Lori Calabrese, MD

Tag: IV Ketamine for Alcohol Use Disorder

  • Is Dissociation Important for Ketamine to Work?

    Is Dissociation Important for Ketamine to Work?

    Dissociation is necessary for antidepressant benefits of ketamine.

    The Big Question

    Is dissociation needed? Is it necessary? Can you get better without it, or with “just a little bit” of dissociation? Does the kind of dissociative experience you have during a ketamine infusion predict whether ketamine is going to work? Or how much it will help? …. or If it will help faster? If it will work better….? Will it be scary? Will it be negative? Can it set you back….or make you worse? Can you do anything to shape it (yep, the dissociative experience) to get the most out of it? Boy, what IS dissociation anyway? And is dissociation important for ketamine to work?

    I’m tellin’ ya, that is the question of the hour. Every hour. (Or every 90 minutes, I should say. Because that’s the time we set aside for you, when you receive a ketamine infusion. )

    When you come in for ketamine, we dive deep. We look for what you used to be like at your best self—really like. Or… if it feels like you never had a best self, we go back further still. And then we look at all of the factors that have contributed to where you are today: what happened, how it happened, what the interplay is genetics, experiences, people in your life, work and the things you love, symptoms and how they’ve spiraled out of control, treaters and treatments that didn’t work out for you.

    We want to understand your narrative. Because if you are a candidate for treatment with IV ketamine, we want to offer you the hope and the possibility to change that narrative….and write a new one moving forward.

    So the question is what does that? What moves you forward? Ketamine itself? the racemic molecules, the NMDAR antagonism and disinhibition? glutamate activation? the multiple downstream effects involving AMPA activation, and g-protein fast action sliding off lipid rafts? The production of BDNF (brain-derived neurotrophic factor), and the growth of new branches on neuronal trees that leads to synaptic plasticity and flexibility of thought?

    There is a lot of action that ketamine creates (and a lot that we are still exploring because we don’t have all the answers yet about exactly how it works). And it is all very wonderful and scientific. We love the molecular, we love the granular….we love translational neuroscience. But more than that, we love the transformation that we see when science blooms deep in the mind.

    And that’s what happens in dissociation.

    Science blooms in the mind.

    Let me tell you what that means.

    Dissociation has been described with all kinds of terms, including feeling dreamy, floaty, spaced out …. Detached from yourself or not a part of yourself, feeling detached from your surroundings. Having changes in your sense of self and where you are–feeling like you’re not yourself but a collection of thoughts or a mind/heart somewhere in the universe.

    You’ll hear people describe it as feeling weird, loopy, or really trippy, with visual experiences, or feeling that time expands or contracts. Feeling an ineffable sense of awe. Or sometimes feeling like something dark is trying to intrude.

    Early reports with IV ketamine for depression suggested that dissociation was associated with a good response to ketamine. Not that it was to be avoided, but that it was actually OK. More than OK, it was part of the treatment and part of what might be helping lift depression.

    More recent clinical research, and the experience of countless ketamine clinicians and thousands of patients suggests not only that is it welcomed, but that the dissociative experience during your treatment could be necessary, maybe even IMPORTANT for you to experience, to remember, to analyze and to integrate into your life’s experience as your move forward…and AWAY from your depression, your anxiety, your trauma.

    We think dissociation is incredibly important, and that the way that you recall your experiences during dissociation, interpret them, and look for meaning will help you grow, develop flexibility of thought, open you up to new possibilities and reawaken old loves (like the love of music, or sports, or the outdoors) or invite you to seek out new ones. The biological changes that lay the structure, and the ineffable and sometimes spiritual or mystical experiences that can occur during dissociation can be absolutely transformative. Stunningly effective. In a way nothing else we have is.

    Is it important?

    You betcha.

    Can we prove it?

    Ah. That’s another story.

    Prominent Ketamine Researchers Seek Answers

    Recently, two veteran neuroscience researchers in this exciting “ketamine for depression” saga, Elizabeth D. Ballard, Ph.D. and Carlos A. Zarate, M.D., published a groundbreaking paper in Nature Communications. They addressed the question about whether dissociation is important for ketamine’s antidepressant effects.

    To do that, they scoured over 76 papers — peer-reviewed published reports and clinical trials of IV ketamine used in the treatment of depression, reviews, psychedelic research.

    There are physicians who offer 6 ketamine infusions at a “standard dose” of 0.5 mg/kg over 40 minutes. This was the early protocol used in early research trials. And there are certainly many who haven’t veered from it.

    There are others who have taken a more flexible path to help more people achieve remission. We’ve hinted about how we titrate the dose, the rate, and the number of infusions, in an effort to evoke a better response. Getting better is what matters. Living better is what sings.

    Still, there has been some controversy about the role dissociation plays in ketamine achieving that response, especially remission from severe depression. So, we applaud Elizabeth Ballard, PhD and Carlos Zarate, MD for their diligence in trying to find answers to the questions.

    Let’s talk about their paper, and address the current position ketamine holds among treatments for depression and other disorders, and how far it’s come.

    This beautifully written manuscript highlights the immediate antidepressant effects ketamine treatment produces, along with the short-term dissociative effects that often occur during the infusion itself.

    So… is dissociation important for ketamine’s antidepressant benefits? Let’s see…

    They say the primary purpose for their publication is to scrutinize other studies and to learn — through a close examination of other research — and figure out the answer to this question. Is the side effect of dissociation necessarily a requirement of the antidepressant impact that is so restorative to so many… you could even say most…patients?

    Oral antidepressants have a slow onset of relief, taking at least weeks, and often months, to bring relief. In fact, after all that waiting, sometimes those medicines don’t improve symptoms much at all. (If you’re reading, you probably know this firsthand.)

    Ketamine, in contrast, can create rapid improvements in many symptoms within hours or a day. Ketamine treatment is not for everyone (for a variety of reasons). But for those who are good candidates, ketamine usually provides more relief and more remission than any other medicine we use.

    Extraordinary Restoration in Treatment Resistant Conditions

    Ketamine shows its greatest effectiveness and rapid responses in treatment resistant depression, bipolar depression, PTSD, OCD, social anxiety disorder, substance dependence, and suicidal thoughts.

    As we’ve also talked about before, in a separate action, ketamine has become known for rapid eradication of suicidal thoughts. We’ve reported our own real world results about how ketamine can stop suicidal thoughts in an afternoon in the office, preventing visits to the emergency department and hospitalizations.

    Chemists originally developed ketamine as an anesthetic to replace phenylcyclidine (known as PCP) in the ’60’s because PCP caused delirium, agitation, hallucinations…and violence. So it was taken off the market. Those chemists set out to develop ketamine in the same laboratory to initiate anesthesia. Ketamine didn’t illicit violent behaviors, thankfully. But dissociation and out-of-body experiences accompanied it and it was labeled a dissociative anesthesia. 

    Then, in the early part of the 21st century, studies began to explore what ketamine might do for people with treatment resistant depressive disorders using small doses…and the results were eye opening.

    As far as the connection between dissociation and an effective antidepressant response to ketamine:

    A study in 2014 found that the other side effects of ketamine, such as systolic blood pressure changes, diastolic blood pressure changes, pulse changes, or manic symptoms, weren’t associated with improvement in depressive symptoms…not at 230 minutes, or at 7 days after the infusion.

    On the other hand, dissociative symptoms were associated with antidepressant improvement at 230 minutes, and at 7 days after the infusion.

    Another finding of note was that some subjects with treatment resistant depression respond enthusiastically to their rapid improvement. But, when healthy subjects received the infusions, some of them experienced a transient period of dysphoria, feeling uncomfortable and ill at ease, after a ketamine infusion.

    Beyond various side effects — including dissociation — that others have experienced, there’s more to consider. Let’s talk about the importance of a patient having the ability to access a “non-ordinary state” of mind to fully benefit from the work that ketamine does.

    This “non-ordinary state of consciousness” can usher in neuroplasticity in the brain. Where the synaptic connections are growing, proliferating, changing… and this state of change can open your mind to think new thoughts, and to think differently about things that happen.

    Like how you feel about a trauma, or a stressor, and to change your response to that experience.

    The experiences, the meaning, the imagery often open up new and deeper ways of thinking about the experiences in your life in new ways, and give you an opportunity to perhaps forge a new path.

    How exhilarating that can be!

    So now, ketamine treatment…a series of infusions over a few weeks….is building a reputation for effectiveness with treatment resistant depression, bipolar depression, social anxiety, PTSD, OCD, and substance dependence. And by a separate action, ketamine has shown it can eradicate suicidal thoughts rapidly.

    Because ketamine’s effects have been so remarkably effective in those it helps, it’s inspiring the development of new medicines in hopes of discovering more wonderful treatments for people who suffer.

    So what is dissociation, really?

    According to one expert, dissociation is defined as a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. These veteran researchers acknowledge that it would be beneficial if ketamine could be as effective without the side effects of such things as dissociation. But it is not yet clear whether the dissociation is a core feature of the antidepressant response. Or, it could be just a side effect. Ballard and Zarate point out that the evidence is just not conclusive or clear.

    Yes…but what’s important about dissociation??

    Well, that depends on who you are…and where you’re coming from. The early researchers showed it was important because it was associated with a better response to ketamine treatment. Ballard and Zarate, in the paper we talked about above, question that because their analysis of the literature to date suggests the findings are inconsistent. They conclude that “the relationship between dissociation and ketamine remains an open question.” Part of the question may be that the rating scale used in most of the the studies to “measure dissociation,” the CADSS, might not be the right one. It was designed to measure dissociation just before and after the recall of traumatic memories in patients with PTSD. But it might not really be the best scale to capture the rapid dissociative experience that happens during a ketamine infusion and the range of experiences —like perceptual changes, peacefulness, bliss. (There are other scales out there that might capture these better.)

    So…if you’re a researcher, “important” means predictive of, or statistically associated with, or prognostic for. Then “is dissociation important?” means “is it necessary for response or remission?”

    Stick with us here.

    However, if you’re a pharmaceutical company, you might see dissociation as just a weird and hard to quantify experience. Troublesome. You list it as an adverse effect. (Because it’s not the primary goal of treatment–remission is.) It could get in the way of your FDA approval, and of allowing your newly developed drug to be approved for at-home use. It can affect your sales. It might get in the way, it might push you to test and produce low doses and leave it at that.

    BUT…if you’re the one sitting in the chair, what you want to know is this:  Is what I experience during an infusion important for ME?  How can I make sense of it? For me? How can I use the experience… to help me? Can dissociation—and the whole experience—actually help me?   

    Is dissociation important for ketamine to work?

    What ketamine infusions can do for you is what is important to you. The whole experience — from start to finish, from the beautiful serene setting to your mindset and your intentions (and your hopes and your fears) as the infusion begins — can and should be integrated so that you can move forward and into a better, richer, life.

    Infusion. Infused with hope.

    There really is hope.

    At Innovative Psychiatry, ketamine treatment continues to be the best treatment we offer for rapid relief and remission of depression and suicidal thoughts, and for rapid relief in so many of the conditions we’ve discussed. We look forward to following the research — and working with our own patients, who are often our finest teachers — and to learning from all of it as the field moves forward.

    We’re also set and ready to provide ketamine treatment for you in our safe offices. We’ve installed a system that destroys bacteria and viruses, including coronavirus, from the air and lifts them from hard and soft surfaces so you can get treatment, even in the midst of a pandemic, without hesitation or fear.

    We titrate your dose and adjust your infusion rate to make your treatment comfortable, productive, and effective. We want you to get better. We want you to find your joy again…to embrace bliss.

    If you’ve found that your medicine for your disorder isn’t helping, call us.

    We’ll talk about your history, your symptoms, your needs… and determine if ketamine treatment is a good fit for you. 

    Although we can’t guarantee your outcome (no one can), we’ll offer you our best judgment, and all of our clinical expertise. This treatment is very effective for the majority of our patients, and it could be transformative for you.

    Call us and let’s work together to see what ketamine treatment can do for you.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Do You Suffer From Pandemic-Induced Social Anxiety?

    Do You Suffer From Pandemic-Induced Social Anxiety?

    When you think about going to a gathering, walking into a room full of people, how do you feel? Tense…nervous…?

    People are getting vaccinated.  It’s highly likely, if you’ve had both vaccine injections, that you may be invited to an July 4th gathering of friends and family who’ve also been vaccinated. Can you imagine? How long has it been since you were invited to a backyard barbecue? Would you feel excited to go? Or would you find yourself feeling a bit nervous about it? You may have struggled with social anxiety for years, or you may be one of the new breed who never felt socially uncomfortable until the COVID-19 pandemic kept you socially distanced for a year and a half. Pandemic-induced social anxiety is an emerging real problem for so many.

    A study recently published in Lancet Psychiatry found that about 1/3 of COVID-19 survivors suffer from long term brain disorders. They looked at 236,000 who were diagnosed with the coronavirus over a six month period. Turns out that 34% display neurological or psychiatric disorders. Of those, 13% had never suffered from these before.

    They found that those who had survived the COVID infection were at increased risk for brain disorders. Psychiatric disorders. Neurological disorders.

    So you have to ask yourself…should that be a surprise?  Over a year of keeping to yourself, seeing no one in person except for your own household. If you live alone, that’s a long time to be isolated. And when you’re around strangers, at the grocery store, for example… Everyone is wearing a mask and you can’t tell if anyone is smiling or not. The world can become a drab place.

    At the very best, the last 14 months have been disruptive, challenging, and alarming. Routines have been tossed out the window, normal interactions with friends, family, acquaintances, and co-workers have all but stopped. Major conferences, gatherings, and events were cancelled. 

    In short, we’ve all adapted to a different way of living. And little by little, life is going to change again. And eventually, we’ll be changing to a world with lower risk. But not yet.

    For now: do you suffer from pandemic-induced social anxiety?

    It comes in all sorts of forms. We ask ourselves, has he been wearing a mask consistently?  Does she practice social distancing? And we still need support.

    That’s quite a jump from the way it used to be, when we’d say, “Of course we’ll be there! What can I bring?”

    There are also those who have dealt with social anxiety for years, so this isolation was easier to adjust to. Until it got old. While theirs isn’t pandemic-induced social anxiety, theirs has likely been exacerbated by the pandemic.

    Because on some level, we humans need some social interaction. Until the pandemic, we naturally chose the amount of interaction — and the type — that fit most comfortably.

    But now it’s harder. Scarier. And the stakes are higher. Add to that the nagging feeling that people around you are probably judging you… harshly. 

    If you already struggled with social anxiety before the pandemic ever happened, you know that feeling. It’s awful. That horrid sense that you just know the people around you are so put off by you… that they’re talking about you.  About you!  When in truth, they’re likely talking about where they’re going Friday night…or what they thought of the latest blockbuster movie.

    If you never tasted social anxiety before now, you probably had no idea what it’s like. But now, people who have developed social anxiety from the restraints, isolation, and precautions of the pandemic are experiencing that horrid feeling themselves for the first time. And, that feeling feels real. 

    When you’re in the throes of it, you are acknowledging as truth the FACT that everyone in the room is appalled by your appearance or behavior and they’re ALL judging you and verbalizing it to the person next to them. You believe that feeling.

    You know what?  

    This is an early stage of post-COVID reaction, specifically post-COVID social anxiety.

    And just like social anxiety probably didn’t go away on its own when there was no pandemic… it may not go away on its own now. 

    It may be that you can slowly help yourself adjust to the new reality and give yourself time to resolve it, or you may have to take intentional steps.  

    By treating yourself with compassion, you may find you can identify the scenarios that stir up anxiety for you, and not force yourself to do too much too soon. Determine to be your own best friend. Give yourself credit for baby steps. Maybe coffee with a friend, or taking a walk with a neighbor. As you find yourself comfortable in these smaller situations, then you can increase your exposure as you feel ready.  Lunch with two friends. Dinner with a friend, relative, or co-worker you really like!

    Because, if you’re paying attention to what pumps up anxiety for you, then you probably realize that dinner with someone you don’t like is unnecessary stress this early in your recovery … or maybe we should say …this early in your re-entry.

    And that really is what it comes down to, isn’t it? Everyone is re-entering society over this next year. And that means some will be re-entering in spite of pandemic-induced social anxiety. After you’ve had both your vaccines. After most others have had both of theirs, too.

    We can all expect to see people jumping into public places, parties, dinners, ball games, just as soon as it’s possible, but that doesn’t mean you should do the same.

    A friend who lives in Texas where restrictions have been lifted, stopped in a popular restaurant recently to get takeout for her family.  She expected the restaurant to be practically empty, but to her surprise it was packed, with a full waiting room! 

    She knew that ALL those people weren’t vaccinated. And most weren’t even wearing masks.

    This illustrates how much the general public may be chomping at the bit to get out and about again,  whether it’s wise or not.

    That being said, there are probably plenty of people pressuring friends to go with them to public places. And those pressured invitations may be just one more way this re-entry environment stirs up anxiety for you.

    Don’t put yourself through that. BE PATIENT with yourself, and stand up for yourself when others are moving ahead faster than you’re comfortable.

    Take it slow and do what’s best for YOU.

    By limiting your face-to-face interaction to only vaccinated people, you’ll automatically reduce your own anxiety to some degree because you know you’re safe.  Pandemic-induced social anxiety may be daunting, but you choose what you’re ready for day by day.

    And if these outings continue to be difficult, talk to someone you trust.  Whether it’s a family member, or a close friend, or a therapist, it can just help you to relax about the issue to say it out loud. It can help  you feel more normal. And will possibly help reduce anxiety, too.

    Finally, we have to address the question, “What if this anxiety doesn’t get better? What can I do?”

    If you’ve found you’re gripped inside every time you go out, and it never seems to get better in spite of all you’ve tried, you may be a candidate for IV ketamine treatment.

    Ketamine is that mild-mannered anesthesia medicine that wears a cape and leaps tall buildings in a single bound when it’s applied to treatment resistant depression, social anxiety, PTSD, bipolar depression, substance use disorders, and suicidal thinking.

    (I just couldn’t resist.)

    It has helped many of those who have received it to achieve remission. Because IV ketamine treatment is not one of those meds that just, you know, takes the edge off symptoms. Rather, it either doesn’t help someone… or it transforms them to a joyful, hopeful person with a new lease on life.

    And while ketamine treatment isn’t for everyone, it helps such a large percentage of the patients we treat that chances are good it will transform your life, too.

    At Innovative Psychiatry, we want to make your IV ketamine treatment give you the best it’s got. So we’ve worked out methods and protocols to give you the most personalized titrated dose and rate available. 

    We also have invested in a state-of-the-art system for destroying viruses, bacteria, and molds in the air and on hard and soft surfaces to protect you and keep you safe from infection like COVID, influenza, and even pollen. Your focus needs to be squarely aimed at getting better, without the worry of contagious disease. We want you to feel safe.  

    With that said, if you’re still sitting squarely in the midst of your anxiety, call us.

    Everything we do all boils down to our primary focus of seeing you get better, and live well with joy and purpose.

    Our patients each represent a wonderful story of restoration and resilience. We want to see your story join theirs.

    With only one life you get to live, it’s worth the effort to find the path for your best life.

    We’re here and look forward to hearing from you.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Overcoming Feelings of Shame and Worthlessness Even in a Pandemic!

    Overcoming Feelings of Shame and Worthlessness Even in a Pandemic!

    Grace had been depressed off and on since her she was a little girl. No one called it depression back then.  She was shy, and her withdrawal was dismissed by others as just another of her odd behaviors. They thought she just got more “wound up” than some people. After she was grown and married, the family psychiatrist diagnosed her depression and prescribed antidepressants. 

    Overcoming feelings of shame and worthlessness had proven her most difficult challenge. She tried the first prescription for a few years, with only a little improvement. She was accustomed to trudging. Eventually, her prescription was changed, and she began to feel much better. So much better in fact, that she considered herself overall better for years. She was grateful to be one of those 30% who were actually helped by medication.

    Even though Grace experienced loss from divorce and deaths in the family, and though she grieved, she never became depressed like she’d been before. Sadness was different than major depression, as a medical condition. She still functioned through her days, but felt sad for a good while after each loss. Until she could finally move forward again.

    But then the pandemic spread around the world. It imposed changes upon households everywhere, like isolation, mask wearing, and social distancing. Basically, adaptations were required from everyone.

    It was a shock. And it was tiring.

    As far as Grace was concerned, she began to notice her optimism was diminishing. The resilience she had come to expect and rely on weakened. The agitation and short tempers in loved ones she trusted startled her, shocked her, and shook her foundations. She felt beat up.

    More and more beat up… until she didn’t want to expose herself to the blows of others.

    And she withdrew.

    Of course, Grace told herself she was isolating herself to comply with social distancing, but little by little she had to admit to herself that this was something more. She found herself losing motivation and initiative, and a desire for interaction with others, as well. She began to read. In fact, she read all day until she went to sleep every night. She stopped answering the phone, and went to her mailbox at night to avoid running into anyone. 

    Heaven forbid she should have to see anyone…to be expected to interact. No way!

    Then, of all the horrors, her hair was falling out. Alarmingly quickly. What was this? She found wads of her hair on the shower drain. She felt it glide along her arms as it fell out and slid to the ground. Her brush and comb was full of her hair!

    Not to mention, she struggled with insomnia. She was still taking her usual medications, including her antidepressants and a sleep aid, but nothing seemed to be helping. It was baffling when it had all been under control for so long.

    Eventually she had to face that she was depressed for some reason, and what was worse, she suffered from pretty severe insomnia.

    Why? Where had this come from? 

    The state she was in was shocking when she’d been doing so well for years. Even decades!

    Overcoming these feelings of shame and worthlessness …well it seemed impossible.

    As a natural introvert, she couldn’t imagine that the isolation would bother her. It didn’t feel like it was bothering her…

    And she loved to read. She just hadn’t had time for so many years that she’d gotten out of the habit. The freedom to read one book after another was delicious. She reveled in it. 

    Well, not at first. At first the reading was more like something to fill her mind while she lay in bed. To keep her thoughts captured. But eventually, it became a pleasure. Her only pleasure.

    Even so, Grace was noticing some phobias in herself that had been absent for decades. What on earth? Seriously??

    She went out of her way to avoid contact with people. Trips to the grocery store were hard, but she managed ok as long as she didn’t look anyone in the eye. She had to have food, after all.

    Thankfully, her doctor had made small increases in her antidepressant and sleeping prescriptions, in hopes the changes would help.

    Along with the phobias, shame arose. Shame at her withdrawal and for avoiding people. Shame for all her life’s mistakes. Boy…when it rains it pours. And she was in a deluge!

    In all those quiet days and nights she had an abundance of time to think. To revisit the failures of her life. Those times when she handled conflict poorly. All those times she let someone down. The mistakes and misunderstandings of her marriage, and her divorce. She was drowning in regret, and the ways she failed her children. The shame of her human missteps was unbearable. So unbearable that she felt worthless. Unworthy to be loved, or to take up the air she breathed. 

    On one particularly sorrowful night, it occurred to her how easy it would be to make her life stop. She had various tools in the house that would simplify the action.

    Finally, as news of more people receiving vaccines led to hope that things might soon open up, Grace began to see some light at the end of the tunnel. She found that she laughed out loud as she read certain books. Then she found herself more animated as she talked with loved ones on the phone. Her energy began to return, and cooking seemed easier.

    Maybe she would eventually emerge from this…?

    After a year in a pandemic, severe ice storms unprecedented in some areas…depression, isolation, anxiety, brought on by isolation…  This has been a very — no, extremely — difficult year. Pat yourself on the back that you’re reading this and in one piece.

    No kidding! It’s been a bear, hasn’t it??

    What about you? How have you fared?

    You may be beating yourself up for what you didn’t do. Were you optimistic…or did you grow pessimistic and disgusted with the world…and yourself? Did you find ways to make the best of annoying circumstances… or has it been a struggle? Did you enjoy the camaraderie that came with the awareness that the entire world was in the same boat… or have you felt alone?

    Don’t punish yourself!

    Reports from across the globe speak of increasing numbers of people diagnosed with depression, when they’ve never been depressed before. You’re not alone! Those who already grappled with disorders found them getting worse. (Reports of hair loss have skyrocketed.)

    Overcoming feelings of shame and worthlessness can be so hard, and they can come unexpectedly. The world has seen a level of shock on an individual level that hasn’t been seen in over 100 years. If you think you haven’t been deeply affected by the happenings of the last year, you may have been touched in ways you didn’t realize.

    None of us is an island, as they say. We’re all connected in ways we may not understand, but also can’t really deny.

    If you haven’t tested positive for COVID-19, you may have been surprised like Grace at some of the impact that still invaded your life. Inexplicably. 

    On the other hand, if you already were receiving treatment for a disorder like severe depression, PTSD, bipolar depression, or suicidal thinking, it might have gotten worse.

    Are you like Grace, finding your treatment is no longer enough? Do you try and fail to overcome feelings of shame and worthlessness? Do you know those painful feelings are also a symptoms of some disorders, like severe depression, bipolar depression, and PTSD?

    If you can relate to Grace’s struggles, hurts, despair, and shame, you’re among friends. This pandemic has been tough on everyone, and it’s shown no mercy. In addition, if you were already trying to climb out of an emotional hole before the pandemic, this year of difficulty may have been business as usual for you.

    But there is help.

    If your medication hasn’t helped, IV ketamine just might. It reverses symptoms for so many.

    Understand that ketamine infusions aren’t for everyone. They never have been. Still, research continues to explore the depths and limitations of ketamine. And because of its wide therapeutic success in others with treatment resistant mood disorders and trauma, the likelihood it will help you is strong.

    At Innovative Psychiatry, we just want to see you free of defeating symptoms, with the energy, clarity, and hope to move forward and enjoy a productive and rewarding life.

    To that end, we’ve supplied protection for you from coronavirus and bacteria in the air and on surfaces in our office so you can focus on getting treatment so you can get better. Even though the COVID-19 cases have dramatically reduced, the pandemic continues. But when you’re in our offices, you will be protected and cared for.

    Everything we do is focused on helping you get better, achieve remission, and enjoy your life and your relationships. It’s amazing the energy and insight you can have in relationship building when the burden of symptoms is removed.

    Life is getting better and will keep improving. We want that for you and are here to help.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • IV Ketamine for Teens ? Ya gotta be kidding me, right?

    IV Ketamine for Teens ? Ya gotta be kidding me, right?

    We’re not. We’re dead serious. We want to keep them alive.

    Maybe you have a teen like the ones we see. Maybe you are are one… like the ones we see. Or maybe you’re quiet. Kind. Smart. Everybody’s friend. Absolutely gorgeous. An athlete. A contender. Someone who’s had it all. Or maybe you’re NOT any of that. Maybe you’re a worrier, shy, awkward. Maybe you feel like you’re always messing up, like no one wants to be with you, like no one knows how to help you. Like you’re lost. Like you just don’t get it. How everybody else is goofing around, laughing, having fun while you just sit there, wondering how it ever happened that things got so screwed up, and that you got so messed up. Know anybody like that? If you do, or if that is you–or your teen, or your sister, or your best friend–listen up. You’re in the right place. Because there is IV ketamine for teens.

    Just when you think that nothing can help, know that we have help. We have the experience, and the guts and the compassion–and we had the foresight–to see the potential that ketamine infusions could offer adolescents who are just suffering.

    We knew it years ago, when we first started using IV ketamine for treatment resistant depression. Then bipolar depression. Suicidal thoughts. We saw it, and decided to really look at what happened to real people (who always have 50 million things going on, not just one rarified condition or syndrome. We looked at our own patients, in our own practice. We wanted to look at our own numbers, the truth of who gets better, how many get better, what does it take– (in terms of ketamine) — how much? how often?

    We stepped up, powered up, and wrote up a critical research report and published it in a peer reviewed journal about what happens for patients who come to see a psychiatrist to see if ketamine treatment can help–for their depression, it was back then–and find that it can stop hopelessness and suicidal thinking in an afternoon.

    The thing is, we saw years ago it could help adolescents… Adolescents who weren’t just needing to take a pill to get better. These didn’t get better with one pill, or two…or a combination of several. And when they didn’t get better, it was said they had treatment resistant depression.

    But treatment resistance is a funny thing. It used to be that it meant you’d tried 4 different meds, then it was dropped to 2 different meds, and now in this adolescent study, treatment resistance was defined as having been treated with one medication that didn’t work.

    We’re glad that the requirement was just one failed medication trial before they were given the opportunity to be treated with IV ketamine.

    Why?

    Because so much is happening in a teen’s life and it’s happening so fast. They’re rate of growth is so intense that a day, a week, a month, of loss causes too much loss. And when there is no resolution found, time can fly by in years, and a teen loses a major block of development they never can get back.

    IV ketamine for teens to put a stop to loss.

    So what losses can they afford? To miss a month…or a semester…of high school? Or college?? To drop out of basketball? Lose friends? Teens often don’t have the patience and tenacity for a friend who just doesn’t show up. Or one who is always down. Defeated.

    Adolescents need action. They need solutions that work quickly. They don’t have the time to wait for 4 different medicine trials that go on for weeks or months. There is just too much loss.

    That’s why IV ketamine is so important.

    When there’s no time to lose this is something that works fast.

    How much can your kid afford to lose …how much can you afford to lose?

    Hopefully we’ll able to have more and more data coming out so that our kids won’t have to suffer so long… so they get better faster. So we can treat them with what is most likely to work before trying something first that probably won’t.

    We do the best we know in this profession. But we need more studies and more information. And until we have it…well, like I said, we do the best we know.

    And we know this treatment has been in use to help adults of all ages for years. But what if you’re a teen? Teens get depressed, suffer social anxiety, even suffer from PTSD, suicidal thoughts, and bipolar depression. And when it’s treatment resistant, the unrelenting symptoms can interfere with your life, your development, and your hope. So we step forward and reach for IV ketamine for teens.

    A study was just published about treating these kids with IV ketamine, to see if it was truly effective and safe…more about that coming up. But get this:

    76% of this study group below had relief within 3 days of the ketamine infusion!

    Imagine what that would mean to a teen who’s suffering, hopeless, and giving up.

    So IV ketamine treatment has been effective in smashing those symptoms in thousands of people. But let’s look at this study especially for adolescents:

    IV Ketamine for Teens

    A team of researchers at Yale University led by Jennifer Dwyer, M.D., conducted a 4-week study using IV ketamine in teens with treatment-resistant depression recently published in the American Journal of Psychiatry. They selected 17 adolescents ages 13 to 17 who had been diagnosed  with major depressive disorder, or MDD. 

    It’s a massive undertaking to find kids that don’t have 6 different things going on with them… a cluster of co-morbidities. Teens who have just one diagnosis are the only ones that fit into a study like this. Just finding the subjects for a study is hard.

    Each teen in the group had been failed by at least 1 antidepressant medication treatment, but overall the average of failed treatments among the group was 3.24. (That’s a lot!–a lot of trials, a lot of weeks and months waiting for medications to help and being disappointed when they didn’t.) The average length of the current depression episode for these teens was 21 months. Almost two years. Too long.

    This crossover study gave each teenager either IV ketamine 0.5mg/kg over 40mins, or IV midazolam 0.045mg/kg over 40 mins. 

    Then 2 weeks later, each teen received an infusion of the other medicine. 

    It’s important to understand that midazolam (which is from the Valium family) is often used as the “placebo” tested against ketamine because it provides an experience of deep relaxation, so at low doses it can be a bit difficult for the subjects to know which one they’re receiving. (Often, though, there are little clues and little differences between them so that they can tell.) But midazolam provides no antidepressant benefits.

    It turned out that 76% of the adolescents experienced at least a 50% or greater antidepressant response within 3 days following their ketamine infusion.  (Compare this for a second: with an oral antidepressant, only 35% get 50% better….after 6-8 weeks.)

    IV ketamine for teens prevents loss of important moments in their lives.

    Were there side effects during the infusion in the study? Of course. But minor. For example, adolescents who had received ketamine experienced an increase in blood pressure compared to the midazolam infusion, but within a few hours those effects subsided.

    Oh, the beauty of it.

    When you’ve struggled and hidden in sullen isolation, sometimes for years… and you don’t know whether to search for a solution or hide, it’s so darn hard. You’ve missed class, missed practice…because it was too hard.

    Until something happens… and you realize you only seem mad at others — and the world — because you feel so terrible.

    Because you’re depressed.

    And you also may be laboring under the weight of other disorders as well, like trauma, PTSD, OCD or social anxiety…ugghhhh. When all of these different symptoms or disorders cluster and tangle together, it’s so much harder to find relief.

    Then, after months or years of searching for help, you learn about IV ketamine treatment. 

    And you come back to yourself after treatment. Older and a bit wiser maybe, but joyful and creative again. Able to love again.

    This is the beautiful story about how IV ketamine can transform adolescents…and can restore their hope.

    For years, the use of ketamine treatment was up in the air. Respected doctors and neuroscientists were quick to offer their professional opinion… which was to wait. They said that ketamine had not been researched enough. There was not enough information to back it up…so they said.

    But now we know that IV ketamine can transform adolescents, adults, and even children. It can erase suicidal thoughts, and give you … a teen… the time you need to get the help you need to see things differently. To redefine what life can be for you. To rebuild your hope. You purpose. And to restore the energy you need to build friendships that are strong and healthy.

    We’ve waited a looong long time. Too long for some adolescents…

    Even though we need more studies and more questions answered, we have to be willing to step up and take care of our kids who have everything on the line. For them it could be a matter of hope vs despair…life and death.

    We live on that line all the time.

    For all of us. We choose life. We need to choose it for our kids, too.

    Every body deserves a seat at the table for IV ketamine treatment and ketogenic diet for remission.

    At Innovative Psychiatry, we find great joy in watching young promising people like you — who come to us without hope or confidence — tell us enthusiastically after their treatment how good they feel and how their life is getting better and better.

    And because this process, this treatment, is so important, we took steps to make our office a safe place for you. We have technology that destroys viruses and all kinds of germs in the air and on surfaces, so you can feel safe and protected from infection of any kind. Whether it’s COVID-19 or influenza, or strep…it all dies immediately. So you can be in the safest possible environment during this pandemic and focus on your treatment and getting better.

    If you’re an adolescent with symptoms of depression or anger, if you have tried antidepressants that haven’t helped, ask your Mom or Dad or someone who cares about you to call us.

    We want you to find your joy again. To find your freedom and your hope.

    We’re here to help.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Keep Your Eyes on AKT: It Might Explain How We Learn and Forget Fear

    Keep Your Eyes on AKT: It Might Explain How We Learn and Forget Fear

    You may hear people say, “Antidepressants and other psych meds just don’t do anything…”

    Some people say, “…placebos work better…” Oh please. But why do they say that?  Maybe their own experience with prescribed medicines was disappointing. So — of course — they’re disillusioned about these medicines. We get it. And we know that any given medicine that works for some people won’t help some others at all, or might even make them worse. Sooo… what’s up with that? Well, the answer isn’t simple. We do know that antidepressants,when first prescribed, only help about 30% of depressed people. We know that psych drugs help some people but not others and that men and women can experience depression and anxiety and fear differently. It’s a tangle to unravel it all. That’s why we’re so excited about new developments. We want to keep your eyes on AKT because it might explain how we learn and forget fear.

    Meet Jill and Greg to see how differences affect their well being and livelihood:

    Jill and Greg own a coffee shop together and are partners in life as well. They have a great balance of power, in the tasks they divide between them and the strengths they each bring. Greg is a people person, creative, funny, and efficient at both designing new drinks and training staff to make them just right. Jill is a numbers person, and sometimes comes off a little stiff and awkward, because she just doesn’t have Greg’s gift for setting people at ease. She also has some social anxiety going on.

    She does ordering from suppliers, closes out the books every night, and keeps a close eye on profit and loss. They’re a perfectly matched pair and love working together. That is, as long as they’re both at their best. With Greg building relationships with customers and vendors, and Jill keeping the financial end sound, they really do provide strength for the weakness of the other.
    Unfortunately, they both suffer from disorders that periodically causes some lost time at the shop. When that happens, the one who is doing OK ends up carrying a double load. And both of them struggle with anxiety… or basically fear on some level.

    Greg was diagnosed with bipolar II disorder when he was a teenager. Jill was diagnosed with depression in college. She’s a worrier. He just explodes sometimes—and refuses to call it anxiety. Greg takes medication for mood stability that also has an antidepressant effect. Jill takes an antidepressant that only sort of works. They probably both need medicines that reduce anxiety.

    In a perfect world…

    Since their coffee shop venture requires all hands on deck to run smoothly, Jill and Greg are eager to find the right meds for both of them to help stay in the game. They need to be able to go in to work—they can’t afford not to. It seems to Greg that since his medication helps him as much as it does, Jill should ask her doctor to prescribe the same for her. She’s a nervous wreck! However, she knows enough about changing meds that she can’t just jump on another medication just because it works for Greg. She’s tried that before. It didn’t work.

    At this point, Jill has tried five different antidepressants over the past few years, and has researched enough about IV ketamine treatment that she wants to talk to her doctor about whether she’s a candidate for it.

    Considering something new takes a little bit of courage. She wasn’t sure what her psychiatrist would say. A visit with her psychiatrist surprised her–he was cautious but supported her trying something that might help. Jill decided to pay for it out of savings, because her bouts of severe depression were taking a toll on the shop and their income.

    She arranged for treatment and began infusions. When the treatment was complete, she had received 8 infusions over about 3 weeks, and she felt like she had a new lease on life. Her ketamine infusions seemed to wake up her brain. And that got better and better day by day — even after she completed treatment. She found she enjoyed singing and dancing, and painting became her new passion. When they had a problem in the shop, she had so many more ideas for solving it. Working on the book work was no longer a drudgery–she enjoyed it and got more accomplished in a shorter time.

    Jill and Greg’s life became so much better at work and at play. Greg still had slumps when his meds weren’t quite holding him, but their life was so much better overall. They had read that ketamine treatment could help bipolar depression, too. Maybe the next time he went through a bad bout of that, Greg would talk to his doctor about it. To see if it was right for him—not just to copy Jill.

    Finding the right medicine for you is sometimes a long search. And medicine that works for you may not work for your sister…or your son. But it’s well worth the work researchers do to better understand why.

    A research study at the University of Colorado Boulder offers one fascinating revelation about why those differences between people and genders might exist.

    It has to do with a key protein kinase in the brain called AKT…which functions differently between males and females.

    They found presence of a certain form of AKT (called an isoform) in male mice can help the male let go of fear from a past painful experience–and form a new adaptive response to get around the old fear. Wait, what? Doesn’t that remind you of the way synaptic plasticity helps you adapt?

    Ok, you’re right…mice aren’t people and it doesn’t work quite that way…. but AKT is remarkably similar across mice and humans and this kind of translational research can begin to give us specific information to make our medicines and medical care more specific. Potentially even gender specific.

    So you’ll do well to keep your eye on AKT because so much is being learned about how we learn and how we forget fear.

    By figuring out the very complicated cascades involved in creating synaptic plasticity, we may be on the verge of figuring out how to shape and foster the neuroplasticity–for the better.

    We may be able to personalize medication therapies so that they don’t just broadly address a disease state, but so that they can be specific for the man or woman who needs them. 

    Charles Hoeffer, the principal investigator of this study, said it like this: “We need to stop hitting every ‘disorder’ with the same hammer.”  Well said! (Wish I had said that!)

    We’re always talking about personalizing treatment. About how important it is to provide treatment that fits the individual. Just as that’s true with all of the fine details involved in ketamine treatment, it’s also true with all of the medicines we prescribe.

    So… about AKT. 

    It turns out AKT plays a lead role in synaptic plasticity. We’ve talked about that too…  The idea that the connections between cells in the brain can change and adapt. They can change and adapt as a result of an experience. (This is why trauma can change us.) But — so importantly — these connections can also grow, change, and adapt as a result of the deeply emotional experiences, like the incredibly deep and awe-filled experiences you can have during a ketamine infusion. So many of our patients do. We’ve talked about how taking advantage of that process by scheduling psychotherapy 24 hours after a ketamine infusion can enhance the effectiveness of the infusion. 

    Why? Because therapy helps you think differently about something…and synaptic plasticity empowers those changes in thought. Many of our patients also find that journalling, creative writing, meditation and other activities help to integrate those experiences into their lives, find meaning in the experience, and move forward. Keep your eyes on AKT… there’s so much more to learn.

    AKT helps you create memories. Like a child touching his hand to a hot stove. To encode that memory so that he will be cautious in the future around hot burners, his brain needs to activate protein kinases like AKT.

    In fact, AKT is one of the first proteins to present itself to form a memory like that.

    There are 3 main variants, or isoforms, of AKT and they do different things and affect people in different ways (More on that in a sec!)

    AKT1 is important in encoding new experiences and allowing you to forget the old.

    AKT2 is often found in the astroglia…which are star-shaped brain cells.

    AKT3 seems to be important in brain growth and development. This one plays a positive role in mental health and wellbeing. 

    And when AKT1 and AKT2 are working together in the prefrontal cortex, they’re vital for learning, for memory … for dynamic change.

    Maybe like the kind of dynamic change that you want for yourself. So yes. So many different forms, working singly and sometimes together, in ways we are only now just beginning to understand for people suffering with psychiatric disorders.

    Now. To add another twist to this picture. In this study, researchers found a dramatic difference between genders regarding AKT. 

    They found that male laboratory animals whose AKT1 was functioning well, had far more ability to replace unwanted memories with new ones…than those who were missing AKT1. 
    Draw that out for a moment now…. and imagine men who’ve experienced the trauma of illness, or assault, or combat… and imagine for a moment that they’re given the opportunity to experience something new — maybe hopeful, blissful, awe-filled, like they might during a ketamine infusion — and then the excitement of realizing that a tiny little protein kinase like AKT1 may play a part in helping to encode that new feeling. Turn it into a new memory. Make the old traumas fade. (That’s called extinction learning.) Teeny little AKT1 helps with this. In males. 

    Incredible.

    There are endless little nuances in your brain that translate your experiences, encode them, and shape your synapses…and your individual functioning. And maybe your future possibilities.

    AKT is one to keep your eyes on for sure.

    We keep learning, keep researching, and keep doing all we can to help you get better.

    (Let’s just say we read all this stuff for fun–at nights, on the weekends, and at 5 am with a double shot of espresso.)

    And at this point, serial titrated IV ketamine infusions still do the best job we’ve seen in bringing relief to more people with treatment-resistant depression and anxiety than just about anything else available today.

    But ketamine treatment doesn’t work for absolutely everyone. Is it because of AKT or something different? We don’t know. Not yet. Researchers like the ones at Boulder are still searching to understand the nuances of dendritic growth and synaptic plasticity in order to refine our treatments–and discover better ones.

    At Innovative Psychiatry, ketamine treatment is provided in a virus-free environment.

    At Innovative Psychiatry, we personalize treatment to fit you — all the complexity and all the wonderfulness of you! And we aim for remission. Not just response. That’s the reason we titrate your dose, duration of the infusion, and the number of infusions you need to help you discover — once again — your best self.

    When you struggle and suffer from the symptoms of disorders that can be tormenting and exhausting, getting treatment is paramount. And feeling safe is critical — so we have state-of-the-art technology that crushes 99.999% of all viruses and pathogens. During this pandemic we want to make things easy. We all need a little bit of easy.

    So now, reach out for IV ketamine treatment in a safe atmosphere where this treatment can help you live better, hope more, and enjoy the challenges and relationships in your life that give your life meaning.

    You can live a life of joy, fulfillment, accomplishment, and ongoing hope.

    If your meds have not been providing you relief from symptoms of depression, despair, PTSD, or suicidal thoughts…call us.

    Let’s talk about what you’ve tried that didn’t work. And if you’re a candidate for IV ketamine treatment, we can begin that.

    Even though ketamine treatment isn’t for everyone, it just might be a good fit for you.

    We’re here to help.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Don’t Let Stressors You Can’t Control Hurt YOU: Add Resilience

    Don’t Let Stressors You Can’t Control Hurt YOU: Add Resilience

    Turns Out Winter 2021 Hasn’t Run Out of Stressors to Throw at You Yet…

    People like you have been finding ways to adapt and endure this historical and very strange year. Never think that major factors in society, and in science, and in government, have no effect on you and your personal life. In fact, the ongoing onslaught of external pressures can take a serious toll. In fact, the toll can be so subtle you don’t realize it’s happening. If you find yourself sinking into what feels like quick sand, stop and take action. You don’t have to go down for the count. Stressors you can’t control don’t have to control you or even hurt you. But without intervention, you may find it all gets to be too much.

    Take Janeen and Carole, for example:

    Janeen and Carole were neighbors and had been friends for years. They enjoyed shopping together, stopping for coffee and pastries, or splurging on Italian food at their favorite white cloth restaurant. They were both upbeat single empty nesters and reveled in their freedom once their grown children built lives of their own.

    Carole was the more practical of the two, and Janeen was the more spontaneous, but oh, they had such fun together.

    As the pandemic emerged, and as surprising as it was, they didn’t expect it to have that much of an impact on their lives because they were both already so content doing things at home — together or individually. And they did, whether it was a craft project, or constructing a puzzle, or playing cards.

    However, with the spread of the pandemic, they each knew more and more people who became ill from it. Of course, Janeen and Carole were diligent with all the precautions including masks, gloves, hand sanitizer, and social distancing. Still, they knew someone who was critically ill with the coronavirus, and while she survived, it was pretty scary.

    Then Janeen learned that a life long friend of her family had died in the hospital from COVID. 

    Three weeks later, the brother of her co-worker also died. Both losses hit her hard. Then a cousin also died. Of course, they were reading about someone well-known who also died every day or two. The losses of dear people in this pandemic were unexpected and heartbreaking.

    You know that feeling when something so alarming happens that you hear about it in the news…but you never think it will happen to anyone you know..? Exactly. The alarming aspects of this disaster were getting too close to home for these friends. And in spite of the upbeat friendship Janeen and Carole shared, they discovered stressors you can’t control weren’t as easy to push aside when they plunder your personal life and those you hold dear.

    That Last Straw that Can Break a Camel’s Back…

    Finally, Carole’s sister Greta called and the tone of the conversation turned sour, then bitter…until her sister attacked her utterly unexpectedly. She attacked her political beliefs, her faith, and her family. By the time Carole ended the call, she was shocked and deeply wounded. Devastated. She felt betrayed at the deepest level. Carole trusted her sister. She respected her opinions and felt support from her so fundamentally, that she had always been confident they would never treat each other with disrespect. 

    Carole told herself her sister was just having a bad day. Or maybe the stressors of everything happening were wearing down Greta, too..? At any rate, Carole felt silly that she was so hurt by the things her sister said. She’d never been one to be so touchy with her family, to have her feelings on her cuff.

    But… for Carole, it was as if the clouds had covered the sun. The shades on her life had been drawn. And the light that had normally shone on her days disappeared. Carole didn’t understand what was happening to her. But the color in life had turned shades of gray.

    There was no reason to take her sister’s verbal assault so personally. But still, her outlook deteriorated. She couldn’t seem to help it.

    She read on the internet that depression seemed to be on the rise with COVID…and she wondered if that was happening to her for some inexplicable reason. It was as if she had lost her zest for life. As the days and weeks passed,  she realized she didn’t really care what her sister did…or what Janeen did. She felt so deflated she didn’t want to get out of bed. 

    So she didn’t. 

    Carole’s highly energized and determined personality went limp. Sad. Empty. 

    As days, weeks, and months passed, Carole knew she had become withdrawn. But she didn’t care. Nothing seemed to matter.

    Eventually, she realized she didn’t see any reason to keep living. Her children were living their own lives now, and she was no longer needed. She thought sometimes about how the end of life would come for her. Would she just not wake up one day?

    Or develop a catastrophic disease?  Then she realized she didn’t really have to wait…

    So she wondered how hard it would be to just put a STOP to her life.  To be released from the phenomenal stress she’d lived with.

    The more those thoughts built in her mind, the more reasonable they sounded to her.

    Janeen checked on her regularly, but Carole tried to end those contacts quickly. She just didn’t want to talk, visit, or exert any energy at all. She wished she could just sort of fade away.

    Above all, though, she knew she didn’t want to do anything that caused her family pain… Still, she continued to think about it…

    Another Perspective on Stress

    We talk about stress. How it can defeat otherwise unsinkable people. How it can reduce immunity and how it can contribute to disorders like depression, panic disorder, PTSD, alcohol use disorder, bipolar depression, social anxiety disorder, and suicidal thoughts. Stressors you can’t control are so much more difficult than those you can. And the helplessness that accompanies them does its own damage.

    When we look back in history to extremely stressful situations, we see how severe stressors can lead to suicide in masses of people. For instance, the stock market crash of 1929 for example, illustrates how extreme stress contributed to psychiatric crises for countless people.

    This winter — 2021 — has been a “perfect storm” of circumstances with the combination of the COVID-19 pandemic, flu season, the COVID variants, remote learning at home for kids, remote working from home, (where stressed parents try to do their job while supervising their children in the same space) and now a historical series of severe arctic storms sweeping from coast to coast, with snow, sleet, and ice causing life threatening traffic pileups, a break down in transportation of goods and services, preventing communities from having what they need… plus a presidential election and an impeachment.

    This is proving to be the most stressful, crisis-ridden winter this nation has seen in a very long time. And everyone is facing stressors they can’t control.

    And all this stress is dangerous. 

    Some people have taken every precaution to try to maintain health and safety, and to help contain the fallout of each of these crises.  Others have all but thumbed their noses at the need for precaution, and so many others have fallen somewhere in between. 

    Most people are relatively resilient, and will weather whatever is thrown across their path. But if major stressors are tossed at them day after day, week after week, month after month…eventually they’ll need some sort of relief…a break to recover.

    In this particular winter of 2020/2021, we may find ourselves isolated or quarantined. But we still need that break. We need to reach out for relief.

    By building a network of people we look forward to talking and laughing with online. Or writing for self-fulfillment and to draw interaction from others, or cooking meals and delivering them to neighbors nearby. 

    Stressors you can't control can hurt without resilience. Ketamine treatment restores.
    We all need to give. We all need to receive. And we all need feedback.  When we give, receive, and participate in feedback…well, those are stressors we can control…so they help.
    When the things we need as humans are accessible and balanced in our lives, it’s easier to maintain a certain equilibrium. 

    But our human needs aren’t always easy to fulfill, and as stressors pile high upon us, we may need more to help us survive.

    We may need a treatment to help restore equilibrium. These are highly stressful times for many, many people for a multitude of reasons. While we need to lean into our support system and find it’s not in place, we may need extra support.

    Something that IV ketamine treatment excels at is resilience. And resilience chases away the clouds of disillusionment and despair. It helps you bounce back after disappointment and devastation. You may have an abundance of resilience already. But if you don’t, ketamine treatment can sure restore it and arm you for what you face when you’re confronted with stressors you can’t control.

    At Innovative Psychiatry, resilience is a remarkable and startling bloom we often see in our ketamine patients. After years of living in a slump, stripped of courage, patience, hope, purpose…to see the same person develop a bright and open countenance, to hear the laughter in his voice, the hope, the confidence…the warmth; to see a life changed so splendidly makes what we do so rewarding.

    While ketamine is not effective for everyone — we so wish it was! — its extraordinary impact is life-transforming for many. Neuroscience researchers continue to probe to find reasons for those it doesn’t help.

    We also have protocols to ensure your safety when you come to our office for treatment. With Novaerus units in each room that remove the coronavirus from the air you breathe, and surfaces treated by Steramist, which removes 99.999% of all the virus, bacteria, and dangerous pathogens from ALL surfaces, we are diligent about keeping our air clean. We all wear masks, and keep the door locked. We’ve made so many changes… and reinvent down to the smallest details.

    You can feel secure knowing that, so you can seek treatment for your depression, PTSD, social anxiety, and suicidal thinking symptoms without fear of COVID infection.

    When it seems that the things in life you could always trust seem to fall around you, and the dread of it wears down your ability to try anymore, you might want to call us.

    You might want to discuss your options for getting your resilience back.

    And if you do, we’ll do our best to help you navigate your way through the barrage.

    To find the best you to face the circumstances around you and the stressors you can’t control.

    We look forward to talking with you.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Why Are Anxiety and Depression so Prominent in This COVID Pandemic?

    Why Are Anxiety and Depression so Prominent in This COVID Pandemic?

    What makes it so hard?

    Anxiety and depression are so prominent in a pandemic.

    Devon tuned into his department meeting. Another Zoom meeting. He was so tired of online meetings…the technical lapses, interruptions…  you can read people so much easier face to face. At the same time, he could sit in an easy chair for the meetings, so that wasn’t so bad. But no one seemed like themselves. Anxiety and depression are so prominent and have clearly taken their toll on his colleagues.

    Still, maybe there’s also a palpable energy in face-to-face meetings. He wasn’t sure if that was the problem or not, but Devon found it more and more difficult to focus, and to think creatively for his job. As the year had passed, he felt less and less capable and more like dead weight. 

    He kept asking himself what was wrong with him? Where were the sparks that flew when he dove into a problem?  Rather than sparks, Devon felt more like a dud.

    Then, he got the phone call about his next door neighbor’s son. Just like Devon’s family, his neighbor’s son was taking his high school classes at home, and online. At first, the young man Stewart, had stopped logging in to classes. Devon had heard this was becoming more and more of a problem in his community. 

    But, apparently Stewart was becoming more and more depressed. Devon just learned yesterday the boy had ended his life…right there at home.

    The grief settled over Devon like a black fog. This on top of the recent deaths from COVID-19 of two of his friends, 10 days apart. But Stewart was 15. His whole life was ahead of him. It was all too tragic.

    COVID Tragedies Can Trigger Anxiety and Depression

    He’d watched the boy grow up, playing with his own kids over the years. And it stirred up more worry about Devon’s own family. He and his wife had tried to keep a close eye on their children to be sure they logged in to school and did their work.

    But, they couldn’t be everywhere and they both worked online. But they tried. Still, life was becoming increasingly overwhelming. His heart went out to Stewart’s family. And he felt a low, sinister rumble of trepidation within himself. The dangers of the pandemic went far beyond the risk of getting sick with the virus. 

    The fear of becoming too depressed to function, or of his family succumbing to it, rose inside him till his  ears were buzzing.

    All in all, Devon knew he had to keep functioning, and presenting a solid, unified front with his wife. He also knew the danger of drowning in it all. When his meeting ended, he called a highly recommended psychiatrist for a consultation appointment. He wanted to be proactive, before it was too late to think straight.

    There’s just something about a pandemic that can make happy people depressed or relaxed people overwhelmed with anxiety.

    We’ve talked about it before. In the early months of COVID-19, that the circumstances that accompany a widespread environment like this can lead to your symptoms worsening. It can also lead to symptoms you never suffered before. Anxiety and depression are so prominent these days.

    Well, at this point, this global state of affairs has been causing stressors that aren’t new anymore. But they do go on and on and on….and on…

    And periodically, we need to stop and take a breath and ask how you’re doing?

    At this point, there have been 99,195,630 COVID-19 cases globally, with 2.1 million deaths. In the US, 25.2 million cases, and over 419 thousand deaths. The numbers are staggering. And the scale of this pandemic is difficult to grasp.

    These are people. Our teachers, our friends, our neighbors, our families. Grandparents. Parents. Our children.

    And…since we are a species with both mind and body, it stands to reason— doesn’t it? —that both our minds and our bodies are impacted by this. With anxiety about sickness, anxiety about isolation, anxiety about lifestyle change and lack of spontaneous freedom, it does stand to reason that the problems and stress factors would pile up and also lead to depression. Anxiety and depression are so prominent these days…and they often go together.

    We’ve watched a 1st wave of COVID spread, then a 2nd wave, then a 3rd…and it’s not over. The virus changes, mutates, and different strains have varying impacts. Some cause milder symptoms, some spread much faster, some cause more severe symptoms. It goes without saying that all this has affected you…and all of us,

    Most of us know people who have had the COVID-19 virus, and many of us have seen our friends and loved ones die because of it. This is a traumatic time that none of us will forget.

    Research Helps Us Understand the Impact of a Tragic and Stressful Experience

    A group of Danish researchers in Copenhagen and Aarhus, Denmark led by Søren Østergaard conducted a survey during each of those 3 waves to better understand the variation in psychological well-being regarding symptoms of anxiety and depression during this pandemic, among participants in Denmark. 

    Their results were relevant to the global community, even though severity of the disease hasn’t been equal everywhere.

    They reported results of the survey for wave 1 (March 31st to April 6th), wave 2 (April 22 – April 30th), and wave 3 (November 20 – December 8 … just last month.)

    The 1554 respondents were an average age of 49.5.

    There was a statistically significant decline in psychological well being from wave 2 to wave 3, especially with men. And during wave 3, worry, anxiety, and hopelessness decreased over those levels in wave 2, but feelings of guilt increased.

    Anxiety and depression have been prominent in Denmark, too.

    In a nutshell, these researchers ended the paper with the statement that by late November to early December, the psychological well being of the Danish population had fallen again to the level of March/April, when it had been at its lowest.

    Overall, they found that when COVID cases are high, and the measures to reduce the spread of the virus like quarantine, isolation, social distancing, and major lockdowns are the most widespread, there is a significant impairment of psychological wellbeing.

    What Can You Do with This Information?

    Setting aside the particulars of a study in Denmark, and focusing on right here in the US, we need to find ways to intervene in your own state of mind. Your own wellbeing.

    Gather online with friends and family to interact for online chess. Talk and laugh together. Watch your grand babies blow bubbles.  Share a spaghetti dinner, complete with candles, where each participant cooks at home then all connect and chat while eating.

    Social interaction is fundamental to your well being. When you share a meal on Zoom, you don’t have to wear a mask!

    Even so, if this ongoing pandemic seems to be having a serious impact with depression, social anxiety, hopelessness, even suicidal thinking, ketamine infusions may be able to turn that around and refresh your resilience. There is still hope.

    Anxiety and depression so prevalent during pandemic

    At Innovative Psychiatry,  we’re all about helping you get a leg-up to manage these challenging times, and meet the frustrations in your life with flexibility and peace. We offer IV ketamine treatment — after a thorough screening and evaluation — to those whom we determine are good candidates for ketamine’s extraordinary benefits. Ketamine treatment is not for everyone, because circumstances as well as the medical and psychiatric history of some patients indicate ketamine is not the right choice. However, it can be so helpful to so many…it can be transformative.

    We provide a safe place for treatment. We now test our staff at least once each week to verify they are COVID free… We can also refer our patients to a local DNA lab that will do same day PCR testing for those patients who wish it. In addition, we installed technology that destroys the coronavirus and all viruses and bacteria in the air and on all surfaces fast.

    Our goal is to help you get better and to keep you safe.

    You have struggled, tried to break through, tried to carry the anxious and depressive symptoms that have weighed you down for a long, long time. We want to help you put that struggle in your past. So you can feel restored. So that you can be your best self. To have the energy, freedom, and hope to build your life again with creativity and joy…and to have the resilience to move from day to day and week to week.

    You needn’t postpone it any longer. Call us.

    We can answer your questions and sort out the possibilities together.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Bipolar Mixed States: The Doctor Who Diagnosed It in the 12th Century

    Bipolar Mixed States: The Doctor Who Diagnosed It in the 12th Century

    If you suffer from mania, you’ve also experienced the transition that leads to it.

    Someone identified that transition emotion over a thousand years ago. Surprising?  Here we are in the 21st century, with all the technology and neuroscience we’ve discovered at our fingertips, and we still face that same emotion. And it often plays a strong role in bipolar mixed states.

    What is it?

    Anger.

    So many in our current society speak of various psychiatric disorders as if they’re a product of modern contrivance. Sometimes in psychiatry, our role is not only to treat those suffering from a disorder, but to also defend them against the cruel cynicism of skeptics who discredit their struggle.

    For someone who suffers from emotions that plunge so low, so dark, they don’t know how to hang on to a fiber of life… then without warning, those feelings change…shift…and become energized then agitated… with no reason….until they’re replaced by anger then rage….and more energy than can be managed….until they’ve reached a state of euphoria, unlimited possibility, and very high creative energy….  Someone like this knows the helplessness of erratic emotional states.

    And if you’ve experienced these wide changes in emotions, you know it’s painful.  When it’s happening inside you, it feels normal. It feels justified…because you don’t realize it’s happening because of malfunctioning signals in your brain.

    If you feel anger…even rage… it just must be justified, right?

    But many people with a disorder like this have to experience it for many years before they can identify those moments when their mood swings in a new direction. It’s hard.  Really hard.

    So let’s talk about this ancient philosopher and physician from the 12th century, Avicenna.

    He saw this disorder, this syndrome… and described it.  He talked about how it affected both the psyche and the body.  Pretty profound for a guy who lived around the year 1100 AD.  He called this condition “melancholia” and in present day mental health we might think of melancholia as depression. 

    But the syndrome he described included mania. And mania specifically identifies what we now know as bipolar disorder.

    In his early descriptions, he divided this condition into two phases, the early phase and the chronic phase. Symptoms of the early phase were described as suspicions of evil, fear without cause, quick anger, involuntary muscle movements, dizziness, and ringing in the ears.  

    For the chronic phase of melancholia, he described moaning, suspicion, sadness, restlessness, and abnormal fear such as the “sky falling upon one’s head,” or “being swallowed by the earth.”

    In our current environment, we would likely consider these last two as delusions, or psychotic features.

    Not all people with bipolar disorder have delusions during manic or depressive episodes. But in some cases, it happens.

    Avicenna also described some symptoms we might now see in “bipolar mixed states” such as increased libido, involuntary laughter, and acting as though one is king… which we’d now call “grandiosity.”

    These can all be symptoms of the manic phase of bipolar disorder.

    These are descriptions that are more than 1100 years old. But they describe a condition that we still see today, and work hard to identify and treat. What is so hard is identifying it first. An episode of anger does not mean you have bipolar disorder — not by a long shot. And even if you have bipolar disorder, getting angry could be just… getting angry. It may not mean you’re in a manic, hypomanic or even mixed state.

    How to tell? Sometimes it’s difficult. It may take several episodes. Sometimes it can take years.

    You don’t have to let it. The good news is that mixed mood states are treatable. If you’ve been ridiculed for the medicines you take, or the psychiatric treatment you participate in… if people around you don’t believe this is not only a valid and debilitating disorder, or think it’s something modern day doctors have dreamed up, here’s proof your struggle is valid. 

    People can be so… uninformed. You have to just shake your head in disbelief.

    According to Avicenna, people have been suffering with this at least since the 1100’s. It’s still the real deal.

    And he described bipolar mixed states without using the term itself: a combination of depressive and manic symptoms all tangled together at the same time. With a back drop of depression, and the addition of agitation, grandiosity, heightened sexual drive, anger, and emotions that are easily aroused, changed, that alter quickly. 

    There are doctors who attempt to diagnose bipolar disorder as specifically depression with at least one clear episode of mania or at least one clear episode of hypomania. But for a large population of patients, this is utterly frustrating. Because what they have–and what you may have–are mixed states, or mixed episodes.

    If you’re one of them, you know.

    You KNOW you’re not either black or white emotionally. You KNOW you’re not specifically depressed or manic.  

    While you may be depressed at times, and you may experience mania at other times, you know that you also have all sorts of combinations of emotions in between the two.

    It can feel like you are a vertical accordian with shifting degrees of manic and depressive symptoms at the same time and with the ratio shifting throughout the day, or from day to day … over sometimes every few days. So many variations make it hard to identify, difficult to explain, and frustrating to report. Symptoms like grandiosity and anger can signal other disorders, as well.

    And you know it’s real, though you may be told something different.

    When you suffer like this, you first need validation that there are things happening inside you that you don’t cause.

    This is a very difficult condition, and what you experience may be different than what someone with the same diagnosis experiences. But it’s real.

    And it’s treatable.

    Bipolar disorder can be challenging to treat effectively — and may need patience and determination for you and your doctor to tame — but hang on to hope.

    We’ve only talked about bipolar mixed states and mania but there is also depression in bipolar disorder. And bipolar depression is also extremely difficult to endure. It can be terrible.

    Thankfully, bipolar depression can be treated effectively by IV ketamine. 

    Another aspect of the depression in bipolar disorder is the risk of suicidal thoughts. And IV ketamine can remove those thoughts and give you the freedom to live in joy.

    At Innovative Psychiatry, we offer IV ketamine treatment for bipolar depression and see patients whose treatment has helped them emerge from the depressive symptoms that held them down. Not everyone, of course, but many.

    And these patients often talk about how much easier their condition is to manage since the depression is gone.

    While bipolar depression can be tough to break, ketamine treatment can break it. Give yourself the opportunity to see how good you can feel, how productive life can be, without bipolar depression undermining you.

    If bipolar depression interferes with your life, call us.

    We’re here to help you achieve remission, with resilience, hope, and the joy of a loving and productive life.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Explore: Method to Differentiate Bipolar Depression vs Unipolar Depression

    Explore: Method to Differentiate Bipolar Depression vs Unipolar Depression

    As you may know, May is mental health month.

    IV ketamine can restore her joy whether it's bipolar depression vs unipolar depression.

    And as such, it’s a good time to talk about symptoms of mental health disorders, don’t you think? We want to increase understanding and dispel stigma which will help people who suffer gain better access to the help they need. Stigma is steeped in ignorance about something someone doesn’t understand. In addition, the global circumstances of these last few months have impacted the mental health status of so many. So let’s use this month to broaden understanding and better equip us to respond to ourselves and those around us. So here’s something to talk about: A new way to differentiate bipolar depression vs. unipolar depression may be emerging.

    Leading Cause of Disability

    The leading cause of disability in the world today is not heart disease or cancer…it’s depression. Depression is that common. We talk about severe depression and we talk about bipolar depression. When you see someone with either of these conditions, they may look rather similar from your vantage point, but they’re actually two distinctly different conditions.

    When we diagnose someone in this depressed state, it can be difficult to determine whether they suffer from major depression or bipolar depression, unless they have a history of mania or hypomania to determine the difference.

    Unipolar depression and bipolar depression don’t feel the same…but they do sort of look the same.

    Which is why a doctor asks whether you’ve had times when your mood was elevated, you felt energetic, hyperactive, maybe irritable, angry… and overly confident…all at the same time?

    For this reason, so many with bipolar disorder are first diagnosed with major depression, especially those with bipolar II disorder, since their symptoms include far more depression than hypomania.

    When you first see a psychiatrist about your depression, it’s important to be patient. Because some of your symptoms may not have emerged yet…and you may appear to have unipolar depression. Then later, mania or hypomania emerges, and your doctor may change your diagnosis to bipolar disorder, along with your prescriptions.

    Because of the challenge of diagnosing someone accurately who has a low mood, researchers have been seeking a means of using some sort of biological markers to determine scientifically the proper diagnosis and character of the depressive symptoms.

    This man is in pain but doesn't know if it's bipolar depression vs unipolar depression.

    Something that would differ in patients with unipolar depression from those with bipolar depression. Possibly brain activity. Or maybe proteins in the blood? Possibly genetics?

    Exploring Bipolar Depression vs Unipolar Depression

    An interesting study conducted by Brain and Behavior Foundation researchers, led by Mary Phillips, Ph.D., performed with a relatively small group of subjects, suggests a way your doctor might differentiate the two disorders clinically to aid in accurate diagnosis.

    Using functional magnetic resonance imaging (fMRI), full brain scans were conducted on a group that included 18 bipolar patients who were in bipolar depression, 23 depressed patients who’d been diagnosed with major depressive disorder (MDD), and another 23 who were healthy without a diagnosed disorder.

    It’s unfortunate that their study involved so few, and also that 90% of those with bipolar disorder were diagnosed with bipolar II disorder, leaving only 10% who had bipolar I disorder. A more evenly distributed group might have told us more.

    Even so, they did make some significant observations.

    The working memory system is used by the brain to maintain, manipulate, and update information that is associated with tasks that are presently at hand. When the networks of nerves in this system are damaged, learning – reasoning – and decision- making ability can be disabled.

    This is particularly true in those with mood disorders, like depression.

    So, the researchers gave each participant an easy task and a difficult one, while the participant was undergoing an fMRI brain scan. The design of the tests was to highlight that people form expectations about a task before they fulfill it.

    Bipolar depression vs unipolar depression can both be treated effectively with IV ketamine treatment.

    A person might feel the task will be easy, so there’s little stress in performing it. But if he expects the task to be difficult, his stress increases before he begins.

    It turned out, that there were patterns of neural (brain cell) activation in the medial and lateral areas of the prefrontal cortex, that were related to how easy or difficult a task would be.

    Mechanism Defends the Person with Bipolar Depression From Emotional Pain

    The researchers reported that people with bipolar disorder may actually block anticipation of a negative experience to avoid experiencing negative emotion while performing a task. That basically people with bipolar disorder seem to have a built in defensive mechanism to help protect them from negative emotions.

    So enlightening. People with unipolar depression don’t do this. They feel what they feel. But those with bipolar experience such damage from their negative emotions.

    As I said earlier, unipolar depression and bipolar depression may look similar to someone observing people suffering from these. But they feel different.

    Let’s add to that, that both of these disorders can often end in suicide, unfortunately. Even so, it’s more common in bipolar disorder.

    There are traditional medicines for people with these disorders. And those medicines do help a lot of people.

    But not all.

    For that reason it’s important to seek help until you find treatment that helps you feel better, function better, and live a rewarding life.

    IV Ketamine Doesn’t Differentiate Between Bipolar Depression vs Unipolar Depression – It’s an Extraordinary and Robust Depression Treatment

    At Innovative Psychiatry, we offer IV ketamine treatment to help you experience relief from severe depression that prescriptions haven’t helped…. And for bipolar depression that is unrelenting in spite of prescription medications.

    Bipolar depression vs unipolar depression for this woman is still crushing.

    IV ketamine treatment isn’t effective with mania or hypomania. But the mania or hypomania is easier to manage and treat without bipolar depression. This treatment can be exceptionally effective for both unipolar and bipolar depression. In fact, it can be utterly life-changing.

    And… in regard to the risks of suicidal thoughts, IV ketamine treatment can erase those thoughts in an afternoon. A few hours. And if you’re not plagued by thoughts of death and dying, you’re a great deal freer to work toward healing, restoration, and joy.

    In this current global crisis, suicides have been increasing, among those with disorders, healthcare workers, physicians, and more.

    IV ketamine can save lives by removing thoughts that lead to suicide.

    IV ketamine has given her joy instead of depression.

    If you suffer from bipolar depression or unipolar depression, and medications haven’t helped, call us.

    Let us help you find your joy again, and your hope. The current global crisis is temporary, but it has affected the outlook of millions. The good news is that joy can be restored, and hope can return. You can feel resilient, and equipped for what life has in store.

    We’re here for you, and we’re working within a safety protocol so you can be treated without fear.

    Better days are ahead.

    To the restoration of your best self,

    signature of Lori Calabrese, M.D.

    Lori Calabrese, M.D.

  • Ketamine Restoration in the Amygdala Repairs Social Connections

    Ketamine Restoration in the Amygdala Repairs Social Connections

    Nick walked in after school, slamming the door behind him.

    His mom looked up, startled by the noise. “What’s that dirty look about..?? You’re so judgmental!!” Nick was fuming, and with that he headed upstairs. His mom followed him upstairs and spoke softly, knowing her son was apparently volatile. She didn’t realize that what just happened could be repaired by ketamine restoration in the amygdala.

    “Nicholas, I’m sorry my face looked judgmental. I wasn’t feeling judgmental…I was startled by the noise the door made, and concerned that you seemed so upset. Did something happen..?”

    Nick crumbled. 

    He didn’t know why he misread his mom, or why he was so angry. Nick hated himself for being hateful. He just felt so angry so much of the time, and when he wasn’t angry, he just wanted to cry… what was wrong with him?

    “Sorry, mom.  I thought you were mad about me slamming the door. I have a lot of homework and I just don’t want to do it. It all seems pointless.”

    Nick’s mom knew he’d been under a cloud since the last school year. He was seeing a psychiatrist, which he always dreaded. The medications didn’t seem to be helping, in spite of the fact he was on his third different medicine.

    He’d all but refused to see the therapist any more. As his mom, she just wanted him to feel better and enjoy his adolescent life, but she was hitting a wall. All she knew to do was to encourage him to keep trying and to provide a little comfort where she could.

    “Why don’t you come downstairs, and I’ll make you a sandwich. Eating something might help your homework seem a little easier to face.”

    Ketamine Restoration in the Amygdala

    While Nick ate, he decided to mention to his mom what his buddy in History had told him.

    “Mom, you know Zach? He’s been down for a long time…even longer than me. He told me today that he’s getting IV ketamine treatment. He said he took pills for a year and they didn’t help, no matter what brand the doctor ordered. Anyway, his dad read about this treatment, and Zach says it’s already helping.”

    “Really Nicholas? Does his doctor give him the treatment?”

    “No, he said his dad is taking him to a different psychiatrist who does it. He says his own doctor is all for it. He’ll go for two or three weeks and he’ll be done. So far, he’s finished the first week.  I can tell he’s doing better. He smiles and laughs. It’s weird. But I also envy him…”

    “I tell you what, Nicholas. You go work on homework, and I’ll see what I can find out about this treatment. IV ketamine you say? We’re going to find help, honey.”

    Three months later, Nick walked in the door, smiling ear to ear.  

    “Hi Mom. Since it’s Friday, is it ok for me to go to a movie tonight with Zach and Tim?  Oh and by the way, Chelsea said she’ll go to prom with me.”

    Nick beamed.

    “Oh that’s fantastic, Nicholas! I’m so glad she said yes. She’ll be on the arm of the nicest and best looking guy at school!  And sure, the movie’s fine. Zach and Tim are great guys.”

    IV ketamine restoration in the amygdala can make all the difference.

    Depression Can Impair the Amygdala’s Ability to Process Faces

    To the casual observer, this may all sound a little too easy. And for some people, it might be. Everyone’s different. But for most people like Zach and Nicholas, their misery is reversed by a series of 6 IV ketamine infusions, sometimes a few more.

    And in some cases supplements are needed to address low blood levels of certain hormones or nutrients first. But, when you consider the comparison of that to years of traditional antidepressants that aren’t working, it’s an easy choice.

    On top of that, the prospect of joy – and hope – in place of the damaged relationships caused by a short temper, a hopeless outlook, and absent motivation, is again…an easy choice.

    Humans like to feel good. When you don’t, you’re not very pleasant to be around, you know? Is there anything that makes you feel worse than severe, unrelenting depression complicated by anxiety and phobias?  It’s misery.

    And the thing is, it colors the way you see everything. You can be looking in someone’s face who’s just preoccupied, and interpret their expression as angry, critical, irritable… then you snap at them about it, and they feel attacked from out of nowhere.

    Guess what?  There’s a scientific reason you do that. It’s not just your imagination. And the good news is that IV ketamine treatment actually changes something deep in your brain to help you interpret their facial expression for what it’s intended to be.

    To understand this, we need to talk about the a wonderful structure in the brain called the amygdala.

    Ketamine Restoration in the Amygdala

    The amygdala consists of 2 almond shaped structures deep in the sides of the brain at the temporal lobe. It’s one part of the limbic system which processes emotion, records emotional memories, influences behavior, motivation, and the sense of smell, as well. 

    One key job the amygdala performs is helping you to look at facial expressions in others and determine their emotion. For instance, if you see someone frowning, with their face tense and lips tight, do you assume they’re happy? Of course not. It’s your amygdala that sees their expression and determines they may be angry.

    Well, when someone is suffering from a disorder like severe depression or bipolar depression, their amygdala may be malfunctioning.

    Study Explores Ketamine’s Effect on Amygdala Function

    So recently, a team of researchers led by Joana R.A. Loureiro in Los Angeles and Chicago set out to study what effect two rapid acting depression treatments have on the amygdala’s ability to accurately process facial expressions. Using functional MRIs (fMRI) they tested 44 adults who were all experiencing an episode of severe depression.

    They divided the group into two parts: 17 subjects were given an individualized number of treatments of ECT and 27 were given IV ketamine infusions 2 or 3 times a week until they had received 4 infusions. 

    This was an interesting approach because both forms of treatment affect brain function and emotional processing, so they wanted to see if it worked at the level of the brain cells. 

    Since interpreting the facial expressions of others is such an important part of social functioning, they focused on the subjects’ ability to accurately do that. The subjects were tested by the task of matching emotional faces on a screen. If the face at the top of the screen was smiling, they needed to match the face at the bottom of the screen that was also smiling.

    They found that both modes of treatment improved the accuracy of the subjects’ amygdala function.

    When Depression Impairs – Ketamine Repairs

    Now, about the type of scenario that Nicholas and his mom experienced. At the moment he walked in the door he believed he saw criticism and judgment in her facial expression, when her look was actually surprise and concern.

    When someone is severely depressed, it’s as though they have an affinity for negative feelings and beliefs. So, when they see a facial expression that appears negative to them, it goes to the bone. They feel it so deeply and lightening fast.

    It’s easy to see that this type of misinterpretation and reaction only further damages relationships that are already fragile when someone is severely depressed.

    And even though both ECT and ketamine improved the amygdala’s function, ECT is a treatment that carries some bias and even stigma for its side effects and history.

    We also know that ketamine not only blocks the NMDA receptors but it also activates AMPA receptors and an array of other actions that can make you feel remarkably better.

    And there’s another life-changing benefit ketamine can provide:

    IV ketamine can stop suicidal thoughts in a few hours.

    This in-depth study shows yet another way that depression impairs your function, and how ketamine treatment can restore it better than ever.

    Reach Out for Ketamine Restoration in the Amygdala – And Get Your Joy Back

    At Innovative Psychiatry, want to help you feel a lot better than just “less depressed.” We want you to experience joy, a song in your heart, hope for the future, and energized motivation to build the life you want, with healthy and strong relationships.

    It’s almost like using a car jack to crank up your life and replace the pain and loss with new ideas, new projects, new joy in relationships.

    If you can relate to Nick, and you want to feel joyful and able to care about others as you put your best foot forward, call us.

    We want to work with you and your healthcare team to help you experience extraordinary relief. 

    Reach out now for hope.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

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