Lori Calabrese, MD

Tag: IV Ketamine for Alcohol Use Disorder

Who’s Affected by Severe Chronic Depression?

Just think about it. How far reaching is this one condition?

Sure people talk about being depressed with a casual tone. You get the feeling they feel crummy…but it seems to be their response to circumstances. And when circumstances change, they seem to forget they felt bad. But when you think about who’s affected by severe chronic depression, you think of people who don’t have the energy to get up in the morning. You think about people who are trapped in substance abuse and have grown to hate themselves. You think about people who are just tired. Of everything.

Let’s take a closer look at the people affected by severe chronic depression. Who are they?

Gary is one.

Gary worked hard his entire life. He worked tirelessly to help others improve their lives. He worked to inspire and comfort. But, when you’re in the business of helping people enjoy richer, more meaningful lives, there are always those few who spurn your efforts, and even come back to crush you, if they can. And sometimes it’s the one you believed in the most.

In Gary’s case, there were two of them. They robbed his house when he was away for the evening. Then, spread false stories attacking his integrity. And Gary was cut to the heart. After being robbed and betrayed, he was hurt, angry, disheartened. In fact he was shattered.

Even though he’d always been optimistic, and bounced back after disappointments, this time he utterly lost his footing. Shock and devastation swarmed around and within him. He lost his bearings…and withdrew into the quiet safety of his house.

He found himself acting strangely, behaving in ways he never had before.

Months went by. He ordered food from Amazon and avoided any human contact if at all possible. He didn’t answer the door, and friends gave up, one by one, and became absorbed with their own lives.

A relative helped him get in to see a doctor finally. He was diagnosed with Bipolar II Disorder. The doctor prescribed a medicine to help prevent the hypomanic episodes, but the depression and withdrawal didn’t improve much. Years went by and he settled into a routine of leaving the house maybe once a week. His warm, inviting personality became subdued and cautious.

Something needed to give. To help free him from the box he’d built around himself.

And thankfully something did …but we’ll get back to that in a moment.

And Who ELSE?

Dan is.

Dan had his first drink when he was 14, and was hanging out on a Saturday night with his brother’s friends. They were all 16 and 17, and after getting some six- and 12-packs of beer, they all went to the lake on a Saturday night and drank all they had. Some ended up vomiting, others passed out in the car. Dan did both. But he liked the way the beer made him feel, and he knew he’d be up for drinking more when he had the chance.

High school beer bashes led to frat party blow outs, and while he experimented with some other things when he had the chance, it was alcohol that became his “go-to” in good times and in bad.

At 42, he drank whenever he was free. He had managed to get through college with a degree and land a job that was steady, but nights and weekends were his time to reward himself — whether anyone was with him or not. He worked hard to earn the right to get smashed on Saturday night.

After marrying in his 20s…hoping for happily ever after… he found himself alone and single again in his 30s. So many fights about his drinking. She was just beautiful, and he was so proud to be seen out with her, but she was so critical.

Alcohol Addiction and Depression… A Dangerous Combination

Now in his 40s, Dan began to understand why. And he realized he was likely to spend his life alone and drunk, if something didn’t change. He’d actually tried to stop drinking but something always happened and he was back at it. He felt pretty defeated. It seemed to be bigger than he was.

Every day he dragged himself out of bed, and went to work. He was often hung over, but 25 years of this had helped him develop an armor that got him to work, helped him function well enough to not get fired, and then home again to repeat the habit of every other night of his life. He had come to hate his empty, dead-end life, and his empty, dead-end self.

Dan hadn’t enjoyed anything in his life in at least ten years. He endured, and barely existed. He had no purpose. No joy. He was the chair person for the Dan Hatred Club. It was hard to see any reason to keep living. He wondered how to stop without it hurting too much. He was convinced no one would notice if he was gone.

There’s more to Dan’s story.

And I want you to know what happened. A little later.

While it’s so true that many people are very ill, even disabled in some cases, with severe chronic depression, you can see that many have other illnesses that are complicated by depression.

Some people suffer with a complex combination of disorders, and diagnosis and treatment can be complicated, too. We talked about Gary and his traumatic experience, the depression and phobias that followed and led to his eventual confusing behaviors, and a Bipolar 2 diagnosis.

We talked about Dan, his early introduction to alcohol and the long term impact it had on his brain…and his life. How his drinking gave way to poor social function, and the inability to give his best to his marriage. Eventually he found himself in a self-destructive rut and didn’t know how to turn it around. Then the suicidal thoughts began.

So who else is devastated – and disrupted – by severe depression symptoms?

Cheryl is.

Cheryl is 26. She’d finished college and was working on her masters degree in forensic psychology when she found herself pregnant. She and her husband wanted children, but they weren’t sure when.

Still, she felt like she was carrying a miracle within her, and the couple set about learning all they could about pregnancy, their baby’s development, and child rearing. They wanted this to go perfectly. She would find a way to complete her masters degree. But she was determined to celebrate their child’s life.

Her pregnancy was hard at first, with morning sickness that seemed unrelenting. But around the 13th or 14th week she thought she might be feeling a bit better. She began to browse in baby stores, looking at the tiny clothes and trying to imagine her baby wearing them. Her clothes were also getting tighter, and she shopped to find some pants that were looser and more comfortable. It was all beginning to feel amazing, just thinking about this little person who was safely cradled and growing out of sight….but under her heart.

The weeks dragged by, and her excitement about her baby became almost too much at times. She and her husband began shopping for a bassinet, a crib…and a stroller. She learned about support meetings for breastfeeding mothers and attended as often as she could. There was so much to learn!

Weeks turned into months, and finally she was in her third trimester. Just 3 more months. Through her pregnancy her emotions were filled with excitement and joy. A sense of wonder seemed to give the whole world a glow.

Happy Times Preparing for Baby

She and her husband attended childbirth classes and toured the hospital. They practiced exercises and breathing patterns at home to try to truly equip themselves for the adventure of labor and delivery.

Then, when she was 41 weeks along, those Braxton-Hicks contractions everyone talked about began to get out of hand. Within a couple hours she was in the ER being checked out.

Finally, she was in labor.

Cheryl’s labor progressed normally the first 10 hours. Then, in spite of hard and nearly constant contractions she was no longer progressing. Her doctor confirmed his suspicions: the baby’s head was lodged at an angle in the pelvic region and couldn’t move forward. He called for a C-section.

Within 15 minutes she was wheeled into the operating room, and suddenly asleep. When she awoke, everything seemed strange. Then she remembered the labor, the baby, and oblivion.

Her husband was smiling and told her they have a beautiful baby girl. She felt too groggy to understand what he was saying. She blinked hard to try to clear her head. Her husband handed her a little bundle. She laid it in her lap. What was it?

As the fog cleared her head, her memory of the labor returned. Her new baby slept in her bundled blanket. And Cheryl put the pieces together. She had had a baby. She was sleepy because of emergency surgery. The baby couldn’t get out… But where was that baby?

Traumatic Birth Can Interfere with Bonding Between Mother and Child

She asked her husband, and he told her their baby was in her lap. But the bundle in her lap didn’t look like anyone she knew. It just didn’t feel real…somehow…

She felt no connection to this tiny human, in spite of her husband’s reassurance… She felt sure she would have recognized her own baby, right?

Cheryl found herself detached, stunned, disconnected from feeling like a mother. Her strange behavior puzzled her husband. Why didn’t she cuddle their beautiful baby girl? The nurses tried to help her breastfeed, but the baby only cried. Almost as if this baby girl could sense her mom’s disconnect.

Cheryl and her husband took their new baby home and named her Phoebe Mae. She desperately wanted to feel something good toward the baby. But, she didn’t. She couldn’t. All that anticipation for 9 months, and this is it? Endless exhaustion and sleepless nights? Where was the joy..?

Her behavior worried (and angered) her husband. He just didn’t understand his wife’s coldness. Was this damaging Phoebe? What damaged Cheryl to cause this?

Months went by and Cheryl had long since taken up bottle feeding Phoebe formula. Besides, her husband could help more easily this way.

Then, Phoebe’s first smile was for her daddy. And her first laugh, too. Cheryl felt a bit jealous that she stayed with her daughter all day and fed her and took her on walks, but she really only responded to her daddy.

“They’d both be better off if I was gone…”

Postpartum depression.

It hurts the mom, it hurts the baby, and it hurts the dad. The severe chronic depression that can occur after the baby’s birth is heartbreaking and interrupts bonding between mother and child.. sometimes retarding a child’s development.

Which brings up another point.

Who Else is Affected… or should I say, Overwhelmed ?

The family is.

Everyone who loves you. They worry, they try to help, they pitch in, they listen.

And try as they might, they’re helpless. And desperate for solutions. Your severe chronic depression breaks their hearts.

These few examples give only a glimpse of the complex symptom clusters any one person might suffer. There are so many more.

But IF, and only IF, you can safely and effectively reduce or even eliminate, the symptoms of depression, you may be able to see your life restored and functioning again.

Of course, traditional SRI and SNRI antidepressants play their role in helping people with depression feel better. Roughly a third to half of them…maybe a bit more. For those people, antidepressants are enough.

But for the rest, those who continue to suffer no matter what pills they take, there seems to be a need for more than reuptake inhibitors. These people need restored circuitry, new connections, fast and prolific signaling deep into their brain. They need restoration.

Maybe they need IV ketamine treatment.

Remember, there is no medicine for depression that is as fast working as ketamine. No other medicine is as widespread in its antidepressant benefits in the brain. And no other medicine helps as many people recover, even achieve remission, and build restored, rewarding and fulfilling lives like IV ketamine treatment can.

Plus, it’s safe.

Ketamine doesn’t cause long lasting side effects. The notorious effects most antidepressants display, like sexual dysfunction and weight gain, don’t exist with IV ketamine. Ketamine doesn’t raise or lower the blood levels of other medicines you’re taking. It just goes to work. And, hopefully for you, it accomplishes the transformative restoration it’s so famous for.

The World Health Organization includes ketamine on its List of Essential Medicines. Respected around the world in ORs, ERs, disaster areas, and war zones, ketamine isn’t new.

Remission Often Replaces Severe Chronic Depression at Innovative Psychiatry

Innovative Psychiatry in South Windsor, CT is the premier provider of safe, rapid, and effective IV ketamine treatment for depression and other psychiatric disorders in Connecticut. We were the first ketamine treatment center of Connecticut — in fact in our four state region. Because we treat the most severe cases of treatment resistant depression, bipolar depression, anxiety, PTSD, substance abuse disorders, and social anxiety. We were intent on finding treatment that turned these symptoms around.

How did IV ketamine treatment impact Gary, Dan, and Cheryl? Did they recover from their own severe chronic depression symptoms?

IV Ketamine Treatment Does Its Best Work When Symptoms of Severe Chronic Depression Seem Untreatable

Remember Gary?

And his boxed-in anxiety-filled existence? The same friend who helped him go to the doctor, also helped him access IV ketamine treatment.

After 7 infusions, Gary bloomed. The warm, outgoing, generous man who had served people in need all his life re-emerged. Gary’s confidence returned along with his energy to participate in the lives of people who needed his help.

His life became rewarding again, filled with activity and relationships. You might say his best self was restored.

Then there was Dan.

Dan was suicidal when a friend told him about IV ketamine treatment. He learned that ketamine not only relieved depression, but could be effective in helping break addiction. And… that it could stop suicidal thoughts in a few hours. Dan wanted to see what it could do for him. He felt like this was his last ditch effort. He didn’t want to die, exactly. But he didn’t want to live like this any more.

Well, he was not disappointed. The first half hour of the first infusion, those images of death and thoughts of dying disappeared. Almost like poof! gone. He emerged from the infusion smiling. That was a good start alright.

That night, he found he had no interest in a drink, so he skipped it. How about that, he thought to himself.

After the second infusion, he definitely felt less depressed. Improved. NOT great…but better. By the time he arrived for the 4th infusion he was feeling pretty good. Hopeful…motivated.

It’s been six months since his 6th infusion now, and Gary feels like he’s living. He’s stopped drinking completely, sees a few friends, met a terrific woman. His future looks bright.

And Cheryl…?

Well, Cheryl’s husband heard about ketamine for depression from a friend at work. He encouraged her to talk to her doctor about it. Her doctor said that effectively treating the depression could reverse her struggle with bonding.

When Phoebe was six months old, Cheryl received her first infusion. On the way home with her husband she could tell no difference. He encouraged her to keep an open mind. That he’d heard it could take awhile.

By the 4th infusion he noticed she was taking initiative in the kitchen, preparing a new recipe. She hadn’t done that since Phoebe was born. Then the next day she was sitting with Phoebe playing patty cake… and that night rocked her, kissing her on the forehead as she drifted off.

She was expressing joy more and more and laughing with Phoebe. By the end of the 6th infusion she didn’t feel perfect but she did feel happy. The doctor said it would get better and better.

Severe Stress Can Cause a Setback

Then Phoebe got sick. At 8 months she caught her first cold. Cheryl was up all night comforting her, sitting with her near the humidifier to help her breathe. This continued for 4 days until Phoebe started feeling better.

But the lack of sleep and strain took their toll. And Cheryl’s depression returned. Not as severe as it had been. But severe enough. A couple weeks later her husband asked her to call the doctor, who told her she may need another “booster” infusion. So she complied.

She felt much better again after the infusion, and Phoebe stayed well all summer. They had daily walks in the sunshine, and Cheryl and Phoebe both had rosy cheeks and and a tan.

The next time Phoebe got sick in the fall, the stress didn’t affect Cheryl adversely at all. She had the resilience to go without sleep as she cuddled her baby girl through the illness.

Before long, Phoebe turned a year old. Cheryl and her husband threw a big party for all their friends. It was a celebration of their little girl’s milestone, and for the joy Cheryl and her husband were enjoying again.

This Can Happen for You, Too

These stories all have happy endings. But low dose IV ketamine isn’t for everyone. Is there any medicine that is? Nope…not a one. But the response rate to ketamine treatment is remarkably high.

Still, that remarkably high response rate relies on skilled administration. Low dose IV ketamine treatment is not a one-size-fits-all treatment. It requires careful titration, identifying specific responses in the patient, and finding the sweet spot in dose and rate that yields the best outcome for each individual.

Unfortunately, many providers of ketamine don’t understand this, and give the same dose at the same rate to every patient, then schedule them to come in for regular maintenance infusions, indefinitely.

In other cases, they try a different dose with each successive infusion, because they don’t really understand how to achieve the therapeutic response.

Find Restoration from Severe Chronic Depression

Innovative Psychiatry is the premier provider of IV ketamine treatment in Connecticut for safe, effective treatment of depression and other psychiatric disorders. We offered the first ketamine treatment center of Connecticut for severe chronic depression and other disorders.

Innovative Psychiatry offers you a most extraordinary psychiatric treatment, IV ketamine. Some people require booster infusions now and then for awhile, and others achieve remission with the initial six infusions.

Every brain is different, just as every person is different.

We can’t predict what it will be like for you, but we can promise to provide the most effective administration of this remarkable treatment that can be found anywhere.

Can you relate to Gary, Dan, or Cheryl..? Or maybe to their loved ones? If you have similar symptoms or variations of your own, that have not responded to the treatments you’ve tried, call us.

Like the people we’ve talked about here, you can have restored joy, renewed initiative and motivation, the energy to pursue your dreams, and to rebuild relationships.

We’re here to help. Let’s work together to help you live a fulfilling and rewarding life.

Lori Calabrese, M.D.

To the reinvigoration of your best self,

October 28, 2019
The Teen Suicide Epidemic – What You Can Do

Sam Chaney walked up to the quiet car in the dark.

It was a place by the lake frequented by teens for romantic interludes, or beer drinking. This car was dark. Silent. But running. He tapped on the window with a bit of anxiety. He’d just been reading about the teen suicide epidemic this morning.

“Hello – Metro police! Open the door please…”

Silence.

Tap tap tap…”Open up!”

Nothing.

Sam stepped back and looked at the car. Only then did he see the rags stuffed into the exhaust.

“Oh no….”

After trying to open the door, Sam used his baton to break the glass. The choking odor of exhaust wafted into his face. Carbon monoxide…

Inside the car he saw the lifeless bodies of four teenagers. One looked to be no older than 14.

Immediately he called for emergency personnel and then pulled each body out onto the ground in the fresh air.

One by one he checked their pulses. Nothing.

Instinctively, he did 15 chest compressions, then breathed twice into the mouth of each one. Then 15 more.

After the first one, he moved on to the next, then to the next. Their bodies were cold.

What is Causing the Teen Suicide Epidemic?

The suicide rate in teenagers has increased 56% since 2007. (Centers for Disease Control and Prevention) And even though the homicide rate in teens decreased 23% between 2007 and 2014, it increased again 18% between 2014 and 2017. Even so, the suicide rate has now surpassed the homicide rate in teenagers.

Suicide deaths in teens are also higher than accidental deaths such as transportation crashes or drug overdoses. These accidents represent the 3rd leading cause of death in people aged 10-24. But suicide has risen to the 2nd leading cause of death in teenagers.

Why??

We don’t really know. There are so many reasons. So many factors. Depression rates in children and teens have increased; in fact, they’ve increased across all age groups. Increased drug use has led to increased overdoses, too.

But a big factor seems to be embedded in the dramatic increase of social media use among this age group. This is a generation who has cut their teeth on facebook, instagram, and pinterest. Add to that Yelp, where they feel free to blast a restaurant with criticism every time they eat, just for the sport of it.

A Forum for Speaking One’s Mind – Uncensored and Unsupervised

In short, social media has allowed them to speak their mind, which isn’t necessarily bad. But to speak it without a filter aimed at diplomacy or compassion. We all know it’s easier to say something critical in writing than face to face. And during the teen years, insecurity is often considered hidden by cruelty to others.

Because of this un-squelched form of communication, privacy has taken a hit, too. A middle schooler catches someone in an awkward situation and sends the photo or video to his contact list. In seconds, a fragile, shy, insecure 13 year-old is publicly humiliated with nowhere to hide.

Darwin’s theory about the survival of the fittest is reduced to survival of the ones who dish out the most cruelty without falling prey to the same treatment.

For a child or teenager, the teen suicide epidemic seems daunting and intimidating. Her life experience or capacity to cope with such public shame is painfully limited, if not utterly lacking. And the under-developed prefrontal cortex in her brain prevents her ability to see such a crisis in the “big picture,” –that is, the idea that this too shall pass. Impulsivity can then win out …with a decision so permanent that all that’s left is the grieving.

Far too many of the children and teens who have taken their lives, had been reporting bullying. When circumstances didn’t change, they seemed to feel it was left up to them to stand against the assaults and onslaughts by themselves. And eventually, they may have become weary.

Chronic Stress Causes Pruning of Signaling Structures = Depression

We know what chronic stress does to the circuitry in the brain. Eventually, the synapses break down, dendrites become pruned…and depression ensues.

So a depressed person is more vulnerable to suicidal thoughts…images… and even action.

And there’s another factor.

Too often, as teens become depressed, they grow silent. They withdraw.

At Herriman High School in Utah, a total of 6 students ended their lives in a single year.

After each successive death occurred, the teachers, administrative staff, and parents became increasingly desperate to do something to prevent more.

The students, as well, experienced increased anxiety, overwhelm, and concern that students around them were suffering but no one knew who was at risk.

Parents Seek Answers for the Teen Suicide Epidemic

Parents spoke of the need to teach their children to talk about their feelings, and how things are going, from an early age. The mother of a boy who died said that she had no idea her son was struggling. She just thought he was being a normal teenager. She said, “We need to give them the ability to talk! And I think we’ve missed that along the way.”

As a result, both students and administration initiated programs to help everyone cope with their own anxiety and grief, and to also encourage everyone to reach out to anyone who seemed to be alone, isolated, or struggling.

QPR

In this atmosphere of tragedy, communication became a key focus. Since the parents of some who died recalled that their child had seemed withdrawn, spending long hours alone and talking very little, the students and staff learned to watch for withdrawal in any student. They developed a code: QPR. Similar to CPR, QPR is specific for saving the life of someone who’s suicidal.

Photo by Rachel Lynette French on Unsplash

Q stands for Question. They realized that people who are struggling may wish they could talk to someone, but maybe they don’t know what to say. In fact, they may not realize they’re struggling as much as feeling “off.” So the strategy they developed is to be bold enough to ask questions.

“Hi, would you like to sit with us?”

“How are you…?”

“You don’t seem to be feeling very well. Do you want to talk about it?”

“Are you at a point that you’re going to harm yourself?”

For teenagers, who struggle to talk at all, this initiative requires a brutal bravery, but as they weigh the awkwardness against the loss of life, they find they can push past the nervousness, and just ask.

P stands for Persuade. It means pushing through your own feelings to focus on the feelings of another. Then persuading that person to trust you enough to accept your invitation…answer your questions…consider solutions…

R stands for Refer. Part of the P in Persuade includes persuading the person to accept help and treatment: the solutions. It means including parents, the school counselor, and outside psychiatric help, as well.

Students refer to QPR as a useful tool for fighting the teen suicide epidemic and also for the helplessness they’ve felt as they’ve heard the announcement of each student who died. They feel armed with a way to help stop the deaths, and to know they’re doing something.

Joining Forces to Save Lives

Just as this high school pulled together to close the gap between hurting teens and everyone else, we can do the same.

To approach those who seem to struggle and dare to get your hands dirty. Dare to ask the questions. Then listen. Then work together with them to help them get treatment and to be safe.

Lots of Help is Available

But start with a comprehensive psychiatric — find the best doctor you can to do the best job they can to pull together all the pieces, all the stressors, all the symptoms. To diagnose and to offer treatment — rapidly.

And to present options and reasonable choices for treatment, the evidence for each, and the speed of response: medications, different talk therapies, TMS, and IV ketamine.

Speed is critical if you’re trying to save a life.

IV Ketamine Treatment works fast to Restore Brain Circuitry

So often, anguish is missed. Overlooked. Or it just doesn’t lift even with the first or second (or third) thing you’ve tried.

We see the end-results of anguish every day when everything breaks down: depression, anxiety, self-loathing, withdrawl. Loss of interest. Loss of eye contact. You don’t even smile anymore. (Or when you do, it’s phony.)

If you feel like this, or if someone you love feels like this, if treatment isn’t working, know that there is hope. You can feel better, you can repair and rebuild the circuitry that will allow that. And it can happen fast.

We know, because we’ve published our own results in a peer-reviewed journal.

IV ketamine treatment specializes in rebuilding broken down dendrites and dendritic spines — it turns on mRNA to switch on DNA to turbo-boost Brain Derived Neurotrophic Factor (BDNF) and those dendrites and synapses just explode in new growth. Repairing and restoring the circuitry, and giving you joy, initiative, motivation, energy, … and hope.

Once repair gets underway, your brain can transmit signals along those repaired and restored pathways. Your brain lights up, and your eyes light up with it.

There are solutions.

And even if your insurance doesn’t cover this extraordinary treatment yet, there is financing to help you pay for it. And there are voices clamoring for it to be covered because it can stop suicidal thinking. It can turn around that trip to the ER and make it unnecessary. It can help avoid the need for hospitalization.

Not always. But most of the time.

If you’re interested in seeing whether IV ketamine treatment might be an option for you, call us.

We’ll work with you, your doctor, your therapist, and your family, to help you feel better, function better, and really enjoy the details of your life again. If it’s been a really long time since you felt that way, you’re probably going to be astounded. Because the longer you’ve been ill without relief, and the more severe your symptoms are, the better IV ketamine treatment may work for you. It’s funny that way. It’s a bit of a show-off.

Let us help you find yourself, your creativity, and your heart again.

To the restoration of your best self,

Lori Calabrese, M.D.

We can all help prevent suicide. The National Suicide Prevention Lifeline provides 24/7, free and confidential support for people in distress, as well as prevention and crisis resources for you or your loved ones.

The National Suicide Prevention Lifeline 1-800-273-TALK (8255)

The Veterans Crisis Line and Military Crisis Line 1-800-273-8255 Press 1

Crisis Text Line: 741-741 Free text hotline 24/7

October 21, 2019
Get Your PUFAs Straight and Watch Your Mood Lift

We’re smack in the middle of a couple weeks focused on the quest for improved treatments for depression and anxiety.

This past Thursday was World Mental Health Day, dedicated to raising awareness for mental health …and this year’s efforts were focused on “40 seconds of action” to help reduce the risk of suicide. Because every 40 seconds, worldwide, we lose someone to suicide. And right on the heels of #WorldMentalHealthDay, we’re jumping into #OCDAwarenessWeek, which is promoted internationally each year by the International OCD Foundation during the second week of October. It’s an opportunity to LEARN about Obsessive-Compulsive Disorder and find ways to support those who live with it every day. And every discovery that researchers find lays the groundwork for improved wellbeing and fact-based treatment regimens. Like polyunsaturated fatty acids (PUFAs) in your brain. Let’s talk about how you can get your PUFAs straight and reduce the symptoms of depression.

BBRF Researchers Help You Get Your PUFAs Straight

The Brain and Behavior Research Foundation (BBRF) just released information about a new study that may explain why some people have more severe depression than others.

Led by M. Elizabeth Sublette, M.D., Ph.D., and J. John Mann, M.D., and published in the Journal of Affective Disorders, the study identified a relationship between polyunsaturated fatty acids (PUFAs), specialized proteins that transport serotonin (SERTs), and the severity of, as well as vulnerability to, depression.

This is a short excursion into only ONE aspect of the complexities of major depression and bipolar depression. But it’s important, and may give us something that we can do — actively, ourselves … every day — by modifying our diet. It’s back again–the importance of what we feed our brain. Not just diversifying our microbiome, ensuring we take in micronutrients, but choosing the best lipids to feed our brain health. Getting our fatty acids right.

See what you think of this…

BBRF Researchers Find New Discovery About Reducing Your Vulnerability to Depression

Using PET scans, researchers have found an intriguing relationship between certain types of polyunsaturated fatty acids (PUFAs) and the specialized protein transporters that move serotonin (SERT) to where it needs to be to do its job to reduce anxiety and improve your mood.

These are both ordinary, commonly seen components in the brain, but together, they seem to play a role in either causing depression… or at least causing you to be more vulnerable to it.

This study discovered a significant relationship tied to a certain PUFA known as arachidonic acid (AA). They identified a relationship between PUFAs and levels of that serotonin transporter, SERT, in the 6 most important areas of the brain. Plus, it showed how these two factors may influence the severity of depression.

The relationship is U-shaped, and inverted. It’s nonlinear. And that’s important.

Sounds complicated, I know. But here’s how they discovered this connection.

Study Subjects Stopped Their Medications for At Least 2 Weeks

The research team invited 21 adults, who were each in a full episode of major depression, to participate in the study. Each of these participants had refrained from any medication that affects serotonin levels or the biochemical system that produces arachidonic acid for at least 2 weeks.

A number of weeks before the PET scans, the team evaluated plasma levels of each participant for three specific PUFAs. DHA and EPA are both omega-3 fatty acids, and AA is an omega-6 fatty acid.

Measuring these three levels in six specific and key regions of the brain demonstrated their significance in depression.

Now get this:

In a healthy brain, SERTs are widely available in abundance throughout the brain so they can remove and recirculate those serotonin molecules from spaces where they can’t function.

For example, when they get stuck in spaces between the sending and receiving neurons after a signal has been sent. This is what happens: The SERTs take up the serotonin and return it to the sending cell. So it’s ready for the next message that needs to go out. Easy.

Now that’s what happens in a healthy brain.

However, a number of peer-reviewed studies have found that there’s a low availability of SERT in the brain of someone suffering from depression…or bipolar depression. The most commonly prescribed antidepressants, (SRIs), block the SERTs so the SERTs can’t move the serotonin out of those spaces where they’re stuck. This keeps serotonin available in the synapses between the neuron cells which promotes more signaling.

But In A Depressed Brain…Well, You Need to Get Your PUFAs Straight

However, this team of researchers discovered something about those three PUFA levels they analyzed before the scans. Only AA actually affected the availability of SERTs across those six brain regions they viewed with PET scans.

In fact, they found that the lower the AA level a person had when evaluated before the scans, the greater that person’s SERT transporter level they saw in the PET scan.

Reduced AA level = More Transporters; and Therefore Improved Mood…?

This is so revealing. We need to get our PUFAs straight.

Because depression and bipolar depression are complex and are each affected by so many factors. We’ve learned so much about depression through observing ketamine’s actions in the brain. And while we no longer believe the key to depression treatment is as simple as increasing level of serotonin (or any other neurotransmitter), we do know that serotonin binding plays a strong role in freedom from depression or conversely, a vulnerability to it.

Of course, our BBRF research team called for more studies to verify these findings. They asked that other researchers carry them a few steps farther. We need more information about the science behind polyunsaturated fatty acid supplements in depression. How do we work with complex, inverted, U-shaped relationships?

Hopefully, we’ll be hearing more about the effect AA has on depression and vulnerability to it.

This may sound like a little thing …a small finding from a ton of research. But it’s a breakthrough. And when you add up all the individual breakthroughs, together they can result in your changed and improved life.

Get Your PUFAs Straight and Bring Depression To Its Knees

At Innovative Psychiatry we rejoice with our patients whose symptoms lift after IV ketamine treatment. These patients didn’t responded to traditional medications. We continue to use a myriad of medicines, treatments, and regimens to relieve symptoms. And we bring the latest research findings to our practice. But for most patients, nothing compares to IV ketamine’s restoration of resilience, creativity, and initiative. The results bring fresh perspective, fresh hope, and renewed relationships as people rebuild their lives with enthusiasm and clarity.

Let’s keep spreading the word that remission of symptoms can happen. It’s no longer a pipe dream.

If you… or maybe someone you love… aches for relief from trauma or depressive symptoms, call us.

We know others who suffered from the same kind of pain, vacant-ness, and despondency you do. We can help.

To the restoration of your best self,

Lori Calabrese, M.D.

October 14, 2019
CT Psychiatrist Shows Titrated IV Ketamine Can STOP Suicidality

Data Published from a Real World Psychiatry Practice Shows How Ketamine Infusions Can Avert ER Trips and Hospitalizations

SOUTH WINDSOR, Conn., Oct. 8, 2019 /PRNewswire/ — Lori Calabrese, M.D., Innovative Psychiatry (https://www.loricalabresemd.com). Local psychiatrist publishes data demonstrating that the use of a series of IV ketamine infusions, with dose adjustments, can stop suicidal thoughts and avert ER trips and hospitalizations. The research, published in the International Journal of Psychiatry Research, comprised a retrospective chart review of 231 patients with treatment resistant depression and co-occurring complex psychiatric illnesses treated in a large psychiatry office.

“This is the first report from a real-world psychiatry practice treating severely ill, suicidal patients with treatment resistant depression and complex psychiatric co-morbidities. It involved looking back at the treatment we provided to a large number of patients with treatment resistant depression who were suicidal. For them, serial, titrated ketamine infusions were life-saving. There were no suicide deaths or suicide attempts, no need for ER trips or psychiatric hospitalizations,” says Lori Calabrese, M.D., Medical Director of Innovative Psychiatry in South Windsor, CT. “This is the first report of IV ketamine used to treat suicidal thoughts in patients with treatment resistant depression in a real outpatient practice setting, the first report of the use of serial titrated infusions in comprehensive psychiatric practice, and the largest group of patients reported from one site in published studies of IV ketamine for treatment resistant depression and suicidality,” she says. “It’s a lot of firsts.”

Dr. Calabrese explains that this population of adolescents and adults is the most challenging to treat because their lives are at risk. Medicines that can rapidly treat suicidal ideation are few and far between, and desperately needed. “Remarkably, most of these patients had already tried at least 4 different antidepressants without improvement. The majority had made previous suicide attempts, had been hospitalized, and were currently being treated with complicated medication regimens without relief. Others had no relief from ECT or TMS (transcranial magnetic stimulation). Yet most of them responded dramatically to ketamine infusions,” she stated.

In many cases, a single ketamine infusion stopped suicidal thoughts completely, even if they’d persisted for months. If they didn’t stop, a short series of treatments significantly reduced suicidal thoughts in 79%, and completely stopped suicidal thoughts in 59%. “This is a dramatic result,” Calabrese states. “We’ve never had anything like this to offer patients.”

Of the 231 severely ill and high risk patients, there were no suicide deaths, no suicide attempts, no need for trips to the ER for suicidality, and no psychiatric hospitalizations during treatment and for an additional 4 weeks.

The lack of available treatment options, other than ECT, for people with treatment resistant depression who are suicidal, and often have several other psychiatric conditions associated with agitated states and increased suicidal risk, causes a critically high burden for these patients—financially, in quality of life, and in survival. “This treatment can offer these patient an extraordinary possibility,” Calabrese states. “The potential to avert suicide, preserve life, reduce patient and family suffering, and reduce healthcare costs is enormous.”

To learn more about Dr. Calabrese’s work with IV ketamine for treatment resistant depression with suicidal thinking, go to https://www.loricalabresemd.com, call 860-648-9755, or email info@loricalabresemd.com.

About Innovative Psychiatry (https://www.loricalabresemd.com) – Full service psychiatry practice offering patients innovative treatment including, but not limited to, IV ketamine infusions.

October 8, 2019
APA IPS: Innovation and Collaboration Improve Access to Psychiatric Care

I just returned from the annual meeting of the American Psychiatric Association’s Institute for Psychiatric Services: Mental Health Services Conference, in NYC.

This conference was presented in collaboration with the World Psychiatric Association. The World Psychiatric Association represents 120,000 psychiatrists in 120 countries. The heart and focus was that innovation and collaboration improve access to psychiatric care. It’s easy to miss the numerous populations who struggle to get help. And need it so desperately.

What a wonderful gathering. This group convened for psychiatrists and all the allied professionals who work together in mental health. Social workers, therapists, psychologists, counselors, psychiatric nurses, and mental health workers on every level. With the theme, “Improving Access Through Innovation and Collaboration,” the sense of learning and sharing together was palpable.

An audible commitment pervaded the crowd who recognized not only the value, but the vital role each discipline plays to provide mental health care to those who need it. The President’s theme concept definitely found its mark. Innovation and collaboration improve access to psychiatric care for everyone.

Abundant Presentations

There were presentations about suicide, about issues for LGBTQ youth, about the mental health and well-being of physicians and medical students, about addiction, and about where opioid use and psychiatric disorders intersect. There was a round table discussion about the presence and needs of mental health sufferers in the criminal justice system, an area sorely in need of solutions.

One session informed about talking, and listening, to patients about marijuana and CBD, and provided information psychiatrists need to know for these discussions.

Poster Presentations on 3 Floors

Then there were poster presentations. Four separate sessions of them!

Poster presentations on the latest findings in a wide variety of current subjects. One presented the issues that come into play when a patient requests a hastened death. Heavy subject matter, without question. Another considered a case of delusions of persecution in someone suffering from migraine. Another reported on psychiatric needs in the refugee crisis. Still another described educating an underserved community about ADHD.

And there were several on suicidality, where I also presented my own findings in treating suicidal thinking with IV ketamine infusions.

The enthusiasm for my poster bubbled over. So many asking questions, wanting discussion and details. I wish I had had more time. But it was thrilling to see how much psychiatrists ache to have better treatment alternatives for their most vulnerable patients. I think many were captivated by the fact that out of this population we had no suicides, no suicide attempts — not even trips to the ER. No one needed to be hospitalized.

IV Ketamine Treatment Can Make Such a Difference

IV ketamine treatment really is a game changer. And it can be a life-saver. We’re learning — and have so much more to learn— about how infusion dose and dissociation play a huge role in the outcomes.

We read the literature. (It keeps us up at night!) And we trust the literature. And sometimes we allow the literature to even think for us… So it really helps when our colleagues try an approach we haven’t heard of especially if it turns out to be effective. It adds a tool to our tool belt.

When we go to conferences, one of the driving forces is that we’re always hoping to find another tool or two we can use to help our patients improve.

It was thrilling to me to talk with other psychiatrists who would like to learn more about how ketamine can help, and who want to make sure they know enough about it in real practice settings to begin to talk with their patients about if, when, and how much. We all want better tools, better responses, better results. We need to be careful, thoughtful. And bold enough to stay on the cutting edge.

Some were hand-picked by the President of APA

There were presidential presentations, which were arranged by Bruce Schwartz, M.D., President of the APA. He invited specific leaders to speak on pressing subject matter from their expertise and experience.

One highlight was the presidential presentation by the esteemed Charles Nemeroff, M.D., Ph.D. He’s Professor and Associate Chair for Research at the University of Texas Dell Medical School in Austin, TX. Dr. Nemeroff has published more than 1100 scientific reports focused on the pathophysiology of mood and anxiety, particularly in children of abuse and neglect.

Dr. Nemeroff’s presentation centered on personalized medicine in psychiatry. His point of view is that personalized medicine is advancing slowly, but as we move forward, the future for our patients shines brighter and brighter.

I see the importance of his words in my own practice, and with my own patients. There is always room for improvement. Now, more than ever, the stakes are high, and time is short.

The Tragedy of Inmates Who Need Treatment

Another presidential presentation that was deeply felt by many was a round table discussion. It was chaired by Althea Jeanne Stewart, M.D., regarding the disjoint between mental health needs and the criminal justice system.

If you’ve ever encountered the experience of an inmate with a disordered brain, you know— the pain and frustration these suffer, the frustration of staff, and the intense difficulties for everyone involved.

We must continue to confront these difficulties in our system, and do the hard work required to apply better solutions.

Innovation and Collaboration Improve Access to Care for All Patients

The theme for this year’s conference was a solid one. Ongoing innovation will yield more effective treatment. And in collaborating with a team of experts, more psychiatric patients will have the care they need. But one of the stakeholders is the insurance industry and the insurance companies who pay for care. We need them to realize that and innovative treatment like IV ketamine can stop suicidal thinking enough to reduce their dollar spend on ambulances, mobile crisis calls, ER visits for suicidal ideation and hospitalizations for people who fear they will harm themselves.

Because as we advance forward, our society will only benefit from a broader and larger population of people who are functioning well, and feeling well. Who can fill their positions, contribute their talent, raise their children, take care of their world. For that to happen requires accessible psychiatric care.

And in the case of outpatient care in the privacy of an office setting, extraordinary treatments like IV ketamine …could mean the difference between life and death.

We see it every week at Innovative Psychiatry. Not only life and death struggles, but life that’s rewarding. Full of hope. Where purpose, meaning, and reward replace despair. Where you have the energy and creativity to restore and strengthen your relationships. And where joy thrives.

We attend meetings to bring home more to help you find restoration. If you have severe symptoms of depression, bipolar depression, social anxiety, PTSD, substance use disorder, or postpartum disorder, call us. We’ll help you find out if IV ketamine treatment can help you heal and find joy and purpose in your life.

Lori Calabrese, M.D.

To the healing of your best self,

October 7, 2019
Cost of Ketamine Treatment: Is it Worth It?

“IV Ketamine treatment…? I can’t afford that.”

“Sure, I want to feel better. I’ve tried so many medicines and treatments. I don’t even know what it’s like to enjoy something, anything…or to feel happy. I don’t have the energy to even get out of bed half the time, much less get anything done. But…the cost of ketamine treatment is way out of reach for me. I don’t even know if it’s worth it?” That’s Ann Marie, out loud.

“When I go to work, my mind is plagued with images of people dying… or me dying. Dark, hopeless thoughts and pictures in my head. Sometimes gruesome…

“But we all know IV ketamine treatment is for people who’ve got money…. right?”

……….

This is what people say to themselves, and to their family…comments like this, or others similar…

And since IV ketamine treatment can restore your hope, your motivation, and initiative, you’re likely to be far more able to make those payments after you’ve benefitted from the treatment.

So, maybe they aren’t seeing the big picture… in fact, maybe you aren’t seeing it either. It’s something to think about.

Because, you know, you don’t have to have the free cash to pull the payment out of your wallet on the spot. You know that, right? Countless companies offer medical financing to pay for medicines and procedures over time. Advance Care Credit, United Medical Credit, and M-Lend are a few.

For example, have you thought about the benefits of investing in IV ketamine treatment ? Yes, there’s an initial investment, but have you thought about this..?

Discontinue Medications and Save $$

For one thing, you’ve likely been taking medications for your depression or other disorder for years…haven’t you? And even though they haven’t helped, you may still be taking them.

But, the beauty of ketamine is that it works independently of SRIs, SNRIs, anxiolytics, etc. So by investing in as few as 6 ketamine infusions, or a few more as needed, you may find you’re well enough to think about eventually tapering some of the add-ons that didn’t add anything.

Some of your medicines may not be expensive, but some may be pretty pricey. In some cases, people have found that IV ketamine treatment paid for itself in 3-6 months. Even when you have insurance, your treatment costs can be exorbitant. Now it seems like everyone has a huge deductible to pay before insurance even kicks in. How much money would you save if you were able to stop taking those …. add-ons that maybe aren’t adding anything? Well, that money could go toward paying for your IV ketamine infusions.

Then, there are those calls for extra appointments with your doctor when your symptoms flares.

Fewer Doctor Visits

If you’re not having symptoms, you may find you don’t need to see your doctor as often as you were when your symptoms were so persistent and so severe. What a relief that would be–if you didn’t need to call to be fit in for extra appointments when you took a dive, didn’t have to reach out to an answering service on the weekend. You’d probably prefer to spend that time and money doing things you enjoy, right?

Why pay for a parking garage and sit in a waiting room when you’d rather be hiking in the woods, or playing tennis, or shopping? When ketamine goes to work on your brain systems, and restores the circuitry there, you regain the power to enjoy. And if you’re enjoying yourself, it’s likely you may not feel the need to check in with your doctor nearly so often.

Add to that the expense and the hassle of lab work. Some medications require that regular lab work be done to monitor your liver, or your kidneys, or your blood sugar and your cholesterol.

To spend more of your time enjoying your life, your work, your hobbies, and your relationships is a far more fulfilling way to spend your time than having blood drawn in a lab on a Saturday…don’t you think?

And money spent on co-pays and fuel, as well as wages lost from missed work and days you take under your FMLA for symptom flares and doctors’ visits…well, those funds have such better uses when you feel really well. Baseball tickets, funnel cake, or…a picnic in the park!

Cost of Ketamine Treatment Improves the Quality of Your Life

But most of all, it’s the quality of your life. While the costs can be reclaimed in countless ways by a happier, healthier you as time goes on, can you put a price on your improved, deeply rewarding, utterly fulfilling new life?

James comes to mind. A patient of mine who couldn’t remember ever feeling happy, or having fun, or enjoying those little moments in his life. Ketamine worked for him. And now, he enjoys a fragrance he notices in the air, the way the meat responds to the fire when he’s cooking, the clear blue of a mountain spring.

Things he never noticed before because of the dark gray cloud that hung over him, suffocating him. He arranged financing for his treatment, and that monthly payment feels easy, because he lives every day the life he had wished for as long as he could remember.

And his life has bloomed, because he has the energy to step out and live. He has a family that’s growing and his mind is on his family’s future…in fact, he realizes his whole life is ahead of him. He invested himself and the cost of ketamine treatment was part of that.

Then, there’s Lisa. She grew up in a home where she never felt understood. She was sensitive, intelligent, and meticulous. Her parents were hard working, confident, and not so tuned-in. Not really understanding their daughter’s sensitive nature, they made a plan for her from earliest childhood. She would be a doctor, and would make them proud.

But Lisa’s heart turned to music, and she sang like an angel. From the time she was losing her front teeth, she could feel her parents’ pressure to be who they wanted her to be. She wanted so much for them to appreciate her for who she really was.

Lifelong Depression Wears Down Brain Circuity

By her 6th birthday, she would arrive at home after she got off the bus, and enter the dark house frightened, alone, and shaken. The anxiety from those long afternoons alone in a dark house grew to a dread that followed her wherever she went.

Depression drained her energy, and her hope in life. Adolescence turned out to be a cruel time, and she felt she didn’t fit in anywhere. College was a chance to excel. Getting married was a no-brainer. And though she had transient reprieves from the trudging existence she endured, the dark hopelessness and choking despair always returned.

Pregnancy after pregnancy…she could conceive, but had no energy to care for the children, and would just go back to bed. The kids spent a lot of time at their friends’ houses while she slept on the couch. They learned how to make their own mac and cheese.

Hospitalizations didn’t make much difference. Medicines her doctors prescribed brought no relief. The kids raised themselves.

The Cost of Ketamine Treatment

But finally, when her first grandchild was on the way, and Lisa wanted the ability to build a relationship with this child, she heard about what ketamine treatment was doing. She learned that she would need at least 6 infusions, so she needed to be prepared to pay for them.

Those who knew her and loved her wanted to help. Eventually, a friend offered to help her pay for the treatment.

For Lisa, it got unreal right then. There was an unreal-ness about suddenly having a way to get real help…to maybe have an opportunity to feel good for the first time in her memory.

And as she’d hoped, within a week she was improving. Little beams of hope penetrated her cold damp tomb of anxious despondency …one little beam at a time. It was slow. She started taking walks, just because. Then she started reading books and meeting friends for lunch.

A friend’s help made the cost of ketamine treatment manageable.

Now, Lisa is a rosy-cheeked, very active grandmother. She takes her granddaughter on picnics and to the zoo, for ice cream, and to play in the park and feed the ducks. Her grown children watch in disbelief–where was she when they were little?–but they’re relieved that she is finally functioning, happy, productive, and interested.

She has the energy to share all kinds of experiences with her grandkids…both the physical as well as emotional energy. They play games and she teaches them about good sportsmanship and the competitiveness to win, too.

Lisa made little payments to her friend for three years to repay the loan that gave her back her life. She says that loan was the greatest gift she’s ever received. She has the power to love again. To dance and sing and play ball with her family.

Ketamine Treatment Must Be Available to Those Who Need It

Is there anything more important than the power to live your life well? Happily, generously, joyously?

When people ask me how they can afford to pay for this treatment, I wonder. A lot.

I wonder how we can afford to stand by while our sisters, our friends, our kids, and our husbands slowly shut down.

I wonder how we justify the days lost, the jobs lost, the unpaid FMLA’s, the lost opportunities. The kids’ games that we missed, the holidays we suffered through, the long agony of a weekend that was empty.

I wonder how our insurance companies so readily deny payment for an infusion that could stop suicidal thinking and save a life –but quickly fork over $1300 for an ambulance ride to the ER and another $1500 for the night spent on a gurney, waiting to see if the crisis worker will hospitalize you or send you home?

Insurance will pay for that, and refuse to cover ketamine infusions? The procedure exists, the billing code is there, the diagnosis is clear …the results speak for themselves.

I wonder, sometimes, not about affording ketamine, but about how we can afford this: to live like this, day after day. What’s it costing us? What’s it costing our kids?

In the light of the transformative effect of ketamine at its best, you owe it to yourself to find a way to give yourself an opportunity to live – and live well. To enjoy your life, to invest in it, to learn and grow, to stop the suicidal thoughts, to get rid of the depressive symptoms. To be happy.

It’s true that IV ketamine treatment can’t offer a 100% response rate, but no medicine can do that. The cost of ketamine is an investment… But there are few investments available to us with the return that comes from this extraordinary treatment.

James made this comment, “Instead of spending all my energy trying to figure out how to survive the week and how to ignore the suicidal thoughts that are always there, I’m excited about figuring out my next step, and I’m looking forward to good things happening. I’ve never experienced anything like that before.”

Everyone should have the opportunity to live free of symptoms, and to have the energy and hope to invest in the things you believe in.

At Innovative Psychiatry, we’re investing in you and your future. If you’ve suffered and treatments haven’t helped, call us. The cost of ketamine treatment? We think it’s worth it. It can make real living, fulfilling engagement, rewarding relationships, available to you.

To the unveiling of your best self,

Lori Calabrese, M.D.

September 30, 2019
ASKP Conference 2019: Celebrating the Response to Ketamine

The Importance of Meeting Together

Every once in a while — sometimes only once or twice in a physician’s career — a medicine or treatment comes along that’s a game changer. Something that sets its own records, raises its own bar, and helps people so profoundly that their lives are better because of it. A treatment so remarkable, it establishes a turning point for them. Where life is divided by the “before” and “after” of that treatment. IV ketamine is such a treatment. And we’re celebrating the response to ketamine every day.

In the field of psychiatry, ketamine’s use off-label has established that line: the misery of “before” and the wellbeing of “after” for growing masses of patients who suffered all their lives, lived at risk of suicide, and found life difficult to bear. The same people who now are enjoying their families, their friendships, their work, and their hobbies.

And because ketamine is FDA-approved for anesthesia, it presents us with a double- edged sword. On the one hand, it has shown us how safe it is with patients in every age group for 50 years at very high doses as an anesthesia and in pain. And on the other hand, its rapidly growing use in psychiatric disorders is off-label — outside of its FDA labelling for anesthesia.

Collaboration in a New Field: Ketamine Off-Label

Neuroscience researchers, psychiatrists, anesthesiologists, emergency department physicians and more have been scrambling to understand this medicine and its effects for years as we navigate this new territory.

And the best way to do that?

To put our heads together and exchange information, experiences, ideas, and data; and learn all we can together to bring the safest, most effective treatment to our patients.

Do we see it all the same way? Of course not. But by coming together regularly we grow and expand our grasp of what ketamine can do for our patients.

And we have something deeply in common. We’re all celebrating the response to ketamine we see at every turn.

ASKP for Ketamine Treatment

The American Society of Ketamine Physicians (ASKP) is about this very thing. We gathered a few days ago to learn from each other, grapple with difficult issues we face, and to expand our knowledge and expertise to better serve our patients.

This was the second annual meeting of ASKP, and we’re inspired by how we’re growing in numbers and experience.

As physicians we vow to first do no harm. And then of course, beyond that, we want to help. For more than 50 years, and in more than 19,000 scientific papers, brilliant minds around the world have dug deep and broad in their research — from their universities, their labs, their clinics, and their practices to understand the science and the nuances of ketamine. All so ketamine can help people who suffer.

Dr. Jennifer Winegarden, who spoke on the use of ketamine in refractory cancer pain, put it like this:

“We are really here because we want to relieve suffering, but coming up with a consensus for how exactly we’re going to do that is a lot of work; we are still in our infancy in discovering how we are going to do that.“

The Speakers

Steve Mandel, M.D.

Steve Mandel, M.D.

President of ASKP and one of its founding members, introduced the meeting with a call for collaboration.

He quoted Stephen Hyde, MD, a pioneer in ketamine treatment in Australia, stating “Given the unacceptably high rates of suffering, disability, and premature death experienced by people with treatment-resistant depression and the surprisingly low rates of problems arising from the use of ketamine to treat the disorder, this is a therapy that all patients and their doctors should be discussing.”

And the speakers? Well, to read the list is to begin to stroll through ketamine’s hall of fame in clinical psychiatry. It was inspiring to listen to speakers who’ve been blazing the trail in the field of ketamine for treatment resistant depression.

Sanjay Mathew, M.D.

Professor of Psychiatry and Behavioral Sciences at Baylor University Medical School Houston and a key player in ketamine research in psychiatry, addressed us with a comprehensive review of ketamine for treatment-resistant depression even though the Houston airport was under water! Fantastic.

Gerard Sanacora, Ph.D., M.D.

Director of Yale Depression Research Program, another major thought leader and key researcher in ketamine and esketamine for TRD — in fact, a leader every which way! — the lead author on the APA Council of Research Task Force on Novel Biomarkers and Treatments for the Consensus Statement in 2017 on the use of ketamine off-label for depression . . . I could go on and on. He summarized the new data on esketamine, the left-facing ketamine enantiomer from Phase 2 and 3 clinical trials.

Amit Anand, M.D.

Professor of Medicine at the Cleveland Clinic and Vice Chair for Research for the Center for Behavioral Health there, and an expert on brain imaging, psychopharmacology of mood disorders, and ketamine. He spoke on a new study of the comparative efficacy of ECT vs ketamine for treatment resistant depression (TRD) where they plan to enroll 200 patients–so exciting because it will be so large.

David Sheehan, M.D.

Of course, one of the true greats in our field. He is the father of anxiety research, and an expert in depression, suicide assessment and harm reduction…. and the list goes on. His clinical work and research career spans 50 years and more than 800 publications on anxiety, depression, and suicide. He has developed multiple rating scales in the field that are widely used in clinical research and presented a gripping talk on the assessment, documentation and pharmacologic management of suicidality. He is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, and has mentored and collaborated with scores of the major researches in the field over his career.

Rachel Dalthorp, M.D.

ASKP Board member, clinical psychiatrist and specialist in reproductive psychiatry at Balance Women’s Health in Oklahoma City, OK, spoke about hormonal challenges in ketamine treatment, and how to work with them to ensure optimum response.

Omid Naim, M.D.

of Santa Monica, CA and La Maida, spoke about the importance of creating and building community in transformation and healing.

Jeff Becker, M.D.

Jeff Becker, M.D.

a clinician with deep expertise in neurospychiatry funtional medicine and noetics, first researched ketamine in 1998, and has been using ketamine in his clinical since 2004. He spoke about fMRI findings in ketamine treatment, and the important roles of chandelier cells, pyramidal neurons, and basket cells during ketamine treatment. Jeff, as always, was brilliant.

Daniel Richman, M.D.

Attending Physician at the Hospital for Special Surgery and a Clinical Instructor in the Pain Management Ceneter at New York Presbyterian and Memorial Sloan Kettering, and an expert on the treatment of Complex Regional Pain Syndrome (CRPS), presented a review of the challenges and the success in using ketamine infusions in anesthesia for CRPS — extraordinary help for the worst pain imaginable.

Jessica Katzmann, Psy.D.

focuses on ketamine-assisted psychotherapy in her practice, Healing Realms, and she spoke about how to help patients experience wellness and process their improvement and their experiences after ketamine treatment.

Jennifer Winegarden, D.O.

an expert on hospice medicine and the Chief Medical Officer of The Medical Team Hospice in Michigan, spoke on end of life care in hospice treating intractable pain with ketamine.

There were lightening abstract presentations which wrapped up the conference: ketamine infusions with concurrent TMS, (Cindy McKinzie, PsyD. and Melanie Dillon, LCPC of Chicago), a case report of ketamine use for PMDD (Cassandra Gentry, PA, of Balance Women’s Health, OK), and a a review of Ketamine for Anxiety (Michael Banov, MD of PsychAtlanta in Georgia).

My Own Presentation

I was honored to speak about my own work with ketamine. The talk was titled, “Real World Results: When Ketamine Stops Suicide” — pretty edgy, but thank goodness, I wasn’t the only one who spoke on suicidality. Suicide was discussed at so many different points throughout the conference, wherever we clustered, over coffee … and Dr. Sheehan’s superb talk on the assessment of suicidal ideation was a beautiful synthesis of clinical research, wisdom, and temperance. He drove home the important point that it is impossible to predict suicide for an individual.

My data on using IV ketamine in suicidal patients with treatment resistant depression was published recently in the International Journal of Psychiatry Research. As I said, we’re celebrating the response to ketamine at Innovative Psychiatry.

I spoke about the real world results we’ve seen when we use ketamine for treatment resistant depression — and find that many of the people who come to us are suicidal, have made suicide attempts, have been hospitalized for suicidal thinking.

Real Patients in the Real World

They feel terrible, and want those terrible thoughts to stop. One of the striking findings in my practice is how quickly — and completely — ketamine stopped suicidal thinking in real patients.

I say real patients because I really mean real people–with complicated lives, multiple stressors, multiple other psychiatric stuff going on at the same time — most had 3 other psychiatric diagnoses in addition to treatment-resistant depression. Most were on 4 or more psychiatric medications, and had failed multiple antidepressants in the past. Many had been hospitalized, many had made suicide attempts… or multiple attempts. Many had failed ECT. Some had failed TMS.

Or….I should say, our available treatments had failed them.

They were just doing the best that they could to hold on until a better treatment became available that could help them.

A Holding Environment

For many of them, that better treatment was a short series of IV ketamine infusions — with the dose increased (or “titrated”) along the way.

We work to create a holding environment–to hold on to hope, to offer it to our patients when their hope is strung out pretty thin, to offer it to their families, to give them a chance and to buy a little time so that treatment of their underlying depression, anxiety and trauma can begin. So that the suffering can stop.

There is palpable excitement in the room when suicidal thinking falls away. In the IV ketamine treatment room, in the patient’s living room, in a crowded lecture hall when you describe this to other doctors. (…That’s me answering questions on the floor after my talk.)

Celebrating the Response to Ketamine – The Game Changer

Ketamine infusions don’t always work. I have to emphasize that, because we have to be clear: of course they don’t. We’re trying desperately to understand what are the factors involved when they don’t work for some people.

But when they do –and they often do — when suicidal thoughts just stop, when the veil lifts, when the ability to enjoy things again slowly creeps back in for someone who has been stuck for so long in such a bad place …. well, then, it’s a celebration.

So today we’re celebrating the response to ketamine.

We’re talking, we’re writing, we’re buzzing with hope for the future and for the future of our patients.

And we have hope to offer them. Real data from hundreds of people that we’ve treated. So that we can say, in our hands, this is what we find, this is what we see, this is what you can expect.

We need more research–the elegant, beautiful, randomized, placebo-controlled trials with carefully curated patient populations, and primary and secondary endpoints, and exhaustive data analysis.

And we need more real-world results with real, lived experience. Live suffering. And, yes, the messiness that comes with the complex and devastating psychiatric disorders that we treat every day.

So indeed, let’s work together.

Let’s celebrate the response to ketamine, and talk.

Let’s talk about serial, titrated ketamine infusions, and how they can stop suicidal thinking. How they can maybe turn around that trip to the ER because you might not need it. How they might keep you out of the hospital.

Most definitely, let’s talk. While we celebrate (and let’s keep celebrating the response to ketamine). And let’s talk so that we can save lives.

Let’s talk so that we get insurance to listen and to reimburse you for a treatment that can potentially save your life.

Because an infusion is cheaper than an ambulance ride. Less expensive than a night on a gurney in the ER. Much less awful than days spent hospitalized on a psych ward.

Oh yes, let’s do talk. Doctor to doctor. Doctor to patient. Mother to daughter. Friend to friend. Share the news:

Lori Calabrese. Titrated Serial Ketamine Infusions Stop Outpatient Suicidality and Avert ER Visits and Hospitalizations. Int J Psychiatr Res. 2019; 2(5): 1-12.

We’re working hard every day to help you find the resilience you wish for, the fulfillment of a rewarding life, the enrichment of strong, mutual relationships.

To the reinvigorating of your best self,

Lori Calabrese, MD

September 23, 2019
Where Can You Find Real Help for a Suicidal Person?

What is a suicidal person like? How do you find help for a suicidal person? Can you describe the profile of someone who wants to die? Are they melancholy? Irritable or agitated? Are they funny? Always making people laugh when they’re dying inside? Do they present themselves one way in public and another way in private? Are they sad…do they fit in …or are they misfits?

Yes. The answer is YES. And NO.

A suicidal person can be any of these people, or none of them. Someone like you …or me. Or different than both of us.

Anyone is capable of suicide given the wrong set of circumstances.

Someone who can’t remember a time when he wasn’t sad… or just vacant. A person who’s had a series of deep losses, major stressors, and profound disappointments: all in a row…or all at once.

Someone who just finished medical school. A young mother; a 9 year-old child. An elderly field laborer. A mail carrier.

The pastor of a mega church. The owner of a multimillion dollar consulting firm. A thirty year-old single father. A world-famous performer. The head of a university medical department. A kindergarten teacher. A 14 year-old girl.

Sister, father, son, daughter, grandmother.

WHO is a Suicidal Person?

For every person you find who ends his or her life, there are thousands with similar circumstances who don’t.

Why? What makes the difference?

What causes one person who seems to have “everything to live for” want to die, and another whose life is similar want to live and not even consider dying…? Why is it that two people can face shame, humiliation, failure; and one wants to die and the other bounces back and moves forward?

One thing is for certain. It’s not about one person being weak and another being strong.

Or about one being flawed and another being “normal.”

The complexities of suicidal thoughts as symptoms of a deeper, more complex underlying condition cannot be completely explained yet…certainly not here. But, somewhere in it all you’ll find genetic links, brain circuitry, complicated response mechanisms, and more.

Why does one person bear the burden of kidney malfunction or lung disease and another doesn’t? Or Type 1 diabetes? Or liver disease?

One person’s genetic makeup provides a tendency toward more resilience and another’s genes lean more toward less resilience. One woman’s genes map out a future with breast cancer while another’s don’t.

How Many In a Week..?

Last week was Suicide Prevention Week. On last Monday, September 9, 2019, a beloved associate paster of a prominent church in Riverside, California, officiated over the funeral of a lady who had ended her life. Before the day was over, he had ended his own, too.

Don’t ask why. Ask, “How can I help?”

We Need to Supply Real Help for a Suicidal Person

Then, two days later, the director of psychological services at a prominent state university jumped from his 17th- story balcony.

The gentle and caring pastor was a devoted, loving husband and father of two. He founded Anthem of Hope in 2016, for those who suffer from depression and suicidal thoughts. He had always been open about his own struggles with the same.

Jarrid Wilson was a kind-hearted, vibrant, encouraging person, with two beautiful children, and an amazing wife. He’d suffered from depression since childhood. His depression and suicidal thoughts became too much to bear for him that day.

His wife is grief-stricken, suffocating with the loss of her best friend, and his church is stunned.

Our hearts go out to his family, his church, and all who knew and loved him.

Jarrid’s life didn’t end because of something that was wrong in his life, but because of something that was malfunctioning in his brain. This is why we promote treatment for suicidal thoughts.

When you hear someone say, “She had so much to live for,” remind them that this is an illness. It’s not about hating her life.

Gregory Eells, Ph.D., was accomplished and a strong, capable leader. Was there a reason, or was his death also the symptom of an underlying disease..?

That’s the thing about suicide. Since we don’t know what his thoughts were, we can only guess. But it’s important to understand that stress…too much of it for too long…can lead to depression.

Prolonged Severe Stressors Can Result in Depression and Lead to Suicidal Thoughts

Stress breaks down those signaling structures and interferes in other areas of the brain. When that happens, the connections between brain cells become pruned and sparse… and signals are reduced in strength and number. The more severe the depression, the more profusely suicidal thoughts may grow.

Crisis on top of crisis; death and loss; financial difficulty; illness; divorce; foreclosure; …all of these things together can prune away those connections and lead to deep and overwhelming depression.

Then come the thoughts. Maybe a desire to escape the torture? Possibly. But more likely they’re somehow related to the poor communication of signals within the brain. The darkness. The silence. The void. The vacancy of any reward.

These thoughts tend to intrude in your mind when your depression and anxiety are most severe. Some people experience these intrusive thoughts of death and dying no matter what they’re doing. The more their condition worsens, the more these thoughts bombard their minds.

Suicide is Reaching Epidemic Proportions

In 2017, 1.4 million people attempted suicide, succumbing to those intrusive thoughts. Of those, 47 thousand people died. We talked last week about how this means that suicide is the 10th leading cause of death in this country alone.

And we haven’t even scratched the surface of all the people who have suicidal thoughts, plans, or intentions. Most of us are unaware of the numerous people around us who struggle with suicidal thoughts, because they maintain a brave mask.

This is why IV ketamine treatment is so vitally important now more than ever. As suicide threatens to take more lives, we need more and better ways to prevent it. And to do that, we need treatment that stops those thoughts.

IV Ketamine Can Provide Extraordinary Help for a Suicidal Person

By a mechanism that’s separate from what ketamine infusions do to relieve depression, they also can stop those intrusive suicidal thoughts in an hour or two…or an afternoon. So even those patients who might not feel relieved of depression symptoms after ketamine infusions, may still be relieved of those thoughts of death…and dying.

IV ketamine infusions are a life-saving treatment, and nothing else comes close. Other medicines that have been used for this purpose required weeks or months to be effective. And, well…with someone severely suicidal, that may be too late.

Ketamine acts in a multiple areas in the brain, and in a variety of ways. We do know some of the ways it works, but we suspect neuroscience researchers will continue to uncover more and more of ketamine’s handiwork going forward.

Ways IV Ketamine Goes to Work in Your Brain to Lift Depression

We know that as a NMDA receptor antagonist, ketamine increases levels of the excitatory neurotransmitter glutamate, the most prolific neurotransmitter in the body.

We know that ketamine turns the mRNA switch to “ON” which turns on DNA, that turbo boosts BDNF (brain-derived-neurotrophic-factor). Then the BDNF acts like a rich compost, stimulating growth of the connections between neurons, or brain cells, called synapses…and their branches of dendrites and dendritic spines.

These synapses, and dendritic branches proliferate abundantly throughout the brain, building superhighways for signaling to be high speed and abundant, lighting up the brain like a Christmas tree.

The slow, dark, sluggish signals that crept along during depression, explode with speed and efficiency as the brain comes alive.

When this happens, your thoughts become creative, extensive, and bright. Your outlook soars, and so does your initiative and sense of purpose. Resilience replaces despair, and hope sets down roots. THIS is real help for a suicidal person.

While all this is going on, there’s a change in the lateral habenula, that tamps down that bursting of cells that prevents you from enjoying reward. Your ability to enjoy moments, scenery, beauty, appreciation, and love is restored.

Then, there are those G cells stacked up on lipid rafts in the cell membrane. They lazily while away the afternoon. Then IV ketamine comes along and slides those G’s off the lipid rafts and puts them back to work moving signals down the highway.

These are the things we KNOW about. We’re sure there are more actions we don’t know yet. But we will.

The result is joy. And hope. And the energy and motivation to take initiative and build relationships, strengthen bonds, improve productivity at work, creatively advance in all you do, for a rewarding and fulfilling life.

Spread the Word and Stop the Torment to Provide Real Help for a Suicidal Person

At Innovative Psychiatry we see people like Jarrid and Gregory often. And we see so many others. People who don’t want to die…but who don’t want to keep living like this, tormented by pain and suicidal thoughts, images, and ideas. People who want to enjoy life, enjoy their families, and invest their energy in their careers, hobbies, and interests.

We’re thrilled and relieved to see the majority of them walk out without suicidal thoughts at all, confident they can get better with therapy and medication. Or they walk out in remission.

That’s the beauty of IV ketamine treatment at work. We’re trying to get the word out that there is now a treatment that can rapidly stop suicidal thinking. Help us spread the word.

We’d like to help you.

Are you tired of living like this? Do you ache for the freedom to build your relationships, your career, and your hope?

Protect yourself from those thoughts of death that try to lure you to an action you don’t want to take. Call us. Let us help you tap into the life you hunger for.

You’re not alone, and we’re here to help.

Please, if you have suicidal thoughts, call us. Or call the Suicide Prevention Lifeline: +1(800) 273-8255. Those intrusive thoughts are symptoms of an underlying condition and treatment can help.

IV ketamine treatment can erase those thoughts in an afternoon. We want you to live and to discover what life can be for you. We want to help you heal.

To the healing of your best self,

September 16, 2019
Suicide Prevention: #Bethe1to Save a Life

Today marks the beginning of National Suicide Prevention Week 2019, and tomorrow, September 10, is World Suicide Prevention Day.

More than just observing a day or week like this, let’s use the opportunity to learn what we can actually do to make a real difference in the life of someone who suffers from suicidal thoughts. The National Suicide Prevention Lifeline has created the hashtag #BeThe1To to pull together people interested in learning what you can do to help.

Suicide Prevention: #Bethe1to Intervene

Approximately 1 million people die by suicide each year, according to the World Health Organization. That’s about 3000 people per day, or one death by suicide every 40 seconds. In the US, over 47 thousand people died by suicide in 2017. As such, suicide is the 10th leading cause of death in the US alone. But those are the ones who died. 1.4 million attempted suicide.

When someone experiences suicidal thoughts, it doesn’t mean they’ll necessarily make an attempt to end their life. So if there were 1.4 million people who attempted to die, can you imagine how many suffer in silence from the torment of suicidal thoughts?

And here’s the thing…

You don’t really know whether a particular person who’s experiencing suicidal thoughts will try to stop living, even if you do know they’re having suicidal thoughts.

And that’s why it’s so important to know what you can do, and learn how to get comfortable doing it.

Suicide Prevention: #Bethe1to Make the Effort

So let’s talk today about how YOU can intervene and help protect people in your circle from making an irreversible decision. National organizations dedicated to suicide prevention, like Suicide Prevention Lifeline and the American Foundation for Suicide Research cannot ferret out everyone at risk. To reach all of those suffering requires your help, engagement, and willingness to reach out.

Most people do care about the number of people dying by suicide, but the majority of those who care, don’t really know what they can do to make a difference. And that’s why these organizations exist.

#Bethe1to highlights what you CAN do. YOU CAN be the one to listen. To reach out. There’s an abundance of myths and misunderstandings surrounding suicide, and more importantly, suicidal thinking. When someone is having suicidal thoughts, those thoughts often begin as an intrusion into their mind in most cases, rather than a decision. In most cases, the thoughts are a symptom of an underlying condition.

Think there’s nothing you can do? That’s a myth.

Just be genuine. Sincere. Caring.

The longer the thoughts go on, the more they can torment. And possibly influence the person experiencing them. So you can #Bethe1to interrupt the cycle, distract this friend or loved one from the influence of the thoughts, and counteract the thought’s impact.

So WHAT CAN YOU DO?

#Bethe1to ASK

Start with developing a new habit, a new aspect to your interactions. Check on the people around you at work, at school, and at home. Ask questions. Inquire about their wellbeing. Show them that they matter to you.

“Are you Okay?”

Simply asking the people who are in your world if they’re okay can give you a more accurate idea about their wellbeing. Your question doesn’t need to be intrusive, but rather just a simple way of showing that you care about how they’re feeling, rather than just focusing on what they can do for you, your business, or your family.

“How are you feeling these days..?”

The more you ask, the more comfortable you’ll get with asking the questions, and with the conversations that ensue. At the same time, it can set your friend at ease if you talk about your own mental health and experiences so he knows you can relate to his struggles. But avoid dominating the conversation by focusing on yourself. The goal is to get him talking.

“You know, you have seemed kind of quiet lately, and I don’t notice you hanging out with the people you usually do. I just wondered how everything’s going for you..?”

It’s true that much of the time, that person will say something like, “Sure, I’m great! How are you?” To which you can respond that you’re great, too, and smile and move on. But when someone is suicidal, they tend to isolate themselves… or may have been isolated from others. That aloneness leaves them without connections to others … and without feedback or support.

The more isolated a suicidal person is, and continues to be, the more likely they may be at risk of imminent death.

So let them know you’re here… to listen. Resist the temptation to tell them why they shouldn’t hurt themselves…or how hurt people who love them would be.

That isn’t productive. Ask them reasons why they want to die, and accept what they say without judgment. Then ask them reasons they might want to live. Focus on their reasons for living or dying…not your own.

Studies show that by replacing their isolation with interaction, caring, support, and connections, you can help them move away from the risk of suicide and see value and purpose in their life again.

Once they tell you they’ve thought about how much easier it would be if they died, you know they’re having suicidal thoughts. And you can say that the fact that they’re having these thoughts is likely an indication that something’s going on with them…

#Bethe1to Keep Them Safe

The next step is to keep them safe. If someone tells you they’ve been thinking about dying, or that their loved ones would be better off without them, they’ve admitted to you that they’re having suicidal thoughts.

Begin your response with reassurance that they’ve taken a good step by talking about it. People can be overwhelmed by feeling vulnerable after revealing something so intensely personal. They may withdraw from fear of judgment.

Your reassurance is invaluable at this point.

To keep them safe, ask more questions and stay connected. Ask them if they’ve ever tried to hurt themselves, to see how concrete these thoughts are to them. Ask them if they’ve thought about how they might do it…? If they have a plan and if they’ve taken any steps toward that plan. It’s also important to find out if they’ve considered the timing yet… when do they plan to do this?

While it may sound uncomfortable to talk about these details, this is where life-saving begins. Further, many people are reluctant to discuss these details because of the fear that they’re planting the idea of suicide in this person’s mind. And maybe they fear they’d feel responsible if the suffering person took action. But this is not the case.

Suicide Prevention: #Bethe1to Reach Out and Reverse Their Isolation

Studies have shown that engaging this person in conversation and connecting with her about her plans, helps her air these thoughts…consider the realities and consequences. Most importantly, discussions like this promote connection, and dispel isolation. The very conversation itself establishes human connection and communicates the value of her life. Or of his life.

In addition, the information you gather through this discussion helps you evaluate whether you need to take action. The more details they have thought through, the greater the risk and more imminent the danger they’ll complete their plan.

Plus, if the method they plan to use is a method that’s likely to cause a final irreversible result, such as a firearm, and if they have access to that method readily available, then you may realize you need to do something to protect them.

Perhaps drive them to the hospital, or call for help, if necessary, to protect them.

Research has revealed that if you can put time and space between this person and his suicidal plan, he is likely to rethink the plan.

How often have you heard, “If they’re determined to die, you can take the weapon away from them and they’ll just find something else…”

This is not actually true. In most cases, removing the method and keeping them safe for awhile gives them time to rethink their plan. With support, they’re more likely to see value in their life and relationships and they tend to move away from the imminent threat.

#Bethe1to Be There for Them

Do the best you can to be there physically, if at all possible. At the very least, be on the phone with them. Talk with them about others in their life they trust and would like to have nearby. It’s important that you not commit to be there with them if you know you won’t follow through. Remember, protecting them from isolation is life-saving. Keep them connected to you and to others who will help them remember the good in their lives.

Someone with suicidal thoughts is likely isolated, and feels they don’t belong. Ask them about the people in their lives they like or trust and would like to have nearby.

#Bethe1to Help Them Connect

At this point, help them reconnect with those they’d like to have nearby. Help them connect to other resources where they can build more connections with people who understand and will listen. Online organizations or local organizations in the community will give them more to plug into. And a place to reach out.

Ask them if they’ve considered a therapist, if they have insurance to help with that…what their feelings might be about it.

This can give them the safety net of a place and people to turn to if there is a future crisis like this one.

An excellent resource is to contact the Suicide Prevention Lifeline: 800-273-8255 for talking, more resources, and advice.

There is also a MY3 app they can put on their phone for safety, crisis, and other resources. Through the app they can make connections for support, too.

A study conducted by Gould et al. on the impact of Applied Suicide Intervention Skills Training (A.S.I.S.T.) used on the Suicide Prevention Lifeline showed that calling the Lifeline reduces the likelihood of death, and individuals were found to be less depressed, less overwhelmed, less suicidal, after talking with the trained counselors trained by Applied Suicide Intervention Skills Training.

In other words, persons who call this crisis hotline actually feel better after the call because of the degree of insightful and targeted training the volunteers have had.

#Bethe1to Follow Up

Once they’ve been released from the hospital or crisis center, give them a call, send text messages, drop them a post card – or all of the above – over time.

This helps to remind them they’re valuable, that their life is valuable, and that they do belong. Combined with psychiatric care and community mental health support, your effort to maintain connectedness can help protect them from falling back into the “suicidal thinking” frame of mind.

Supportive ongoing contact can help them move forward on a path toward restoration.

When you talk with them, listen. What they say is far more important than all the things you may want to say. You’ll learn about where they are in terms of life-threatening decisions. And, since they’ve been so isolated, being heard and feeling cared about are vital tools for restoring their desire to live.

And… don’t tell them “everything is going to be alright.” It can sound to them like you haven’t listened at all. Listen to how they’d like their life to be. Support their own view of the future. Their own reason to live. Not your own.

And one more thing: talking over a meal can also raise their blood sugar, and improve their mood. Deeply depressed individuals sometimes don’t eat well. The simple experience of eating nutritious food can boost their outlook in small increments, while combining the food with friendship can have a significant effect on their hope… at least temporarily.

At Innovative Psychiatry we use innovative treatments to arrest suicidal thoughts:

IV Ketamine Treatment Can Stop Suicidal Thinking in an Afternoon

Once you’ve helped your friend or loved one put some time and distance between them and their method and plan, they can consider IV ketamine treatment for suicidal thoughts. IV ketamine has proven to be remarkably effective for removing suicidal thoughts in most cases.

That’s in addition to severe depression, bipolar depression, social anxiety, PTSD, addiction, panic disorder, and OCD. With a different mechanism used to relieve other symptoms, ketamine can erase those thoughts and images of death and suicide within just a few hours.

By doing this, it can erase the tormenting images and thoughts, so you can feel better, sooner. And at the same time, you can turn your focus to building a better outlook to maintain remission through all of the things that help keep you well.

IV ketamine treatment can lift the burden of suicidal thoughts and images, and can also transform your life with new initiative, motivation, fresh perspective…and hope. It can give you the energy to rebuild your relationships and your career.

You can be free of suicidal thoughts, despair, and that awful feeling that you don’t belong or fit in.

You can live a full and rewarding life, and IV ketamine treatment can help.

To the restoration of your best self,

Lori Calabrese, M.D.

September 9, 2019
“r” is for Recovery From Any Addiction – Lori Calabrese, M.D.

September is National Alcohol and Drug Addiction Recovery Month 2019, and as we celebrate and support everyone in recovery, let’s also talk about what might help others who are trying…to actually get there.

“r” is for recovery whether you seek recovery or are actively working your recovery every day. Addictions can involve alcohol, opioids, other prescription medicines, illicit drugs, food, sex, the internet, amphetamines, hallucinogens, tobacco, cannabis,, inhalants, or something else. Then, addictions to impulses, like stealing, shopping, or setting fires also cause suffering and torment…and shame.

Addiction Takes Hold in Small Steps

Watch how our friend Nicholas subtly advances toward addiction one seemingly innocent step at a time…

Nicholas enjoyed school while he was growing up. He was quick to raise his hand and answer the teacher’s questions. The fact that he was usually correct had nothing to do with his eagerness to answer. Nicholas just enjoyed people. He enjoyed connecting and interacting, whether it was one-on-one or in a classroom. Nicholas was a people person.

He loved meeting new people and engaging them in conversation from the time he was 3 years old. His eyes sparkled as he listened and responded to their stories, and he just had a way that set people at ease and made them feel valuable.

In elementary school he usually received A’s or Excellent. And he continued to try to do well in school as he got older. The other students really liked him, and he had friends across the various cliques that sprang up in middle school. He never saw the point in isolating himself with any particular group of students. You could say he just relished activities with whomever he thought was nice to be around.

Nicholas also loved baseball, and it didn’t hurt that his uncle was his coach. He built strong bonds with the boys on the team, and they played together every year.

All in all, he liked his life, and made the most of opportunities to excel and have fun.

Unresolved Pain

But after his first year of high school, there was something that didn’t sit right. He felt less confident, and his parents noticed his moods changed more than they used to. The little disappointments of the past — with his friends, or his parents — began to build inside him. He found himself resenting his dad for the pressure he felt from him about school and sports.

“r” is for recovery… small steps lead to addiction…but small steps can also lead to recovery.

The more that time passed, the worse his resentment became. Eventually, his emotions had blown past resentment until they were full-on rage.

Sometimes he wondered why he was so mad. Why now? What delayed his reactions to events from years ago until now? He didn’t know. But it was eating him alive.

Little things can turn into big things if you don’t know how to resolve them… “r” is for recovery….

He had some friends who were planning to see a movie on Saturday night. They said they would meet up with some girls and have a good time.

He knew he needed a reprieve from the pressure so he told them sure, he’d meet up with them.

The First Step that Led to Addiction –Eventually…

And he did. They met outside the movie…all four of the guys, and then 3 girls walked up. They decided they weren’t interested in the movie and all walked to someone’s van at the back of the parking lot. Before he knew it, plastic cups were being passed around and someone was pouring Jim Beam.

small steps. but “r” is for recovery…

This was his first time to get drunk. And he did…so drunk he wasn’t sure where he was. And then a patrol car pulled up and started calling everybody’s parents.

Nicholas was embarrassed when his parents showed up. Drunk as he was, he apologized every way but Sunday to them. He played the innocent card …but knew deep down this would not be the last time.

Truth be told, he liked the way that bourbon made him feel. He wanted to feel that again.

And soon.

…step by step addiction happens subtly. but step by step recovery can take hold. “r” is for recovery …

Addiction is a Hard Taskmaster

At first it was just a misstep, but missteps snowballed, until he could no longer control it. The alcohol controlled him.

Twelve years later, Nicholas thinks back and doesn’t remember very much of high school. Getting drunk Fridays turned into staying drunk all weekend. By senior year, he was drinking every day. And only sometimes made it to class.

“r” is for recovery…

After high school, he tried to hold down one job after another, but sometimes he was too sick to go to work.

Now he’s been through 3 different rehab programs. He’s determined it will work this time.

He has his 90 day chip. But every day is hard. Every minute that passes he wishes he had a drink.

“r” is for recovery… one step, one minute, at a time…

But his eyes look yellow and so does his skin. The doctor told Nicholas he’d not live to see 40 unless he stopped drinking. He told him he needed to get nutrition from a balanced diet, but Nicholas doesn’t feel much like eating. And hasn’t in a while. Still, he knows he doesn’t want to die.

Now after 30 days in rehab he’s got a good start.

“r” is for Recovery, One Day, One Hour At A Time

He goes to AA every day. Sometimes 2 or 3 times. Staying sober scares him because he’s relapsed so many times before… But his life depends on it now.

Nicholas isn’t alone.

September is National Alcohol and Drug Addiction Recovery Month.

And 22 million Americans are in recovery as we speak.

Alcoholics Anonymous Supports People in Recovery

Alcoholics Anonymous is the 12-step program that’s most well-known. They report 2 million members globally, and there are around 130 other programs that work on a similar premise.

They say that 50% of their members stay sober, 25% are sober awhile, then relapse, then come back to sobriety. The other 25% don’t stay sober.

A key to recovery through this program is working the 12 steps, which helps the individual face the things that torment him/her and are triggers for relapse.

Many in recovery say that Step 4 is the most difficult to get through because of the pain of facing their failures, hurts, and scars. Then each step advances you to facing, admitting, and making amends for offenses, failures, and injuries caused to others.

A key to helping the recovery process become solid and strong is persistence. Nurture resolve every day, and do the next right thing each minute.

This process takes courage, but helps to resolve some issues that can trigger relapse. Addressing each one strengthens your freedom from them.

Facing these steps is vital for your life to improve. “r” is for recovery…

But there are still the 25% who never reach sobriety, healing, and stability.

What about them…?

IV Ketamine Can Help with Addiction

At Innovative Psychiatry we have promising results with the use of IV ketamine infusions to treat the memories that trigger relapse. The same treatment also can dramatically relieve depression which may be caused by addiction … or may have predated it.

One size doesn’t fit all in addiction treatment, whether the addiction is a substance or a behavior. But remarkable work has been done regarding ketamine treatment for various addictions.

We talked before about the work carried out by Krupitsky and his colleagues, using IV ketamine to treat alcohol use disorder. They referred to the enhancement and regeneration of neurons seen in neuroplasticity and neurogenesis. The ability of brain cells to adapt and change is neuroplasticity. This process is invaluable in recovery from addiction.

Ketamine also blocks drug-related memories, as well as the painful memories that trigger relapse, and enhance the effectiveness of psychological therapy through neuroplasticity.

If you have struggled with alcohol use disorder and would like additional help, call us.

You’ll still need to do the work to change your thinking, bu IV ketamine can give you a leg up so you can.

Give yourself the best hope of freedom from addiction and a healthy lifestyle going forward. Rebuild your career, your relationships, and your hope.

To the reconstruction of your best self,

Lori Calabrese, M.D.

September 2, 2019

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