Lori Calabrese, MD

Tag: Anxiety

Holidays with Depressed Family…How’s It Going for You?

Holidays with Depressed Family … Not Easy

Are you enjoying this holiday season…? This time of shopping, music, winter hats and gloves… hot chocolate and marshmallows. Sounds like a Christmas carol, doesn’t it…?

On the other hand, there’s another side to the holidays, isn’t there?

Is setting up the tree, and unwrapping all your ornaments, something you make time for, and do with quiet joy…?

Or is it something you cram into the 45 minutes between work and the holiday chorus concert while the kids scarf down McDonald’s and fight over who gets the last cookie…?

The traffic to go anywhere is jammed in gridlock…so driving home from work… well there’s no way you’ll ever get home.

That “Christmas Card” Family Holiday

Wouldn’t we all love to have that dreamy kind of holiday…?

Yes, maybe.

But I’d like to suggest that a “perfect Christmas card holiday” wouldn’t be as perfect as it sounds. And here’s why.

Because it isn’t reeeeally sitting inside a Norman Rockwall painting on the wall that scratches that itch we all have for meaning in life.

And because it really isn’t silent perfection that fills our hearts — no matter how pretty the picture.

But isn’t it the people…?

Isn’t it being with Aunt Sue who talks a lot, and Grandma Jansen and her raucous humor, and the wild and wooly cousins we grew up with…the crazies and the noise….?

Life is messy. It’s not a pretty little picture, and we aren’t images on a holiday card. And you could even have a fault or two yourself … right?

Holidays with Depressed Family Members Can Be Messy

But you love them. And they love you. You have history together. You’re family.

If you have some people in your family who are a bit out there, eccentric and even occasionally annoying, that’s part of the patchwork quilt that makes you who you are and gives your family uniqueness.

And…If you have family members or friends who have the challenge of managing bipolar disorder, depression, anxiety, PTSD … this may be a particularly taxing time for you and for them.

You know those stresses that turn your holiday moment into a chaotic nightmare…? As much as you feel the stress, they are possibly more distressed than you are. When you have all you can handle, and someone in the room makes a scene…or explodes into an outburst… or leaves and no one knows where he is…you want to pull your hair out.

Nothing wrong with that. You’re human.

In Family Gatherings, Stronger Ones Carry the Load

But, as you know, it’s also true that you may be a little more predictable. Your emotions may be a little more reliable. And you may be a little more skilled at managing them. These loved ones of yours probably do the very best they can. And they want meaning and love just like you do.

Of course, this isn’t news to you. You know all about all this, because these are your family members. You’ve been there…and done that. Still, it doesn’t hurt to get a little encouragement from others who also understand your situation. Sharing the holidays with depressed family members can be challenging at best…and sometimes downright traumatic for everyone.

Holidays Can Breed Crisis

Caleb was a young man in his twenties, who had been diagnosed with bipolar disorder when he was a young teenager. He’d had bouts in psych hospitals. He’d also had bouts in jail. And bouts in rehabs. By this point in time, his confidence in himself was pretty much shot.

He had such a gifted personality… you couldn’t sit in the room with him and not laugh your head off at his incredible humor. When he was good, he was your favorite person in the world.

But far too often, he was sick. Nosediving into depression and crippling anxiety. You could tell when his fun self was transitioning to his tormented self. And that could happen at any time. Sometimes there was a trigger that set him off. Other times it just happened with no warning.

Holidays were tough for him. His hopes were high and his anxiety that he’d fall apart were higher. You probably already can guess that the anxiety can lead to a panic attack.

So it was Thanksgiving, and the memories and interactions got to be too much and he left. Just walked out. He walked to a bridge in his community. He sat on the bridge and watched the traffic underneath, contemplating what he was going to do.

Thankfully, his family drove up soon enough. They’d been looking. And they held him…reassured him…and he agreed to get in the car and go home.

That Thanksgiving wasn’t a flawless Christmas card experience for the family…but isn’t it all about the people you love anyway? The family’s memory of that Thanksgiving was about safely returning home with him.

Depressed People Have So Much to Bear

Cherri was 16. She had been depressed so long she couldn’t remember what “happy” was like. She looked mad and sullen to those around her. But it wasn’t that. She was so numb. So silent. So hopeless. So paralyzed.

She thought about death. About relief. She had self-medicated with various substances in the past then spent 18 months in rehab. After she came home, she was white knuckling sobriety, but was still miserable.

Then her grandmother died a week before Christmas. She’d been so close to her. At times it seemed Grandma was the only one who understood her. At least it felt that way. Cherri couldn’t bear the pain.

The day of the funeral she ran away. She just couldn’t face everyone. She needed to be alone with her memories of Grandma as she knew her.

When the family arrived at the funeral home, they mumbled among themselves about Cherri’s selfishness to turn all the attention to herself. In their own pain and loss, they didn’t really realize it wasn’t about Cherri being selfish.

It was that she was so sensitive, and she could feel the feelings of the people around her. And she wanted to protect her private feelings about her grandma.

When the family returned home after the funeral, Cherri was alone in her room…looking at pictures of Grandma with the family.

People with Depression, Anxiety, Bipolar Disorder, and PTSD Need Extra Support This Time of Year

Holidays are complicated. The next few Christmases for Cherri may be tumultuous, too. That’s the way it goes. Everyone grieves in their own way.

For those of us who love vulnerable hearts who themselves suffer from anxiety, depression, bipolar disorder.…PTSD… may we be patient with our families, and with ourselves.

And accept life at this time of year as it happens.

Because it’s all about love … after all.

If you have a family member who is suffering, where treatment hasn’t helped, please call us. We’d love to help you and help your family. That’s what we do. We offer advanced treatment options, like IV ketamine treatment and TMS. We offer hope.

May your holidays be warm and heartfelt, and may you feel loved by those around you …

To the emerging of your best self,

Lori Calabrese, M.D.

December 4, 2017
Can You Overcome Phobias? Apply IV Ketamine to Your Backstory
Let’s talk about anxiety…and phobias.

I guess we all have something that gives us the creeps, or we’d just like to avoid, like snakes or spiders, or pet poop.

But for some people, there’s a strong persistent reaction to that thing or situation to the point that it’s amplified far beyond the actual potential danger or threat of the “thing” in question.

Most of us feel uneasy about something from time to time. Getting up to speak to a large group for the first time, for instance. You might feel a little shaky or have a tremor in your voice, sweaty palms, and the worst…? Blushing while you try to collect yourself to begin your talk! This level of anxiety is uncomfortable, but not all bad. It can help you focus on your goal…motivate you to work hard to prepare.

The Crippling Burden of Phobias

However, for some, the blushing can billow out of control, sending tremors through your body, along with trembling hands, incapacitating sweating, and a paralyzing halt to functioning.. When your mind is blitzed with fear, and you can’t move, it’s safe to say you may be trapped in the rigors of an anxiety disorder. And that thing or situation that triggered all this may be a phobia.

And you know what? All of this started somewhere. Something probably happened, something traumatic, or heartbreaking, or terrifying. At some point there was probably a shocking experience that initiated this response of heightened anxiety, dread, and fear. Whatever that was..it’s your backstory. Your history. The reason you now suffer this way.

There are as many phobias as there are people who suffer from them. Phobias tighten their grip on anxious people regarding anything from fear of embarrassment in front of other people to fear of spiders, or of a tree, or the color yellow.

It’s easy to make light of these fears if you’re not a sufferer, but for those who are, the fears are crippling.

So, an anxiety disorder is not to be ignored. Anxiety demands your attention. In fact, it takes over and dominates your mind until you do something to find relief and reassurance.

The throes of anxiety can lead to phobias, to depression, to obsessive compulsive disorder. It’s no laughing matter, and in some ways, it’s the flour in the recipe for psychiatric mood disorders.

Phobias Leave the Sufferer Powerless

Once you’ve experienced a gripping, fear-fueled shut-down, you’ll probably find yourself avoiding another opportunity for a similar incident.

If you’ve been there, you know you can’t just “buck up” using mind over matter, and “get over it” as friends or co-workers might suggest. You can’t wish this reaction away. And time doesn’t automatically heal it. It’s embarrassing to be incapacitated by anything. People don’t usually understand.

Typically, phobias are divided into 3 categories.
- Simple phobias, like fear of a snake or dental work or air travel
- Social phobias are fears of embarrassment or humiliation in front of others, and play on feelings of insecurity
- Agoraphobia, the fear of being in a situation it would be hard to escape from… whether it’s fear of embarrassment or fear of harm
And it gets complicated. In any of these situations, if you suffered a panic attack, that panic attack can become the thing you’re afraid will happen again. So you avoid the situation for fear of suffering another attack.

Painfully Common

Anxiety can lead to one phobia or another, because when a persistent dread plagues you to the point that you arrange your life around a thing or event with the focus to avoid it, a phobia begins to form.

Around 3.3 million Americans at some point in their lifetime suffer from an anxiety disorder. Roughly 19.2 million Americans wrestle with phobias.

And anxiety often comes before depression.

We’ve known this for years. A very large study of thousands of female twins with major depression who all had various phobias — agoraphobia, social phobia, situational phobias, animal phobias — found that the most common phobia associated with major depression was agoraphobia.

Another conclusion was that a “modest proportion” of the genetic vulnerability (remember these are twins) to major depression is shared with a genetic vulnerability to phobias. What’s more, the non-genetic factors — like environmental experiences — that can predispose someone to depression, significantly makes a person more vulnerable to agoraphobia, specifically.

Risk of Agoraphobia Highest After Trauma

This means, if you’ve experienced something excessively painful, traumatic, and overwhelming in your life, your risk for agoraphobia is high. And the trouble with agoraphobia is that it isolates its victim…which makes the depression worse.

So, you can see the link between anxiety, depression, and phobias. And you can also see that treating the anxiety can even prevent the depression as well as phobias. But how?

There are some medications that will relieve anxiety, as well as depression, in some people. But, as we’ve discussed so often, those antidepressants and anxiolytics don’t end the anxiety, they just reduce it…for some people.

To the frustration of countless sufferers, the effectiveness of these medications for anxiety and/or depression is patchy… and it takes weeks or months for any given person to find out if she’s going to experience relief.

Those weeks and months can be a dangerous waiting period for those whose misery is leading to thoughts of suicide. And unfortunately, so many of these medications seem to stir up those very self-destructive thoughts.

Can You Overcome Phobias…?

Here’s good news. IV ketamine in low doses has shown consistent results in 80% of those who suffer with anxiety and depression where nothing else was effective. Nothing else brought relief.

So, that’s how IV ketamine works on your backstory… it restores your brain to its optimum function by targeting the structures and systems in your brain that lead to anxiety…and depression. IV ketamine treatments focus their effects on those changes in your brain that happened when you were hurt, traumatized, shocked… and began experiencing feelings you want to avoid. When the phobias began.

And within minutes or hours of the infusion, suicidal thinking can disappear, and those thoughts are forgotten. In their place is relief, like a ton of weight has been lifted off the sufferer’s shoulders. The previously sullen, nervous, fidgety feelings dissipate during the course of treatment, and the power to enjoy life blooms.

Three treatments a week for two weeks. That’s a typical treatment course. And your outlook becomes lighter throughout the two weeks of infusions. Lighter as the dread lifts. And lighter as the fear melts. Even lighter when the depression dissipates. Free of suicidal thoughts.

A recent study published in the Frontiers in Cellular Neuroscience Journal demonstrated that long-term ketamine dosing can help erase fear memory … (which is what leads to phobias) … through DNA methylation of brain-derived neurotrophic factor.

Another thing… You may have read about the “problem” that ketamine isn’t lasting. But that’s the reason for the 6 session treatment protocol. Once you’ve had those 6 or so infusions, you’ll realize how much you really feel like the you that had been submerged all these years.

Hope.

Real hope. And relief from the albatross that’s weighed you down.

Fear. Dread. Nervousness.

No more. Can you imagine??

In some cases, we find it helpful to continue a monthly maintenance infusion. And that’s all it takes to give the freedom, energy, insights, and power to rebuild your life again. The power to confront your fears . . . with confidence.

Now, if you can’t remember when you were really yourself, without the sullenness, depression, listlessness, agoraphobia and more… then you’re in for a treat.

Many patients say they’d lost sight of who they really were, of what it was like to be at ease.

It’s almost miraculous.

If you’ve suffered from an anxiety disorder that doesn’t get better, or phobias that rob you of your freedom, call us or arrange an appointment. It’s our privilege to thoroughly evaluate you, your DNA, your history, to determine the best outcome for you.

We live to see you well. Let’s do this together.

To the rediscovery of your best self,

Lori Calabrese, M.D.
July 21, 2017
No. 7 Medical Innovation for 2017: Ketamine for Treatment-Resistant Depression (Video)

Hope and Fast Treatment for the Severely Depressed.

For one-third of U.S. patients with depression, standard medications aren’t enough. With nearly 43,000 suicides a year, the need for effective treatment looms large. In 2013, ketamine, a drug commonly used for anesthesia, was studied for its ability to inhibit nerve cells’ N-methyl-D-aspartate (NMDA) receptors. Within 24 hours of receiving ketamine, 70 percent of patients with treatment-resistant depression saw an improvement in symptoms.Cleveland Clinic experts predict that 2017 will be the year that NMDA-receptor-targeting medications become widely available.

In this video, learn why ketamine for treatment-resistant depression is one of Cleveland Clinic’s top 10 medical innovations for 2017.

[Read the Original Article]

May 31, 2017
IV Ketamine + Neuroplasticity = Relief, Relaxation, and Relishing Life

I could use some of that. We hear that all the time. Relief, relaxation and relishing your life can sound so far away … but it doesn’t have to be. As word gets out about IV ketamine treatment for depression and other psychiatric mood disorders, more and more studies are emerging.

New information is surfacing about the effectiveness of this medication. And it’s inspiring more discussion, more research, and deeper understanding of the causes of depression.

And there’s more.

As evidence grows through research and clinical data, it seems clear that depression interferes with the neuroplasticity in the brain. Including diminished neurogenesis in the hippocampus and diminished synaptogenesis in the prefrontal cortex. In other words, depression messes with the growing neurons or brain cells and the synapses or connections that allow the neurons to communicate with each other.

A big factor in this is that stress reduces an important growth factor called BDNF, or Brain Derived Neurotrophic Factor. Sort of a “compost” for neurons. Without BDNF, your neurons become tattered and sparse.

They diminish in size and number … and thin out.

When you’re depressed, these measly neurons with their poor synaptic connections just have a much tougher time communicating with each other … so there is less creative thought, if any. Well-being tanks. And your world becomes darker, less hopeful, and without future. It’s a bad place to be in.

A brain that is well-connected is a brain that experiences creative thought and well-being. A brain in the dark is a depressed brain.

IV Ketamine + Neuroplasticity

Here’s where neuroplasticity comes in. (Don’t let the word shut you down.)

In this context, plasticity refers to the brain’s ability to change at any age … whether for better or for worse. So the term “neuroplasticity” refers to the ability of your neurons to adapt and remodel themselves. In the past 10 years or so, neuroscientists have come to understand that your brain is constantly remodeling itself throughout your life. And when it remodels itself, it remodels its networks, And because of that, it remodels how it works.

So, to put it briefly, when you think dark and despairing thoughts, or angry and vindictive thoughts, day after day after month after year, this thinking actually reshapes and remodels your brain. It’s kind of shocking, really.

The brain remodels itself. Your brain remodels itself.

Dark, negative and hopeless thoughts have a detrimental impact on your brain’s structure and on how it functions. Your brain changes to fit your thought processes … to respond to your stressors. By the same token, if you read inspiring and creative books, spend time with joyful people, and create joyful experiences, your brain can change over time for the better.

The very structure of your neurons can change — in a lush way. Richly. For the better. For your good.

Wow.

This is where people say, “I want some of that.”

Well, this is an oversimplification, of course. It doesn’t account for all of the different factors, illnesses, and environmental influences that shape the way your neurons look and act — grow and function — but it IS an illustration of one way the brain can change. At any rate, It appears that one reason IV ketamine treatment is so effective for so many different psychiatric symptoms is because of the way it enhances neuroplasticity in the brain.

Growing Your Brain Structure Garden

For example, when you take the time to learn a new language as an adult, you’re putting parts of your brain to work that respond by growing to accommodate.

A study of taxi drivers in London revealed that through the process of memorizing the streets of London to pass certification, that a specific structure in the brain enlarges to manage that information. The hippocampus is the memory center in the brain, and this study revealed that drivers who’d been driving taxis for decades had the largest hippocampi of the group.

Just an example to show how the brain changes with the right type of stimulation.

By the same token, the amygdala is the fear center in the brain, and it’s been studied extensively in childhood trauma, and in adult anxiety, depression, and bipolar disorder. The newest research shows that the size of the amygdala can change rapidly in response to recent stressors — even in people who’ve never had any of the these conditions. The left amygdala was smaller in people who’d had a recent stressor — it didn’t even have to be longstanding or chronic. And the shrinkage was enough to be seen on an MRI.

So here’s the point.

Ketamine’s Rapid Action

Ketamine acts rapidly in numerous ways, and its fast action is changing lives, as well as saving them. It stimulates changes in the brain that affect its structure and its function.

One example is that it quickly matures new neurons so they’re functionally mature and doing their job within 2 hours. Traditional antidepressants just can’t do this. As more neurons proliferate, mature, and migrate from the hippocampus into far-reaching brain regions, ketamine also stimulates the formation of more synapses, especially in the prefrontal cortex. The greater the communication throughout the brain, the better functioning the brain, and the greater the well-being of the individual. You.

The more synapses that are generated, the more neuroplasticity, or ability to change and grow, the brain will enjoy. And a growing, adapting brain provides a higher level of living and learning for you to experience. Plus a greater sense of joy and well-being.

Let the Sunshine In

It’s as if the proliferation of neurons – and the synaptic connections that empower them to communicate – opens doors and windows in the brain to let the light and fresh air in. This wonderful circulation of signaling gives the brain new thoughts, new hope, new relief.

Basically, IV ketamine + neuroplasticity = relief, relaxation, and relishing your life.

If you’d like to know more about innovative treatments for your psychiatric symptoms, please call for an appointment so we can evaluate what’s going on.

Innovative Psychiatry is committed to help you find and develop your best self. Let’s work together.

Joining forces with you to discover your best self,

Lori Calabrese, M.D.

April 18, 2017
Ketamine Wannabe Drugs … of the Future

Ever have somebody copy you? You know, try to be like you? Imitate what you do, where you go? try to get what you have? They wannabe like you. Well, maybe not just exactly like you — kind of like you and better than you all at the same time.

It’s happening with ketamine.

We’ve been talking for awhile now about the breakthrough of low dose IV ketamine. In fact, everybody’s been talking about ketamine for treatment-resistant mood disorders. We’ve expounded on its effectiveness in relieving suicidal thinking, treatment-resistant depression, and other psychiatric disorders. Did you catch the discussion about which route is most effective and why we use it? Check it out here.

You should know about all the ways it’s changing the horizon for psychiatric treatment. Like how it stops suicidal thinking within hours, rather than weeks. And how people who have lived with depression and despondency for years — no matter what medication they were taking — can feel depression just lift within hours. Maybe you’ve been there yourself, or you know someone who has.

But there’s more to talk about.

The discovery of ketamine’s therapeutic effects on depression has opened doors to more revelations of the chemical sort. Mechanisms of action. Delivery systems. Ways of leveraging the funding of pharmaceutical companies to develop more versions of ketamine, maybe with the same or similar benefits, but without any side effects …

Think of it like this:

Ketamine wannabes want to “be like” ketamine and wannado like ketamine — except better, without side effects, for longer.

But it turns out that’s easier said than done.

Since ketamine is no longer under patent, it’s unlikely that a pharmaceutical company would be interested in investing the necessary funds to conduct extensive trials and research about its effectiveness to treat mood disorders at this stage … at least on ketamine specifically.

Or that a company would shell out time and money to study long-term response and remission rates, or long-term safety, for a well-known generic like ketamine — even if it is being used in a new way in new settings to treat new conditions. There just wouldn’t be the return on investment in the long term.

However, by making changes in the molecules and targets that provide the therapeutic results for ketamine, new versions of the drug in the form of ketamine wannabe compounds that specifically target mood disorders are being designed and developed, and are in the race for FDA approval.

Ketamine Wannabe Drugs

So grab your chemistry lab goggles, and let’s explore some of these molecular discoveries among ketamine-wannabe molecules.

Ketamine is a racemic compound — it has two parts that are mirror images of each other joined together like Siamese twins. If we split it right down the middle where the mirror images join — presto! — we have two “new” drugs. One faces right and the other faces left. We call the left-facing one “S” or in the world of pharmaceuticals, “es–” as in esketamine. So it turns out in this case that changing the structure of ketamine slightly could give us the same benefit, hopefully fewer side effects, and easier use. In other cases, molecules like ketamine are coming down the pike that act on similar targets or in similar ways to help with depression without some of the potential side effects of ketamine.

They both wannabe and don’t wannabe like ketamine. They wannado better.

Esketamine

Esketamine has been approved in Europe for a decade and a half – specifically for anesthesia – and Janssen Pharmaceuticals has acquired a patent to utilize it in the US as an intranasal spray for treatment-resistant depression.

The Food and Drug Administration has awarded “breakthrough” status to esketamine to zoom its advancement through to approval with less interference from various obstacles and the usual red tape that slows everything down.

They plan to specify it for use it in a clinical setting (as opposed to at home) for the sake of controlling the dosage, as well as to prevent sale on the street.

Rapastinel

Another pharmaceutical company – Allergan in Dublin, Ireland – has designed a peptide in this same “ketamine-like” category. You may know that a peptide is a chain of amino acids bonded together in a specific way, and this one looks pretty effective as an adjunctive treatment in depression. It has characteristics like being fast-acting and long-lasting and it’s given as an IV infusion, like ketamine.

Ketamine’s action with NMDA receptors is to block ion channel activity. Here’s where rapastinel is different. It binds to the glycine site on the receptor and regulates or modulates it by changing the shape of that site. Pretty cool. The result is that rapastinel reportedly has a minimum of dissociative or out-of-body side effects that are sometimes experienced with IV ketamine infusions.

Rapastinel is in Phase III trials in the US as an adjunctive treatment for major depressive disorder, and more trials are expected in Europe and Japan. Soon, it’ll be ready for FDA approval for use in the clinical setting to treat depression.

AV-101

Still another pharmaceutical company in San Francisco is working to create a small molecule drug that possesses all the good traits of ketamine without its potential dissociative side effects: VistaGen Therapeutics.

This molecule is one that’s back on the scene from over 30 years ago. At that time, it couldn’t cross the blood-brain barrier to do its work. And consequently, couldn’t impact the depressive symptoms a person was experiencing.

But now, the molecule (which is considered to be a “pro-drug”) has been revamped and this current version does cross the blood brain barrier, And when it does, it’s metabolized from a pro-drug into an active drug that modulates a certain glycine binding site at the NMDA receptor — unlike ketamine and different from rapastinel.

So while ketamine completely blocks certain NMDA receptor ion channels, AV-101 just sort of regulates the receptor gently…which seems to result in gentler side effects.

A New Frontier – Ketamine and Ketamine Wannabe Drugs

There are plenty more versions of modified “ketamine wannabe” molecules in the wings, developing to hopefully even replace ketamine at some point. Hoping to improve on ketamine’s action. Aspiring to lesser side effects. Working towards easier administration. We’ll just have to see how that goes.

And one day this miraculous breakthrough medication – ketamine – may become obsolete like so many cornerstone discoveries of the past.

But right now, boy are these exciting times! We’re on the threshold of a brave new world in psychiatry. A world where people who’ve suffered without relief for years, even decades, can finally experience relief and build a fulfilling life.

One last thought…

All of the companies working with these small molecule drugs are investing in priceless research that’s opening more doors and windows of understanding –. which will, in turn, only increase the benefits for people who just haven’t responded to or tolerated anything else.

For example, we know that ketamine, rapastinel, and AV-101 all work at the NMDA receptor site. So it’s been assumed that that action is the key to their effectiveness. However, when researchers blocked the AMPA receptor, none of these drugs worked. I’ll say it again. None.

Which revealed that the AMPA receptor needs to be activated for the drugs to deliver their fast antidepressant, anti-suicidal results.

And this revelation may lead to more breakthroughs for more who suffer … through ketamine wannabe drugs.

We’re on this. We stay up at night. We watch closely to glean all we can from the research that’s exploding, so we can continue to provide the most up-to-date, cutting edge, fresh discoveries that neuroscience offers.

And…we’ll be here to help you find your best self.

So call us, and let’s find the right innovative solution for you.

To the emerging of your best self,

Lori Calabrese, M.D.

April 12, 2017
IV Ketamine and Treatment-Resistant Mood Disorders

IV Ketamine and Treatment-Resistant Mood Disorders

After reading today about a beautiful young man – let’s call him Tom – whose life ended tragically at the crossroads of despair, I started thinking.

Like many of my own patients, he had a wondrously warm and giving heart — and a compassionate heart the size of Montana for homeless animals.

His talent for music generated moving, exquisite collections of melody and lyrics that stunned listeners with its charm.

Such sensitivity, such beauty for the world to enjoy.

But his life ended far too soon, because he could find no relief for his illness.

Bipolar disorder.

Tragedy Without IV Ketamine

I’ve treated many people with similar stories in my office. I’ve offered the best that we had–medications, combinations, the latest research, the newest adjunctive treatment, supplements, recommendations for lifestyle changes, collaboration with the the best therapists in the area, resources, articles, support–everything I had. I never stop trying. But until a few years ago, we had little to offer those who didn’t respond to traditional treatment. Or who were just sick of it.

And that’s tragic. Really, really tragic. But more common than we can bear to think.

It’s not just about bipolar disorder or treatment-resistant depression. We’re talking about postpartum depression, PTSD, and other psychiatric mood disorders.

I thought about Jacie. Jacie wasn’t expecting to get pregnant when she did, but she was happy about it, and enjoyed the feelings of wonder about this tiny new person growing inside her.

But around the time her second trimester began, she noticed her initial lilting emotions weren’t lilting anymore. In fact, she felt gray…dull…and couldn’t seem to relate to the idea of a baby.

Once the baby was born, everything was a struggle. She felt angry, frustrated, and exhausted beyond belief. And guilty that she wasn’t enjoying this innocent baby girl. In desperation, she talked to her doctor honestly about how she had been feeling. And her fear she might do something to hurt herself or her child.

He referred her to a psychiatrist he trusted, and she began seeing her. Her depression had gone on a long time — untreated.

IV Ketamine and Treatment-Resistant Mood Disorders

When depression comes during pregnancy, it can be so much worse than postpartum depression that begins after the baby is born … and so hard to treat. In Jacie’s case, her depression didn’t budge, and the persistence of it affected her relationship with her baby, and her marriage.

She was surrounded with people who loved her. She was fortunate in that sense. But nothing seemed to ease the agitation and misery she endured. Or her self-hatred and guilt that she resented her baby and didn’t know how to change it, or feel better. To be the kind of mom her baby needed.

Traditional antidepressants and psychotherapy just aren’t effective for some people. If you’re one of them, or you know one of them, you know what I mean. Since depression is caused by a complexity of changes in the brain, there’s no simple solution.

And in my musings, another man came to mind — Dan. He’d suffered with PTSD for over 15 years. War time trauma, loss of friends in combat and the powerlessness he felt to save or protect them; it all tormented him.

He’d been told he should be “getting over this” by his friends and his family. Oh, they meant well. But they had no idea what they were saying. And suggestions like those didn’t help. Not at all.

He struggled just to get through the day … to have a relationship with his wife … to work at a job, to pay the bills.

He wanted to be productive, but every time he had a few good days or weeks, it didn’t last because of the dreams, the night terrors…the reactions to noises or touch. Then he’d lose his confidence, walk off the job, and withdraw again.

The loss of life, of peace, of relationships, of fulfillment, for people like these has been unavoidable till now.

For those who couldn’t benefit from the traditional treatments for mood disorders, there just weren’t any solutions. IV ketamine and treatment-resistant mood disorders went to war.

Your treatment-resistant mood disorder won’t win over IV ketamine.

These stories are just examples, but they represent multitudes of individuals whose lives have been interrupted, oppressed, tormented, or in some cases cut short, by symptoms of disorders that remained unaffected by traditional treatment.

And that’s why I thought of all of these people.

Because the ineptness of so many antidepressants left me feeling powerless to help; too many of my patients were crippled by their disorders, but desperately wanted the same chance at building happiness and fulfillment as anyone else.

Too many.

And that’s why I’m excited now and so full of hope.

That’s why I talk so often and so enthusiastically about this emerging frontier of new therapeutic uses for that anesthetic-turned-antidepressant, IV ketamine.

Because for all all the Toms, Jacies, and Dans who found no help at all from previous treatments, 80% now experience relief, restoration, and often total remission after IV ketamine treatment.

We’re still working to find solutions for that other 20%, and we won’t stop. But we’re helping 80% of those for whom we had nothing, nada, zip…zero… that would help.

All my training didn’t prepare me for the heartbreak of those who are so desperate for relief and can’t find it. But hope is growing, and ideas are flourishing for ways to use this new knowledge to spawn more solutions.

Relief and Solutions are RISING

So after my musings about those who weren’t helped, and the sadness I feel that we didn’t find solutions soon enough, it’s exhilarating to know there’s an entire frontier opening. A new world of treatment for those who weren’t helped before, through the discoveries surrounding ketamine for depression and other new solutions that will spring from it.

IV ketamine and treatment-resistant mood disorders … it’s a fight to the finish, and ketamine is winning.

Are you wondering if you’ll ever be able to have a life…? If you’ll ever get to feel stable — emotionally, financially, socially?

You really aren’t alone. Sometimes you just can’t see there’s support at your fingertips… help just beyond your line of sight.

Reach out and let’s talk about the things in your life and feelings that interfere with the power to live life the way you want to.

Power to find your best self, and share it with those around you.

Power to enjoy.

To the power for finding your best self,

Lori Calabrese, M.D.

April 3, 2017
IV Ketamine: Doing What Prozac Can’t

Excitement about IV Ketamine

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

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

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

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

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

What Would You Do?

His answer?

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

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

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

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

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

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

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

More Questions

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

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

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

Most Promising Since Prozac

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

IV Ketamine: Doing what Prozac Can’t

No new medication for depression since Prozac!!!

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

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

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

Period.

IV Ketamine – Doing What Prozac Can’t

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

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

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

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

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

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

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

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

Now they are.

IV Ketamine is Changing – and Saving – Lives

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

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

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

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

You can feel better.

Much, much better.

To the release of your best self,

Lori Calabrese, M.D.

March 22, 2017
How Ketamine Turbo Boosts Brain Compost to Improve Your Mood
In a recent post, we talked about the impact of Brain Derived Neurotrophic Factor (BDNF) on the prolific development of neuronal synapses, or nerve connections, in the brain. BDNF is like a rich, organic compost that spurs dense growth. And we talked about how IV ketamine turbo boosts brain compost and multiplies the connections in your brain that improve your mood and sense of well-being.

Ketamine Turbo Boosts Brain Compost to Improve Your Mood

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

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

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

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

BDNF on Steroids

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

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

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

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

Take a Look at Your Beanstalk, Jack!

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

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

But then, does that change as time goes by?

Ramshackle, Rundown Garden

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

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

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

It feels like a wasteland.

IV ketamine treatment can change that.

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

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

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

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

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

And how about you?

How is your brain garden?

Is it prolific with verdant life and freshness?

Or does it need a turbo boost?

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

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

To restoring you to your best self,

Lori Calabrese, MD
February 23, 2017
Your Microbiome: How It Affects Your Mood

What Is Your Microbiome and Why Does It Matter?

In the last five years, researchers have learned more and more about the the organisms in our own intestinal tract, our microbiome. Let’s talk about the connection between those organisms and their affect on our physical and mental health, for better or for worse.

The types of specific organisms that flourish there have a strong influence on the function of the brain and nerve pathways — and, therefore, on your mood and peace of mind.

What does Depression have to do with your belly?

Anyone who suffers from depression may know there’s an inherited tendency for that to occur. If either of your parents also struggled with depression, the chances are stronger that you might, too. But beyond your own personal DNA, there’s another huge area of DNA that may influence the moods you experience far more.

Deep within your intestines is a community of microscopic bacteria which are both helpful and harmful. This community of trillions of mutually beneficial microbial cells make up the bacteria of your gut. We call it your personal microbiota. Each of these cells contains genes, and the combination of the genes in all of them is your own personal microbiome.

If the genes in your microbiome influence low stress and a positive outlook, the effect on your mood is likely to be positive. But if the genes in your microbe-flourishing gut are favorable to high stress and melancholy, the impact on your outlook is likely to push you into a rut of stressed living.

For the most part, this microbiome is friendly and beneficial to your digestion. It makes use of far more nutrients from your food than would be possible without it. However, in recent times, scientists discovered that this same community of bacterial organisms are to blame for inflammatory and autoimmune diseases like atherosclerosis, asthma, and autism.

You can change your life

Learning to understand the microbiome and even influence its effect is potentially a superbly rewarding endeavor.

So we have to ask: if this teeming ecosystem of bacteria in our intestines can accomplish good productive health-promoting feats, or trigger destructive diseases that can cripple us for life, is there a way to affect this microbiome so it does good and not evil?

To better understand the answers to this and other questions, we need to understand how the natural flora in the gut exchanges information and products with the brain.

The vagus nerve can bring the strongest guy to the ground

And it turns out there’s a nerve that connects the two, called the vagus nerve.

Have you ever seen someone faint at the sight of blood? This fainting reaction happens when the vagus nerve tells that person’s brain to suddenly dilate blood vessels in the body, which results in fainting… and they go out like a light.

It’s the reason that you might see a picture of something gory, and feel a sick feeling in your stomach right before your brain declares “lights out” and you fall to the floor. It’s the vagus nerve that sends those signals.

So with that in mind, what does the vagus nerve communicate to the brain, and what determines that choice?

Think of it this way:

When friendly, health-promoting bacteria ( probiotics) dominate the environment in your gut, those bacteria tell the brain that the environment is favorable for an upbeat mood. Then the sullen melancholy feelings mysteriously melt away. Nutrients and protein are sent to the brain to nourish that upbeat mood, and your glum outlook subsides.

But the opposite is true if the dominating bacteria promote depression, stress, and anxiety.

The gut is the largest organ in the immune system? Really??

The gastrointestinal system is the largest organ in the immune system. This flourishing ecosystem of bacteria can have a positive or negative effect on other aspects of your well-being. So it’s important to your daily welfare to understand how this happens. Then you can take action to promote the best possible environment in your gut for your best well-being and mental function.

Certain bacterial families weaken your immune system, decrease your confidence and emotional stamina, and promote a chronic long-term condition of high stress.

Others reduce stress and promote wellbeing and resilience.

Studies have shown that the more extreme stress is in your life, the community of symbiotic organisms in your gut will create a favorable environment for chronic stress, and unfavorable for mental relaxation.

Stress or Relaxation

Just as “birds of a feather flock together” so it is with these organisms. If you allow stress to go unchecked, the bacterial environment in your gut will shift. And it will come to match that ecosystem of stress and illness. Over time, you’ll find you feel locked-in and stuck in that stressful lifestyle and the outlook that goes with it.

But, it’s also possible to actually change the environment in your gut. It can be made to support low stress, an upbeat outlook, and energy to enjoy life. And you can do it through the foods you eat, the things you do for pleasure, the amount of sleep you get, and more.

For instance, studies have discovered that when lab animals were given probiotics, their high anxiety behaviors were calmed and their immune response was normalized, as well as their apparent relaxation.

Psycho-biotics

If probiotics do that much for lab animals, how much more will they do for you?

Certain bacteria in specific families are considered “psycho-biotic” organisms because, like the probiotics just mentioned, they have an antidepressant effect on the brain.

Further, through systems involving these gut microbes, nutrients are processed and passed through the blood-brain barrier. That improves the relaxation of processes that take place in the neurons. (The nerves that carry information signals to and from the brain.)

The point here is that these probiotic systems are even equipped with a transport to make sure the right nutrients reach the brain and produce the hoped-for results.

This is all great news for those of us who feel we drew the short straw concerning mood disorders in our family tree. It turns out that by investing in the mountain of genetics in our gut microbiome, we have the power to turn our genetic destiny on its proverbial ear.

Watch for my blog next week. Learn more about good microbiota to nurture. See a list of actions you can take, foods you can eat, and factors you can include in your daily life. All of this will ensure your probiotic heroes are flourishing in your gut promoting your best, most productive, and well-adjusted self.

To the flourishing of your best self,

Lori Calabrese, MD

If you’ve suffered from depression, anxiety, or other mental health obstacles and have not had relief, Dr. Lori Calabrese, MD offers innovative psychiatric solutions. Contact us here for an in-depth evaluation. We’ll learn which solutions could work for you best and transform your life as you know it. We’re here to help you find your very best self.

November 24, 2016
How to Stay Present Through Emotional Pain

Coping with emotional pain may leave you feeling like life is passing you by. It can be difficult to remain focused on the present while you’re dealing with emotional pain, but it’s crucial to do your best to live for each day. If you’re having trouble staying present through emotional pain, here are some tips to help.

1. Expose Your Fears

At some point, we’ve all experienced the fear of losing control. Many people feel as though they have to control their feelings and emotions during trying times, but you need to let this go. In order to fully heal from emotional pain, you need to relinquish control by exposing your fears.

2. Label Your Feelings

Recognizing and labeling your feelings is another way to stay present through emotional pain. This allows you to fully understand what you’re feeling and why you’ve having those feelings. It greatly enhances your mindfulness because you’re focusing on what you’re feeling at that exact moment.

3. Let It Out

Sometimes, you just need to sit down and have a good cry to release all the emotions you’ve been carrying. Crying is a sign of strength and not a sign of weakness so don’t be afraid to let your emotions run down your cheeks. After a good cry, you may find yourself feeling a little better and able to focus more on the present than before.

Dealing with emotional pain can be difficult but it’s important to remain focused on the present. Try your best not to let your emotional pain keep you from enjoying the little things life has to offer. To learn more about staying present through emotional pain, or to schedule an appointment, contact us at 860.648.9755.

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

November 3, 2016

error: Content is protected !!