Lori Calabrese, MD

Tag: innovative psychiatric treatment

  • Bipolar Disorder in Teens: Early Treatment Leads to Better Outcomes

    Bipolar Disorder in Teens: Early Treatment Leads to Better Outcomes

    Teen girl loves her grandmother shows that when bipolar disorder in teens: Early treatment leads to better outcomes.Don’t you just hate it?

    Hate the drudgery and pain of fighting an illness that doesn’t respond to treatment?

    Granted, there are some illnesses that you can find remedies for, and recover.

    Maybe a steroid injection, or an antibiotic, and you start noticing improvement in a couple of days.

    But not all disorders are like that, unfortunately. You know what I’m talking about . . .

    Sometimes It’s Hard to Get Better

    Some are much harder to fight, more complicated to treat, and the prognosis is less predictable.

    Like cancer, for instance. Or multiple sclerosis … or Lou Gehrig’s disease. Some respond better to treatment than others, and some illnesses make recovery almost impossible.

    If you have bipolar disorder, you may have noticed that the longer you have it, the less you seem to improve.

    Long term treatment failed for this lady because bipolar disorder in teens early treatment leads to better outcomes.The older you get … the longer you’ve been treated. And the more medications you’ve tried, the more the symptoms seem to get worse.

    Now that’s not the case for everyone. Some people see a psychiatrist for the baffling mania they’ve experienced. They can get on a schedule, take their meds, follow their prescribed lifestyle plan, and they feel better and better.

    But not all.

    Some spend all their savings seeking treatment, following their doctor’s advice, getting help from family members to keep medications on schedule … And years go by without improvement. Symptoms swing more and more out of control. And work performance deteriorates, becoming almost impossible. Family relationships become more strained… if not broken.

    Why is that?

    Bipolar Disorder Can Become Treatment-Resistant Over Time

    A certain group of psychologists and neuroscientists wanted to know the answer. So they pulled together a pile of 8 papers and 2 more meta-analyses, which involved 8942 patients.

    If meta-analysis is a new term to you, here’s a short explanation. When researchers do a meta-analysis, they combine the information from a number of different studies to see what the consistent outcomes are — despite all of the differences across the studies.

    So you can try to imagine how many studies had to be used, and how many different factors had to be analyzed, to learn about the experiences of these almost 9000 patients.

    Five of the studies compared the first manic episode with those that followed. The others compared those with fewer episodes and those who had more of them. The result of all this . . . ?Teen mania episode needs treatment now because bipolar disorder in teens: early treatment leads to better outcomes.

    Those who received psychotherapy and/or medications at the earliest stages of the illness had the best outcomes across the board. Best outcomes in terms of symptom severity, social function, relapse, remission, and employment.

    The take home message is . . . the sooner you are treated after your first manic episode, the sooner you feel better, are able to manage your symptoms, and continue with a rewarding life.

    On the other hand, the more you cycle, the further you advance into later stages of this illness, the less effective your therapy and medication treatment become. So … the more likely you are to experience more cycling and more impairment … and the less likely you are be able to function in a job or support yourself.

    And there’s more . . .

    Bipolar Disorder in Teens: Early Treatment Leads to Better Outcomes

    Another study in Bethesda, Maryland, scrutinized patients at the date of entry into their network, the Bipolar Collaborative Network, to determine whether their date of entry was associated with early onset of the disease. They determined that those who entered the network at a younger age were more likely to have had an early onset of the disease as opposed to those who entered the network at an older age. And those who entered at an older age were less likely to have people with the disease in their family.

    They also found that those who developed manic symptoms at younger ages were more likely to have parents or grandparents with bipolar disorder.

    So, this all comes down to a major conclusion:

    Outraged teen from manic episode needs treatment now because bipolar disorder teens early treatment leads to better outcomes.

    Since bipolar disorder needs to be identified, diagnosed, and treated quickly after onset, it’s important for family members to recognize the symptoms to help your loved one seek and receive treatment…as soon as possible.

    To that end, here are some symptoms of mania to watch for:

    There is almost nothing else in psychiatry which can develop so quickly and be so devastating. Manic symptoms, or mildly-manic symptoms, which we call hypomania, can dig you into a hole fast. So we teach our patients and their families to look for symptoms that occur at the same time that they are developing marked mood swings, or an elevated or irritable mood:

    • episodes of high energy, excessive happiness, or irritability
    • feelings of excessively high self-esteem, or super powers
    • a diminished need for sleep … being able to go for days with little or not sleep
    • increased talking at a fast rate of speed, with such pressure that you cannot be interrupted
    • easily distracted from one subject to another
    • fast stream of ideas and thoughts
    • taking great risks time and again, such as substance abuse, unprotected sex, and reckless driving

    In addition, there are depressive symptoms to watch for:

    • low, depressed mood
    • diminished enjoyment in favorite activities
    • low energy level and fatigue
    • major changes in sleep patterns … such as sleeping too much, or inability to fall asleep
    • inability to concentrate
    • feeling “bored”
    • diminished appetite, loss of weight, or sudden weight gain
    • complaints of stomach aches or headaches
    • thoughts of death or suicide

    Some of these symptoms can be also be seen in children or teens with other psychiatric disorders. But if the teen has a parent who has bipolar disorder, it’s critical to evaluate for that.

    But know this: bipolar disorder isn’t easily diagnosed. It’s not uncommon for a child or teen with bipolar disorder to be diagnosed Teen boy received early treatment because bipolar disorder teens early treatment leads to better outcomes.with major depression or other psychiatric disorders before the bipolarity can be identified. It’s a complex illness that requires scrutiny and observation over time. Basically, the sooner the diagnosis can be determined, the sooner effective treatment can be initiated.

    By the same token, if you have bipolar disorder and were not treated early after your first manic episode, don’t despair.

    At Innovative Psychiatry, we specialize in “difficult-to-treat” disorders and are committed to search for the most effective treatment to help you rediscover your best self.

    Call us for an evaluation and let’s use the tools at our disposal to identify and find the most effective treatment for your specific needs.

    Because we believe in helping you discover your best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

     

     

  • IV Ketamine Infusions Restore Your Power to Enjoy

    IV Ketamine Infusions Restore Your Power to Enjoy

    A man sitting on rocks and taking in the beauty around him because IV ketamine infusions restore his power to enjoy a moment.

    IV Ketamine Infusions Restore

    Jacob couldn’t remember the last time he was really at his best self.  He’d struggled from day to day since he was about 4. Getting out of bed, getting dressed, and going to school, from first grade through high school… every day had been awful and just exhausting. As he got out of the car for school each day, he’d look at his mom with pain in his eyes–and then drag himself into school, throughout his day, and through the night.

    His parents didn’t know how to help. They talked with him and tried to do things that would cheer him up.  But his inner pain seemed suffocating, and they felt helpless.

    One day when he was 14, they found him on the floor behind the sofa, wedged against the wall in a fetal position.

    He just disconnected…ran out of the energy to endure any longer…from the dead emptiness inside.  The anxiety.  All of it.

    He thought about how to end his life every day. Some days he was obsessed with visual images of that final act.

    Treatment-Resistant Depression

    His doctor prescribed an SSRI, an SNRI, and then different combinations of medications, but none of them worked. Not really.

    Eventually he refused to take any more, or attend any more therapy sessions.

    School was something he just endured, or avoided, until he graduated.

    College was a roller coaster–and life had been too hard for too long. He was exhausted. Isolated. Disinterested. And he eventually dropped out.

    A Drug Called Ketamine

    Then he read an article online about a drug called ketamine that was helping people recover from severe depression.

    And he started looking for more information about it–studies, information, and just about anything he could find about this anesthesia-turned-club-drug-turned-antidepressant.  

    He found a few interesting articles, a few sensational titles, a lot of talk…and fascinating research that had been going on for years on using IV ketamine infusions to restore life for people with severe depression.

    Who knew?

    Was it possible there was a treatment for crippling depression and anxiety that could work when nothing else did?

    His parents were pretty skeptical.  They looked for hard science, research studies he could participate in, or a doctor he could see who knew something about this kind of treatment.  

    Turns out it’s pretty hard to find a psychiatrist who gets the devastation of depression and anxiety and hopelessness. One who can sift through the complexities, discuss the risks and benefits of all of the available treatment options, in order to provide the best possible options for someone whose symptoms just haven’t gone away.

    Jacob’s first infusion of ketamine was extraordinary. The terrible heaviness that had weighed him down since he was four lifted for the first time about half way through the infusion.

    And when his parents met up with him, they saw a lightness in his expression that they hadn’t seen in years. His treatments continued…his symptoms faded.

    He had missed most of his childhood, and he spent most of his young adulthood wanting to die.  But when IV ketamine infusions restored his ability to enjoy and experience beauty in life, it changed everything. He couldn’t believe it, but he actually wanted to live now. And was so glad he could.

    Low dose IV ketamine infusions restore this man's ability to experience the beauty of a sunrise. Lori Calabrese, MD provides IV ketamine for depression

    How Effective Are IV Ketamine Infusions?

    Before we go on, it’s important we point out that ketamine infusions don’t work for everyone. Every one’s brain is different.  Everyone’s needs are different.  And for some people, IV ketamine infusions don’t work.

    But we see a lot of Jacobs. 

    Because IV ketamine infusion therapy does produce remarkable results in 80% of patients who have suffered with treatment-resistant depression, and the terrible, persistent depressive episodes in bipolar disorder, and for large numbers of patients with unrelenting anxiety disorders.

    What is it about ketamine that delivers such dramatic, fast results?  How does it affect your brain that it causes this wonderful, fresh relief…?

    First, let’s talk about growth factors.  The brain has its own special growth factor, called BDNF–brain-derived neurotrophic factor.  That growth factor is like really rich, earthy compost.  And we think that one of the really remarkable things about ketamine is that it turns on signals and opens up pathways so that the brain begins to manufacture and release more BDNF.

    This is kind of radical news.  

    Most people don’t know that the brain continues to grow new cells all throughout life–and when there is rich compost, these cells, called neurons, grow new branches, and form more and more connections.

    The Role of Glutamate

    Glutamate is the most prolific neurotransmitter in the body. It operates throughout higher levels of the brain, so it’s especially effective in a widespread and quick proliferation of synapses. It causes them to branch like trees in fast motion, creating a virtual forest producing abundant relief, especially in a part of the brain called the mPFC (the medial prefrontal cortex).

    Some neurotransmitters bring a calming balance to the brain and mood, others bring a stimulated excited balance. Serotonin is one of the calming ones… Glutamate is one that excites the neurons.  

    Because glutamate is so prolific and widespread, when it’s stimulated to increase, the impact on mood is fast to take hold and spread.  

    Now, when uptake of glutamate from the synapses is disturbed or blocked, you experience less of the feelings of reward…like for instance the enjoyment of a sunrise, or the fragrance of a rose. This impaired ability to “enjoy” is a symptom of depression.

    However, and this is great news, when glutamate is released, there’s a prolific blooming and branching of synapses, which quickly connect different parts of the brain to each other. It’s almost like watching a film in fast motion as the synapses branch into more and more neural connections. The result is a rapid improvement in communication between networks of cells in the brain.  And your ability to feel good quickly improves.

    So how to get glutamate to be released??

    Enter IV ketamine.

    Ketamine Stimulates Budding New Branches in Brain Cells

    Low dose IV ketamine infusions cause a burst of glutamate.

    Those bursts of glutamate trigger the branching of dendrites (the branches on the tree) and the budding of bunches of synapse communication junctions, and in a short time, you feel better and better.

    So how does it do that?  We think that IV ketamine infusions cause bursts of glutamate that very quickly stimulate AMPA receptors, which activate calcium channels, which lead to the release of BDNF (good compost), which turns on the mTOR pathway, which — voila! — increases protein synthesis right in the brain. Neurons are made of protein. So dendrites branch.  Synapses form.

    New growth.  New connections.  Not just in the structure of your brain but in the very fabric of your life.

    Psychiatrists get really excited about these things.  You should get super excited, too.  Geez.

    Think of a brain cell like a tree in springtime that explodes with the stretching and unfurling of new branches, new growth, new buds, all stretching towards the sun.  That’s what happens.  If you have been so tied up in knots, wound up with tension and anxiety, and deadened to the joy of life…you can feel your shoulders relax for the first time in years.

    Second, a study by the National Institute of Mental Health in August of 2015, revealed that ketamine reduces suicidal thoughts, as an independent and parallel benefit to the antidepressant effect it provides. And studies at Yale, Oxford, NIMH, Houston’s Baylor College of Medicine and New York’s Mount Sinai School of Medicine provided overwhelming evidence of the remarkable effectiveness ketamine demonstrates against treatment-resistant depression.

    How?

    Because of glutamate, and the richness of BDNF, and the fast-growing synapses branching out on neurons throughout the prefrontal cortex, causing relief to bloom along with them.

    Breakthrough Innovative Treatment

    Isn’t this amazing?

    If you’ve suffered from depression, or bipolar depression…or crippling anxiety, you KNOW how amazing this is.

    You’ve known the desperation, misery, and despair.

    Maybe you’ve forgotten what it’s like to feel good, or even to feel ok.

    You’ve lost touch with enjoying yourself.

    But all that can change now.

    Now you can feel good in ways you’ve forgotten.

    Find your love of music, or art, or reading.

    You can feel again.

    Because of glutamate. 

    Because of flourishing synapses.

    And because of ketamine.

    Let us help.  

    Call us for a thorough evaluation so we can discuss innovative treatment options for you. IV ketamine infusions restore your ability to enjoy your life, and we’ll help you with whatever it takes to accomplish that.

    To the emerging of your best self,

    Lori Calabrese, MD

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

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