Lori Calabrese, MD

Blog

Outrageous Behavior: Mood or Personality??

Outrageous Behavior: Mood or Personality Disorder?

You met her at your friend’s house, and you’ve been dating a few months… Then you notice a blouse in her purse with price tags… no receipt. What???

Did she steal this stuff? You really like her, but …. theft? What the heck is going on…?

When you ask her about it, she tells you she borrowed the top from a friend for your date on Friday.

Hmmmm…

A week later you notice the blouse is hanging in her closet. Is she going to return it?

She’s been a little on edge lately… could it be guilt? But you hate to rock the boat because the nights are so HOT lately…

Then, another shock. She borrows your credit card to put gas in her car…(which seems off)…and you discover she spent nearly a thousand dollars on dinner with “friends!”

Outrageous Behavior: Mood or Personality…?

Confrontation time. Is this amazing and beautiful woman a scammer? A con artist? Is there any other explanation?

Her response is to lash out, scream expletives, and take off in her car. She returns in a couple hours and she’s been crying. She tells you she doesn’t know what got into her, or why she did any of it. That she really likes you and wants you to respect her – and trust her. That sometimes she loses her perspective and just does things she can’t explain.

After a long and tearful discussion, you learn that she did shoplift the blouse. She won’t take it back to the store, or pay for it— too risky. She could get arrested. But she’s got a better idea, she says: she’ll give it away. Donate it. And the next thing you wonder is… if you’re in over your head…

Scammer? …or maybe bipolar disorder..?

So is she messed up? Is she just someone who gets off breaking the law? or is there another explanation?

To find out, she needs to put her trust in a skilled and experienced psychiatrist.

A good one, who will tease apart her symptoms, their causes, and work to bring her disordered mind to order and peace.

It could possibly be that she’s fundamentally a rule-breaker. Someone who doesn’t think they apply to her–and doesn’t think what she’s done is a big deal. On the other hand, since she seems to care a great deal, you should pause. Ans she should be evaluated.

Untreated bipolar disorder can cause all kinds of outrageous behaviors along with the sorrow and remorse

Is She Hysterical or Just Seeking Attention…?.

Sometimes, outrageous behavior can be a source of embarrassment to those who love you.

Take Jason, the manager of the cell phone shop in town. You have no idea what he deals with until one day a glamorous woman walks into the shop crying, “Jasie, Jasie…pleeease I need your help!! There’s a spider in the car!!”

You can see Jason is embarrassed. He tells her he’ll be able to break away in a minute after he rings up this customer.

“But Jasie!” She’s all a-flutter, breathless, in a panic. She takes off her beautiful shoe and holds her tan, pedicured little foot up to show him. “See that dot? I think it bit me!!” And she sobs and sobs big tears that splash on her cheeks…

You can see Jason has his hands full. So, you gesture for him to go ahead and tend to her…it’s ok…you don’t mind waiting. He takes her to the back and her sobs get louder. “I was at home, all alooone…. So I got in the car to go see Celia, and suddenly I saw that spider!! I was terrified Jasie! I didn’t know what to do!!!”

Unbelievable.

Jason tells her under his breath that her foot looks like it will be fine, and promises to take her to dinner after work. She goes out the door smiling ear to ear and tells him to call her at Celia’s. Her bracelets jingle as she waves.

You Can Love Them… But Do Get Them Help

You really feel for Jason. He was clearly embarrassed for his customers to get this glimpse into his private life. You wonder how on earth he stays with such a drama queen. You know you couldn’t take it.

He smiles half-heartedly and rings up your purchase. Then apologizes for the scene. He quietly explains she’s had some serious blows lately and she’s been upset a lot by a series of little things. “I guess she’s just having a bad day…” he quipped.

So what on earth is the story with this lady? Is she like this all the time? Is this anxiety or drama? How can you tell the difference?

Once again, her story needs to be teased apart, and a deeper history collected. It’s possible that the “blows” Jason referred to were multiple deaths in the family, betrayal by her best friend, combined with a lost pet, or some other major crisis.

People do sometimes reach the “end of their rope” and find it hard to cope with the most minor thing.

When that happens they may exhibit signs of depression or anxiety, which can be treated … to help them get their footing again.

But it’s important to know the full picture. Was she always a drama queen? Or did she have a history of coping well until just recently…? Enduring traits can suggest an underlying personality structure that just seems to get more and more fixed and unyielding as a person gets older.

Outrageous Behavior – Mood or Personality?

Meanwhile, your boss’s secretary is silently miserable. She’s married to a guy who acts superior to everyone. He boasts all the time and makes degrading comments to waiters at restaurants or when he’s buying something in a store.

Then word gets out that he’s having an affair with her next-door neighbor. Another affair. After all the I’m sorry’s and all the lies. After all the promises. She’s devastated.

What is the matter with someone like him? Is he just a total jerk?

Maybe he is. I know you may wish you could give him a swift kick, but there’s likely more to the story.

On the one hand, he could be a narcissist. But to find out would require some in-depth information gathering to figure that out. Still, there are other possibilities, too.

Has he suffered a job loss? Maybe he feels betrayed by a layoff right in the middle of his career. He may be depressed if something like that is the case. It’s still not an excuse for making his family miserable.

Nor is it an excuse for infidelity. But, sometimes people take that road when they’re down on themselves. In fact, sometimes people do all sorts of destructive things when they feel bad, rather than seek help.

Still, sometimes depression shows up in men by their anger, irritability, and short temper. If it’s depression, it can be treated. And getting the depression successfully treated may help him set things right again in his life.

Miss Jekyll or Mrs. Hyde…

The romance you’d always dreamed of. Finally, you’d met the most interesting and charming woman. She was everything you’d hoped to find: beautiful, fun, a hilarious sense of humor, always with a twinkle in her eye… and a wildcat in bed.

She was so natural in a crowd and loved to entertain. She seemed like the ideal companion, lover, and partner. You felt so lucky.

Oh, there were little moments while you were dating that caught you by surprise, sure, where she seemed to react to a small thing you did or said. Moments that seemed to come out of nowhere… but the next time you talked, all was forgotten.

Her charm was addictive…and made you feel like a million bucks.

But several months later, everything seemed to change. She wasn’t so pleasant when you were alone. Sometimes you felt like she drank too much. And when she did, she wanted to do more and more risky things. She said you just didn’t know how to have fun.

The next day she stormed into her job and slammed her keys on her boss’s desk, shouting, “I QUIT!!”

When she got home and told you the story… well, you didn’t say a word. You didn’t dare.

Then, one night, she stormed out of the house. Again. You got in the car to find her… and when you spotted her she was walking in the dark…and agreed to get in the car. But, as soon as you asked what was going on, she screamed she was going to kill herself and threw open the car door as you were flying down the highway.

You were so relieved to park in the driveway. So much drama.

The next week she tells you she’s having an affair with her optometrist. That you just weren’t spending enough time with her.

What happened…?

You’re friends tell you she’s crazy and you should pack your stuff and leave no forwarding address. You think there’s more to it. You see her when she’s sweet, thoughtful, caring, nurturing… she can be a wonderful person.

But this is scary.

What do you do??

Once again, there can be a handful of explanations. Some are more hopeful than others.

This is a good time to get an insightful psychiatrist involved. Because she may just be a brat who never learned to be accountable for her behavior. However, that’s probably not the most likely explanation.

People with bipolar disorder sometimes have these outrageous behaviors, but when they’re not manic, they can be deep thinking, insightful, considerate people.

People with borderline personality disorder can sometimes appear like this.

Even people with substance abuse disorders can show these symptoms.

You’re right to not make a snap judgment. As to what you should do, that’s another matter. If she has a psychiatric mood disorder, she can be treated and go on to live a fulfilling life. But you may want to see a counselor you trust, to help you navigate this relationship.

With counseling, you can learn how to be a therapeutic presence in her life, while taking good care of yourself. With counseling, you may also determine this relationship is not the best for you or for her. But follow your instincts and get support for both of you in the interim.

You’re not alone.

So many, many stories. So many lives in disarray. Outrageous behavior rings the gong. It makes everything stop–or it should make everything stop. Because so often it damages the lives of everyone it touches. Sometimes it’s personality, plain and simple and enduring. (Which is really hard to take.)

But so often, outrageous behavior is the bellwether of damaged or disordered brain functioning. Sometimes, the ones with outrageous behaviors are likely damaged (by genetic factors, environment, concussions, illnesses, substances–you name it) and unable to function in a normal, healthy way. So they behave in ways that cause damage to others and to their own overall lives.

In cases like these, the first step is to withhold judgment, as tempting as it is to judge and label. How often have you heard that you don’t know someone’s story until you walk a mile in their shoes?

When you see behaviors like these, you may be seeing symptoms of a disorder, rather than someone who’s deliberately choosing to be a brat. Deep down, it’s the desire of most of us to enjoy the respect of those around us. Most of us restrain our reactions to maintain that respect. But there are those who just can’t.

Rule of thumb: If it looks like bad behavior, check it out.

Ask an expert. Not your friends. Not a Facebook group. Because you might be mistaking a terrible mood or anxiety disorder as someone’s personality — or personality disorder. And that same person just might behave “respectably” and with constraint if their disorder were effectively treated. This is where shame lives. This is where stigma comes in.

Let’s take a breath before we judge. Let’s stop the stigma.

If you’ve experienced some of these behaviors and you secretly carry your shame and wonder what’s wrong, or if you see outrageous behaviors in someone you love, reach out. Innovative Psychiatry offers novel and advanced treatment for psychiatric mood disorders, including IV ketamine infusions — one of the most extraordinarily effective treatments in psychiatry. It can give you your life back.

We want to see you well and are eager to work with you to determine what will give you the best results.

Call or schedule an appointment. You can have control over your impulses, and build strong relationships in your home and your work.

To the release of your best self,

Lori Calabrese, M.D.

April 30, 2018
21st Century Psychiatry: Neuroscience Discoveries Fight Stigma

Stigma: A Mark of Disgrace Based On Belief in Certain Assumptions That Have No Factual Basis

“He’s not depressed…he just needs to get up and get busy.”

“PTSD is just a fancy name for weakness. Get over it!!”

“Bipolar disorder? What an excuse for bad behavior! Get some discipline in your life and you’ll be fine.”

Sound familiar?

Comments like these are insulting, stigmatizing, and prejudicial. They hurt. And they have no basis in fact.

In this day and age, there is no excuse for them.

These are just some examples of the stigma expressed in hurtful words that serve to fuel shame in people who have depression, bipolar disorder, a trauma history, or who struggle with substance abuse.

Why Are Psychiatric Diagnoses So Hard for Some People to Accept?

Do you ever hear someone say, “Diabetes… ridiculous. Work harder and you won’t have trouble with blood sugar. I work hard and I don’t have diabetes!”

Or…

“Cardiovascular my foot! You’re fine. Get back to work.”

Probably not. Why is that?

Because there is no real stigma attached to malfunctions in the heart or the terrible sudden dysfunction in the pancreas of a child who develops Type I diabetes.

The more science learns about the human body, and its ailments, the more credibility those ailments have.

Why The Brain is Such a Target of Stigma

Except for one part of the body…. And that’s the brain.

Since ancient times, the intricate and complex functions of the brain have been steeped in mystery and wrapped in tales of fear, sorcery, and voodoo. All of this has contributed to the stigma that has hovered over people with psychiatric illnesses like a dark cloud of shame.

As recently as decades ago, patients admitted to psychiatric hospitals for behaviors their families didn’t understand were heavily drugged and incapacitated.

There is a population of individuals today who still stand by the opinions that reigned at that time…and they’re still influencing younger family members and friends with those erroneous views.

Stigma-busting Research

If you’ve faced stigma about your psychiatric symptoms from family, friends, or your job, we have some encouraging news for you. We both know that the expression of stigma is simply a sign of ignorance. Lack of up-to-date information underscores old and outdated beliefs. The best defense against stigma we see about psychiatric disorders is information — scientific information.

A recent study shows we can use a blood test to distinguish biomarkers in bipolar disorder that are different from those in schizophrenia. Investigators have also developed a blood test that could help doctors more quickly diagnose schizophrenia and other disorders.

This one detects certain types of inflammation and oxidative stress. Another test can differentiate 20 metabolites found in urine that distinguish schizophrenia and bipolar disorder.

Tests like these are building a foundation of what we would call biological proof for various psychiatric disorders — proof that they’re real, that there are underlying genetics for many and pathophysiology — how things go wrong — that is being worked out and understood in labs and universities and clinics around the world.

These are exciting times!

Neuroscience discoveries fight stigma .. .And the more we talk openly about the data points, the sooner we can dispose of the stigma.

HOPEFULLY.

If you know me, you know I abhor the term “mental illness” — a term that subtly suggests that psychiatric disorders are somehow different — maybe even less valid — compared to so-called “physical illness.”

This is just another way of perpetuating the myth… and the stigma… that psychiatric illness has less credibility.

The fact is, psychiatric disorders are just as physical as pancreatic disorders, or pulmonary disorders, or gastrointestinal. They’re just a lot more complex to see.

The brain is the most intricate, “multi-media” operating system in the human body. It is absolutely the “last frontier” in medicine. And it has as much credibility as any other body system…and is as real as Saturn or Jupiter…two planets we can see but can not yet touch.

And if you’ve suffered from severe psychiatric symptoms, you KNOW how terribly real and concrete they really are. Because psychiatric disorders can encompass your whole body.

Neuroscience Discoveries Fight Stigma

So here’s another piece of scientific discovery that rips yet more of the stigma-fied rug out from under uninformed individuals who make hurtful and ignorant comments.

Millions of people are living today who remember when psychiatric disorders were blamed on poor parenting or even demon-possession. Thankfully, we’ve made light years of progress since then through the dedicated work of neuroscience.

In a commentary on many studies, published February 2018 in Biological Psychiatry, the authors explained discoveries made by researchers about micro RNA (miRNA) and how it plays a role in either improving or exacerbating symptoms of psychiatric illness.

One finding showed that a certain type of miRNA could be found in tumors; another type was found throughout the body serving a variety of purposes.

miRNA-9 is found most abundantly in the brain, while miRNA-21 is abundant in a variety of tissues in the body. miRNAs can regulate a multitude of genes throughout the body.

And certain miRNAs regulate processes in the brain, like synapses and the replenishing of brain cells, or neurons. They estimate that 60% of all genes are regulated by at least one miRNA …and sometimes by many.

Tight and Multi-layered Gene Control

When multiple miRNAs regulate the same gene, it allows for regulation of many layers of processes and tight control of the protein “expression” of these genes. Genetic expression basically involves turning on the protein or RNA that the DNA creates to fulfill that gene’s blueprint.

This is how genes “express” themselves in the organism they are designed for. When something goes wrong in that process, it can lead to illness. In fact, improper expression of genes has been linked to pretty much every kind of illness or disorder across most of the body’s systems, such as cardiovascular, autoimmune, infectious, neurodegenerative, and psychiatric disorders.

So in the study of miRNA, researchers discovered that miR-137 regulates the maturing and differentiation of neurons, which has an impact on cognition and the physiology of the brain.

How about that?

miRNA and Neurogenesis

Another miRNA, miR-16 hinders the development and growth of neurons. Fluoxetine, an antidepressant, seems to decrease that hindering function, allowing more neurons to grow and thereby decrease depression.

Also, it seems to suggest that antidepressants that hinder or block the function of miR-16 increase growth of neurons in the hippocampus. Another plus!

And if fluoxetine can decrease those miRNA hindering functions, how much more so could IV ketamine treatment …right?

Neuroscience Discoveries Fight Stigma…

Well-meaning (but uninformed) adults in the ’60’s, ’70’s, and 80’s used to say “if mental illness is real, show me…where is it? Take a picture and show me!” These comments were even made by people in medicine. Shameful, really.

Stigma is such a terrible thing.

Well, the pictures are emerging. Concrete evidence is spreading.

And if you suffer with psychiatric symptoms…you don’t have to listen to those heartless comments anymore. There is a wealth of documented science that’s growing every day, every month, and every year.

Neuroscience Discoveries

I hear the things people say to my patients that cause deep hurt … that promote shame … that silence good hearts, and I’m struck by their courage to keep going. To fight stigma. To get well.

So, another point or two about miRNAs.

Various alterations, like the one accomplished by miRNAs to block the work of miR-16, have been linked to a number of psychiatric disorders. Researchers found this link in blood, postmortem brain tissue, and cerebral spinal fluid.

… And Another Discovery

Also, researchers have found that miR-132 is altered in the brain tissue of subjects in cases of schizophrenia and autism, and in the blood serum of subjects with major depressive disorder…as well as in animal models of depression and addiction.

Researchers think this may be due, in part at least, to the alteration of miR-132. Researchers suggest that this happens because of the role miRNA play in circadian rhythm or brain-derived-neurotrophic-factor (BDNF). We know (and love) BDNF. This protein has a clear role in mood regulation, cognition, and the growth of neurons.

Neuroscience Discoveries Fight Stigma

One last thought. This increasing knowledge about miRNA and how it can shape the causative factors of psychiatric disorders lays another row of bricks in the foundation of our understanding of the causes of different psychiatric conditions, and opens up new directions to improve treatment.

In addition, it’s further documentation that there are real cellular, biologic processes behind our diagnoses. And our treatments.

If stigma has intimidated you, take heart.

Neuroscience has your back.

Innovative Psychiatry Offers Advanced Treatment

And so do we. We see all forms of psychiatric illness here, and we work hard to find more effective ways to help you heal. At Innovative Psychiatry, we offer the most advanced and effective novel treatment options, like IV ketamine treatment and transcranial magnetic stimulation (TMS), along with medications, adjunctive help with nutrients like curcumin, and strategies to strengthen your microbiome.

To date, IV ketamine treatment rises above all other forms of treatment for many individuals who’ve been failed by traditional treatment.

If you suffer from depression, anxiety, cocaine or alcohol use disorders, PTSD, OCD, bipolar disorder, or suicidal thinking… and have not been helped by medications, call us. We’ll work together to determine the best treatment to help you live a productive, joy-filled life again. Build relationships again. Enjoy your favorite interests again.

To the restoration of your best self,

Lori Calabrese, M.D.

April 22, 2018
Ketamine, or “Special K,” Effectively Treats Severe Depression in Study

More research backs the club drug ketamine, or “Special K,” for treating severe depression in therapeutic settings.

British researchers tested the drug on patients in the U.K. to see if ketamine, which has shown promise in previous trials for treating serious and suicidal depression, might be beneficial in an NHS hospital setting. The NHS is the publicly-funded health care system in the U.K.

In the study, 28 patients with treatment-resistant depression were given ketamine intravenously over three weeks. Although several patients relapsed with symptoms within a day or two, researchers say almost 30 percent had benefits which lasted at least three weeks and 15 percent did not relapse for 2 months or more.

“We’ve seen remarkable changes in people who’ve had severe depression for many years that no other treatment has touched,” study author Dr. Rupert McShane, a researcher in Oxford University’s Department of Psychiatry, said in a statement. “It’s very moving to witness.”

He added, “For some, even a brief experience of response helps them to realize that they can get better and this gives hope.”

Ketamine is a general anesthetic that is often used by veterinarians on animals such as cats. When taken illicitly in high doses as a club drug, ketamine carries a dissociative effect or puts people in what’s nicknamed a “K-hole,” meaning they feel detached and experience distortions in how they perceive sights and sounds.

The U.S. government classifies ketamine as a Schedule III drug, meaning they have moderate to low potential for physical and psychological dependence.

But increasing evidence suggests the drug may help people with severe clinical depression who aren’t helped by antidepressants.

A 2013 study led by researchers at Mount Sinai Medical Center in New York, involving 72 patients with treatment-resistant depression, found almost 64 percent of patients showed improvements in symptoms within 24 hours, and 46 percent had improved symptoms one week later.

In 2012, Yale researchers reported ketamine could treat depression by spurring the release of the neurotransmitter glutamate in the brain, which triggers the growth of synapses, or spaces between nerves that allow information to flow from one nerve cell to another. Chronic stress and depression damages these synapses, the researchers stated at the time, but a single dose of ketamine may rapidly reverse the damage. However, the improvement that’s seen within hours may last only a week to 10 days, they warned at the time.

In the new study, patients received either three or six ketamine infusions lasting 40 minutes; patients were asked to report their mood symptoms daily and were given memory tests a few days after the final infusion.

Three days after infusions ended, 29 percent of patients halved their depression scores, with duration of benefits varying between 25 days and eight months. The response often took a second infusion to become evident.

“Patients often comment that that the flow of their thinking seems suddenly freer,” said McShane.

Suicidal ideas diminished overall, however there were some issues: some episodes of suicidal behavior and severe depression occurred among some participants, some patients were anxious during infusions, and some stopped treatment entirely because they felt it wasn’t working. Many experienced the detached feelings, but none felt euphoric. There were no adverse effects seen on tests of memory and bladder function.

The study was published April 2 in the Journal of Psychopharmacology.

The team overall has given 400 doses of ketamine to 45 patients, nine of whom have benefited greatly. They hope to build on these studies by trying different doses of infusions and adding other drugs in hopes of prolonging the effects.

Reuters reports U.S. drugmaker Johnson & Johnson is developing a nasal-spray form of the drug, called esketamine, that has shown promise in mid-stage trials.

[Read the Original Report Here]

April 16, 2018
Functional Brain Connectivity: Vulnerability and Resilience in Siblings with Bipolar Disorder

Do You Wonder about Your Family?

Connor’s mom was diagnosed with bipolar disorder before Connor was born. He’s now an adult who was diagnosed with Bipolar I Disorder ten years ago. He has a brother and a sister, both grown, also. But his sibs, Todd and Della, have never experienced psychiatric symptoms, and feel healthy, balanced, and able to cope with the challenges of life. They don’t really understand why Connor has so many struggles.

(Healthy siblings often don’t.)

Sadie’s dad has Bipolar II Disorder and Sadie was diagnosed with Bipolar II during her second year of college. Her three brothers, James, Tim, and Hal, don’t experience symptoms of bipolar disorder … but they each have other things going on. James has been melancholy throughout his life, Tim has OCD (but refuses to deal with it), and Hal eventually was diagnosed with PTSD after a deployment in Iraq.

What’s going on in these two families?

Functional Brain Connectivity Affects Vulnerability and Resilience to Bipolar Disorder

Why is every child in one family plagued by brain dysfunctions that result in psychiatric disorders, while the other family has only one child with a psychiatric illness?

First of all, we don’t understand yet the full answer to that question. But as a result of extensive studies, neuroscientists understand more than they used to.

We’ve talked before about genetic markers and traumatic experiences.

But something else has emerged to give us more insight. The default mode network was discovered several years ago.

Learning about it helps us understand how neurons in the brain are connected.

Functional Brain Connectivity in the Default Mode Network (DMN)

So first, let’s talk about the default mode network (DMN). The DMN is a network of neurons that connect brain regions that are necessary for bringing up information about yourself and how you felt in certain experiences in the past, thinking about others with empathy, judging someone’s attitude, remembering the past and thinking about the future … all these skills depend on the default mode network.

When you focus on a task, whether it be writing a report, balancing your checkbook, or changing a tire, the DMN becomes quiet or de-activated.

That’s because your attention, concentration and focus is right there, right in the moment, honed in. And the DMN quiets to allow you to do your thing.

When that highly-focused task completes, the DMN activates again.

It’s at its peak when you’re wakefully resting. Not when you’re asleep.

Let’s say you’re “sittin’ on the dock of the bay, watching the tide roll away…”. In times like this, your DMN is in full throttle. Organizing, sorting memories, rebuilding the connections (synapses) while you’re daydreaming. Or while you’re meditating.

It’s a beautiful thing.

That is, if you’re brain is healthy.

Impaired Connections Play a Role in Bipolar Symptoms

Researchers know that in bipolar disorder connections like these don’t work properly. Sometimes the connections break down and don’t work at all.

Bipolar disorder and other psychiatric disorders affect the connectivity of some important networks, such as the default mode network, the sensorimotor network, and the central executive network.

When there’s an imbalance between the functions of the default mode network and the sensory motor network, the result is … chaos … and disconnect.

And the chaos that ensues really mirrors the chaos that happens in bipolar disorder. What happens on a brain level can be expressed in your real life. In a very direct way. It’s almost palpable.

Bipolar’s genetic link creates another piece in the puzzle. But researchers still work to understand the bridge from the genetic link to bipolar symptoms. We do know that siblings of a person with bipolar disorder are ten times more likely to also develop bipolar symptoms than someone who has no relatives with this disorder.

And yet, in spite of that statistic, a large number of relatives continue to be healthy and unaffected.

So why are some sibs able to “avoid” developing a disorder like bipolar, and others aren’t?

What Makes the Difference?

A team of researchers at the Icahn School of Medicine Mt.Sinai NY set out to learn more. They worked with a group of 78 people with bipolar disorder diagnoses. The team screened these participants to ensure they had not experienced an episode of mania or depression in 3 months. Then, they recruited 64 of their siblings — BUT ensured these siblings had NOT experienced bipolar symptoms. Finally, they added 41 healthy volunteers with no psychiatric disorders as a control group.

Using functional MRI scans, they collected data of the functional brain connectivity of bipolar patients, their unaffected siblings, and healthy volunteers to compare. They took the fMRIs during the resting state, when subjects were awake but not focusing on anything in particular. They wanted to first look at what the brain was doing when these folks were “sittin’ on the dock of the bay…”

Some aspects of brain region connectivity remained the same in all three groups. But they found changes in the default mode and sensorimotor networks. In bipolar disorder, the sensorimotor network doesn’t work smoothly. But rather it disrupts the processing of sensorimotor information in the brain. And creates chaos.

The authors of this study pointed out that recent studies have revealed reduced motor coordination, sensory integration, and selective attention in both bipolar patients and their unaffected siblings.

Increased Motor Impulsiveness with Impaired Functional Brain Connectivity

And in this current study, increased motor impulsiveness was associated with those who were diagnosed with bipolar disorder, as well as their siblings.

To simplify, the study demonstrates the cause of the kind of reduced GABAergic and glutamatergic receptors that coroners see in autopsies of people with bipolar disorder. The impaired neuroplasticity that results from the dysfunction of the DMN and sensorimotor network probably bears responsibility.

In other words, the broken down connections in these important networks in the brain may help explain the chaos of symptoms in bipolar disorder.

And, the study also confirmed the connection between default mode connectivity and resilience…or in this case, the ability to of the brain in certain individuals to NOT develop bipolar disorder.

Great Connectivity in the Default Mode Network = Resilience

So the better the connectivity in the default mode network, it appears, the more resilience that individual has, even if he’s related to someone with bipolar disorder.

And that introduces new ideas for developing novel ways of preventing bipolar disorder, or at least changing its course.

And both the default mode network as well as the sensorimotor network could possibly be made stronger and more resilient through interventions that enhance plasticity in those networks.

So that’s the lesson we learned from siblings who haven’t been affected by bipolar disorder. We learned that the adaptations that occur in some sibling brains perhaps could be explored and used to protect all relatives from this illness. And hopefully in the process, a similar method protects everyone from this disruptive and cruel illness.

Neuroplasticity. You’re going to be hearing a lot about it. You’re going to want it for yourself and your family.

Hope for the Future…and Hope for Now

There’s hope for the future to wipe out the suffering caused by bipolar disorder, PTSD, anxiety and thoughts about suicide.

But for now, we don’t have those developments. We’ve only just begun.

However, we STILL have hope. Hope for feeling better, being better, living better. And that’s through treatment that leaves others in the dust. In the years I’ve been in practice, I’ve treated patients with just about every conceivable psychiatric disorder, and have prescribed medications that target a kaleidoscope of symptoms. I still do.

But the most robust and extraordinary tool I’ve found for helping people to recover, build lives and relationships, and experience the joys of life, is IV ketamine treatment. Administered with the utmost care and precision to enhance it’s best effect on the delicate systems of the brain, I’ve been privileged – sometimes joyfully overwhelmed – at the numbers of people who have enjoyed real remission, joy, and relief.

If you’ve been dragging a severe psychiatric mood disorder around with you without real and lasting relief, call us.

Disorders like depression, general anxiety, social anxiety, PTSD, OCD, bipolar disorder and suicidal thoughts can be relieved…and quickly. This isn’t like those antidepressants that take weeks or months for you to feel the benefits.

We specialize in treatment-resistant psychiatric disorders. There aren’t many that ketamine treatment doesn’t conquer. We often say that ketamine treatment isn’t for everyone. And it’s not. But more than likely it could change your life for the better. Let’s find out.

To the blooming of your best self,

Lori Calabrese, M.D.

April 16, 2018
How Stress Takes Down the Best People…and What To Do About It

Heather was 38, and had had a series of extreme stressors over a period of several years. She was a giver at heart, always looking for ways to help — always trying to make the lives of people she knew easier or more fun.

But then her husband left her. It was the same old, tired story — an affair with her closest and dearest friend. But still … she was left with two enormous losses, and a crippling sense of betrayal about both of them.

She tried to function for the sake her of two children, Katie and Noah. One foot in front of the other. One day at a time.

Another Devastating Crisis

Three years later, Noah was hit by a school bus and rushed to the hospital. He had a concussion and his pelvis and femur were broken in so many places they gave her minimal hope he’d walk again. Weeks in the hospital, then months of rehab. Asking neighbors and family members to pick her daughter up at school, get her to piano lessons, grab dinner.

She was exhausted. And Noah was beginning to walk with a walker and just starting back to school when she got a phone call from her mother.

Another Overwhelming Tragedy

Her dad had died when she was 25 and her mom lived alone. Mom just found out she had an aggressive form of breast cancer. She’d been told to expect a year minimum of treatment then re-evaluation. But when her mom got so tired she couldn’t drive back and forth to chemo, there was nothing to do but have her mom stay with her. She’d probably be there through radiation, too. Heather asked her mom’s neighbors to look in on her house.

So a household of three greatly stressed people became a household of four extremely stressed people. Heather just held her chin up and set out to get through this, too. The idea of losing her mom when she was so young was terrifying.

She cooked, cleaned, ran the kids around. Made dinner. Went to work. Drove her mom to chemo. Did everything.

Stress Takes Down the Best People

Finally, 6 months later, her mom had to be admitted to the hospital. Her next door neighbor offered to take care of Katie and Noah for a few days. Thank goodness. But then … Heather didn’t get out of bed or out of her pj’s for three days … and she felt less and less like getting out of bed after that. She went through the motions of getting her kids to school and back home again … and feeding them when they were hungry. But she was numb. She was barely functioning.

Finally, darkness wrapped around her like a cold box, and she felt hollow. Numb. Adrift.

Someone from the church came to see her. When they saw how she looked, they could see she’d been through too much for too long. They went to work to take over the care of her mom, and took her to the hospital. Heather was admitted with severe Major Depressive Disorder.

Heather’s a giving, kind, and generous person. But chronic and repeating stress can take down the best people, and Heather was no exception. It brought her to her knees.

How Stress Brings Someone Like Heather to Her Knees

We’ve talked and talked about what stress does to your brain, and how it contributes to depression.

But let’s talk about why that happens.

Thanks to recent studies sponsored by Brain and Behavior Research Foundation, we’ve learned some things lately.

And I’m excited to share them with you.

It all makes so much sense when you get a peek inside the brain to see what happens.

MIcroglia Unwittingly Launch a Destructive Attack

There are immune cells in the brain, called microglia, that are responsible for defending against infection, among other things. One of the other things they do is help build and change the construction of neural connections in the brain.

Huge. And hugely important.

In this study, the research team, led by Ronald S. Duman, periodically caused laboratory mice to undergo stress-inducing conditions over a period of weeks. Then they evaluated the effects of this chronic stress on their brains.

It’s not surprising that the mice displayed symptoms of depression and anxiety. The team demonstrated that the neurons in the prefrontal cortex — which control your abilities to make decisions and function socially — react to the stressors.

Specifically, these brain cells signal the microglia to begin “remodeling” pyramidal neuronal circuits … which basically WEAKENS them. The outcome is that the synaptic connections between the neurons in the prefrontal cortex begin to break down. And too many of them are lost.

Sounds like Heather. Broken down. Lost.

Maybe that sounds like you.

How to Stop the Damage?

Then the team carried it another step.

When they blocked the neurons from signaling the microglia, the chronic stress the mice were subjected to did not affect their synapses in their prefrontal cortex so they did not become depressed.

The research team concluded that finding a way to block the neurons from signaling the microglia could be a way to treat anxiety and depression.

(It seems to me this could be a fantastic way to prevent anxiety and depression in those subjected to long term chronic stress, such as first responders, those with chronic illnesses, and more.)

You can imagine that if you undergo extreme stress over an extended period of time, that more and more of these connections will be lost due to microglia activity. And depression and its accompanying anxiety become more and more severe.

So what can be done about this deconstruction… these massive losses of synapses?

Restoration through an Extraordinary Medicine

Enter IV ketamine treatment, which has been shown to rapidly rebuild and proliferate these synapse connections that have been broken down by depression and anxiety … which are caused by stress and which create more stress of their own.

Remember that tiny doses of ketamine, administered properly, turns on mRNA to switch on DNA which turbo charges the brain-derived-neurotrophic-factors (BDNF) so the synapses grow, branch out, and proliferate creating a dense forestation of neuron connections.

And when all these neurons in the prefrontal cortex are tied together with a dense network of synapses, you come alive. Joy returns. Creativity blooms. Initiative and motivation billow.

This is what we can do about those lost synaptic connections.

Innovative Psychiatry Offers Expertly Administered Ketamine Infusions

We know that stress takes down the best people. You probably know someone like Heather who tries to help everyone, but eventually she’s the one who breaks down and needs help.

At Innovative Psychiatry, we see extraordinary, positive outcomes in treatment-resistant depression and bipolar depression, as well as in PTSD, OCD, social anxiety and suicidal thinking. That means that very ill people can get really, truly better. As in happy, upbeat, full of energy, initiative, and hope for the future.

You can feel like yourself again. With the energy to embrace each day, the hope to look forward to the future. You can enjoy an afternoon breeze, a beautiful ocean view, or the fragrance of a summer rose.

When was the last time that happened?

If you suffer from depression, anxiety, bipolar disorder, PTSD, OCD, social anxiety or suicidal thoughts, and medications haven’t helped, call us. We can help you leave psychiatric disorders behind, and live a fulfilling life.

Live as the best you you can be.

To the emerging of your very best self,

Lori Calabrese, M.D.

April 9, 2018
World Bipolar Day is for YOU

World Bipolar Day is for You.

Whether you know this illness intimately, because it’s part of every hour of every day for you, or whether you love someone who suffers. And even if you don’t, you can help with support, kindness, and funds. Make this world a better place. World Bipolar Day is for you.

How does bipolar disorder start?

Bipolar symptoms can begin at a variety of ages, and in a variety of ways. This is one person’s story, and you can see how, in this case, seemingly “normal” symptoms gave way to the full blown illness.

As a toddler and preschooler, his tender heart and sparkle in helping others gave him the reputation as the sweetest child with the most disarming smile in the neighborhood.

But he also cried. Long, mournful weeping…for no apparent reason. His mother would hold him and rock him…try to comfort him for hours. Eventually, the sorrow would pass and he could play happily again.

Later, came waves of guilt and shame. His first-grade teacher disapproved of his constant activity in the classroom… and the pain of it was so severe he’d sit in the dark in his room after school overwhelmed with shame too intense to cry. Just shut down with his own feelings of worthlessness… He told his mom he was a juvenile delinquent.

What causes a 7-year-old to feel worthless? Where does suffocating shame come from for an innocent child?

His parents thought he was just especially sensitive, and tried to console him.

Accidental Blows to the Head Can Cause Damage

At the age of 9, he had his fifth blow to the head. It was always something. An accidental blow with a baseball bat, falling on his bike and hitting his forehead with the handle bar. Baseballs would come out of nowhere and hit him squarely in the temple or forehead. It was uncanny. One massive goose egg after another.

Years later his family learned that serious blows to the head can lead to psychiatric disorders, like bipolar disorder.

By the time he was 10, he was old enough to know something was wrong. His pain, his torment, his humiliations at school, plus corrections from his teachers were piling up. The nitpicking from his friends was too painful to overlook.

His long periods of sad emptiness had become too hard for him to endure. His mom had always told him it would pass. But he told her that it never has and he can’t bear it any longer.

He wanted to die.

How often do you hear a 10-year-old say such a thing?

A Disordered Brain that Can’t Read

During middle school he had more and more difficulty reading even though he had learned to read well when he was 4. He could see the words on the page, but couldn’t make sense of them. To make it worse, they danced around the page and he lost his place every 2-3 words.

The humiliation.

And the scandal…A difficult thing that kept emerging consistently, was his fascination with sex. As a preschooler, he was punished for cajoling the little kids in the neighborhood to remove their pants so he could explore, or later having sexual experiences with friends, and all sorts of exploration … And more shame.

**Hyper-sexuality emerged before the manic mixed states, though he had had many times of extreme excitement since he was born. Was that mania? Or just a little boy being a little boy..?

Then, he was 14, and felt new feelings for a pretty girl he knew. It wasn’t long before he had coaxed her into bed, telling her he would “take care of everything”…to not be afraid. “He knew what he was doing.”

Painful Conflict Leads to Outburst

Then, when his parents told him he couldn’t see her any more, he had his first manic episode.

He exploded, shouting and spitting out curses as if he couldn’t say them fast enough, and his lips sort of popped as he pushed out the words, like the way they do when you say the word “bubble.”

His family had never seen this before. This fourteen-year-old spoke as though he was a grown man. That he was in love and would marry this girl, and their relationship wasn’t his parents’ business.

They’d never seen him like this. He stormed around, cursing, and screamed as he slammed the door.

“Was this just the erratic emotions of a 14-year-old teenager?” his parents wondered.

Super Human Strength During a Mixed States Episode

Outside, he grabbed a 4ft. tall shrub with both arms and pulled it straight out of the ground by the roots, screaming with rage.

**Superhuman strength would always accompany his mixed states mania…this was a sign of things to come.

Scenes like this happened more and more often. Whoever was with him when it happened, would see a look in his eye, then his veins would stand out on his forehead and neck while words pounded out and exploded from his mouth expressing his frustration and rage and hurt.

Nothing within reach was held sacred. He threw whatever was available whether it was a full Coke can, a prized porcelain heirloom, or a boot. Or… a TV or chair through the window…or a dresser… His family became familiar with these “episodes” over time, and most would leave the room or the house to avoid it. His mom stayed close so he wasn’t alone.

**It’s noteworthy that he never turned his rage and strength toward a person…always inanimate objects.

High Risk Behavior Leads to More Pain

By the time he was 15, his girlfriend was pregnant. But, there had been a variety of sexual encounters of all types by then. Sometimes his parents knew …sometimes they had no idea. This time, a baby boy was placed for adoption and his heart broke. It was the most painful loss of his life.

**It’s important to recognize that hypersexuality is a strong symptom in over 57% of people with bipolar disorder. Don’t be afraid to talk about it. It’s real. And needs treatment.

New Diagnosis for Improved Treatment

In between these cycles, he was gentle, considerate, creative, affectionate. He lived to help others feel good about themselves. He was born friendly, never met a stranger, but was quick to get acquainted and help anyone who needed it. Not a shy bone in his body.

He loved to create music with this guitar and jammed with others and played in a church band. His humor brought delight to every situation.

**It’s been said that a person with bipolar disorder is really two people. The wild, out of control, risk-taking trouble maker…and the gentle person who pays for the fallout.

When he was admitted to a psychiatric hospital for teens, he was given the diagnosis of bipolar I disorder, with rapid cycling and mixed states. He’d been diagnosed with Major Depressive Disorder a few years before, and had been taking medicine that didn’t improve the way he felt.

But now, this diagnosis explained the unexpected explosions, the gnawing drive of hypersexuality, the pressured speech, the guilt and shame, grandiosity as in the belief he could control unpredictable forces to his own desired outcome… it all began to make sense.

His changes in appetite, sleep, feelings of worthlessness, his difficulty concentrating and reading, and his obsession with death and the desire to die, led his psychiatrist to the bipolar disorder diagnosis.

A Family’s Observations Help Doctors See What the Patient Overlooks

His parents explained to the doctor that he often felt desperately depressed, wanting to die, locking himself in the bathroom to try to hang himself. Then after awhile… he finally became quiet and within a couple more hours he played his guitar, wrote lyrics, and genuinely apologized for all that had happened that morning.

Until something reminded him of the girlfriend he lost, and he’d rise into a rage, shooting words like bullets with blood in his eye, slamming doors, crashing lamps, throwing dishes…until he broke down in tears and sobbed and sobbed. And eventually he fell asleep.

**Rapid cycling like this was the hallmark of all his cycles.

Sleep Can Reboot A Shattered Mind

He often woke from sleep with a clean slate. Peaceful and thoughtful. When he was awake during the night while others slept, he’d make imaginary creatures out of pieces of fruit and take pictures of them and send them to people he cared about with a cute greeting. Or write letters filled with cartoon characters.

He wrote poetry, lyrics to songs, played the guitar… riffing along with a song on a CD… It seemed he never stopped.

**The triad of care that’s vital for anyone with this disorder: sleep, healthy food, and medication. If any one of these elements is missed, it can trigger an episode.

Never-Ending Cycles + Self-Medication

He’d be doing fine, then a few days would pass and he would become agitated, describe the feeling of “fire ants on his brain.” Before long he was escalating into a suicidal rage again.

This scenario defined his life, through his teens and twenties. He learned to shave in jail, never completed high school, and got his GED in rehab.

His profound desire to just feel better…just be happy…drove him to try various forms of intoxication, from beer to marijuana, from paint thinner to meth, from cocaine to crack.

It’s no surprise that this guy’s misery and anguish were then complicated by the throes of addiction. Risky behaviors like unprotected sex and illicit drugs always called to him like ancient sirens who lured sailors to shipwreck.

And his bipolar disorder was getting worse.

Self-medicating Made Everything Worse

He took every medication his doctors prescribed but nothing made a real, lasting difference. And the chemicals he turned to for relief magnified the chaos in his mind and body.

Then another girlfriend…another pregnancy. And he determined to gain control of his life, determined to be a good father. This was a second chance…

Voluntary surrender to a drug rehab for nearly a year…it helped the addiction, but bipolar raged on.

**IV ketamine treatment is bringing balance to so many people now who have suffered with treatment-resistant bipolar disorder. But it was unheard of in his day.

After rehab, he tried his hardest to be a good dad to his new son. They played games, shared long walks and talks. They shared their love for music and rhythm. But he was often too ill to function. Often unable to sleep. Insomnia plagued him.

Insomnia Undermined Everything He Worked For

By the time he was 31, he had achieved 6 months sobriety, stayed away from crack cocaine long enough to realize it was good to be at home, be with family, and eat home cooking. But his suicidal thoughts became more and more frequent and dominating. Unable to sleep, awake for days on end, he feared the mania would return. And it did. Way too often.

And with the mania there was torment.

He always loved a party with his family, and special times with his son, but far too often good times would trigger mania again, and he’d lose control of his life.

His sense of humor still kept everyone laughing.

The problem with his hilarious humor was that enjoying it, even laughing hard, the brilliance of his gift exploding… he’d be on a roll…and that could trigger another nightmare of mania, drinking, arrest, etc. So he tried hard to stay calm and even-tempered, the same way you try not to laugh if you’ve just had an appendectomy.

There were times that he broke out in hives trying to hold his bipolar reactions inside.

Bipolar Disorder Can Wear Out Even the Strongest Person

His 33rd birthday passed, and after studying medical books about the brain for years, learning about the amygdala and hippocampus, learning more about the pathology in his brain that had held him captive for 30 years, after months of suicide attempts a few times a week, slicing his arms every direction and watching the blood pump out in spurts, he told his closest, most trusted friend he didn’t think he’d live much longer.

He resigned himself to accept there was no escape that would work, but he had a nagging gut feeling his time was coming. He was weary of the ER visits, the whispers and cruel comments of hospital staff. And he was weary of the fight.

The last week of April and the first week of May, an overwhelming mania sent him running and running and running. Coming home in the middle of the night to hose off and put on dry clothes then back out running and running and running some more. Sort of Forest Gump style.

He couldn’t stop. The meds didn’t stop it. The emergency meds — for times like this — didn’t stop it, either.

He began “seeing” various people and talking to them… feeling offended that they didn’t answer him.

He told his family these people were camping in the woods where he ran. After that, he was talking to people at home that his family couldn’t see.

**Times like this had by now earned him the diagnosis of Schizoaffective… because of his auditory and visual hallucinations.

The running continued for two weeks, until on the afternoon of Cinco de Mayo someone walking her dog stumbled upon a man’s body at the edge of his beloved woods.

The police said it appeared he decided to lie down for a nap. His family, through their tears, later thought it was fitting he exited this world on Cinco de Mayo … because he’d always loved a party.

The autopsy showed dehydration and a slightly enlarged heart.

His family called it death by bipolar disorder.

——————

World Bipolar Day is for YOU

World Bipolar Day has been established to help us all see what those who suffer experience in their private lives. To motivate us to find solutions. Treatments that work.

This is the true story of one man who lost the fight.

But there are millions who have similar stories to tell. And others with different stories of their own. It’s easy to point the finger and criticize another person’s behavior, without knowing the brain changes that cause it. And without walking in their shoes yourself.

World Bipolar Day was celebrated last week on Friday, March 30. Let’s keep it going. Please consider contributing to organizations that are searching for understanding and better and better treatments. Brain and Behavior Research Foundation, for example.

And seek out those who struggle to live with this illness, and treat them with support and compassion even though you may not understand them. There’s something better than stigma. It’s called kindness.

World Bipolar Day is for you. Whether you’re suffering with this disorder, or whether someone you love is suffering. Because if that’s the case, you’re suffering too. And… if it’s not about your suffering, it may be about your support.

At Innovative Psychiatry, in South Windsor, Connecticut, we’re seeing very encouraging outcomes in bipolar disorder with IV ketamine treatment. Its effects are dynamic with the depression aspect of bipolar disorder. But that’s not all. We’re seeing overall improvement in mental organization and executive function, too.

There’s so much to learn about this amazing medicine, and, of course, so many questions we still seek answers to. But we’re pleased by the positive outcomes we see.

It’s likely IV ketamine treatment could have saved our friend’s life. He was a perfect candidate for it. But, he didn’t know about this treatment. However, now you do.

If you suffer from bipolar disorder in any form, and medications aren’t helping you maintain a healthy, fulfilling life, call us. Or schedule an appointment.

We believe in your recovery and health. We believe in hope.

To the restoration of your best self,

Lori Calabrese, MD

April 2, 2018
International Conference on Ketamine for Psychiatric Disorders 2018

Can you say PHENOMENAL???

Let’s hear it for Ketamine Treatment and Oxford!!

I just returned from a history-making global conference focused on research and clinical evidence for ketamine for psychiatric disorders. Experts from nearly every continent spoke of their own data and evidence from this emerging field of the the science behind ketamine and the extraordinary help ketamine treatment provides. The entire room was held spellbound for three days, from the first word spoken until the final applause Friday afternoon. It was an unforgettable event in the most beautiful and historic venue at Wadham College, Oxford, UK.

A 400-Year-Old Chandelier in a 400-Year-Old Room

In the 1650’s, a group of individuals including such celebrated thought leaders as Robert Hooke, Robert Boyle, Christopher Wren, and Thomas Willis began an “Experimental Philosophy” club where the fundamental premise required that orthodox thought was rejected and the world was viewed through the “broadened lens of experimental scrutiny.”

Well, this club became the Royal Society when members of the family of King Charles II got involved. When that happened, the revolutionary became the norm.

It seems only fitting that this international conference on the revolutionary breakthroughs for treating psychiatric disorders should be held in this same building, and on these same grounds.

Rupert McShane chaired this ground-breaking event. Hats off to him for beginning what we hope will become an annual international conference.

Luminaries in the Ketamine Adventure

Gerard Sanacora, a frontline researcher for ketamine treatment in psychiatry, spoke first. He previously served as the lead researcher of the American Psychiatric Association Counsel of Research Taskforce for Novel Biomarkers and Treatments which published a consensus statement about ketamine for this purpose in mid-2017.

Dr. Sanacora kicked off the conference with an overview of the literature and key studies that have explored ketamine’s mechanism of action in treating psychiatric disorders. It was brilliant!

We’ve been keeping you informed about some of those in recent times … but there was so much more that was discussed.

Luminaries all around! We were graced with Peter Somogyi and David Lodge whose seminal work on NMDA and axoaxonic cells paved the way. Many of the top ketamine researchers and clinicians in the world presented their findings: Colleen Loo, Jennifer Southgate, Nuri Farber, Steve Levine, David Feifel, Declan McLoughlin, Haggai Sharon, Alison McInnes, Samuel Wilkinson, Michael Grunebaum, Elias Dakwar, Rupert McShane, Raquel Bennett, Karen Lascelles, Jeffrey Becker, Ian Anderson, Gordon Fernie, James Stone, Meng Lei, and Dan Iosifescu. Jose Miyar covered regulatory issues. Jonn Donello and Suresh Durgam discussed new breakthrough findings for the mechanism of action of Rapastine, and Jaz Singh presented new data about the safety and efficacy of esketamine.

And of course, the extraordinary international collaborative teams involved in all of this work … the freshness of perspective emerging across the field — from doe-eyed young researchers to seasoned principal investigators … the breadth and energy of molecular, cellular, neuroimaging, and clinical work represented in the posters.

Breathtaking doesn’t do it justice.

We talked about everything ketamine from mice to men … and from chandelier cells (just as gorgeous as the chandeliers King George IV gifted to Wadham College for the Holywell Music Room) to psychotherapy.

How fitting that we heard about paradigm shifts in the very room where Handel and Haydn first played! Raquel Bennet, Founder of KRIYA Institute, explored the importance of the dissociative experience as transformative, and the many ways ketamine has been used in clinical practice.

Biologically to induce neuronal plasticity (we talked about this before), as a sort of lubricant to enhance psychotherapy, and to deliberately induce dissociation … which can be transformative for the patient.

Jeffrey Becker offered us an elegant unifying hypothesis for ketamine in clinical practice, exploring the GABAergic interneurons and Jungian archetypes in treating people with depression.

The depth and breadth of this conference was amazing. The sheer richness of talents in the room, the knowledge and experience gathered into this one place from all over the world. Everyone talked about how much more we need to learn, and the questions that still need to be answered.

Ketamine for Psychiatric Disorders – Global Conference! Stunning.

These were basic scientists, principle investigators, neurimaging experts, clinical researchers, psychiatrists, anesthesiologists, psychologists … it’s astonishing to realize the scope of interest and exploration there is in perfecting this most remarkable treatment to help you get better.

When you feel depressed, deeply and severely … or when your vigilance and terror from PTSD is tearing apart your family … or when bipolar disorder rips you apart … It can feel like you’re all alone and no one out there cares. You know you don’t know the solutions. So you feel like you’re relying on scientists to figure out the solutions … but … is anyone really trying to help you?

This is why I tell you about this conference. This sharing of data, preliminary findings, hypotheses, results… just to show you there are people all around the world who explore the solutions to your pain, and work on solutions for you … and others like you … as feverishly as they can. They care. And they’re dedicated to learning more and more. All to help you.

As for me, I presented data from my clinical practice. It demonstrates that ketamine can be used to stop suicidal thoughts. And it happens often in a real-world outpatient clinical practice. What’s more, it provides an alternative to hospitalization.

Someone recently mentioned to me that he predicts the excitement over ketamine will fade away.

Of course, he’d probably read negative media accounts and had probably missed the science … and all the studies. But I have to say, I wish he and others who share that “doom and gloom” outlook could have been present to hear all the extraordinary work going on with ketamine and related compounds.

It seems pretty clear to me: ketamine treatment is going to be with us a good while.

Ketamine Can Make Antidepressants Work Better for Hospitalized Patients

Declan McLoughlin spoke of his study in Dublin using ketamine to try to prolong remission after ECT. He also explained his work using ketamine as an additional treatment combined with antidepressants for hospitalized patients in Dublin.

These are just examples. But they don’t even scratch the surface of all the topics covered these three days last week.

There’s no question that ketamine treatment has a long way to go to reach “mainstream status.” Everyone in the upper echelons of research and practice seems to agree we need to know so much more. The more we learn the more questions arise that we need answers to. But we know so much more than we did even two years ago.

This is the breakthrough we’ve wished for … depressed and anxious people, suicidal people, people wracked with PTSD, or torn by bipolar disorder, trapped by OCD. This is what you’ve yearned for. So have I. Many say this is the greatest breakthrough in fifty years in psychiatry. But we can go further than that.

This is the best, life-changing breakthrough for people who suffer with psychiatric mood disorders EVER.

There is so much more to learn…so much! Ketamine is the new frontier in psychiatry and the treatment of psychiatric mood disorders and more.

Ketamine for Psychiatric Disorders like Substance Use Disorders

One more story I have to tell you about. Elias Dakwar (we’ve talked about his work) discussed his research with ketamine in treating substance use disorders. You might remember our post on crack cocaine use in February.

We talked about how Dakwar and his team studied responses of crack cocaine users. Those who were currently using and had no intention of stopping. When they had been given ketamine infusions the day before being offered either crack or money, they had the motivation to turn and choose money, and their craving was so diminished that they also had the power to turn down crack.

That brings up something we’ve talked about here: that ketamine restores initiative and motivation.

All in all, this conference gathering of great scientific minds, young researchers, and brilliant clinicians was a huge step forward for the needs of depressed and anxious people. A huge step forward for the use of ketamine in the treatment of psychiatric disorders.

Research is ongoing to test ketamine’s use with psychotherapy, ECT, TMS, and traditional antidepressants. Plus, its effectiveness intravenously, intramuscularly, subcutaneously, orally, and intranasally.

Now we’ve all gone back to our home offices, and our work will continue. And this time next year I hope we’ll see that ketamine’s advantages have taken another big step forward.

Meanwhile, at Innovative Psychiatry, we’re still here providing IV ketamine treatment. And we see life-changing results with it for people with treatment-resistant depression, bipolar depression, social anxiety, bipolar disorder, PTSD, OCD, and suicidal thoughts.

If you’re suffering from a mood or anxiety disorder, treatment hasn’t helped, I’m sure you’re far more concerned about your desire to feel better and function again, than about a conference. And that’s why we’re here and want to help. We try to offer you the best that the world has to offer. This time from the first International Conference for Ketamine and Related Compounds.

Call us or schedule an appointment here to be evaluated.

There is hope. You can feel truly better.

So don’t judge your next treatment by the ones you’ve had before. This time, chances are, you’ll see a difference. And you’ll remember how to live again.

To your life and the emerging of your best self,

Lori Calabrese, MD

March 26, 2018
Depression researchers stop ketamine nasal spray trial because of psychotic-like effects

Depression researchers at Black Dog Institute and University of NSW had to abort a “promising” pilot trial into the efficacy of ketamine nasal sprays after patients experienced psychotic-like effects and temporary loss of fine motor skills.

The researchers were hopeful the trial would work as an earlier study in the US had shown ketamine – an anaesthetic drug shown to have rapid antidepressant effects – could be safely delivered using a nasal spray.

But in a paper published in the latest Journal of Psychopharmacology, the research team, led by Professor Colleen Loo, said they had to stop the trial at five participants with severe depression (they were aiming for 10) because of unexpected side effects – their blood pressure shot up, they became uncoordinated and they suffered “unpleasant” psychotic-like effects.

Researchers had to stop their ketamine nasal spray trial because of concerning side effects. (Spray in photo is unrelated)

“The US trial gave a single fixed 50mg dose of ketamine over five sprays but the improvement in mood wasn’t as much as in previous studies … so we decided to give 100mg, twice the dose, over 10 sprays,” she said.

“We saw a range of tolerance levels and we think it’s because one person’s blood vessels in the nose can be so different to the next person’s, and when you spray, it crosses the thin lining, gets taken into the blood and straight to the brain. Some people got huge hits.”

One of the five participants, Cheryl*, said she had tried a raft of treatments for depression over the past 10 years and only ketamine – given by under-the-skin injections in a different trial – had renewed her “desire to live”.

About 1 million Australians suffer from depression.

Photo: Shutterstock

The 66-year-old retiree from Sydney was “extremely optimistic” when she joined the pilot trial but as it went on her blood pressure increased and she couldn’t fully control her hands, making it difficult to correctly self-administer the nasal spray.

All participants were given training in proper self-administration techniques before receiving either a course of eight ketamine treatments or an active control over a period of four weeks, under supervision at the study centre. Each treatment consisted of 10 sprays.

Following initial reactions, the dosage was adjusted for each patient to include longer time intervals between each spray.

Professor Colleen Loo from Black Dog Institute.

“In my opinion, all drugs have side effects and while the side effects were a concern, I felt I was in a safe environment and the staff knew what they were doing,” Cheryl said.

“You need to understand that I was keen to do anything to alleviate my depression and the side effects were worth the risk.”

Over the past 20 years, researchers have established that ketamine, when intravenously administered, can help people with “treatment-resistant depression”, and are now working to make it a less invasive, “clinically useful” treatment so that patients can get well and stay well.

The clinical trial has cast some doubt on nasal sprays, but it is still a promising method, with Johnson & Johnson’s pharmaceutical company Janssen conducting trials using a sibling of ketamine called esketamine, also a general anesthetic and a dissociative hallucinogen.

Professor Loo said the concerning outcome of her study didn’t mean Janssen’s trials couldn’t be successful because it was using different preparations and spray methods.

“It’s clear that the intranasal method of ketamine delivery is not as simple as it first seemed,” she said.

“I wish them luck because sprays are better than injections … this is not that straightforward, all of these complexities are things we need to sort out before we can come out and say: ‘Yep this is ready for mainstream clinical use’.”

Associate Professor Christopher Davey, head of research group Orygen’s Mood Disorders program, said he was disappointed by the trial’s outcome because ketamine was so promising and nasal sprays would have helped it one day become widely available.

“There’s a real need for a new antidepressant treatment; the traditional medications don’t start working for weeks and at least half the people won’t really get a benefit from them,” he said.

“I think it is an exciting development in psychiatry because we are finding potentially a new pathway for effective medications; it’s opened up this door of investigation.”

Johnson & Johnson told Fairfax Media the Black Dog Institute’s ketamine study did not in any way relate to its own trials, which use esketamine.

“Esketamine is an investigational compound being studied by Janssen as part of a global development program,” its spokesman said.

“Esketamine is not an approved medicine in Australia and remains in clinical development. Esketamine received Breakthrough Therapy Designations from the US Food and Drug Administration in November 2013.”

In any one year, around 1 million Australian adults have depression, according to beyondblue.

In another study last year, Professor Loo showed the effectiveness of ketamine’s antidepressant effects in elderly patients when delivered in repeated doses, which were adjusted on an individual basis and given by subcutaneous (under the skin) injections.

“Our prior research has shown that altering the dose on an individual patient basis was important. However, we wanted to see if a simpler approach using a set dose of ketamine for all people and administered by nasal spray could work just as well in this latest pilot,” she said.

“More research is needed to identify the optimal level of ketamine dosage for each specific application method before nasal sprays can be considered a feasible treatment option.”

Her team is now recruiting participants for the world’s largest independent trial of ketamine to treat depression, to determine the safety and effects of repeated dosing using subcutaneous injections.

For help or information, contact Lifeline on 13 11 14 or beyondblue on 1300 224 636.

* Cheryl’s surname has been withheld.

[Read the Original Post Here]

March 20, 2018
Ketamine: What’s Dose Got To Do With It?

Ketamine’s Power Against Depression

We’ve talked before about how ketamine works through a variety of actions to relieve depression in people with Major Depressive Disorder (MDD).

Like the hero in an epic movie, ketamine treatment works in several brain areas at once to improve brain functioning. It triggers a cascade of actions that repair, restore order, and create peace once again.

We know that ketamine turns on mRNA which switches DNA “on” to turbo boost brain-derived-neurotrophic-factor (BDNF). BDNF, in turn, serves as an ultra-rich compost to speed up the dense growth of synapses, dendrites, and dendritic spines to rebuild a superhighway of infrastructure in the brain for signals to move rapidly from cell to cell and deep into the brain.

This is AMAZING.

And there’s more…

While this is happening, there are lazy little G proteins piled high on lipid rafts in the neuronal cell membranes — and they’re needed to enhance signaling along these dense pathways. But they can’t do their job because they’re just piled on those rafts … and unable to operate.

Ketamine, like a proverbial grade school hall monitor, quickly causes these G proteins to slide off those lipid rafts, get into place, and get back to work with their signal transmission job.

The result of all this is a brain that’s communicating at lightning speed again within hours, rather than weeks or months.

Genetic Tests

We’ve talked before about tests that help indicate whether a person is likely to respond to ketamine or not.

One of these tests checks a certain genetic biomarker that signals a person’s likelihood to respond to ketamine treatment. It’s a certain allele, which is one of two more forms of a gene that can arise on the chromosome for BDNF.

The alleles are called Val and Met. You can be a Val/Val, a Val/Met, or a Met/Met for BDNF.

It’s the Met allele that seemed to impede the antidepressant effect of ketamine treatment for depression, anxiety, bipolar disorder, PTSD, OCD and suicidal thinking. Early on, it was reported that those with the Met/Met alleles were least likely to respond to ketamine treatment, and those with Val/Val were most likely. (Those with Val/Met fell in between.)

However, we’ve noticed in our practice that sometimes our patients who don’t have the Val/Val alleles, and don’t seem to respond to ketamine rapidly, tell us weeks or months later that they’re feeling so much better, and are enjoying their lives again. Hmmmm …

What Causes the Delay?

That made us wonder what made the difference …? Why were some of those specific patients enjoying a delayed, but just as robust, response to ketamine treatment…?

So … a new study shines a light on this mystery. (Science is so fantastic!)

A team of researchers from Taiwan and the US has found evidence that ketamine’s antidepressant effects are related to the size of the dose given.

And, importantly, evidence that Met carriers respond to ketamine.

First Study to Explore Ketamine with Taiwanese Subjects

The researchers conducted an elegant double-blind placebo-controlled study of 71 Taiwanese adults who received one ketamine infusion.

Neuroscientists believe ketamine treatment’s effectiveness as an antidepressant depends, in part, on the BDNF gene.

An important fact is that Chinese people typically have at least one copy of the less responsive BDNF allele, Met.

So in testing the effectiveness of ketamine treatment for these Taiwanese participants, the researchers were testing whether ketamine relieves depression in people with the Val/Met allele, and also whether the size of ketamine’s dose determines effectiveness.

Huge. AND exciting.

Ketamine: What’s dose got to do with it?

This was the first study to compare the effectiveness of two different doses of ketamine — 0.2 mg/kg and 0.5 mg/kg.

The researchers genotyped the participants and confirmed that the Met allele is the predominant BDNF gene in this specific group of people — they were Val/Met or Met/Met. In European descendants, the BDNF gene alleles most often seen are the Val/Val pair.

Another factor they explored was whether ketamine’s effectiveness varied depending on the severity of the patient’s depression.

Size of Dose Determined Effectiveness

All in all, they learned that lower doses of ketamine, such as 0.2 mg/kg, weren’t effective at all. (Good to know, because we’ve never used doses this low.)

So if you’re asking, “Ketamine: What’s dose got to do with effective depression treatment…?” you now know that tiny doses under 0.5mg/kg are too low to treat depression and other psychiatric mood disorders.

Only the higher dose, 0.5 mg/kg, was effective, which validates the current most commonly used starting dose, and the starting dose that we use, too.

Also, when they evaluated ketamine’s effectiveness in those with mild depression, they found it really wasn’t effective. (We’ll get back to this later.)

But it was remarkably effective in those with moderate to severe depression.

So, we know that ketamine is effective in people with moderate-to-severe and treatment-resistant depression. And we know it can be effective in people with the Met allele for BDNF — as well as in people with the Val allele, of course. All you Mets, take heart.

Questions That Need Answers

But there’s so much more to be explored.

More studies — for instance, to determine how ketamine infusions could be used to help you if you have mild depression. Using a different dose, different intervals…?

Don’t you wonder… what if a study were performed among subjects from an equal distribution of multiple BDNF gene variants… if we could learn more about what role the Val and Met alleles play in fast response or delayed response to IV ketamine treatment?

Or whether a higher dose than 0.5 is needed for those with the Met allele? Or a longer infusion? Maybe a longer series like 9 infusions instead of 6?

The more we learn, the more we can hopefully bring relief and remission. Relief and remission to adults and adolescents with suicidal thoughts, anxiety, depression, bipolar disorder, social anxiety, PTSD, OCD, and substance use disorders.

Exciting, isn’t it?

If you suffer from depression, anxiety, bipolar disorder, social anxiety, PTSD, OCD, suicidal thinking, or substance use disorders, there’s hope. At Innovative Psychiatry, most of those we treat with IV ketamine achieve remarkable improvement — as in remission — from their symptoms.

We use the most precise state-of-the-art methods of administration. We provide a thorough psychiatric evaluation of our patients’ needs and progress.

And we see people get better every day.

If you’re suffering from symptoms that haven’t responded to other treatments — or if you’re just tired of side effects that never end — call us, or send us a note here. You can feel better, with a new initiative, motivation, and joy. Soon.

To the restoration of your best self,

Lori Calabrese, MD

March 19, 2018
Help Your Kids Prepare for the Future: Learn Psychiatric Symptoms with Teens
Do you know how many students will be registering for college this year? Have you thought about it..? Take a wild guess.

Close to 4 million…! Can you imagine the diversity in that number? That’s more than the population of Los Angeles!

Serious Challenges for an Adolescent or Young Adult

In addition to the size of this group, there are also stressors this LA-sized group of people is facing for the first time in their lives.

Their first time to leave home, their first time to enter the workforce, their first time to be accountable to strangers on their own, while taking much harder classes than they’ve taken before.

They’re moving to a new place full of strangers, among whom they’ll hope to find friends.

Plus unlimited access to alcohol and illicit substances. Easy access to sex. And the responsibility to recognize within themselves signs of health changes…including mental health.

It’s a tall order. And every college and university is packed with a whole crowd of them each and every semester.

Going to College with Anxiety or Depression

If your teen – who’s becoming an adult – has already been diagnosed with a psychiatric disorder, you’re a step ahead in one sense. You and your child have faced the illness, and hopefully, she has adjusted to her medications. It’s much easier for a teen to go through that process at home than in another city, away from the comfort and understanding of her family.

You still need to devise a plan to help her maintain stability and go for help when the stability changes.

So it’s vital to her success that you ask her psychiatrist and therapist if they offer telepsychiatry so that they can follow her when she’s at school. If not, ask them for referrals in the area or contact the counseling office for therapists and psychiatrists near campus or in the area.

Then make calls and explore. If you can establish a connection with the professionals your son or daughter could see in case of difficulty, it will make it much easier for her to go for help if symptoms rear their ugly head.

Keep some things in mind:

1. She’s likely to make some mistakes… Don’t fix them. Listen and encourage her to think through some solutions.

2. Be sure she knows where to go to fill prescriptions.

3. Check on her regularly. Without hammering her with “mental health” questions, find ways to get updates on red flag areas. Clinical psychologist Bobbi Wegner says to watch the “trilogy of health”, i.e., sleeping patterns, eating, and energy. If any of these are out of whack, dig deeper.

Then, if something’s not right, remind her of the psychiatrist and therapist you found, and encourage her to make an appointment. If she can’t seem to do that due to anxiety, phobias, or depressive symptoms, you may need to intervene and help her seek treatment.

“My Son’s Resilient and a High Achiever. He’ll Be Fine.”

Famous last words… so to speak. What if your child seems resilient and confident about studies, friends, his life while he’s in high school…?

Don’t let yourself fall into la la land, and tell yourself no news is good news. That’s just not true.

l. Putting your head in the sand about potential mental health symptoms when your kid goes to college, is as silly as sunbathing on top of a travel trailer while watching an approaching tornado fifty yards away. Feeling confident isn’t going to determine the future.

What’s the saying…? Prepare for the worst and hope for the best. Learn about anxiety and depression just as you have learned about meningitis, pneumonia, and the flu.

2. Be prepared to hear your son say he’s overwhelmed during semester finals. Listen, and offer to help. Sometimes that’s all they need to hear… but if he wants to keep talking, welcome it.

3. Make sure your kids know it’s completely acceptable to ask for help.

Here are some tips for conversations to help your teen communicate his feelings and learn psychiatric symptoms:
- I’m so sorry you’re feeling like this. Do you have any thoughts about why?
- It sounds to me like you don’t want to go to class. Why do you think that is?
- What do you think is going on…?
- How can I help…?
- I’ve noticed so and so…, how do you feel about it?
Questions like this tend to open conversation while helping him figure out for himself what’s going on.

Start these conversations when your kids are young…so that by adolescence they’ll be building some skill to recognize problems – as well as solutions – themselves. This gives them equipment to manage their emotions and fears when they’re on their own.

Will Your Child Suffer Mental Health Symptoms in the Future?

Let’s open up communication with kids about their mental health…to prepare them for college and the future. Let’s learn psychiatric symptoms with teens, and build a family awareness together. It’s empowering, for you and for them.

There is no way to predict the responses your child will have as he enters – and forges through – adulthood. If he seems resilient now, that’s a great start. The child that appears to be the most resilient may continue on as a successful Unsinkable Molly Brown. Or he may find the harder he works, the more overwhelming life seems to become for him.

Especially if he suffers physical injury or severe emotional setbacks. Your resilient 13-year-old can become a burdened 28-year-old…or a disabled 34-year-old..if at some point he needs help and doesn’t get the help he needs.

Clearly, students need to be having conversations with their parents earlier. Mood disorders or learning disabilities need to be identified when they’re as young as possible. Then treatment can be in place before college is considered.

Further, if kids have struggled through middle school and high school with social anxiety, that anxiety may spread to more areas of life through increased pressure and stress.

Social anxiety combined with depression may morph to agoraphobia (anxiety in situations where you perceive the environment to be unsafe with no easy way to get away) given the requisite stressors. And agoraphobia can seriously interrupt a student’s progress for the semester.

Many parents who don’t worry about their high-achieving child have been shocked and felt helpless when he breaks under the pressure. That’s not to say you should be worrying…but rather proactively preparing, just in case.

When To Educate Yourself and Your Kids about Mental Wellbeing

Now, think about this: What if parents started the conversation when their kids are 11 or 12, and kept an ongoing dialogue about how things affect their child? What if a child grew into adolescence informed, so she could recognize suffering in her friends or herself?

What if she had learned to see psychiatric symptoms through the empathetic view of her family, rather than just as a list she and friends snicker about in health class?

Just as we parents talk to our children about sexuality, what if we talked to them about mental health? What if we learned together about signs and symptoms, and with that learning, also learned compassion…?

What if we started now, no matter what their age?

So what do you say about mental health if you’ve never discussed it before with your 17-year-old?

Maybe something like…”I’ve been reading a lot, and realize there’s a lot I don’t know about anxiety and depression. But I’m learning these disorders can happen to anyone…do you know anyone who suffers from something like this? panic attacks? social anxiety? mood swings?

Or if you see symptoms in your teen, maybe lay safety groundwork…” If I promise to not freak out, would you tell me how you’re feeling about things these days?”

The dialogue will see you through, and will usher them, into college safely and with confidence. And in the long term — through clear and transparent communication. Through empathy and respect for themselves and others.

Teaching Your Child to Take Care of Her Mental Health

By fostering an atmosphere of understanding and openness in your home, you can proactively learn – with your children – what mental and emotional well-being looks like. And how to recognize warning signs of illness.

You teach your children about sex. You teach them about drugs. Teach them about mental health, as well.

When your child has grown into a broad comprehension of health, encompassing physical and mental well-being, he can naturally seek out mental health professionals when he sees anxiety or depression symptoms in himself.

Prepare your child to care for his health and wellbeing. Help him locate mental health professionals as well as the campus clinic when he starts to college.

Sometimes Giving Your Child “Room” Is Too Much Space

Fearing the mistakes of “helicopter parenting,” many parents don’t recognize in their adolescents when it’s time to seek help. They give their child room to work through his own problems. Unfortunately, a severely depressed adolescent often lacks the energy or stability to seek the treatment he needs or make decisions about his health.

Way too often, these withdrawn teens feel like failures. And what may look like immaturity to parents and teachers may actually be psychiatric symptoms.

Psychiatric symptoms are not the same thing as a lack of “maturity.” In fact, untreated psychiatric symptoms can be an obstacle to the proper development of maturity.

Psychiatric Symptoms in Teens

There are also those teens who managed to get through high school without treatment. Who didn’t realize life and school wasn’t this hard for everyone else. They just keep pushing through, white-knuckling it every day, every week.

When they finally graduate, they hope they’ll be better now. But then the stressors of living away from home, carrying a heavy load of classes, keeping up with all the reading and assignments…well, it gets to be too overwhelming. Not to mention test anxiety in college students is through the roof.

They were able to continue functioning until now. Maybe they’re in their first or second semester. Then one day they go to bed in the dorm, and just can’t get up in the morning. Or the morning after that. Or the morning after that…. And finally, the guilt and shame and inability to face the pressure any more lead to failing grades. Academic suspension. Shame and guilt.

Their parents are blind-sided. Had no idea their daughter hadn’t been going to class. And they wonder why…?

By learning about mental health together with your kids, you both are prepared if anyone in the family…or friends for that matter… begins to exhibit psychiatric symptoms. So, rather than jumping to the conclusion that your child is rebelling or doesn’t appreciate the opportunity you are paying for him to have…you both can talk about symptoms.

Symptoms to Watch For

Remember the trilogy? Sleep patterns, eating, and energy.

Your child just may be too depressed to get out of bed. He may not have the energy to face his life. In fact, he may be eating constantly…. Or forgetting to eat altogether.

Your kid would not be the first or the 1000th kid who displayed these symptoms in college. But educating yourself and your children about what can happen when stress is too high, or in the wake of a tragedy, helps you all to productively respond if it does happen.

Helping your children learn ways to relieve stress as they’re growing up can also help. But above all, be informed, and help your children to be informed too.

If you have a child or young adult who seems to display symptoms of psychiatric mood disorders, call us. We can help him feel better and function at his best again.

At Innovative Psychiatry, we see wonderful results from the use of IV ketamine treatment in 80% of those who have not been helped by any other treatment. Remarkable relief, initiative, hope, and erasure of suicidal thinking. There’s nothing else like it to relieve symptoms and restore you to full function again.

To learn more about IV ketamine treatment, read this and this to get started. Also, if you don’t have children headed for college, but know someone who does, consider sending them this article to help them prepare, too. Niece or nephew? They might benefit by preparing now, to better manage what comes later.

Your child has his whole life ahead, and there are extraordinary ways to treat psychiatric mood disorders that we’ve never had before. Contact us for an appointment.

To the development of your teen’s best self,

Lori Calabrese, MD
March 12, 2018

error: Content is protected !!