Lori Calabrese, MD

Tag: IV Ketamine for Anxiety

IV Ketamine Can Create Resilience For You This Season

This time of year conjures up visions of sugarplums, elves, and Christmas trees guarding piles of gifts.

There are carolers singing on the corner, and menorahs and dreidels and flickering candle light. Families come together, and friends are invited to share in the celebrations. A manger with a Baby surrounded by angels, shepherds, and wise men. Oh the wonders of this time of year. And oh the suffering for those who find it difficult to cope. But, IV ketamine can create resilience for you… Some suffer because of painful losses and deaths brought to mind again by both treasured or painful memories. Others suffer because of disorders that make it difficult for them to blend at family gatherings, whose symptoms impose so much pain and heartache, even chaos, they’re unable to enjoy any of it.

It’s for these loved ones we write today. The ones who’ve suffered for years – even decades – because their symptoms of depression, anxiety, phobias, addiction, eating disorders, PTSD, OCD, and the suicidal thoughts that eventually often show up and threaten have not been helped by the medicines prescribed for them.

Dreading the family gathering, or finding something else to do so they can justify missing it, they’re often ostrasized for “creating a scene and making the holiday about them.” Cruel judgments and short-sighted disapproval abound. But few realize how very much these dear ones wish they could seamlessly fit in.

Their “scenes” may very likely be due to untreated symptoms.

This is the time when IV ketamine treatment can make all the difference. And it’s not just for this holiday season. It’s for all the holiday seasons that will come in the future. For all the school days, business days, birthdays, and everydays that lie ahead. Ketamine can create resilience for facing whatever life brings…

And let’s be clear about something.

IV Ketamine Treatment is NOT Esketamine Nasal Spray

The ketamine molecule is racemic, which means it is made up of two sides, or enantiomers, which are mirror images of each other. This has caused some confusion. Because they’re NOT identical. Each one possesses its own traits, it’s own strengths and weaknesses. It’s own benefits.

Esketamine nasal spray is the left mirror image. We call each side an enantiomer. Esketamine is the left enantiomer. It has strengths and weaknesses, but it’s not the complete ketamine molecule. This is often misunderstood. It’s also a great deal more expensive than ketamine.

However, esketamine nasal spray is “covered” by some insurances, at least partly. (It’s very expensive and eats up most of your high deductible very quickly.) But having the medication pad for may be a benefit that may make it worth trying for you. The office visits required for administration are another fee–and they are very poorly covered by insurance companies.

Ketamine infusions on the other hand, are not usually covered.

We’re joining with others in psychiatry promoting the idea that IV ketamine treatment should be covered by insurance. It should be. Ketamine is the complete compound with all the benefits. When it’s administered properly, it can be — and often IS — transformative.

IV ketamine treatment can liberate you from the symptoms that make the holidays so painful. Those things that make it nearly impossible for you to enjoy family gatherings.

IV ketamine helps build something to make life so much easier, even holiday gatherings.

Ketamine Can Create Resilience: And It Empowers You to Enjoy

It’s resilience. Depression, alcohol use disorder, anxiety, PTSD, OCD, opioid use disorder, social anxiety, bipolar depression…all of these conditions have symptoms that are sometimes hard to treat. You might say “treatment resistant.” And when the symptoms go on and on, they wear down circuitry in your brain in certain regions.

When the circuits are worn down, the dendrites and synaptic connections between neurons are pruned back and the signals are hard pressed to make much progress getting from one area to another. So you feel vacant…numb…dull…and dark.

But ketamine treatment restores those circuits. It stimulates mRNA to turn on DNA to turbo boost your brain-derived-neurotrophic-factor. When that happens it’s as if a rich compost infuses fast prolific growth into those dendrites, and dendritic spines…and your synapses multiply like gangbusters. Suddenly, your brain comes alive with a wealth of signals darting at the speed of light to help you think, create, plan, accomplish…and to bring you joy…and hope.

Then, there are those G proteins floating along on their lipid rafts. Ketamine shoves them off those rafts and puts them back to work, which gets signals moving really fast, too.

That’s where the resilience comes from. Your active brain communication transforms your outlook and cognitive function. And if something comes along to knock you down, you finally have the resilience to think it through, get back up, and snap back. You have energy to face difficulty, energy to be around difficult people. Energy to contribute, and to rebuild strong, healthy relationships.

Ketamine does that. Ketamine can create resilience by working in so many parts of the brain and it works fast.

Think about it like you’ve rebuilt your car’s engine and you have the capacity now to take on difficult terrain, climb mountains, pull trailers, and get the job done. (I sound like a truck commercial but you see what I mean.)

Restoration for the Holidays – Is There a Better Gift?

If you enjoy this time of year, that’s wonderful. It’s supposed to be a wonderful time of year. Enjoy it. Savor every moment.

But if you don’t …if you can’t… call us. Let us help you find the resilience you wish you had. The resilience to rise above the struggles, and the ability to actually enjoy people you care about.

IV Ketamine treatment may seem expensive at first blush, but when you consider how it can transform your life, and give you hope and resilience for the future, it’s worth finding a way. There are opportunities for financing your treatment through medical financing services. We also see families helping financially to get their loved one a chance to recover.

Feeling better changes everything. Everything.

When you’ve felt like this so, so long, it’s hard to imagine what feeling good would be like. No worries. You’ll definitely know it when you see it. And your family may detect the changes in you before you even notice them yourself.

Reach for brighter days, healthier relationships, better performance in your career. Reach out for resilience.

To the restoration of your best self,

December 16, 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
Omegas: The Very Real Effect of Fatty Acids on Your Brain

Eat a diet that supports your positive mood and mental health.

We’ve talked about the microbiome, or “second brain,” and how we can weaken or strengthen it with what we eat. We’ve talked about eating fresh vegetables of all colors. And how fermented foods like sauerkraut, pickles, kimchee, and kombucha introduce healthful organisms into our intestinal DNA system. We’ve talked about curcumin, and its benefits against depression. Now let’s talk about the very real effect of fatty acids on your brain.

Did you know that some of the most important, even vital, foods you can ingest are fatty acids? Maybe that sounds a little creepy… But it’s true.

The World Health Organization estimates that major depression is the greatest single cause of disability worldwide.

A study by JR Hibbeln showed that around the world, countries that consume the least amount of fatty fish show the highest levels of major depression (MDD) in their population. And countries where fatty fish is the main diet show the lowest incidence of MDD.

You Have a FAT Brain

You think I’m kidding..??

I’m telling you, your brain is 60% fat. 60% !! Shocking fact when you step on the scale. But don’t try to lose that excess weight from your head, because THAT fat is pretty important.

Fats reside in the neuronal membranes–the brain cell membranes–and in the myelin sheaths that surround them. And they’re important for delicate synapses. Remember that synapses are the connections between neurons.

The saturated fatty acids are combined in what’s called a lipid bilayer and that lipid bilayer forms the membrane that surrounds each brain cell. It’s made up of straight chain carbon atoms so the membrane is more firm like butter is firm at room temperature.

Now–this is where it gets interesting– unsaturated fatty acids are made of bent chain double bond curvy molecule structures. Because of this, there’s more space between molecules so when unsaturated fats are incorporated into the cell membrane, the membrane is more fluid. So, if you compared oil to the firmness of butter, these are more fluid like olive oil, for example.

The omega 3 fatty acids are fluid ones.

Another remarkable characteristic of omega-3 fatty acids is that they’re precursors to eicosanoids like prostaglandin which can reduce inflammation. Super important for psychiatric disorders, which are associated with increased inflammation.

Eicosanoids go by the nickname ‘local hormones’ because they act on cells close to their site of production. So fatty acids in your brain cause the release of prostaglandin, which reduces inflammation that contributes to depression.

That’s a mouthful! But it tells a promising story.

Get the effect of fatty acids by eating more fatty fish.

Fatty acids like omega-3s are considered essential fatty acids, and you can only obtain them from your diet.

So to maintain a healthier, more positive outlook, decrease inflammation that can lead to depression, and actually fight depression symptoms, increase the amount of mackerel, salmon, oysters, sardines, and trout in your diet. Make sense? I hope so, because doing that can make a real, tangible difference for you.

In addition, seaweed is a nutrient dense food that’s rich in omega-3 fatty acids. Nori seaweed typically presents itself in sushi, and is a tasty snack on its own. Also spirulina and chlorella are also in the algae family and are a good source of omega-3s that you can add to shakes and smoothies.

Fatty Acids Are Essential for Your Brain Health

In a presentation at the annual meeting for the Society of Biological Psychiatry in NYC last year, Dr. Roel Mocking spoke about the critical requirement of fatty acids in psychiatric wellness.

He demonstrated that Omega 3 fatty acids reduce inflammation, reduce the release of cortisol from the hypothalamus-pituitary-adrenal-cortex-axis, and activate the amygdala.

The amygdala is one part of the brain that contributes significantly in processing emotion and decision-making. When someone’s amygdala is damaged, or destroyed, they tend to be fearless, and don’t use the necessary caution to make safe decisions since the caution the amygdala would create is absent.

So, by multiplying your fatty fish consumption, you provide your amygdala the fuel to be activated to process fear and enhance circumspect decisions. You can also reduce the release of cortisol, the stress hormone that has a negative impact on your health. And you equip your brain to reduce inflammation…all of which improve your mental and emotional functioning.

The Effect of Fatty Acids on Your Brain

Dr. Drew Ramsey, a nutritional psychiatrist, and author of 3 books on foods that feed the brain, is an assistant clinical professor at Columbia University. Dr. Ramsey promotes better nutrition for the brain with his patients. He laments that most Americans overfeed themselves in calories but starve themselves of the critical micronutrients the brain needs to thrive.

He prescribes antidepressants and other medications for his patients, and engages in psychotherapy with them, too. And he teaches that fresh and nutrition-packed foods help make other treatments more effective.

It’s a shame, according to Dr. Ramsey, that it’s so rare for Americans to eat foods that meet the needs of the “most complex and energy consuming organ in the body” which is the human brain.

Eat the Rainbow

He recommends “eating the rainbow,” as in eating all the colors of fruits and vegetables. Fresh foods like oranges, apples, bananas, pineapple, bell peppers, tomatoes, avocados, kale, sweet potatoes, and blueberries.

Combine these with fish like mackerel, salmon, trout, sardines. And walnuts, pecans, and almonds.

These can help prevent harmful inflammation, and feed your brain, your heart, and your digestive system.

They can reduce symptoms of depression and anxiety, and promote mental clarity.

Ketamine Treatment Can Help Give You a Fresh Start

So, if your diet changes and medications aren’t bringing the relief you hope for, then let’s talk about ketamine treatment. Because this remarkable treatment of at least 6 infusions within 2-3 weeks has been changing lives across the country. It just may change yours, too.

At Innovative Psychiatry, we encourage brain supporting foods that improve your outlook and emotional wellbeing.

While we don’t center an entire treatment program around food, we do work with patients and guide them in supporting their brain function by avoiding food dyes and preservatives.

In addition, we show them that by adding healthy foods, micronutrients, and lifestyle changes, they give their brains and emotions an optimal environment for restoration.

If you suffer from depression, symptoms of anxiety, or other mood disorders, and other treatments have brought no relief, call us.

We’ll talk with you and determine whether you’re a candidate for ketamine treatment. We’ll guide you to eat foods that improve your well being. And please do follow the links in this article to read more information about your microbiome and your restoration.

It’s all about getting better. Enjoying your life. Watching symptoms fade and your strengths rise.

Call us, and let’s create a plan to help you restore joy and fulfillment in your life.

July 1, 2019
OCD: Better Treatment Targets For a Happier You

Obsessive-Compulsive Disorder or OCD is a term that is sometimes thrown around mistakenly. It’s sometimes used to describe someone’s careful behavior… you know, like careful organization, attention to detail, or a tendency toward cleanliness, which of themselves are actually normal behaviors. Many of us may be particular about these things without giving them a second thought. So to use the term in jest to poke fun at someone’s distinctive tidiness, for example, should be discouraged. You know why? Because doing so fuels stigma for one thing, and trivializes a serious medical condition. But neuroscience research is showing us that with OCD better treatment targets can give you a happier, more fulfilling life.

People with OCD have recurrent, intrusive, unwanted thoughts that just occur—like cardiac arrthymias—out of the blue and over and over, upsetting them, plagueing them and precipitating compulsive behaviors they use to relieve the anxiety spiked by their obsessive thoughts.

Obsessive thoughts can fall into certain categories — such as fear of harm coming to you or someone you love, fear of harming others or yourself, fear of illness or contamination, or preoccupation with things like patterns, numbers, morality, or gender identity. Insecurity about the future. Fear of throwing up.

And so many others.

The thoughts can have a certain theme for weeks or months… and the themes can vary within a day or over time. How often they occur can vary dramatically even for the same person. Their intensity can vary, too — and really affects the degree to which they intrude in your life.

These thoughts — and the behaviors they invoke — can be so upsetting and time consuming that they interfere with your ability to be on time, and be present, and function at work, school, or in your social life. In fact, they can interfere to such a degree that they cause intense discomfort and distress. And it’s the intensity and distress that sets apart those who have OCD and suffer from a disorder compared to those who are just a bit more hygienic or meticulous than their friends. There’s a BIG difference.

If you have OCD, unpleasant or fearful thoughts can fuel a reaction–and if the reaction is a behavior, we call that behavior a compulsive behavior. That reaction always starts and intends to relieve your anxiety. Right? But it becomes so repetitive and time consuming, it distresses you even more.

Compulsions can range from excessive doubting or asking (did she have an accident? is he cheating on me? did I do that right?) to excessive hand-washing, skin picking, or excessive safety checking — checking and rechecking the door knob, the knob on the stove, or locking and unlocking your car, or something else potentially dangerous. You could meticulously clean, re-read, re-write, or arrange objects. You do … and redo.

And there’s so much more.

There are also some other subdivisions of this disorder that you may not have even heard of: like harm OCD, obsessive slowness, tic-related OCD, and even pure obsessional OCD — where there are no observable compulsive actions but obsessive thoughts that just won’t stop.

Bottom line: many people suffer from a complex mixture of these types of obsessions and compulsions.

It’s surprising how often the diagnosis is missed.

It may surprise you to know that many people with OCD are aware that their intrusive thoughts aren’t true and that the compulsive actions they take don’t help. But they still can’t make them stop. And this causes them severe distress.

OCD: Better Treatment Targets Are Desperately Needed

Brain and Behavior Research Foundation presented a talk recently regarding the work of researchers to find more treatment options for those with OCD who are not helped by current available medications or psychotherapy. Because there’s a HUGE need.

Treatments for OCD

Serotonin Reuptake Inhibitors (SRIs) have been the only proven monotherapy, or singular form of medication treatment.

The serotonin system is pretty extensive. It’s involved in many different parts of the central nervous system: From the hippocampus, cerebral cortex, cerebellum, basal ganglia, thalamus, limbic cortex, and temporal lobe, to the rostral raphe nuclei, caudal raphe nuclei, and the spinal cord. Exhaustive, isn’t it?

Remission with SRIs is only 10-15% which is wonderful for those who achieve it, but the other 85-90%, need more help than that.

Those who achieve a partial response to an SRI experience a decrease in symptoms in 20-40% of cases… but only 20% still enjoy improvement after ten years.

Not great.

So it goes without saying how seriously we need to explore OCD better treatment targets that are effective. So here are some possible options on the horizon…

Augmentation strategies

Glutamatergic agents like Ketamine

Studies continue to investigate IV ketamine treatment for OCD. One study may show good responses, then another shows it’s less effective. Researchers are guessing this may be due to different types of symptoms needing different treatments. You can see that it’s so important to research more deeply — and study different patient populations — to see which ones do respond and which ones don’t. And to learn why.

Is it based on the types of symptoms the patient experiences? Fear of harming others vs. Fear of contamination? Or is it based on comorbidity, such as cognitive rigidity or the presence co-morbid depression or anxiety? Researchers continue to explore these questions.

A common augmentation strategy is with dopaminergic blockade agents, such as atypicals, as they’re called. (A shortcut for atypical antipsychotics–we often avoid saying the “antipsychotic” part and just call them atypicals.) Interestingly, these medicines fast-tracked for FDA approval treat psychotic disorders often have promising results with a variety of neuropsychiatric conditions.

They’re pretty amazing. They can get you unstuck, and get your thoughts unstuck. They’re like Goo Be Gone–you don’t quite know where all of those repetitive stuck thoughts went. They just seem to dissolve.

When the meds work.

Exposure and Response Prevention (ERP)

This form of therapy can be extremely effective, but it’s hard for some patients to see it through. It requires patient and consistent steps to bring about progress.

The steps required can cause so much anxiety that patients sometimes decide it’s not worth it to them… so they quit. It’s also hard to find enough skilled therapists to meet the needs of patients who need this kind of treatment. Here at Innovative Psychiatry we’re not able to offer this therapy to new patients. But we can offer other treatments.

For those who have not improved with medicine or therapy, surgery can be a consideration.

We don’t offer that either. Just sayin…

Ablative Neurosurgery

When medicines and psychotherapy bring no improvement, an option may be ablative neurosurgery. This involves surgically interrupting precise connections between the cortex and striatum.

The cortex is the part of the brain where you make decisions and decide what action you’re going to take. The striatum is important for carrying out those actions. So creating a disconnect between the two interrupts the cycle. This procedure can be 50-70% effective.

The problem with ablative neurosurgery is that it’s surgery…. and its non-reversible

It’s non-reversible.

Deep Brain Stimulation

Deep brain stimulation is high-frequency stimulation achieved by implanting electrodes deep into the brain that are powered by a device planted in the chest…something like a pacemaker for the brain.

When there’s a disturbance in the reward system of the brain it can lead to addiction, depression, and/or OCD.

And good outcomes have been achieved with deep brain stimulation.

For instance, the most common target site that’s been used for DBS is the ventral capsule/ventral striatum (VC/VS) and the nucleus accumbens (NAc) area. This area is approved for deep brain stimulation and is also being investigated for other purposes.

A newer target was utilized in a recent and exciting study. Keep reading…

A recent study (March 2019) seeking an alternative to ablation neurosurgery was conducted by Tyagi et al., and compared the effectiveness of deep brain stimulation at the ventral capsule/ventral striatal (VC/VS) region and the anteromedial subthalamic nucleus (amSTN) region in the same patients. They tested to determine the differences on mood and cognitive flexibility and associated neural circuitry. They also used cognitive behavioral therapy throughout the process.

Each patient received DBS in one region at a time, then at a separate time in the other region. Each patient received significant improvement of OCD symptoms following DBS to each site. But they didn’t get any real additional improvement after having stimulation to both sites at once.

But listen to this – It was so exciting to find that when patients received DBS to the VC/VS region, they experienced improved mood. When they received DBS to the limbic STN area, it improved their cognitive flexibility without affecting their mood at all.

Better Treatment Targets

So while DBS was effective for OCD symptoms at both targeted sites, this implies that if a patient is having more difficulty with co-morbid depression, then she might receive relief for both conditions following DBS to the VC/VS region. However, if the patient’s greatest difficulty is with rigid cognitive thinking and needs more cognitive flexibility, then the NAc region might be the preferred target for DBS. Very cool. How many more sites can be mapped for this?

All in all, this study opened up more possibilities to be investigated for treating OCD by isolating the specific sub-symptoms different people endure. Just imagine how much more effective OCD treatment could be if we were able to identify the targets in the brain where stimulation would relieve each OCD symptom.

OCD: Better Treatment Targets Will Improve Quality of Life

At Innovative Psychiatry, we’ve worked with a variety of treatments for OCD including SRIs, Transcranial Magnetic Stimulation (TMS), and IV ketamine treatment. Both TMS and ketamine treatment continue to be studied to improve outcomes for patients with OCD. There’s lots of work to be done still. And so we keep a close eye on advancements in neuroscience research to help us provide the most personalized care possible at this point.

With each passing year, we hope for more discoveries to guide us to more and more finely-tuned options.

Effective Treatment Includes Tools to Restore What’s Missing

Depression can be treated with IV ketamine treatment and brought to remission. But it doesn’t always happen that way. Your treatment might be challenged by underlying variations in serum levels or cerebrospinal levels of a certain folate or of hormones. In the same way, OCD treatment can be deterred by individual symptoms and the brain regions involved in a given person’s disorder.

This is why personalized treatment and care is so important. So let’s say it again:

One Size Doesn’t Fit ALL!!

We want to help you get better. We want you to have the freedom to pursue the life you want, the career you believe in, and build the relationships that will fulfill your life.

If you suffer from a disorder that has not responded to multiple treatment strategies, call us. We specialize in finding effective treatment for your individual symptoms. No matter what advances are being made in psychiatry and neuroscience, if you don’t feel better, it’s hard to see the relevance. We get that.

Call us. We’re here to help.

To the liberation of your best self,

Lori Calabrese, MD

June 24, 2019
Can Genetic Clues Really Predict Bipolar Disorder and Schizophrenia?

If you struggle with bipolar disorder, and the symptoms that seem to dominate your life, it may help you to know that many psychiatric disorders don’t really come with a list of predictable symptoms.

If you have times when you’re short-tempered, highly energetic, sure of yourself, and quick to argue, you may have a mood disorder…or you may have had a frustrating week at work… And so goes the conundrum. You may feel like you’re low on energy most of the time, or find it hard to identify purpose for your life. How do you know if you’ve got something going on? How can you get a clue? It may seem far-fetched, but can genetic clues really predict bipolar disorder and schizophrenia?

We look for clues all the time–little signs and symptoms that herald bigger problems to come. If you have all that going on… and it seems to run in cycles… depression interrupted by periods of energy, over-confidence, a strong drive to win arguments… then periods when you can only think about dying…or ending your life yourself… Well, chances are, this may be more than a bad week at work. In fact, you should probably see a good psychiatrist in your area to help sort it out — because you may have a disorder. And if you do, treatment can help.

So, let’s say maybe you feel intrigued to talk someone you just met into having risky sex with you…or maybe you’ve lost touch with the limits of your credit cards and feel inspired to do lots of shopping or travel and splurging. Maybe spending money gives you exhilarating feelings, but you feel like you’re accomplishing so much– and …you don’t notice this is out of character for you. You think it’s great.

Oh boy.

Your Disorder May Display Different Characteristics Than Someone Else’s

People with bipolar disorder don’t usually display all the symptoms, but they do display some of them. Whether it’s something like getting frustrated that leads to a major blowup and rage…and display of super human strength… or something like feeling untouchable and indestructible that leads you to do things that are so risky (so incredibly fun!) that the adrenaline just courses through your veins. Rather than feeling fear per se, you feel exhilarated — and want more of that feeling.

Let’s look at it this way…

If you contract a virus, something like the common cold, it’s easy to predict your symptoms, isn’t it?

Sneezing and a runny nose is how it starts.

Sound familiar?

If it’s a particularly nasty cold, you might even have a fever. Then, the runny nose gives way to a stuffy head, maybe a cough or a scratchy throat, and you just feel awful. So predictable. We can pick up on the first inklings

But some psychiatric disorders aren’t quite so easy to pick up on.

So Many Symptoms – Who Can Tell?

Sure, there’s depression. Everyone knows what that is…right? Or maybe not… If you broke a nail right before a black tie event, that may seem depressing. But we’re not using the word appropriately when we say that. Because major depressive disorder (MDD) is a disorder… i.e., an illness. Grab your file and smooth out that nail. It won’t interfere with your fun at all. But if you have MDD, it’s not likely you’ll be able to have a very good time. Depression just takes the fun out of everything.

At the same time if you shopped for the event, spent your entire month’s earnings on an outfit for the affair, and left yourself with pretty much nothing to live on or pay bills with until your next paycheck, it’s pretty clear you used poor judgment. And poor judgment is not a disorder. It’s merely doing something risky that seemed like a good idea at the time …but a tough decision to live with the rest of the month. On the other hand, poor judgment can be a symptom of a disorder.

Oh. Like when?

So can explosive outbursts. Fits of rage. Or destruction of property. Again, they can be, but of themselves aren’t necessarily signs of a disorder. So it begs the question: are there clues that predict whether a disorder is in the making? Are there genetic clues that really predict bipolar disorder and schizophrenia? Well… the answer is sometimes. And maybe.

(This is where we tear our hair out.)

You do need a psychiatrist to figure all this out.

Thirty years ago, a psychiatrist may or may not have been able to help. But chances were much better than they were 100 years ago, you know? At that point, psychiatrists stumbled in the dark and devised theories to explain patients’ behavior, with little scientific evidence. There was so little we knew about the brain. Sometimes they helped their patients, but often they couldn’t.

In the absence of neuroscience discovery, psychiatrists did what all scientists do: they hypothesized. And they looked for evidence to see if they were right.

Is it any surprise this branch of medicine was cloaked in stigma?

Can Genetic Clues Really Predict Bipolar Disorder and Schizophrenia?

Now we’re advancing into the 21st century, and we’re still fighting the stigma that began in the dark absence of clear scientific evidence.

So, let’s talk about where we’ve come in psychiatry.

Now we can separate the genes on the chromosomes.

You know what chromosomes are, right? Your DNA. But that tiny microscopic structure – that’s a map of who we are – is made up of genes. Now those are really tiny.

We know what many of the chromosomes actually do. We also know that a tendency to develop various diseases can be found in specific positions on certain chromosomes.

By the same token, certain clusters of genes in certain locations on the chromosomes can indicate personality traits that emerge in someone who has not yet developed a disorder. Genetic clues that can perhaps predict the later onset of bipolar disorder and schizophrenia… and the list goes on.

Nicholas Pediaditakis, M.D.’s article in Psychiatric Times under the title, “The Dog That Did Not Bark,” explains how this might work. Sometimes, certain clusters of genes are missing… like if the “barking” genes are missing, it could result in a dog that doesn’t bark.

When that happens in people the genes that express themselves as personality traits, can create a “lopsided” personality, as he put it. So the genes that would express themselves as socially outgoing may be missing or sparse, which can show up in the person as aloofness or an aversion to social situations along with a sense of autonomy.

Of course, this is an oversimplification for our purposes in this post, but the point is that this person is “premorbid”(in the sense that he doesn’t have signs of a disorder yet), but his “lopsided” personality can be a signal of schizophrenia or bipolar disorder that may be lurking in the future.

Dr. Pediaditakis goes on to say that this premorbid asocial trait may result in a group of individuals who may be vulnerable and later turn out to develop schizophrenia or bipolar disorder. It’s sort of like a preview in the developing brain. He says,

“This synchrony is an emergent property of complexity. This probabilistic shift heralds the expression of the disorders and results in the development of characteristic symptoms for both schizophrenia and bipolar disorder.”

The Give and Take That Leads to Gifting and Brilliance

He also says that while both of these disorders tend to include psychosis at some point, there is also some trade off with traits that can be quite favorable.

For instance, since their personality doesn’t include social traits, it’s as though they’re able to think in terms of unconventional alternatives and distinguish original and revolutionary patterns …whether scientific, mathematical, artistic, or musical.

Basically, since they have some freed up space in their head, they can also be remarkably gifted. Sound familiar?

It brings to mind the book and movie, “A Beautiful Mind,” about John Nash, Jr., the gifted mathematician who suffered from schizophrenia. And Vincent Van Gogh, the brilliant but tormented artist. And entertainers like Carrie Fisher, Mel Gibson, and Mariah Carey (to name just a few) who’ve struggled with bipolar disorder along with their creative brilliance.

There’s a physiological reason, one only identifiable by neuroscience, that these great talents are simultaneously struggling with a severe disorder, while also displaying their creative gifts. The two might actually be linked, if indirectly.

Neuroscience Leads the Way to Understanding More About These Disorders

Molecular genetics, functional neuroimaging, and translational neuroscience has made great advancements in the diagnosis and treatment of both bipolar disorder or schizophrenia. Stigma about disorders like these is dying a slow death… we hope, in time, it will disappear altogether.

And we hope that time comes soon.

Modern medical and neuroscience breakthroughs are exploding. And they raise the question: Can genetic clues really predict bipolar disorder and schizophrenia? There’s so much more we’re learning about brain circuitry, the hippocampus, the amygdala, the lateral habenula… and what is called translational neuroscience, where we take basic science research and translate it into clinical applications that help people. Like you, and the people you love.

In the meantime, if you’ve been diagnosed with bipolar disorder, and if the medicines prescribed for you haven’t helped, you need treatment that works.

You Deserve to Feel Better

Ketamine treatment can make a dramatic difference in managing your bipolar disorder by wrangling bipolar depression. Scores of people in your position have been relieved to discover the difference ketamine treatment makes.

If your medicines are helping, you’re in a wonderful position. You’re finding you’re able to live your life with less difficulty and build upon the things that matter to you. But if your medicines aren’t working, if you’re tormented, living in chaos, and unable to invest in your job or relationships because of your symptoms, call us.

At Innovative Psychiatry, we see people with bipolar disorder get much better all the time. Because lifting them out of depression that just hasn’t wanted to budge is a game-changer. When ketamine relieves depression, there is so much more time and energy left for managing your life.

We’re here to see that you get the help you need to enjoy your life, build up what’s broken down, and relish your friends, your family, and your work, as well.

It can get better for you. You’ll see.

June 10, 2019
Ketamine and Depression Treatment-Time Marches On

Time magazine recently offered a Special Edition on mental health… Did you see it?

The article about depression treatment – and ketamine specifically – by Mandy Oaklander published in July 2017, was reprinted for this special edition. The title of the special edition is “A New Understanding”…but since the article Oaklander wrote is two years old, I’m concerned this special edition may be misleading.

Her cover article two years ago touted ketamine as an “anti-antidepressant.” This same term is repeated on this Special Edition cover. But, since Oaklander’s article created some misunderstanding when it was first printed, I’m not sure it’s accurate to refer to the contents of this edition as “a new understanding.”

In fact, some of her representations of ketamine treatment border on archaic.

Ketamine and Depression Treatment

The field of ketamine for depression treatment is a new field in the “psychiatry and neuroscience universe” that’s been growing at break-neck speed. A wide variety of healthcare professionals offer this treatment in a wide variety of places and using a wide variety of methods.

Still, because we’re on this quest together, you and me, I want to take a few minutes to express my perspective on this reprint of her article.

What quest?

Well, that would be our passion to find more ways more people can be relieved of the symptoms that impair their lives.

We talked about this after this article was published in TIME two years ago. But we’ve learned so much since then. Through neuroscience research as well as in private psychiatry practice and in meeting and collaborating with other healthcare professionals at national and international conferences since then.

What Have We Learned Since TIME Published That Cover Story?

Lots. About ways to prolong the effects of ketamine, ways to prolong and maintain remission, more of the actions of ketamine in the brain… We focus on ketamine treatment. So let’s talk again now about how she framed ketamine treatment in a less accurate light than we might wish.

Because if you suffer, you want to know. You try treatments and medications for months – and years – in vain. You want to know that you’re getting the best possible information you can get your hands on.

Regarding the route of administration

This article spoke of a lady named Barbara Reiger who’d been depressed since childhood. It said that since no other treatment helped, she goes monthly to a ketamine clinic. And there she has “a needle full of ketamine plunged into her deltoid…”

This route of administration for ketamine treatment is only one of many. In the 2 years since the article, there has been much more research about IV ketamine infusions. The intramuscular route is less predictable than an IV for getting the medicine on board. In addition, it’s more difficult to manage the onset of action or the experience once ketamine is sealed into muscle. You can’t slow its absorption or effects, or stop it.

We later read that Ian Hanley, another person with treatment resistant depression, received ketamine infusions. I assume these are intravenous (or IV). The term “infusion” speaks of the IV route. (Though surprisingly, I hear there are those who use this term to refer to IM injections. This isn’t correct, and can be so misleading to patients who don’t know the implications.)

Is Ketamine and Depression Treatment a “Trip?”

Another point is the experience itself: Is it a “trip?” What does the patient experience with ketamine treatment? Oaklander calls these treatment experiences “ketamine trips” as though the concept of a psychedelic trip is the foregone conclusion with ketamine treatment. While it’s true that there will be a variety of experiences between various patients, and that ketamine is a visionary medicine, ketamine treatment for depression should not be confused with people who use ketamine for a psychedelic trip.

Oaklander’s perspective focuses on ketamine as a psychedelic drug. Such characterization draws a narrow crowd of people interested in psychedelic exploration, but can alienate the larger population of patients who have no interest in psychedelic anything. It’s a misunderstanding of ketamine and its properties to limit the characterization of it.

Who’s in Charge? The Medicine or the Doctor?

And it’s the responsibility of the physician administering the medicine to use a route, a rate, and a dose that allows the patient to know the ketamine is actively working. And to prepare and protect the patient from an overwhelming experience.

As it takes action in (1) her brain circuits, (2) her BDNF to proliferate synapse connections, (3) her lateral habenula, and (4) those G proteins on lipid rafts in the cell membrane, the patient will experience sensations, feelings, and possibly visuals as a result. (Amazing, isn’t it? These are just a few areas of action we know about ketamine! There may be far more!)

Because the brain is made up of nerves that connect with each other, and complex systems that perform vital functions of all types, impacting these circuits gives you certain sensations, thoughts, and experiences.

The sensations feel overwhelming if the dose is too high. And the patient can feel alarm if the rate is too fast or uncontrolled. In fact, the experience might even advance to something you might call a “trip.”

But … a closely monitored infusion should prevent the overwhelm, while allowing full restorative freedom for the medicine to do its work.

Ketamine Can Erase Suicidal Thoughts in an Afternoon

Oaklander also pointed out the rapid and dramatic ability of ketamine to stop suicidal thoughts in a few hours, whether it relieves depression or not.

This is a shining benefit of ketamine — that its ability to erase suicidal thinking is separate from its antidepressant benefits. Lifesaving.

Now about how ketamine lifts depression. Oaklander wrote that the “ketamine trips,” as she called them, help people disconnect from their bodies and thoughts. Her idea was that this experience changes the mindset so completely that the depression lifts.

However, while we know the experience is important as part of the ketamine and depression treatment, research presented at the American Psychiatric Association Conference in San Francisco a couple weeks ago shows it’s not enough to lift the depression by itself. In addition, if that were true, those who have had these “trips” would all be depression–free … and that’s not true either.

Even so, the dissociation the patient experiences during the infusion does serve as a sign of what’s actually going on in the brain. This is ketamine at work, restoring synapses, turbo boosting BDNF. This process is not for entertainment but rather it signals the restorative properties at work, just as pain signals something wrong in the body.

How Ketamine Works… There’s More to Learn

Oaklander’s statement that “experts aren’t sure exactly how ketamine works…” is still true, but we know far more than we did when she wrote the article two years ago. It seems this one medicine has spawned its own frontier, and we keep learning. Research on ketamine for psychiatric disorders presses on around the world.

And real-world practices also present data to give the medical community, and our patients more information that ketamine has taught us.

Learning more about what we already know is paramount. A recent study revealed how ketamine restores brain circuits. We understood that it did… or believed that to be so. But now a two-step process in restoring dendrites and dendritic spines has been revealed through a special laboratory process. This is the tip of the iceberg.

There is so much more we want to know about this extraordinary treatment.

Ketamine and Depression Treatment in General: Keep the Research Coming

And this is where I’d like to see journalists like Mandy Oaklander and her contemporaries use their influence to call for more research. It’s wonderful that pharmaceutical companies continue to search for new possibilities in drugs to target more areas of the brain. The more the better.

But, as Oaklander pointed out in that article, the concern and caution about ketamine lies partly in its potential for abuse, but also in its potential for damaging side effects.

Our concern is that it may be damaging eventually if it’s used too often for too long.

For those who receive ketamine infusions every few weeks or every single month with no end in sight, there may be risks. Since ketamine can help such a large population of people with treatment resistant disorders achieve resilience and remission… isn’t it worthy of the research to find out more that it can do? To build our body of knowledge…?

How many more people can be restored with ketamine infusions if we find out what their physiological and psychological obstacles are? What do we need to learn to remove more of the hindrances to an individual achieving resilience… and even remission?

It’s true that not everyone responds to ketamine treatment. We’ve talked about how preliminary research suggests that those with the VAL-VAL allele respond so quickly, and those with MET-MET can respond more slowly, or sometimes not at all.

But there are also those who respond within the first three infusions, but then their response dissipates. These are responders, and yet not remitters. There are studies that suggest differential responses in certain groups, like the Taiwanese. Let’s find out what we don’t know about why.

In some cases, there’s a cerebral folate deficiency that hasn’t been treated, in others it’s Low T, in others it may be deficiencies only found in the cerebral spinal fluid…

And if deficiencies that cause depression are there, they need to be teased out and treated, so ketamine can do more to restore those lives.

But..what other obstacles are there that can be treated so our patient can get the most out of his ketamine infusions…and enjoy resilience… and get the most out of his life?

We applaud all efforts to find more treatments that will be effective for more patients. But rather than focus on ketamine’s potential danger in the long term, why not invest our resources in finding out how to get more people to remission so they’re NOT exposed for the long term?

What if that pot of gold at the end of the rainbow is not in fact another medication we also don’t fully understand, but rather a better understanding of the one that works so well already?

Thank you, Mandy Oaklander of TIME magazine, for spreading the word about this new frontier in treatment two years ago. While your characterization seemed to stray from our perspective through neuroscience, we have appreciated that TIME magazine helped to make this breakthrough treatment a household word. We’re learning so much and the more we learn, the more we see that we NEED to learn.

Knowledge really is power against psychiatric symptoms.

Here’s hoping we can all walk together to get effective treatment to more people. Several years ago, studies showed that “60-70% of people with treatment resistant depression respond to ketamine” … but we’re making progress.

A number of doctors in private practice are learning to get more out of each infusion for better outcomes for our patients. And we’re seeing responses much higher than 60-70%.

At Innovative Psychiatry, we see extraordinary outcomes in our patients every week. Patients who were too ill to work, who had withdrawn from their relationships, and lost hope in their jobs, their lives, and themselves…go forward to find initiative, resilience, joy, and bushels of hope for a fulfilling and rewarding life after they receive carefully supervised ketamine treatment.

If you suffer and endure with symptoms of depression, PTSD, bipolar depression, addiction, social anxiety, and suicidal thoughts... give yourself the opportunity to feel better and live better. Call us and find out what joy feels like.

June 3, 2019
Study Finds Ketamine Nasal Spray Effective For Treating Depression: What You Should Know

A new study finds that a nasal spray formulated from the anesthetic ketamine is a safe, fast-acting and effective treatment for treatment-resistant depression. Researchers presented the findings this week at the annual meeting of the American Psychiatric Association.

Esketamine, the intranasal formulation of ketamine, recently received FDA approval as a depression treatment when used with an oral antidepressant, based in part on findings from this study. The results open the door to a potential new alternative for the estimated 30% of depression patients suffering from treatment-resistant depression.

The study included 197 adults from 39 outpatient centers over a two-year period. All of the participants had either moderate or severe depression and hadn’t responded well to at least two antidepressants in the past. Participants were randomly assigned to one of two groups: The first switched from their current antidepressant treatment to esketamine nasal spray and a new oral antidepressant; the other switched from their current treatment to a placebo nasal spray and a new antidepressant.

The results showed significant improvements in depression symptoms among those in the esketamine group compared to the placebo group four weeks into the study, with signs of improvement starting much earlier.

“The study supports the efficacy and safety of esketamine nasal spray as a rapidly acting antidepressant for patients with treatment-resistant depression,” the study concluded.

“Not only was adjunctive esketamine therapy effective, the improvement was evident within the first 24 hours,” said Michael Thase, M.D., one of the study authors. “The novel mechanism of action of esketamine, coupled with the rapidity of benefit, underpins just how important this development is for patients with difficult-to-treat depression.”

The researchers reported that most of the negative side-effects in the esketamine group, including dissociation, nausea, vertigo, dysgeusia (impaired sense of taste) and dizziness, disappeared within a couple of hours. A small percentage of patients dropped out of the study due to side effects.

Ketamine has been in headlines for more than a decade as the party drug (aka “Special K”) with promise of becoming a next-generation depression treatment. Early studies showed patients with a history of treatment-resistant depression responded well to ketamine almost immediately. Those studies generally used intravenous ketamine at a low enough dose to not deliver anesthetic effects (what ketamine was originally designed to do in humans and animals), but intravenous ketamine for the treatment of depression hasn’t been approved by the FDA. The intranasal formulation (brand name Spravato) received FDA approval in March of this year but is only available through a restricted distribution system with a certified clinic or doctor’s office.

The news isn’t entirely upbeat, however, with some researchers urging caution as the drug moves closer to pharmacy shelves. In commentary accompanying the study in the American Journal of Psychiatry, Alan Schatzberg, M.D., from Stanford University School of Medicine, cautioned that while this study shows potential benefits of using the drug, “there are more questions than answers…and care should be exercised in its application in clinical practice.”

Schatzberg pointed out that clinicians don’t have adequate information about how often the medication should be prescribed, how long patients should use it, or what the correct course of action should be if patients eventually stop responding to it.

He also highlighted the potential for abuse, echoing concerns raised by many health professionals all along the drug’s road to approval. Using the history of opioids as an example, he added, “We have witnessed four decades of supposedly new and safer opioids that have turned out often to be, if anything, even more abusable and lethal.”

“Still, the agent [esketamine] could be helpful to many patients with refractory depression,” Schatzberg said, ending on the positive, “and efforts to develop rapidly acting agents for severely depressed patients need to be applauded.”

The study was published online in the American Journal of Psychiatry.

You can find David DiSalvo on Twitter, Facebook, Google Plus, and at his website, daviddisalvo.org.

[Read the Original Article Here]

May 29, 2019
Opinion: The New Ketamine-Based Antidepressant Is a Rip-Off

Johnson & Johnson patented a form of the psychedelic with less research and a ridiculous price tag.

In a popular and public move, the United States’ Federal Drug Administration recently approved intranasal esketamine, one of the components of the psychedelic ketamine, for treatment-resistant depression. The nasal spray costs nearly $900 per dose—or roughly $7,000 for the first month of treatment, and each treatment takes at least two hours in a clinic. (It has yet to be decided how much of the cost insurance plans will cover.)

Esketamine can be unwieldy to use and carries a number of significant potential side effects. Shockingly, it was no better than placebo in two of the three short-term Phase-III studies submitted to the FDA for approval.

But the biggest problem at hand is not the drug itself. It’s the fact that instead of representing a revolution in mental health treatment, as it has been touted to do, esketamine is not a breakthrough at all. It’s just a way for pharmaceutical company Johnson & Johnson to make a significant profit off gullible insurance companies and vulnerable patients.

Generic Ketamine Works

Generic ketamine is available for a fraction of the price of esketamine, has been shown to work—and work safely—in small-scale single-dose and multidose trials for treatment-resistant depression, can be administered in a variety of ways, and has already been used off-label for decades to treat thousands of patients with depression and suicidality.

It’s currently difficult, if not impossible, to provide generic ketamine treatment in public clinics, even to patients who need it, because there haven’t been any large-scale, randomized trials, both with and without psychotherapy. Without these trials, and resources, physicians can’t be reimbursed by insurance companies for ketamine treatment like they will be able to do with esketamine.

Ordinary ketamine is a racemic medication, meaning it is made up of two molecules that are mirror images of each other. Because ordinary ketamine is generic, Johnson & Johnson simply isolated one of the two molecules in regular ketamine so that it qualified as “new.” The reality is that we don’t know whether esketamine is more or less effective than regular ketamine because there have been no head-to-head trials between the two. Johnson & Johnson only tested esketamine against a placebo, likely because they feared esketamine might actually perform worse than the generic version.

As many critics have pointed out, this strategy has become the bread and butter of drug development in the United States today. Largely because of the influence of pharma on the FDA itself, our drug approval process rewards copycat variation of already-available drugs instead of truly innovative pharmaceutical design.

When Psychotherapy Is Missing

The trials for esketamine also reveal a larger issue in the field: they de-emphasized the importance of psychotherapy while focusing solely on its chemical effects. The most effective treatment strategy for treatment-resistant depression is intensive psychotherapy along with the use of medication, but the FDA esketamine trials didn’t include therapy at all.

Getting insurance companies to pay for psychotherapy is already difficult, and without it as part of the protocol, they will likely offer no reimbursement for patients interested in receiving a psychotherapy session after their esketamine dose in order to process the experience.

Our colleagues who offer ketamine-assisted psychotherapy say that this is a vital part of the process. One such session can require upwards of three hours of one-on-one treatment in order to prepare patients for the experience, take care of patients while they are under the influence of ketamine, and then integrate the effects afterwards. Ironically, insurance companies would save more money paying for generic ketamine-assisted psychotherapy rather than esketamine treatment alone, as the former is both cheaper than the latter and can lead to long-term remission of symptoms.

Alternatives

Private ketamine clinics currently do exist, but they have to fight the stigma of the drug, and sporadic cases of malpractice. Some private clinics do not properly screen patients prior to initiating treatment and often charge outrageous sums of money—one reason that both patients and medical systems have been hesitant to implement it more widely. Those clinics that are providing ketamine responsibly, however, offer a potentially lifesaving treatment for patients living with depression who have exhausted all other available options.

Although there are no quick fixes for the broken drug-development and approval process that led us to esketamine, it is possible to take concrete steps to address the most glaring problems. Insurance companies and the FDA ought to require head-to-head study designs of clinical trials to investigate generic and patented medications. Additionally, current research on medication-assisted psychotherapy with other psychedelic substances such as MDMA and psilocybincan serve as a model for future research that explores ketamine-assisted psychotherapy, instead of the drug alone.

While Johnson & Johnson rakes in the profits from esketamine, patients dealing with depression and trying to navigate our struggling mental health system will bear the cost. Fostering the development of mental health treatments that are novel, effective, and affordable will require a critical examination of the undue corporate interests that drive drug approval in American psychiatry today.

Dr. Michael D. Alpert is a psychiatrist and clinical faculty at Harvard Medical School. He is also a therapist with the MAPS Clinical Study of MDMA-Assisted Psychotherapy for PTSD.

Dr. J. Wesley Boyd, MD is a psychiatrist and associate professor at the Center for Bioethics at Harvard Medical School.

Dr. Marco A. Ramos is a psychiatry resident at Yale University.

[Read the Original Post]

May 27, 2019
Revitalize Psychiatry: Disrupt – Include – Engage – Innovate !! – The APA 2019 Conference
I just returned from the American Psychiatric Association’s 2019 Conference in San Francisco.

This is the 175th Anniversary of the APA, and look how far we’ve come. The theme this year was: Revitalize Psychiatry – Disrupt – Include – Engage – Innovate. and it certainly provided fodder toward those goals. It was an informative and eye-opening conference with a wide array of talks and poster presentations. Plus, I was privileged to make a presentation, too. More about mine in a bit.

The attendance at this conference exceeded them all, with thousands of attendees from around the world and new research presentation abstracts which spread out over 800 pages!

You may not be aware that the APA is the oldest medical organization in the nation. (We’re proud of that.) The venue was enormous and the camaraderie rich, inclusive, and restorative.

The presentations flowed from every aspect of psychiatry, including geriatric issues as well as issues specifically relevant to children, and adolescents, too. There were talks from ADHD to dementia and addiction to psychosis.

From Saturday through Wednesday the venue was chock-full of courses, convocations, lectures, symposia, talks, and media presentations by the hundreds. There were more than 360 new research presentations every day in the poster sessions which went up every morning and every afternoon.

There’s no way I could ever provide a synopsis here of all the findings presented. But there were a couple I do want to mention.

My own focus was on those presentations specifically related to suicide, depression and other mood disorder treatment, and especially ketamine treatment. I drank up all the information and data I could hold. (That and espresso kept me going.)

Here we’ll talk about two of the presentations focused on ketamine and the one I presented on suicidal thinking.

Ketamine’s Effect on OCD

I was so pleased to see there has been more work focused on ketamine for obsessive-compulsive disorder (OCD). Clinical Psychiatry News featured this article with the title: “Ketamine may help OCD, but much work remains.”

The author, Carolyn Rodriguez, MD, pointed out that the symptoms of OCD are severe, and 1 in 7 people with OCD attempts suicide at some point in their lives. She said that there is a significant and painful delay between the time of diagnosis and the time when the patient experiences benefits from the medicine — 2-3 months or even longer.

She talked about her interest in looking at therapies that worked much faster, and were more thorough. This is so important so that patients could feasibly experience more complete eradication of symptoms.

Since more and more evidence indicates that glutamate seems to contribute to neuron communication as an excitatory chemical messenger, she chose to see what ketamine could do, considering it blocks the glutamate receptor.

The only study using ketamine with OCD was conducted by Dr. Rodriguez and her team in 2013. Not surprisingly, she’s planning a new one now which will compare ketamine with midazolam, to study the effects of ketamine on the circuits associated with OCD.

She Called for More Studies On Ketamine’s Effects on OCD

She says a larger study is needed to learn more about how long ketamine’s effects on OCD symptoms lasts. It’s also important to see if the effects seen in the 2013 study can be replicated.

This is exciting work, as we need more information about what ketamine does for OCD so we can help more patients.

Dr. Rodriguez commented on the FDA approval of esketamine this past March. She made the point that those OCD patients with “contamination OCD” are likely to be unwilling to use a nasal spray.

Disrupt – Include – Engage – Innovate …

Ketamine and Opioid Receptors

Another talk, presented by Nolan Williams, MD, from Stanford University, discussed ketamine’s mechanism of action. Since there’s wide recognition that stress is directly related to a buildup of glutamate outside the cells which causes unwanted effects, ketamine blocks the NMDA receptors, blocking glutamate, and reverses these unwanted results.

Dr. Williams made the point that ketamine affects many neurotransmitter systems and has a wide variety of effects, both good and bad, as a result of that.

Researchers know that ketamine’s effect on pain is complex, and an opioid receptor antagonist prevents ketamine from relieving pain. We know that opioids have an antidepressant effect, and Dr. Williams wondered if ketamine’s antidepressant effect depended on the opioid system.

There were 12 subjects in all who completed the study; 7 had dramatic relief of symptoms. Even more interesting, 6 of the 7 achieved remission.

Now, the design of the study included crossing over between 2 groups of subjects. So, to accomplish this, one half received a placebo an hour earlier, then ketamine. The other half received naltrexone an hour beforehand, then ketamine. As you may know, naltrexone blocks opioid receptors, so if ketamine relies on the opioid system, in part, then naltrexone should prevent ketamine from reducing depression symptoms.

After the ketamine infusion, they allowed the subjects to become depressed again. They became deeply enough depressed to reach the 20% mark on their evaluation tool. Then they were given another infusion of ketamine. If they received placebo with the first infusion, this time they were given naltrexone. If they received naltrexone with the first infusion, this time they were given placebo.

Opioid Receptor Antagonist Blocks Ketamine’s Effects

Those who received naltrexone experienced no benefit from the ketamine infusion, whether they received it prior to the first ketamine infusion or the second one.

The same is true of suicidal thinking as measured on the tool. Those who received naltrexone experienced no reduction in suicidal thoughts.

Interesting, right? But, keep in mind, this was a very small study, and much, much more work needs to be done looking at these issues. This is too preliminary, and these numbers are too small, to make sweeping generalizations. Certainly, closer to home, at Yale, patients treated with naltrexone have responded to IV ketamine. So much to learn!

Disrupt – Include – Engage – Innovate…

Ketamine Infusions Stop Suicidal Ideation in Outpatients and Avert ER Visits and Hospitalizations

Finally, my own story. I had the opportunity to present my own data.

I’m very interested in how IV ketamine can rapidly reverse suicidal thinking in patients with depression. Passionate about it, actually. Taking a long, hard look at my own experience with more 235 adults and adolescents with treatment resistant depression, I presented data which showed that serial, titrated ketamine infusions stopped suicidal thinking in the majority, and prevented ER visits and psychiatric hospitalization.

We have dozens of case reports, small studies, beautifully written case series, and elegant placebo-controlled trials of ketamine treating depressive episodes — and very fine studies teasing out the effects of ketamine on suicidal thoughts in small numbers of patients.

What’s been missing — for us all — are extensive results from real-world psychiatric treatment with ketamine in large numbers of patients like the ones we see every day–people who are complex, and have more than just one thing going on (like anxiety, OCD, trauma, and histories of substance misuse in addition to their depression or bipolar disorder). People who are medically ill, or in chronic pain. Those who have made numerous trips to the ER for suicidal ideation. So many who have been hospitalized, made suicide attempts, have been failed by ECT, or failed by TMS.

People like you. Or like people you know.

When I think about what ketamine can do best, and who it needs to work for first, it’s the patients I see — people like this: Depressed. Sick and tired of it. Sick and tired of treatment not working. With thoughts it would be a relief to not wake up, or with frank thoughts of suicide.

There were No Suicide Deaths, Suicide Attempts, ER Visits or Hospitalizations in my High Risk Group Treated with IV Ketamine Infusions

This is the first report from a real-world psychiatry office practice in the community using IV ketamine to treat suicidal thinking in hundreds of adult and adolescent patients with treatment resistant depression.

The response from attendees to the data was enthusiastic. But we were even more excited with the breadth of new research presented during that same 2 hour poster session. Information that touched on ketamine, suicidality, and treatment resistant depression. It’s extraordinary to see so much energy and thought put into examining these connections. Here are some examples of the new research posters that surrounded me:
- Effect of Ketamine and Esketamine in Suicidal Ideation: Relationship to Depression
- Patient-Reported Outcomes in Major Depressive Disorder with Suicidal Ideation: A Real-World Data Analysis using Patientslikeme Platform
- Care Setting Type and Readmission/Subsequent ED Visit Risk Among Patients with Major Depressive Disorder and Suicide Ideation or Suicide Attempt
- Do the Impact of Risk Factors or Protective Factors for Suicidality
  Change in Response to Effective Treatment? A Case Study
- Esketamine’s Antisuicidality Effects on Treatment-Resistant Depression: A Role for the Subcutaneous Route
- The Relationship between the Big Five Personality Traits and the Suicide Crisis Syndrome in an Outpatient Population
- Resilience Moderates the Relationship between Suicidal Narrative and Suicidal Behaviors
- Effects of Ketamine and Esketamine on the Levels of Brain-Derived Neurotrophic Factor in Patients with Treatment Resistant Depression
- Development of a Real-World Ketamine Database Registry: Centers of Psychiatric Excellent (COPE)
- Managing Esketamine Treatment Frequency Toward Successful Outcomes: Analysis of Phase 3 Data
- Esketamine’s Antisuicidality Effects on Treatment Resistant Depression: A Role for the Subcutaneous Route
And the beat goes on.

Disrupt – Include – Engage -Innovate !!

So, in fact, we enjoyed a wealth of disruptive information shared through hundreds of studies, new technologies, and new paradigms. We engaged with the information and with each other, included diverse groups who attended and the patients they advocate for and treat. We’re moving forward to innovate in our mindset, our approach, our science, and our treatments.

Because after all, it’s for you that we attend these conferences. No doctor practices in a vacuum, but our best and most healing practices are born from collaboration within the psychiatric and neuroscience community.

Ketamine Treatment at Innovative Psychiatry

So here at home, we focus our energies on you. Do you have thoughts about suicide that treatment has not been able to stop? Do you suffer from symptoms of depression that recur or persist no matter what you do?

If so, please call us.

Let’s determine if you’re a candidate for IV ketamine treatment.

While it isn’t the right treatment for everyone, (because nothing is) it is remarkably helpful to most. And we’re learning all the time more ways it can help more people.

We live, study, collaborate, work, and share our findings to help you find the rewarding and fulfilling life you’ve longed for. Together, we can Disrupt -Include – Engage – Innovate …and help transform your life. Give yourself the opportunity to feel well and to enjoy the things in life that mean the most to you. We’re here to help.
May 27, 2019

error: Content is protected !!