at all!”

Each Person is Unique – So Psychiatric Disorders Are Unique in Each Person

But the fact is that there aren’t absolutes, but rather varying degrees of various symptoms that interfere with a productive and fulfilling life. And that’s why we seek to treat these symptoms…because they interfere with your life and the way you want to live it.

At Innovative Psychiatry, we see people with bipolar disorder in all its varieties every day. And we work with you to help you feel better. Not to just improve, but to feel so much better you can finally live and enjoy the things that are important to you. You can build and strengthen your relationships. You can focus again to read what you want to read and do things you enjoy. And you can show up when and where you’re needed.

And if you’ve tried other treatments for your bipolar diagnosis that haven’t helped much at all, don’t give up. Chances are that ketamine treatment may be just what you need to feel balanced, motivated, and able to relax and enjoy the moments of your life.

The beauty of it in bipolar disorder is that it lifts depressive episodes quickly — so you can avoid the risks of switching into hypomania or mania that come with using an antidepressant for weeks … or months.

That is so worth it.

The Concept of Spectrum Disorders

We encourage you to read Dr. Phelps’ book to gain insights about your own condition. And some of my blogs. Try to understand the concept of a spectrum illness. Ask your doctor. Get a second opinion.

And if you’d like to see what life is like without phobias, panic attacks, social anxiety, bipolar depression, PTSD, OCD, and… worst of all… those thoughts of death and suicide, call us.

Because every person is different, and responds to medicines differently than every one else, there are no absolute guarantees. But given our success rate, chances are ketamine treatment can turn your life into one you enjoy living.

To the emerging of your best self,

Lori Calabrese, MD

July 23, 2018
Can Inflammation Cause Depression? It All Depends on Your Childhood

Neuro

Neuroscience Discoveries Show Inflammation Can Cause Depression – Especially If You Experienced Severe Stress in Early Childhood

Lillian was in second grade when her mom went to work full-time. For the first time in her life, she would get off the school bus and walk down the street to her house, pull out her key and unlock the door.

Lillian was intelligent and responsible. But when she opened the front door and walked into the dark house, she was scared. She’d creep to the couch, shaking as she turned on a lamp, and sit there until 5:30 when her parents got home.

She often cried during those hours.

Some people could adapt to that just fine. But for some, experiences like this can be traumatic.

Second grade, third grade, fourth grade…. Those long hours in that dark and empty house were a crucible of terror for this sensitive little girl. It didn’t help that her parents weren’t the “sensitive” types. They chuckled about her fear. They just didn’t get it.

A Child Silently Suffers

As little Lillian advanced to middle school and beyond, she suffered for years with undiagnosed depression. Not that her parents were aware. Quite to the contrary, they were proud of their talented and intelligent daughter. As long as she continued to perform, they were happy.

“I see you have an A- on your report card. What happened? Why wasn’t it an A?” Their idea about parenting was to expect the best of their children, and never praise anything short of that. They fully expected their high-achieving daughter to go to medical school, and they had no intention of threatening their bragging rights by supporting what they considered mediocre.

In fact, they expected her to become a pediatrician. That was the plan.

But Lillian, in spite of her high grades, wanted to ride horses, study animal husbandry, and write songs.

Unwitting Parents Tear Down Resilience

This isn’t the first time parents’ dreams for their child remained unrealized. Neither was it the first time a budding teenaged girl felt misunderstood.

When Lillian and her friend dressed to go to an 8th grade dance, before they walked out the door, her mom said, “Lillian, you need to cut your hair. It looks shaggy. And you need to lose weight in your hips. They’re too big!”

The lithe but discouraged girl looked at her shoes… wishing she could be swallowed up by a hole. How could she face the 8th grade boys when she felt so ugly?

Experiences like these accumulated through her teens. Once she was married and gave birth to her first child, the depression grew more severe. It became worse and worse until she stayed in bed most of the days…unable to function to care for her children.

Finally, she was admitted to a community psychiatric hospital. The depression that had plagued her during her formative years escalated to full blown disability. And she improved only marginally from that hospitalization. There would be many to follow.

But why?

Can Inflammation Cause Depression if You Suffered Early Childhood Stress?

An article by Carmine Pariante, MD, PhD published in Psychiatric Times in May, points out some of the ways research is revealing patients with depression have increases in their inflammatory system. Elevated levels of “cytokines” which are substances, like interferon, interleukin, and some of the growth factors, secreted by the immune system indicate inflammatory activity.

Even so, what’s interesting is that not all people who suffer from depression also suffer from inflammation.

They found through a series of studies between 2009 and 2017 that excessive stress early in life, as well as the stress of lower socioeconomic status and cardiovascular risk factors, can lead to inflammation. But of these factors, early life stress was by far the largest correlate to inflammation.

Can Inflammation Cause Depression?

In recent years, we’ve been able to even connect the dots of inflammation in adults who were exposed in the womb to their mothers’ perinatal depression. The link was so significant that researchers were able to make the connection that stress in the womb is linked to inflammation in adults, with or without depression symptoms.

Stress in the womb is a risk factor for inflammation in adults!

Then they took it a step further…

Several studies revealed that certain genetic variations lead to depression symptoms…but only in those who suffered early life stress.

Then things got even more interesting.

Can inflammation cause depression?

Since omega 3 fatty acids fight inflammation, the researchers found that patients with low levels of DHA and EPA had more inflammation. So they speculated that when the levels of DHA and EPA are low, that condition would cause inflammation-induced depression.

DHA is the nutrient added to many infant formulas that’s also found in breast milk. DHA and EPA are long chain omega 3 fatty acids that account for 97% of the omega 3 fatty acids in the brain. They’re vital for optimum brain function and development.

And the researchers were right. They performed a clinical trial with patients who had these low levels…dosed them with EPA and DHA… and found it prevented or delayed onset of this type of depression.

This discovery showed them that patients with low levels of EPA and DHA omega 3’s can be treated with nutrients to restore these reserves and potentially prevent the inevitable depression that can follow.

Personalized Medical Care Means Faster and More Effective Treatment

This innovative discovery empowers us with one way to provide personalized interventions for depressed patients based on their individual cause of depression.

They also found that of those with low omega 3 levels, only those who experienced early life stress became depressed. Others with low omega 3 levels showed inflammation without depression.

What’s more, those who experienced stress in the womb due to their mother’s depression during pregnancy, showed inflammation and depression in adulthood.

Certainly, not everyone who is depressed shows those inflammation markers in their lab work.

But for those who do, we can provide more effective and novel treatments to help them recover.

If they don’t need an antidepressant, but do need dosing of EPA and DHA, and if that intervention will restore their emotional balance, how much better to treat the real fundamental problem.

More Neuroscience Research is Needed

Neuroscience researchers continue to uncover mysteries as they work to find solutions for your suffering. I would like to see studies involving depressed patients who fit these categories treated with IV ketamine infusions.

Is it possible that the patients who don’t seem to readily respond to ketamine treatment are actually those low in EPA and DHA?

On the other hand, would these patients respond to ketamine treatment without doses of EPA and DHA?

So many more studies are needed. In fact, the more we learn, the more we realize what the questions are!

At Innovative Psychiatry, we continually seek novel and effective treatments for you if you suffer from treatment-resistant psychiatric disorders.

Personalized treatment drives us with each patient.

We work hard to find out how to help you get better, based on what factors led to or contributed to your symptoms.

From ketamine treatment to strengthening your microbiome to adding nutrients to your diet and more… we want you well.

Let’s work together to help you get better, so you can enjoy and build a fulfilling and rewarding life. Call us.

To the blooming of your best self,

Lori Calabrese, MD

July 16, 2018
Anxiety and Panic Disorder: Can This Condition Be Quelled?

Anxiety and Panic Disorder – A Tormenting Presence

“Am I going to die? I feel like I’m dying…”

“No, you’re going to get through this. You’re having a panic attack. Just keep looking in my eyes and holding my hand. These feelings are going to pass in a few minutes. Hold on…” The emergency department nurse reassured the shaken young man.

He looked to be in his mid-twenties, a handsome, dark-haired guy with a 5 o’clock shadow getting ahead of itself.

“What’s happening to me? Am I dying …?”

“No. This is fear. It’s a real feeling…but it’s not an accurate assessment of what’s happening. You’re doing fine. This feeling is going to pass. Hold my hand…”

“How do you know I’m not dying…? It feels like I’m dying…”

The nurse ached for him. “I’ve seen this before. This is a feeling you’re experiencing. It’s a panic attack. Do you have a pet at home?”

“Yes, I have a dog.”

“What’s his name…?”

“Barkley. Do you think I’m dying now? Just tell me the truth.”

“No…you aren’t dying. Your pulse is a little faster than usual but it’s regular and your blood pressure is sta-“

He cut her off…

“Are you sure…?? Why am I sweating? Because I feel like I’m dying…”

“I know you do. It’s hard to feel like this. But you’re ok. This feeling is going to pass. Do you have any children?”

“Yes, I have a little boy. Will you please tell him I always loved him very much?”

Panic Attacks Can Take Many Forms

Sometimes you may scream and cry; sometimes you may feel frozen and unable to move, sometimes you might just talk about the feelings of imminent death or impending doom like our friend Tom in the Emergency Department.

If you’ve never had one, here’s how to imagine it:

Think how you’d feel if you came upon a grizzly bear in the woods. You might be frozen with fear or feel overwhelmed with your imminent death… or you might just break into a sweat — or a scream…

“Tom, you’re going to be able to tell him that yourself in just a little while. What grade is he in…?”

“He’s in second grade. Are you sure this is a feeling? Because…it feels like it’s real. I wish I had spent more time just playing with him. He doesn’t deserve this.”

“Tom, just make the decision now that you’ll spend more time with him. You’ll have plenty of opportunities. What would you like to do more with him…?

“Oh anything. Basketball, soccer, playing at the park… He deserves more… I might be feeling a little better…. Is that possible?”

The nurse sighs in relief. “That’s great to hear. I gave you some medicine to help you relax. I’m glad you’re feeling better…it’s going to get better and better now… “

“Oh, I hope you’re right. I thought I was dying…”

Tom has never seen a psychiatrist. No one in his family has. But there’s high blood pressure, heart problems, an uncle with diabetes.

He checks again. “You’re sure I’m not going to die…?”

Anxiety is a bear, but panic attacks are dragons.

Panic attacks come when you least expect them, and in full force. If this happens to you often … even regularly … you may have panic disorder.

Traditionally, anxiety and panic attacks have been treated with anxiolytics, or medicines that cause symptoms of anxiety to diminish.

And also antidepressants – both SRI (serotonin reuptake Inhibitors) and SNRI (serotonin norepinephrine reuptake inhibitors) varieties. And when they work, well…they’re a Godsend.

But far too often they don’t help. Even after trying 2 or 3 different prescriptions, increasing the doses, adding augmentation agents like buspirone.

Sometimes the side effects of the medicines are just too much. Maybe they’ve made you tired all the time, or interrupted your sleep. Maybe you’ve gained weight. Developed chronic GI side effects. Found that your libido is non-existant or that you’ve developed other sexual side effects.

Then what?

Some people are able to get the panic under control with a combination of SRI or SNRI antidepressants combined with Cognitive Behavioral Therapy (CBT).

If your doctor has tried antidepressants, anxiolytics, and even mood stabilizers in an attempt to help you get better, but no combination has worked… then it may be time to consider more novel advanced treatments.

Things like Transcranial Magnetic Stimulation (TMS) or ketamine treatment.

Novel Advanced Treatments To Consider for Anxiety and Panic Disorder

Sound weird?

These treatments aren’t weird…they’re very 21st century.

Transcranial Magnetic Stimulation (TMS)

TMS uses a magnetic coil placed over your head, that sends pulses deep into the brain. These pulses stimulate your brain cells to become healthier and function properly.

As a result, you begin to feel better and better during the 3rd or 4th week. It doesn’t work fast…but it works well in about 70-75% of people. TMS requires appointments five days a week for roughly 4-6 weeks. And there are treatment protocols for anxiety disorders that are quite effective.

Ketamine Treatment for Anxiety and Panic Disorder…?

Ketamine was developed in a laboratory in the 1960’s as an anesthetic. And it’s been used in the operating room for over 50 years. It’s effective and has proven itself as a safe medicine when used for that purpose.

Then, several years ago, ketamine began to be tested for depression. And it’s made a huge difference for many of those who received it. There have been some bumps along the way, as we’ve learned about how to help its benefits last, and which routes allow the most wonderful outcomes.

Now, in 2018, ketamine is receiving increasing respect as the most extraordinary antidepressant neuroscience has seen in the last 50 years.

What’s more, it’s being tested in laboratories and clinical practices, and we’re finding ketamine’s benefits are widely experienced by people who suffer with a host of different psychiatric disorders.

Things like major depression, postpartum depression, treatment-resistant severe depression. Also anxiety…generalized anxiety disorder, social anxiety, and panic disorder.

Add to that PTSD, OCD, and suicidal thoughts.

This medicine is life changing.

But let’s talk about panic disorder and a case study from 2016 that indicates that ketamine might be useful for it. Because right now, panic disorder lacks extensive studies using ketamine. More studies are needed to validate the results some doctors are seeing regularly in the office.

In the case study, Ms. A suffered deeply from panic disorder, agoraphobia, generalized anxiety disorder, and major depressive disorder.

For far too long, she’d been unable to leave the house or use public transportation, and felt unable to learn to drive because of her anxiety. Panic attacks at least every week caused her to believe that she’d never be able to manage the anxiety that ruled her life.

Her psychiatrist prescribed substantial doses of escitalopram and an intense regimen of electroconvulsive therapy treatments. Then she added 400mg of lamotrigine combined with 30 intensive sessions of CBT. In other words, Ms. A was receiving aggressive treatment. And…

All of this helped to reduce her suicidal thinking and mood improved.

But her anxiety didn’t improve. She remained home-bound because of her fear of leaving and having a panic attack.

Then, 6 or 7 months later, she was seen in the emergency department of her local hospital for severe pain in her neck. An MRI showed she had 2 herniated discs in her spine, so in the ER, she got IV ketamine to treat the pain.

One infusion. For pain.

Symptoms of Panic Disorder, Agoraphobia, and Major Depression IMPROVED

And in the weeks following her ER visit, her anxiety symptoms improved. (This is really pretty cool.)

She felt like shopping at the department store, started a business with a friend, volunteered at a market in her community. Her mood was positive and “normal” for at least 10 weeks. Her doctors attributed it to ketamine — although of course there are a dozen other possible factors.

Still.

We see patients who present to us with all kinds of complex symptoms and often panic disorder is just one of the many that bring them to our office. And we see the pit in their stomachs go away. The anxiety lift. The worry diminish. In each case, one at a time. The stories are too complex and too varied to see them as anything more than case reports right now.

So we need to see researchers conduct more studies. When we treat a patient for another disorder, or when a patient is treated with ketamine for severe pain, and their anxiety and panic disorder symptoms fade away at the same time, we’re the first to smile with them. Then they keep smiling all the way home … and all the way back into their day to day lives.

But we need researchers to do their gold standard, double-blind, placebo controlled studies to rule out variables that may enter into the mix in the office, and to verify ketamine is demonstrating effectiveness for this disorder.

There are backup studies for ketamine and social anxiety … another anxiety disorder. We see extensive positive outcomes in treating PTSD with ketamine, an anxiety disorder that often includes panic attacks.

We need to see more studies for ketamine and panic disorder.

At Innovative Psychiatry, we’re seeing patients with anxiety and panic disorder getting better every week and every month. We want to see you get better, too. If you suffer from panic attacks, anxiety, and any other disorders, call us.You can feel so much better. And we want that for you.

To the healing of your best self,

Lori Calabrese, M.D.

July 9, 2018
Ketamine Treatment Enhances Creativity – Lori Calabrese, M.D.

Psychiatric Disorders and Creativity: Is there a link?

Think about it. Vincent Van Gogh. Virginia Woolf. Michelangelo. Beethoven. Robin Williams. Ernest Hemingway. Carrie Fisher. Anthony Bourdain.

Creative Genius.

There are hundreds, probably thousands more, who fit right in with this good company. Maybe you do, too.

Take John Nash, the Nobel prize-winning mathematician whose story is told in A Beautiful Mind.

Hallucinations, delusions, severe depression, fear, phobias, suicide… Psychiatric symptoms are all too familiar. But how often are they accompanied by creative thought, astounding accomplishments, and indescribable beauty…?

The simple answer to that question is probably more often than you think.

So what IS the connection between psychiatric disorders and creativity? Is there a link…?

A meta analysis by Christa L. Taylor, published in Perspectives of Psychological Science September 21, 2017, shows that researchers have used psychological tests, population surveys, and genetics to examine creativity in psychiatric illness, and vice versa. They’ve found measurably higher rates of creativity in people with bipolar disorder, as well as more cases of bipolar disorder in creative people.

Clearly, for every celebrity who’s been diagnosed with a psychiatric illness there are probably dozens who are pretty healthy and stable. (Although some would say that’s a bit hard to believe about Hollywood…!)

But doesn’t it appear so often that the really brilliant ones, spectacular performers in the arts, the math and sciences…seem to battle complicated symptoms …?

When you consider that the links researchers have found in visual arts, performing arts, politics, business, religion, literature, music, and science translate to exceptional people all around you in school, work, and everywhere in between, it’s worth another look.

Still, researchers have often found these connections in individuals with milder forms of bipolar disorder, such as bipolar II and cyclothymia. Their assumption was that the extreme mania of severe bipolar I disorder would interfere with creative thought.

On the other hand, we can’t ignore the great achievements of Beethoven, Winston Churchill, Abraham Lincoln, John Nash, Brian Wilson, Kurt Cobain, who all experienced severe forms of their disorders.

So here’s what’s interesting…

Psychiatric Disorders and Creativity: Clues in Your Genes

Bipolar disorder and schizophrenia actually share genetic origins with creativity. Interestingly enough, there are some symptoms of schizophrenia that are conducive to creative work. Isn’t that a surprise…?

So when someone has psychotic symptoms ….and is afraid to take medication to manage symptoms… you can sort of see where they’re coming from. But, it doesn’t mean we have to take an all-or-nothing perspective.

Burns Woodward, MD, in his article, Creativity and Psychiatric Illness: Finding the Sweet Spot, makes the point that if people who suffer with psychiatric disorders fear treatment because they don’t want to lose their creative thought, it’s important we listen to their perspective.

By listening, and collaborating in working with them, you can support their concerns and still encourage them to participate in a treatment plan that helps them function better and avoid hospitalization.

This is also good advice for families.

When families dig their heels in, convinced their loved one can’t make good decisions for themselves, the resistance on both ends of that battle usually leads to noncompliance.

But when the family finds a way to build harmony with their loved one’s concerns, treatment becomes a possibility. Their loved one can grow closer to cooperating with a treatment plan.

The Case of John Nash

Woodward also makes the point that in the case of John Nash, his fear of loss of creative thought led him to refuse medication. You can only wish he had had the chance to receive IV ketamine for depression. Ketamine treatment enhances creativity and it might have helped his courage with his antipsychotic medicines.

You see, it was only after he had received the Nobel Prize that he began $Psychiatric disorders and creativity seem to be linked, and sufferers worry that treatment will quell their creative thought.$ developing symptoms of schizophrenia.

His distracting delusions and hallucinations prevented him from the intense focus necessary to do more significant work until after he’d been hospitalized a third time. He finally agreed to medication to manage his symptoms. And you know what? John created his only noteworthy mathematical work while he was taking that medication.

True.

But What if Medication Doesn’t Help?

There are currently medications that help some people who suffer from every form of psychiatric disorder. Be it depression, social anxiety, panic disorder, bipolar disorder, PTSD, OCD, schizophrenia, eating disorders…

But there are so many who receive no relief whatsoever from these medications. And those are the ones we focus on at Innovative Psychiatry.

You are someone we want to help.

Innovative Psychiatry dedicates focus and resources to help you experience relief and hope if you suffer from treatment-resistant psychiatric symptoms.

Ketamine Treatment Enhances Creativity

I can tell you straight up that if you do, ketamine treatment doesn’t work for everyone. It just doesn’t, and we don’t know why at this point. We know every brain is different, just like every face is different. Your brain is uniquely yours.

But what I can say is that we’ve seen extraordinary outcomes in the majority of patients we treat. Ketamine treatment is more effective in more cases than any other medicine in our lifetime.

In the case of schizophrenia and schizoaffective disorder, ketamine is not the treatment of choice.

And yet, studies have found it to be very helpful in stopping suicidal thinking and relieving depression in patients with these disorders. Aziz Walid and his team published a case study in the Journal of Addiction Research and Therapy which demonstrated this.

So let’s talk about psychiatric disorders and creativity. If you’re afraid of medicating the disorder you live with because you’re afraid of losing your creative edge, be encouraged. Ketamine brings creativity back to life.

Ketamine treatment enhances creativity.

This is not an old-fashioned antidepressant that dampens your feelings, your emotions, or your creative thought.

Rather it renews, rejuvenates, and replenishes your creative pathways and signaling systems so you can think more, not less. Create new beauty, new prose, new ideas, and feel truly alive again.

So How Hard Is It To Find Ketamine??

Ok, so don’t get me wrong. Ketamine isn’t something you can pick up at the pharmacy. It’s a powerful medicine that should only be administered by a psychiatrist if it’s used to treat a psychiatric disorder.

What’s more, there are countless doctors providing it who really aren’t qualified to do so.

What Difference Does It Make…?

Because ketamine as an anesthetic is a medicine for anesthesiologists to administer to patients for anesthesia or for pain control.

But ketamine as a psychiatric treatment should be provided by seasoned psychiatrists deeply experienced in treating life-threatening psychiatric disorders as well as suicidal inclinations.

Psychiatrists equipped to provide ketamine are still rare. This treatment is best administered by an expert psychiatrist deeply skilled and experienced in treating psychiatric disorders with IV ketamine treatment. And here’s why.

Ketamine for psychiatric disorders is a treatment of delicate brain systems and should be infused with precision and insight physicians of other specialties don’t possess.

Skilled psychopharmacology as well as insight for personalized dose and rate of infusion are vital skills necessary in psychiatrists who provide ketamine treatment.

Physicians from other specialties lack the training to accomplish this well. Sometimes they’re impatient. Outside of their scope of practice. Unsure about coordinating psychiatric care. Or they’re so familiar with the drug itself that they don’t think they need sophisticated equipment to administer it.

A psychiatrist providing ketamine for various psychiatric disorders should utilize a precise infusion pump and monitoring equipment to ensure the most thorough and effective treatment experience.

At Innovative Psychiatry, we’re expressly equipped and proficient to provide you with treatment for your symptoms that other medications and treatments have failed to relieve.

We see a remarkably high remission rate among people who’ve come to believe that their symptoms are treatment-resistant.

If you’ve tried medications for your disorder that haven’t helped, and you’re afraid to try more medication — or sick of their side effects — we can help. Call us and let us help you find the creativity, initiative, motivation, and enjoyment you’ve been missing. Let us help you find the real you that’s been hidden for so long.

To the resurrection of your best self,

Lori Calabrese, M.D.

July 2, 2018

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