We’re smack in the middle of the holidays! The last month of 2019 has begun. If this December is anything like the past, it will zoom by like a rocket. I hope your Thanksgiving was a joyful time for you. Going forward, it’s part of the tradition at this time of year to overindulge …then let diet and exercise obligations pelt us like hail at the start of the New Year. But I have another suggestion, and it’s related to exercise now. Beginning today, increasing your exercise can reduce your risk of depression going forward. In fact, exercise reduces future depression even in the holidays ahead. Wouldn’t that be nice?
As you know, depression can run in families, and when you’ve experienced recurring bouts of depression all your life, it can seem like an albatross. Something that’s part of your life that robs you of resilience and the energy to face the demands of a busy time of year like this.
If you have other family members who also struggle, you can start to think this is just how life is. And that there is just nothing you can do about it.
Trudging as if in mud, a dark cloud hanging over you…feeling listless and overwhelmed, and just wanting to go to bed.
Another way is to spend at least 30 minutes a day in the sunshine, and in good weather, more than that. Good for your spirit, good for your body as it makes Vitamin D. It’s essential for nearly every chemical reaction that occurs in your body, and especially those that impact your emotions and frame of mind.
And here’s another big one: the E word.
The E word?
That word we dread hearing from our doctorS, and when they ask about it, we look at the floor and mumble.
EXERCISE!!
Now don’t tune me out. Stay with me…
Many of us are on a guilt trip about working out, about not exercising enough on a regular basis. There are those inspiring icons who are at the gym every day, running, lifting weights, building muscle, stretching… the SLEEK ones. You can pick them out anywhere. The mall, the grocery store, your favorite restaurant.
But, my friend, believe it or not, those people are not the mainstream. And you are NOT shameful that your exercise schedule doesn’t match theirs.
The truth is, exercise is for YOU. It’s for your enjoyment (no I’m not kidding), for your own release of tension, it’s for your health to keep your arteries clean and clear and your heart strong…and to ward off diabetes and other diseases.
But that’s not all.
Exercise Reduces Future Depression
Did you know that?
You’ve probably heard it will help you combat depression now…but who feels like getting out and moving anyway? When you feel crummy, exercising is the last thing you feel like doing.
Except that getting outside, breathing in fresh air, and moving your body, your joints, your muscles… can be a lifeline of hope if you let it.
In fact, a biobank cohort study published in Depression & Anxiety, showed that when you’re active it can help prevent depression in the future regardless of your genetic predisposition.
Using a data base of 8000 people of European ancestry, Karmel Choi, Ph.D. and her colleagues determined that an increase in physical activity was associated with decreased likelihood of depression episodes in the future. And this wasn’t just in cases of people with a background of heavy daily workouts or participations in sports.
Whether the activity was intense, like aerobic exercise or the use of exercise machines, or lower-intensity movement like yoga and stretching, each time they added a 4-hour block of activity in per week it was linked to a 17% reduction in the likelihood of a new episode of depression going forward. According to these findings, exercise reduces future depression. It’s worth pushing through.
Exercise – At Least As Important in Fighting Depression As What You Eat
Recognizing this can help your psychiatrist prescribe more movement and activity to reduce depression for you going forward.
When you’re depressed, it goes without saying that you just don’t feel like getting out, being active, pushing through the fog and inertia to initiate exercise, but doing so anyway can open the door to better days ahead.
And even if your doctor tells you to be active 4 hours each week, it doesn’t mean that you will. It can really seem futile, when your outlook is dark. But it’s worth the commitment and the effort.
And if you find you can hardly get out of bed…if at all… and you really do need some sort of a leg up just to start the exercise, you may be a candidate for IV ketamine treatment.
IV Ketamine Treatment Gives You a Head Start
At Innovative Psychiatry, our patients often find they’re so much more able to participate in their own recovery after IV ketamine treatment. By restoring synaptic connections and signaling pathways in key brain regions, returning the lateral habenula to optimal function, your energy can improve dramatically — for getting exercise, building relationships, enjoying your family, doing things with friends, pursuing hobbies, and performing at work.
The G proteins can slide off their lipid rafts to enhance neurotransmitters to do their jobs, and you can enjoy motivation and initiative you’ve lacked for so long…to do things like exercise for the sake of your future health.
It’s true that IV ketamine treatment isn’t for everyone… Some people just don’t benefit like we want them to. But those are the exception rather than the rule. Sometimes when a patient doesn’t respond at first, several weeks later they’ll experience restoration as a sort of delayed response. It can seem to bubble up on its own.
In fact, there has never before been a medicine for depression that has been so quickly and so widely effective. Never.
You Can Enjoy Energy, Initiative, and Hope
If you’ve tried antidepressants without improvement, you owe it to yourself to let IV ketamine treatment show you what it can do. We have financing options to help you access this extraordinary treatment, and we can schedule you within a few days in most cases.
If you want to be proactive toward your recovery with better diet and more exercise… and to invest yourself in the lives of people you love… but you just can’t find the initiative or energy to do it, call us.
IV ketamine treatment offers the most robust, remarkable antidepressant benefits to more people with treatment resistant mood disorders than any treatment we’ve seen in psychiatry to date.
This is YOUR time. 2020 can be your best year yet.
We’ve come so far in ketamine treatment for depression, and we still have so far to go.
KRIYA held the first conference on ketamine treatment for depression in 2015. Now, 5 years later, there are several medical conferences that support the exchange of information in this field. Raquel Bennett,the founder of KRIYA – The Ketamine Research Institute – says that ketamine is a flexible tool and should be used with freedom and skill. She urges clinicians to make the most of the flexibility of ketamine.
This is the last conference by KRIYA that will be held in this format, according to Dr. Bennett. She plans to possibly shift to an online format next year to accommodate the huge numbers of clinicians who wish to be included.
What’s more, KRIYA has supported, from the beginning, the use of ketamine by different routes and for varied conditions, and encourages participation from providers across the gamut of ketamine applications. So we’re a wonderfully diverse crew who come together for these conferences. As for me, I know that I’ve learned so many things and forged new friendships and collaborations from KRIYA conferences.
And…my own contributions have been so warmly received. As far as the educational gathering, there are psychiatrists, psychologists, therapists, ER physicians, pharmacists, anesthesiologists, neuroscientists, nurses, and experts in consciousness medicine.
Raquel Bennet, Psy.D. Stepped Up as a Leader in the Field of Ketamine for Depression
Dr. Bennett reminds us she has created a “tasting menu,” if you will… from
all corners of the field. At this conference, she opted for breadth vs depth to make us privy to all that’s happening in the field of working with ketamine. And she emphasizes that speakers are working from different paradigms. So, she urges us to listen for the paradigm they report from….and learn.
And she’s right when she says that ketamine is a flexible tool that contributes to a variety of needs. When a patient is too depressed to talk, ketamine lightens depression so they can participate in talk therapy. To help manage severe pain and the depression that goes with it. It can help the patient go deeper into therapy, and explore their traumatic experiences gently. It can treat acute suicidal thoughts and prevent hospitalization. And she says, it can induce mystical visions for existential exploration.
Raquel had much, much more to say, but I want to mention some of the other speakers.
Brent Turnipseed, MD and Lindsey Slater, LPC, from Austin, TX talked about their use of EMDR in ketamine-assisted therapy.
In PTSD, the body’s own reaction to a patient’s traumatic memories activates adrenaline , which prevents their ability to process their trauma. Ketamine can calm the body enough that they can process the trauma without the distraction of adrenaline. As a result, it can help relieve their fears.
EMDR works by helping the patient desensitize by brief exposures to the trauma, then by redirecting the patient’s attention, EMDR induces a relaxed neurological state similar to rapid eye movement (REM).
Elias Dakwar, M.D., psychiatrist and the addiction researcher we’ve often talked about before, gave a wonderful presentation.
He presented a thought -provoking talk on meditation and mindfulness as it relates to ketamine in treating addiction.
The field of ketamine for psychiatric disorders, including addiction treatment, continues to wrangle with how to take ketamine into psychiatry but that’s because our paradigms are problematic. Mainstream psychiatry has tried to cut ketamine down to size instead of using this extraordinary medicine as a DISRUPTOR.
Dr. Dakwar entered addiction research after a long time practice of meditation and with great compassion for the patients he sees.
He described his previous and current work in detail–look for it in the journals.
Ian Mitchell, M.D., Emergency Medicine in British Columbia,
spoke about the uses for ketamine in the emergency department. He spoke about its use for sedation during an emergency procedure, such as setting bones, repairing wounds, or the removal of foreign bodies, pediatric sedation for the same types of procedures, sub-dissociative dosing for pain management, especially for neuropathic pain, to prepare a patient for intubation, sedation for the out of control, prehospital pain relief, and to manage an overstimulated patient.
In British Columbia, ambulances are equipped with intranasal ketamine for prehospital pain management as a result of the PAIN-K trial. More of ketamine’s flexibility.
Wesley Ryan, M.D., psychiatrist from Marina del Ray, CA, Parria Zarrinnegar, M.D., psychiatrist in Portland, OR, and Daniel Barton, M.D., psychiatrist from Nashville, TN all presented riveting case reports.
Kelan Thomas, Pharm.D,
spoke about adverse reactions and drug-to-drug interactions that have been documented with ketamine. So important and so well-done.
Annie Oak, a journalist from the Bay area, spoke on the use of ketamine outside the medical setting.
Gita Vaid, M.D., psychiatrist and psychoanalyst, spoke on using ketamine in psychoanalytic psychotherapy in very long session. She talked about how she has witnessed ketamine help patients relax and defenses soften so they can have freedom to talk. The psychotherapist builds relationship with the patient and it can be transformational.
Jason Wallach, Ph.D., is a pharmacologist and neuroscience researcher whose energy and depth of knowledge captivates us every time he speaks. He spoke about the neuroscience and pharmacology of ketamine. Gave an update on some of the other dissociative drugs he’s tested. (I think he’s tested them all!) He made the point that ketamine has been called a dirty drug because of the receptors it hits ex-vivo and in animal models — but that’s not true. It’s really one of the more selective drugs of this class at the doses used in people.
Jessica Katzman, Ph.D., and Harvey Schwartz, Ph.D., spoke about bumps in the road they’ve discovered with ketamine assisted psychotherapy and in the integration work that follows treatment… What is integration? It comes from a latin word that means “to make whole” or “to begin again.” Bring your clinical compass, but don’t forget your humanity. A beautiful duo talk with lots of clinical examples.
Eli Kolp, M.D., a pioneer in ketamine treatment, gave a beautiful talk on the phenomenology of ketamine-induced dissociative states.
There were so many other speakers and so much to absorb–my computer battery kept dying down, so between Surface notes, handwritten notes, and photos, I can’t do justice to the breadth of expertise in the room, and the excitement.
Greg Wells, Ph.D.Sylver Quevedo, M.D., Veronika Gold, M.F.T., Eric Sienknecht, Psy.D. presented as a panel on their model of coordination of care between prescriber and psychotherapist. Peter Koshland, Pharm.D. talked about how to work with a compounding pharmacy for varied compounded preparations of racemic ketamine. Nate Schmidt, A.R.N.P spoke about scheduling and billing logistics.
Sunday was a treasure with a very special presentation by Francoise Bourzat on the Use of Sacred Medicines in the Age of Technology and Medicalization. It was a delight to meet her. She captivated the audience, and her new book, Consciousness Medicine, is a wonderful synthesis of her life’s work.
Kelley O’Donnell, M.D. and Christian Yavorsky, Ph.D. are doing yeoman’s work with KRIYA and presented an excellent (and not dry!) talk on Measuring Clinical Outcomes: Scales and Assessment Tools. And in addition to the training for Ketamine Assisted Psychotherapy that Raquel Bennett presented and discussed earlier in the conference, Jennifer Dore, MD presented a model of training for Ketamine Assisted Psychotherapy developed by Phil Wolfson, MD and Julane Andrews, that they have used around the country.
IV Ketamine can STOP suicidal thoughts fast…Now that’s flexibility of ketamine!
On the last day, and as the next to the last speaker, I took the podium to share my data in working with patients in my own practice, and showing how IV ketamine infusions can stop suicidal thinking, and save patients from having to go to the ER or be hospitalized.
With heartfelt gratitude. These are my people–the clinicians and many of the greats in the field (who were in the audience) who launched my interest, encouraged my work, supported my writing–and showed me how to apply for an IRB. It’s amazing how much can happen in a year. So I saved the newest data and my newest results (using a new protocol and a new rating scale) for my colleagues and my friends here at KRIYA. I wanted them to hear it first.
I wanted to give back to those who have sparked my imagination, nurtured my interests, given wind to my sails.
It gives me such joy to share how this remarkable medicine that can do so much, can also save a life in a short time. And to see clinicians in practice eager to take this information home.
And that’s the beauty of meeting together at KRIYA and swapping stories and describing outcomes and victories that have restored the lives of people we work with.
Looking Back…and Reaching Forward – Preserving the Flexibility of Ketamine
It’s been such a busy fall with travel and speaking engagements each month… along with treating patients. (I’m sure my colleagues are as tired as I am. We need a vacation. Seriously.) But it’s gratifying to look back and know all this information that’s been shared will improve the lives of people we each cross paths with after KRIYA and all the other conferences.
I know these reports “from the front” can seem science-y and vague, but I want you to see how hard clinicians, neuroscientists, and practitioners of all types are constantly working to learn the breadth and depth of what ketamine can do to help people live better, improved lives. That’s really what it’s about. Ketamine’s flexibility allows for treatment that can turn your life around.
And if you’ve been reading along, and wondering if there is help for you, call us. In spite of all the travel and bustle, we’re still in all this to help you get better, live better, and have the ability to build a truly fulfilling life.
You owe it to yourself to try, if you’ve not found a medicine that works for you. It’s not that ketamine is a cure-all for everyone, but it works in so many areas of your brain, that it can restore areas damaged by stress and trauma in most people who are treated with it.
As the holidays approach, give yourself the best chance you can to enjoy the time ahead and the new year that follows.
Just think about it. How far reaching is this one condition?
Sure people talk about being depressed with a casual tone. You get the feeling they feel crummy…but it seems to be their response to circumstances. And when circumstances change, they seem to forget they felt bad. But when you think about who’s affected by severe chronic depression, you think of people who don’t have the energy to get up in the morning. You think about people who are trapped in substance abuse and have grown to hate themselves. You think about people who are just tired. Of everything.
Let’s take a closer look at the people affected by severe chronic depression. Who are they?
Gary is one.
Gary worked hard his entire life. He worked tirelessly to help others improve their lives. He worked to inspire and comfort. But, when you’re in the business of helping people enjoy richer, more meaningful lives, there are always those few who spurn your efforts, and even come back to crush you, if they can. And sometimes it’s the one you believed in the most.
In Gary’s case, there were two of them. They robbed his house when he was away for the evening. Then, spread false stories attacking his integrity. And Gary was cut to the heart. After being robbed and betrayed, he was hurt, angry, disheartened. In fact he was shattered.
Even though he’d always been optimistic, and bounced back after disappointments, this time he utterly lost his footing. Shock and devastation swarmed around and within him. He lost his bearings…and withdrew into the quiet safety of his house.
He found himself acting strangely, behaving in ways he never had before.
Months went by. He ordered food from Amazon and avoided any human contact if at all possible. He didn’t answer the door, and friends gave up, one by one, and became absorbed with their own lives.
A relative helped him get in to see a doctor finally. He was diagnosed with Bipolar II Disorder. The doctor prescribed a medicine to help prevent the hypomanic episodes, but the depression and withdrawal didn’t improve much. Years went by and he settled into a routine of leaving the house maybe once a week. His warm, inviting personality became subdued and cautious.
Something needed to give. To help free him from the box he’d built around himself.
And thankfully something did …but we’ll get back to that in a moment.
And Who ELSE?
Dan is.
Dan had his first drink when he was 14, and was hanging out on a Saturday night with his brother’s friends. They were all 16 and 17, and after getting some six- and 12-packs of beer, they all went to the lake on a Saturday night and drank all they had. Some ended up vomiting, others passed out in the car. Dan did both. But he liked the way the beer made him feel, and he knew he’d be up for drinking more when he had the chance.
High school beer bashes led to frat party blow outs, and while he experimented with some other things when he had the chance, it was alcohol that became his “go-to” in good times and in bad.
At 42, he drank whenever he was free. He had managed to get through college with a degree and land a job that was steady, but nights and weekends were his time to reward himself — whether anyone was with him or not. He worked hard to earn the right to get smashed on Saturday night.
After marrying in his 20s…hoping for happily ever after… he found himself alone and single again in his 30s. So many fights about his drinking. She was just beautiful, and he was so proud to be seen out with her, but she was so critical.
Alcohol Addiction and Depression… A Dangerous Combination
Now in his 40s, Dan began to understand why. And he realized he was likely to spend his life alone and drunk, if something didn’t change. He’d actually tried to stop drinking but something always happened and he was back at it. He felt pretty defeated. It seemed to be bigger than he was.
Every day he dragged himself out of bed, and went to work. He was often hung over, but 25 years of this had helped him develop an armor that got him to work, helped him function well enough to not get fired, and then home again to repeat the habit of every other night of his life. He had come to hate his empty, dead-end life, and his empty, dead-end self.
Dan hadn’t enjoyed anything in his life in at least ten years. He endured, and barely existed. He had no purpose. No joy. He was the chair person for the Dan Hatred Club. It was hard to see any reason to keep living. He wondered how to stop without it hurting too much. He was convinced no one would notice if he was gone.
There’s more to Dan’s story.
And I want you to know what happened. A little later.
While it’s so true that many people are very ill, even disabled in some cases, with severe chronic depression, you can see that many have other illnesses that are complicated by depression.
Some people suffer with a complex combination of disorders, and diagnosis and treatment can be complicated, too. We talked about Gary and his traumatic experience, the depression and phobias that followed and led to his eventual confusing behaviors, and a Bipolar 2 diagnosis.
We talked about Dan, his early introduction to alcohol and the long term impact it had on his brain…and his life. How his drinking gave way to poor social function, and the inability to give his best to his marriage. Eventually he found himself in a self-destructive rut and didn’t know how to turn it around. Then the suicidal thoughts began.
So who else is devastated – and disrupted – by severe depression symptoms?
Cheryl is.
Cheryl is 26. She’d finished college and was working on her masters degree in forensic psychology when she found herself pregnant. She and her husband wanted children, but they weren’t sure when.
Still, she felt like she was carrying a miracle within her, and the couple set about learning all they could about pregnancy, their baby’s development, and child rearing. They wanted this to go perfectly. She would find a way to complete her masters degree. But she was determined to celebrate their child’s life.
Her pregnancy was hard at first, with morning sickness that seemed unrelenting. But around the 13th or 14th week she thought she might be feeling a bit better. She began to browse in baby stores, looking at the tiny clothes and trying to imagine her baby wearing them. Her clothes were also getting tighter, and she shopped to find some pants that were looser and more comfortable. It was all beginning to feel amazing, just thinking about this little person who was safely cradled and growing out of sight….but under her heart.
The weeks dragged by, and her excitement about her baby became almost too much at times. She and her husband began shopping for a bassinet, a crib…and a stroller. She learned about support meetings for breastfeeding mothers and attended as often as she could. There was so much to learn!
Weeks turned into months, and finally she was in her third trimester. Just 3 more months. Through her pregnancy her emotions were filled with excitement and joy. A sense of wonder seemed to give the whole world a glow.
Happy Times Preparing for Baby
She and her husband attended childbirth classes and toured the hospital. They practiced exercises and breathing patterns at home to try to truly equip themselves for the adventure of labor and delivery.
Then, when she was 41 weeks along, those Braxton-Hicks contractions everyone talked about began to get out of hand. Within a couple hours she was in the ER being checked out.
Finally, she was in labor.
Cheryl’s labor progressed normally the first 10 hours. Then, in spite of hard and nearly constant contractions she was no longer progressing. Her doctor confirmed his suspicions: the baby’s head was lodged at an angle in the pelvic region and couldn’t move forward. He called for a C-section.
Within 15 minutes she was wheeled into the operating room, and suddenly asleep. When she awoke, everything seemed strange. Then she remembered the labor, the baby, and oblivion.
Her husband was smiling and told her they have a beautiful baby girl. She felt too groggy to understand what he was saying. She blinked hard to try to clear her head. Her husband handed her a little bundle. She laid it in her lap. What was it?
As the fog cleared her head, her memory of the labor returned. Her new baby slept in her bundled blanket. And Cheryl put the pieces together. She had had a baby. She was sleepy because of emergency surgery. The baby couldn’t get out… But where was that baby?
Traumatic Birth Can Interfere with Bonding Between Mother and Child
She asked her husband, and he told her their baby was in her lap. But the bundle in her lap didn’t look like anyone she knew. It just didn’t feel real…somehow…
She felt no connection to this tiny human, in spite of her husband’s reassurance… She felt sure she would have recognized her own baby, right?
Cheryl found herself detached, stunned, disconnected from feeling like a mother. Her strange behavior puzzled her husband. Why didn’t she cuddle their beautiful baby girl? The nurses tried to help her breastfeed, but the baby only cried. Almost as if this baby girl could sense her mom’s disconnect.
Cheryl and her husband took their new baby home and named her Phoebe Mae. She desperately wanted to feel something good toward the baby. But, she didn’t. She couldn’t. All that anticipation for 9 months, and this is it? Endless exhaustion and sleepless nights? Where was the joy..?
Her behavior worried (and angered) her husband. He just didn’t understand his wife’s coldness. Was this damaging Phoebe? What damaged Cheryl to cause this?
Months went by and Cheryl had long since taken up bottle feeding Phoebe formula. Besides, her husband could help more easily this way.
Then, Phoebe’s first smile was for her daddy. And her first laugh, too. Cheryl felt a bit jealous that she stayed with her daughter all day and fed her and took her on walks, but she really only responded to her daddy.
Who Else is Affected… or should I say, Overwhelmed ?
The family is.
Everyone who loves you. They worry, they try to help, they pitch in, they listen.
And try as they might, they’re helpless. And desperate for solutions. Your severe chronic depression breaks their hearts.
These few examples give only a glimpse of the complex symptom clusters any one person might suffer. There are so many more.
But IF, and only IF, you can safely and effectively reduce or even eliminate, the symptoms of depression, you may be able to see your life restored and functioning again.
Of course, traditional SRI and SNRI antidepressants play their role in helping people with depression feel better. Roughly a third to half of them…maybe a bit more. For those people, antidepressants are enough.
Remember, there is no medicine for depression that is as fast working as ketamine. No other medicine is as widespread in its antidepressant benefits in the brain. And no other medicine helps as many people recover, even achieve remission, and build restored, rewarding and fulfilling lives like IV ketamine treatment can.
Plus, it’s safe.
Ketamine doesn’t cause long lasting side effects. The notorious effects most antidepressants display, like sexual dysfunction and weight gain, don’t exist with IV ketamine. Ketamine doesn’t raise or lower the blood levels of other medicines you’re taking. It just goes to work. And, hopefully for you, it accomplishes the transformative restoration it’s so famous for.
The World Health Organization includes ketamine on its List of Essential Medicines. Respected around the world in ORs, ERs, disaster areas, and war zones, ketamine isn’t new.
Remission Often Replaces Severe Chronic Depression at Innovative Psychiatry
How did IV ketamine treatment impact Gary, Dan, and Cheryl? Did they recover from their own severe chronic depression symptoms?
IV Ketamine Treatment Does Its Best Work When Symptoms of Severe Chronic Depression Seem Untreatable
Remember Gary?
And his boxed-in anxiety-filled existence? The same friend who helped him go to the doctor, also helped him access IV ketamine treatment.
After 7 infusions, Gary bloomed. The warm, outgoing, generous man who had served people in need all his life re-emerged. Gary’s confidence returned along with his energy to participate in the lives of people who needed his help.
His life became rewarding again, filled with activity and relationships. You might say his best self was restored.
Then there was Dan.
Dan was suicidal when a friend told him about IV ketamine treatment. He learned that ketamine not only relieved depression, but could be effective in helping break addiction. And… that it could stop suicidal thoughts in a few hours. Dan wanted to see what it could do for him. He felt like this was his last ditch effort. He didn’t want to die, exactly. But he didn’t want to live like thisany more.
Well, he was not disappointed. The first half hour of the first infusion, those images of death and thoughts of dying disappeared. Almost like poof! gone. He emerged from the infusion smiling. That was a good start alright.
That night, he found he had no interest in a drink, so he skipped it. How about that, he thought to himself.
After the second infusion, he definitely felt less depressed. Improved. NOT great…but better. By the time he arrived for the 4th infusion he was feeling pretty good. Hopeful…motivated.
It’s been six months since his 6th infusion now, and Gary feels like he’s living. He’s stopped drinking completely, sees a few friends, met a terrific woman. His future looks bright.
And Cheryl…?
Well, Cheryl’s husband heard about ketamine for depression from a friend at work. He encouraged her to talk to her doctor about it. Her doctor said that effectively treating the depression could reverse her struggle with bonding.
When Phoebe was six months old, Cheryl received her first infusion. On the way home with her husband she could tell no difference. He encouraged her to keep an open mind. That he’d heard it could take awhile.
By the 4th infusion he noticed she was taking initiative in the kitchen, preparing a new recipe. She hadn’t done that since Phoebe was born. Then the next day she was sitting with Phoebe playing patty cake… and that night rocked her, kissing her on the forehead as she drifted off.
She was expressing joy more and more and laughing with Phoebe. By the end of the 6th infusion she didn’t feel perfect but she did feel happy. The doctor said it would get better and better.
Severe Stress Can Cause a Setback
Then Phoebe got sick. At 8 months she caught her first cold. Cheryl was up all night comforting her, sitting with her near the humidifier to help her breathe. This continued for 4 days until Phoebe started feeling better.
But the lack of sleep and strain took their toll. And Cheryl’s depression returned. Not as severe as it had been. But severe enough. A couple weeks later her husband asked her to call the doctor, who told her she may need another “booster” infusion. So she complied.
She felt much better again after the infusion, and Phoebe stayed well all summer. They had daily walks in the sunshine, and Cheryl and Phoebe both had rosy cheeks and and a tan.
The next time Phoebe got sick in the fall, the stress didn’t affect Cheryl adversely at all. She had the resilience to go without sleep as she cuddled her baby girl through the illness.
Before long, Phoebe turned a year old. Cheryl and her husband threw a big party for all their friends. It was a celebration of their little girl’s milestone, and for the joy Cheryl and her husband were enjoying again.
This Can Happen for You, Too
These stories all have happy endings. But low dose IV ketamine isn’t for everyone. Is there any medicine that is? Nope…not a one. But the response rate to ketamine treatment is remarkably high.
Still, that remarkably high response rate relies on skilled administration. Low dose IV ketamine treatment is not a one-size-fits-all treatment. It requires careful titration, identifying specific responses in the patient, and finding the sweet spot in dose and rate that yields the best outcome for each individual.
Unfortunately, many providers of ketamine don’t understand this, and give the same dose at the same rate to every patient, then schedule them to come in for regular maintenance infusions, indefinitely.
In other cases, they try a different dose with each successive infusion, because they don’t really understand how to achieve the therapeutic response.
Find Restoration from Severe Chronic Depression
Innovative Psychiatry is the premier provider of IV ketamine treatment in Connecticut for safe, effective treatment of depression and other psychiatric disorders. We offered the first ketamine treatment center of Connecticut for severe chronic depression and other disorders.
Innovative Psychiatry offers you a most extraordinary psychiatric treatment, IV ketamine. Some people require booster infusions now and then for awhile, and others achieve remission with the initial six infusions.
Every brain is different, just as every person is different.
We can’t predict what it will be like for you, but we can promise to provide the most effective administration of this remarkable treatment that can be found anywhere.
Can you relate to Gary, Dan, or Cheryl..? Or maybe to their loved ones? If you have similar symptoms or variations of your own, that have not responded to the treatments you’ve tried, call us.
Like the people we’ve talked about here, you can have restored joy, renewed initiative and motivation, the energy to pursue your dreams, and to rebuild relationships.
We’re here to help. Let’s work together to help you live a fulfilling and rewarding life.
We’re smack in the middle of a couple weeks focused on the quest for improved treatments for depression and anxiety.
This past Thursday was World Mental Health Day, dedicated to raising awareness for mental health …and this year’s efforts were focused on “40 seconds of action” to help reduce the risk of suicide. Because every 40 seconds, worldwide, we lose someone to suicide. And right on the heels of #WorldMentalHealthDay, we’re jumping into #OCDAwarenessWeek, which is promoted internationally each year by the International OCD Foundation during the second week of October. It’s an opportunity to LEARN about Obsessive-Compulsive Disorder and find ways to support those who live with it every day. And every discovery that researchers find lays the groundwork for improved wellbeing and fact-based treatment regimens. Like polyunsaturated fatty acids (PUFAs) in your brain. Let’s talk about how you can get your PUFAs straight and reduce the symptoms of depression.
BBRF Researchers Help You Get Your PUFAs Straight
The Brain and Behavior Research Foundation (BBRF) just released information about a new study that may explain why some people have more severe depression than others.
Led by M. Elizabeth Sublette, M.D., Ph.D., and J. John Mann, M.D., and published in the Journal of Affective Disorders, the study identified a relationship between polyunsaturated fatty acids (PUFAs), specialized proteins that transport serotonin (SERTs), and the severity of, as well as vulnerability to, depression.
This is a short excursion into only ONE aspect of the complexities of major depression and bipolar depression. But it’s important, and may give us something that we can do — actively, ourselves … every day — by modifying our diet. It’s back again–the importance of what we feed our brain. Not just diversifying our microbiome, ensuring we take in micronutrients, but choosing the best lipids to feed our brain health. Getting our fatty acids right.
See what you think of this…
BBRF Researchers Find New Discovery About Reducing Your Vulnerability to Depression
Using PET scans, researchers have found an intriguing relationship between certain types of polyunsaturated fatty acids (PUFAs) and the specialized protein transporters that move serotonin (SERT) to where it needs to be to do its job to reduce anxiety and improve your mood.
These are both ordinary, commonly seen components in the brain, but together, they seem to play a role in either causing depression… or at least causing you to be more vulnerable to it.
This study discovered a significant relationship tied to a certain PUFA known as arachidonic acid (AA). They identified a relationship between PUFAs and levels of that serotonin transporter, SERT, in the 6 most important areas of the brain. Plus, it showed how these two factors may influence the severityof depression.
The relationship is U-shaped, and inverted. It’s nonlinear. And that’s important.
Sounds complicated, I know. But here’s how they discovered this connection.
Study Subjects Stopped Their Medications for At Least 2 Weeks
The research team invited 21 adults, who were each in a full episode of major depression, to participate in the study. Each of these participants had refrained from any medication that affects serotonin levels or the biochemical system that produces arachidonic acid for at least 2 weeks.
A number of weeks before the PET scans, the team evaluated plasma levels of each participant for three specific PUFAs. DHA and EPA are both omega-3 fatty acids, and AA is an omega-6 fatty acid.
Measuring these three levels in six specific and key regions of the brain demonstrated their significance in depression.
Now get this:
In a healthy brain, SERTs are widely available in abundance throughout the brain so they can remove and recirculate those serotonin molecules from spaces where they can’t function.
For example, when they get stuck in spaces between the sending and receiving neurons after a signal has been sent. This is what happens: The SERTs take up the serotonin and return it to the sending cell. So it’s ready for the next message that needs to go out. Easy.
Now that’s what happens in a healthy brain.
However, a number of peer-reviewed studies have found that there’s a low availability of SERT in the brain of someone suffering from depression…or bipolar depression. The most commonly prescribed antidepressants, (SRIs), block the SERTs so the SERTs can’t move the serotonin out of those spaces where they’re stuck. This keeps serotonin available in the synapses between the neuron cells which promotes more signaling.
But In A Depressed Brain…Well, You Need to Get Your PUFAs Straight
However, this team of researchers discovered something about those three PUFA levels they analyzed before the scans. Only AA actually affected the availability of SERTs across those six brain regions they viewed with PET scans.
In fact, they found that the lower the AA level a person had when evaluated before the scans, the greater that person’s SERT transporter level they saw in the PET scan.
Reduced AA level = More Transporters; and Therefore Improved Mood…?
This is so revealing. We need to get our PUFAs straight.
Because depression and bipolar depression are complex and are each affected by so many factors. We’ve learned so much about depression through observing ketamine’s actions in the brain. And while we no longer believe the key to depression treatment is as simple as increasing level of serotonin (or any other neurotransmitter), we do know that serotonin binding plays a strong role in freedom from depression or conversely, a vulnerability to it.
Of course, our BBRF research team called for more studies to verify these findings. They asked that other researchers carry them a few steps farther. We need more information about the science behind polyunsaturated fatty acid supplements in depression. How do we work with complex, inverted, U-shaped relationships?
Hopefully, we’ll be hearing more about the effect AA has on depression and vulnerability to it.
This may sound like a little thing …a small finding from a ton of research. But it’s a breakthrough. And when you add up all the individual breakthroughs, together they can result in your changed and improved life.
Get Your PUFAs Straight and Bring Depression To Its Knees
At Innovative Psychiatry we rejoice with our patients whose symptoms lift after IV ketamine treatment. These patients didn’t responded to traditional medications. We continue to use a myriad of medicines, treatments, and regimens to relieve symptoms. And we bring the latest research findings to our practice. But for most patients, nothing compares to IV ketamine’s restoration of resilience, creativity, and initiative. The results bring fresh perspective, fresh hope, and renewed relationships as people rebuild their lives with enthusiasm and clarity.
Let’s keep spreading the word that remission of symptoms can happen. It’s no longer a pipe dream.
If you… or maybe someone you love… aches for relief from trauma or depressive symptoms, call us.
We know others who suffered from the same kind of pain, vacant-ness, and despondency you do. We can help.
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 holdingenvironment–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.
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.
It’s a heart-shattering tragedy when a child dies.
How do you bear such tragedy? …such loss? The waste of a beautiful life…it defies our logic to find reason in it, or to try to make sense of it. But what about when that young child kills herself? Why are young girls turning to suicide?
It’s impossible to grasp. You’re left with the most engulfing sense of powerlessness. And loss…
And it’s heartbreaking to say this horrific tragedy hasn’t happened just once. The numbers are growing. And all too fast.
It’s always been more common for boys to commit suicide than girls, but the number of girls who end their lives is rapidly rising to close the gap. But let’s be real…any child’s suicide is devastating. And any suicide is, too. We’re talking about suicide in little girls, teen girls, and young women.
You wonder why.
Why Are Young Girls Turning to Suicide?
The specific reasons haven’t been studied yet, but Christine Moutier, Chief Medical Officer at the American Foundation for Suicide Prevention, stresses that multiple factors play a role in suicide. Still, she suggests that a significant contributor may be social media.
And more specifically, cyberbullying on social media.
So even though we know that friendships are a high priority to young teens, and the way children and teens socialize is largely centered in social media, it’s also a source of isolation, cruelty, and bullying.
At the age of 10 or 11, many children just aren’t prepared to withstand the verbal and emotional assaults they experience there.
Now, let’s take it a step further.
Since an ounce of prevention is worth a pound of cure, how can these painful social media experiences be prevented for young girls? Let’s think about that.
Maybe there’s wisdom in postponing children’s online presence..?
A study presented at the American Pediatric Association in 2017 focused on cell phone ownership and cyberbullying in 8-11 year olds. Researchers collected data from surveys with 4584 children of this age group between 2014 and 2016.
They found that 9.5 % of these children who own cell phones had been cyber-bullied.
Nearly 50% of the children surveyed reported owning a cell phone. Throughout this age group, there were more children who owned cell phones who also participated in cyber bullying than those who didn’t own a cell phone.
So, again, while cyberbullying is not the only factor influencing the rising incidence of suicide among young girls, it’s an important factor…and one parents can do something about.
Extensive lessons on the responsibility and etiquette of owning a phone might be the obvious first step. Teaching morality and ethics to your child around the use of the phone should be an imperative about treating others with dignity and respect — whether face-to-face or online.
Two world leaders of technology held a healthy respect for the power of online presence, as well as its dangers. The late Steve Jobs limited his own kids’ use of screen technology, and would not allow them to use an iPad when it came out.
Bill Gates and his wife did not allow their children to have cell phones until they reached the age of 14.
Michael Cheng, a Canadian child and family psychiatrist, says that smart phone use at a very young age is damaging to developing brains. Damaging. The constant stimulation from the screen draws dopamine hits easily. This short-cuts the reward center and sets the stage for addiction to those rewards.
How much easier is it to stay online, play games, text back and forth for those rewarding bumps of dopamine, than to go outside, play ball, go fishing, ride bikes … to get the same amount of reward. Why work for that reward if you can get it without leaving your chair?
Dr. Cheng also points out that children learn social skills face-to-face in real life settings. They learn how to read expressions and develop empathy, how to respect friendships and respect themselves.
If their social interaction takes place digitally, they miss learning the nuances of human interaction, while learning to rely too heavily on the acceptance of others online.
They need fresh air and sunshine, imagination and play, camaraderie and boundaries so that their brains develop well.
So, with that said, let’s consider children who end their lives. Children who are bullied at school and online.
Why ARE Young Girls Turning to Suicide…? And What Can Be Done?
Suicide is the second leading cause of death in people between the ages of 10 and 34. Suicides have replaced homicides as the second leading cause of death in teenagers. While more boys than girls end their lives, more girls describe thinking about suicide, considering it, and attempt it.
You may be familiar with the story of 9-year-old McKensie Adams who hung herself after enduring a year of bullying by other students… After reporting this abuse to parents, teachers, and a vice principal, she found a tragic solution. At 9.
Or maybe you heard about 10-year-old Ashawnty Davis, who defended herself in a physical brawl on school grounds as part of an extended bullying campaign. Someone videoed the altercation, and the video went viral. Two weeks later Ashawnty hung herself in her closet.
Or 10-year-old Kevin Reese, Jr., who hung himself in a closet when he reached his limit of bullying at school.
These are just the stories in the news. Stories that have received wide attention. As well they should. But there are so many more that are the grief of a school and a family wherever they happen.
Watch for the Signs
Here are some warning signs to watch for: Is your child feeling overwhelmed with school work? Is she experiencing cyberbullying? In fact, if she’s spending much time on social media she may be increasing her risks… Are there problems within the family? And is she faced with bullying? (or is she being a bully?)
It turns out that some children who have been bullied become a bully themselves. Either behavior adds to their suicidal risk.
You, her parent, need daily input from your child, including really listening and responding. They must know they have your support. Isolation can be a killer.
These girls reported they were subjected to bullying for long periods of time — but maybe they felt they had to be strong and endure it when nothing changed..?
When people in authority didn’t intervene or make them feel safe, these girls —who were happy at home — made a plan and died. Some left notes for their parents, some didn’t. So maybe this is a part of the answer to that question, “why are young girls turning to suicide?” Maybe they thought it was the only solution left.
These Children and Teens Need to Be Reminded We Have Their Back
This is an age when bullying has become the norm. Children are bullied for their race, their faith, their name, their clothes, their friends, their car, their food, and their health.
In most cases, the children doing the bullying are often releasing tension from their own private lives. And are quick to say they never intended for their victim to want to die.
So it’s the parents and teachers who are their best advocates. Be sure there is a record of your report when you inform the school of any bullying you hear about from your child. Prepare yourself for mediation with the other child’s parents so that child’s parents can participate in resolving the problem, as well as teachers, counselors and maybe even a principal.
Be aware that the problem of bullying is rampant. And the rise in suicides, especially among girls, is nearing epidemic proportions, so we just mustn’t assume all is well.
Pay close attention to your child and her/his responses to what happens at school or in the neighborhood. Be aware that children do look for escapes from their pain if they can’t find a solution to their situation on their own or by reporting to people in authority.
Get Ahead of the Potential for Problems
Do be proactive…Don’t assume that things are taken care of at their school. In many cases where a child died, the school had no report of bullying on file. You’re the best advocate your child has. Be involved, engaged, and stay in touch to ensure there are remedies put in place for the bullying.
The most important thing you can do is to encourage open discussions every day with your child about what she’s facing. So you’ll always know when something is going wrong.
As we said before, this applies to both boys and girls. There are still more boys ending their lives than girls, and all children need to feel safe.
So why are young girls turning to suicide? Maybe sometimes it’s because of what’s happening to them.
Suicidal Thinking Can Be Treated Before It’s Too Late
Here at Innovative Psychiatry, we treat teens who who are plagued by suicidal thinking with IV ketamine treatment when they’re as young as 14. You should seek the care of a child psychiatrist for your child who’s younger than 14 and who’s struggling with these thoughts.
IV ketamine can stop suicidal thoughts or plans within a few hours. Sometimes much faster. It’s a way to keep your teen safe from suicide while you have the time to help him or her sort out whatever is going wrong at school or at home or inside.
Even though we don’t treat children in this practice, the bully/suicide trend in children is alarming and heartbreaking. We need to be aware that children are facing things now that earlier generations didn’t. This is even being called “bullycide” in some communities.
If you (or your family member) suffers from the torment of suicidal thoughts, call us. Let’s work together to help you find peace from those thoughts, a renewed hope, and give you the opportunity set order in place in your life.
You can feel safe again, and experience joy again, and find the motivation and initiative to build the life you want to live.
Like other disorders of the brain and mind, bipolar disorder is complicated.
With all the movies and cartoons made at the expense of people who suffer from disorders like this, we want to help more people know more about some of the facts with a bit of bipolar science.
It’s different for each person. The length and intensity of manic episodes, the distribution of time from one end of the spectrum to the other. How hallucinations and delusions fit into the mix. These symptoms are individual.
It’s physical. It can shake and shatter your body, through intense and sudden swings from one extreme to another.
Plus, it can cause such unexpected assaults on your emotions that your body is exhausted. Those swings can feel almost like a convulsion at times.
It can also create sensations. Some people with this disorder complain of feeling like they have fire ants on their brain. Of course, there are no insects involved. But the disordered circuitry creates a sensation in some cases.
And it’s mental. It changes your perceptions of what you see and hear. By coloring the way you interpret what happens, it tattoos that impression deeply in your memory. It can distort your view of yourself, and marinate your thoughts in shame. Then it can turn on the firehose of pain and rage, until you’ve experienced such extremity of horror, you can feel like you sweat blood.
But, that’s not all. Bipolar disorder also seems spiritual, sometimes pulling you into its dungeons of horror until you lose all connection to your own spirit. Righteous indignation can morph to revenge. A little anxiety can billow until it’s a life-threatening terror.
And yet, this disorder can be all of these things, or it can be none of them. OR… you can begin with these experiences, then medication can help them melt away. OR… there may be no medication that mitigates them at all.
What you can’t know when all that is happening, is that specific changes in your brain cells are translated to the violent swings and misery you face in your daily life. You may find yourself craving a bit of bipolar science to try to gain perspective about what’s happening to you.
To help reduce the stigma surrounding bipolar disorder, and the behaviors of people who suffer so deeply from it, let’s look at a tidbit of breakthrough science related to the spectrum of “bipolar disorders.”
A Bit of Bipolar Science…
You’ve heard of the blood-brain barrier, right? Relatively few people outside the medical field have any remote idea what that is. So if you’ve heard of it, consider yourself “in the know.” Kudos!
OK. There are two types of blood barriers in the brain. One is the blood-brain barrier, or BBB. The other is the blood-CSF barrier. And that’s the one we’re going to talk about now.
So the blood-CSF barrier keeps the blood and whatever is in it separate from your cerebral spinal fluid (CSF). Since the CSF is constantly washing the brain tissues, it needs to be free of contaminants, toxins, or components that are harmful to the brain’s delicate circuitry and structures.
The CSF performs a couple of primary functions. One is to cushion and protect that most vital organ – your brain – that keeps everything else humming along. And the other is to keep the toxins in your brain and spinal cord flushed out.
CSF and the Choriod Plexus
But…Where does the CSF come from?
BruceBlaus Wikipedia Commons
So glad you asked. The choroid plexus produces this most vital and beneficial fluid. There are special cells that secrete it, and other tissues absorb it.
Because the ventricles of your brain can handle 150ml of CSF at a time, but the choroid plexus actually makes 450ml a day! Clearly, as it circulates, it also is absorbed or drained off and replaced by more.
This keeps your brain cushioned and protected by fresh CSF at all times.
If the choroid plexus makes too much CSF, and if the pathway for draining off excess become blocked, then the amount of CSF in the brain can increase dangerously, increasing pressure in the brain. And a condition known as hydrocephalus can develop, along with the risk of brain damage.
By the same token, if the choroid plexus makes too little CSF, the brain cannot function. And the cushion it provides to help it remain buoyant within the bony chamber of the skull is inadequate.
So there’s a need for balance between the CSF, the cavities in the brain, and the circulation of it.
About Psychosis
So let’s talk about how the choroid plexus relates to schizophrenia and bipolar disorder with a bit of bipolar science.
There are four cavities in the middle of the brain called the ventricles. The CSF washes and cushions the brain all around, and is produced and distributed from choroid plexuses in these ventricles.
New Research
Newly published research sponsored by Brain and Behavior Research Foundation (BRRF) has directly linked the size of the ventricles with psychosis. While the size of ventricles is not specifically correlated to schizophrenia and bipolar disorder, the volume of the choroid plexus is significantly larger in subjects with psychosis.
In addition, these researchers found that the volume of the choroid plexus in siblings, parents, and children of those with psychosis was less than the affected individual but still significantly larger than those unaffected by psychosis in their family. This demonstrated that the volume of the choroid plexus is something one inherits to a large degree.
But here’s the big news.
They found that when a subject had a larger choroid plexus, they also tended to have lower cognition, less grey matter, a smaller amygdala, larger ventricles, and fewer connections between neurons.
All of these things can be connected to the pathological processes that causepsychosis.
Now that’s news.
But there’s more.
That increased size in the choroid plexus in subjects with psychosis was also associated with increased levels of interleukin 6 (IL-6). IL-6 is a signaling cell in the immune system.
So here’s the rub.
IL-6 can penetrate and seep through the protective barriers between the brain, blood, and CSF. Since researchers know that IL-6 is a strong suspect connected to bipolar disorder and schizophrenia, the identity of the gang of thieves behind psychosis – you might say – seems to be emerging. Add to that the connection between IL-6 and the reduced amount of grey matter in the cerebral cortex, and the case just grows stronger.
“Our findings suggest the involvement of the choroid plexus across the psychosis spectrum, with a potential mechanism involving the neuro-immune system, which functions in regulating the brain and interacting with the body’s immune and inflammatory systems,” the team concluded.
If you struggle with bipolar disorder, schizophrenia, or episodes of psychosis, you may appreciate the work of these researchers that sheds more light on what happens in the brain causing these difficult episodes.
Neuroscience researchers are making great strides in learning more than has ever been known before about the symptoms of these disorders. And the more we understand, combined with a bit of bipolar science, the more research will lead to better treatments.
No matter what your difficulty, whether you struggle with bipolar disorder, PTSD, social anxiety, severe depression, or even thoughts of suicide, we may be able to help. IV ketamine treatment is emerging as a dramatic game changer for people who suffer from specific types of symptoms. And happily, the types of symptoms keep growing in number.
But if you think you’d like to know if IV ketamine treatment might help you, please call us. We’ll help you find out if you might be a candidate for ketamine…because some people aren’t. But if ketamine is for you, you can experience a transformation in your own life.
While ketamine isn’t showing promise for psychosis, it can bring remarkable relief to your depression symptoms. Every little bit helps, doesn’t it?
Since bipolar depression can be the most debilitating symptom for many patients, resolving the depressionin your illness can make your life so much more manageable.
As research learns more, we’ll be right there using it to help our patients. Our whole purpose is a better life, and more hope, for you.
By Peggy McCarthy, Conn. Health I-Team Writer Published 11:51 am EDT, Tuesday, August 13, 2019
Some Connecticut hospitals and doctors and a clinic are starting to treat severely depressed patients with a new nasal spray called Spravato, touted as the most significant federally approved depression medication since Prozac was approved in 1987.
Spravato, which received Food and Drug Administration (FDA) approval in March, has raised hopes for preventing suicides and relieving depression after other treatments have failed. But there are concerns about possible side effects, including drug abuse, elevated blood pressure and heart rate, sedation, and hypersensitivity to surroundings.
The nasal spray is prescribed for treatment-resistant depression after at least two other antidepressants haven’t worked and is given with an oral antidepressant. It is only administered in restrictive clinical settings to reduce potential for abuse and side effects.
Nationally, of the 17.3 million adults with depression, one-third are treatment-resistant, increasing their risk of suicide.
Dr. Jayesh Kamath, director of the mood and anxiety disorders program at UConn Health, has conducted esketamine studies for Janssen, its manufacturer. “I want to make sure people hear the positives and the negatives of this medication,” he said.
While he said that “it is changing how we treat depression” and shows promise for enabling severely depressed people to function, he added that “the results are concerning about side effects.”
Janssen, a Johnson & Johnson subsidiary, is charging $590 to $885 for the medicine, depending on dosage. This does not include costs charged by providers for administering it. Veterans who receive it at the VA will not be charged. Medicaid and Husky will cover it, according to the state Department of Social Services.
A Janssen spokesperson said insurance companies are starting to cover it and Janssen is providing help, such as co-pay coupons.
Janssen refused to provide a list of Spravato-certified treatment centers and applicants in Connecticut but said that nationally about 1,600 sites have been certified. Restrictions imposed on Spravato sites include: prohibiting it from being sent home with patients; requiring patients to remain at the site for at least two hours and not drive for another day; and specifications for dosages, screening and monitoring patients, and labeling and handling of the medication.
Dr. Michael Twist, Wheeler Clinic’s medical director, said Spravato can be a replacement for electric convulsive therapy. “This is going to be a way of getting someone much better much quicker,” he said. “It’s huge.”
Esketamine: A derivative of ketamine
Esketamine is a derivative of ketamine, an anesthetic that has been abused as a party drug called Special K. Yale School of Medicine pioneered research on ketamine for depression starting in 1995. It has not been approved by the FDA to treat depression because as a generic drug, it doesn’t have the profit-making potential to attract research funding, several doctors said.
Ketamine is FDA-approved as an anesthetic administered intravenously or by intramuscular injections. The chemical difference between the two drugs is that ketamine is comprised of two mirror-image molecules and esketamine (Spravato) is comprised of one of those molecules.
Some doctors, including Calabrese, provide it intravenously “off label” for depression treatment, a legal use of a non-approved medication that is usually not covered by insurance.
Calabrese, a psychiatrist, said she will continue to offer intravenous ketamine in addition to Spravato. She said an analysis of 144 of her suicidal patients showed 68 percent no longer had suicidal thoughts after ketamine treatment and 82 percent had diminished suicidal thoughts. She said there were no suicide attempts, emergency room visits, or hospitalizations from the time of treatment through follow-up four weeks later. She charges patients $502 for ketamine.
Dr. Vincent Carlesi, an anesthesiologist and pain management specialist in Stamford and Ridgefield, is among other physicians who offer intravenous ketamine. Patients with depression are referred by psychiatrists, said Robin Asken, the practice’s manager. She wouldn’t provide numbers, but reported seeing “a marked improvement in quite a few of the patients.” The charge is $850 per infusion, which is typically not reimbursed by insurance, Asken said.
Dr. John Krystal, psychiatry chairman of the Yale School of Medicine, said that “it is very moving to hear the stories of people who have been depressed for many years, who have tried multiple treatments without success, and then to hear how they had their first good clinical response to ketamine, often within 24 hours of their first doses.”
He said people have told him it saved their lives.
Yale medical school’s first ketamine study was at a clinic it ran at the Connecticut VA in 1995 and 1996. Five years ago, it established a ketamine clinic at Yale New Haven Hospital and last year, it opened a new ketamine program at the VA, Krystal said.
This story was reported under a partnership with the Connecticut Health I-Team, a nonprofit news organization dedicated to health reporting.
Spravato, which received Food and Drug Administration (FDA) approval in March, has raised hopes for preventing suicides and relieving depression after other treatments have failed. But there are concerns about possible side effects, including drug abuse, elevated blood pressure and heart rate, sedation, and hypersensitivity to surroundings.
The nasal spray is prescribed for treatment-resistant depression after at least two other antidepressants haven’t worked and is given with an oral antidepressant. It is only administered in restrictive clinical settings to reduce potential for abuse and side effects.
Nationally, of the 17.3 million adults with depression, one-third are treatment-resistant, increasing their risk of suicide.
Dr. Jayesh Kamath, director of the mood and anxiety disorders program at UConn Health, has conducted esketamine studies for Janssen, its manufacturer. “I want to make sure people hear the positives and the negatives of this medication,” he said.
While he said that “it is changing how we treat depression” and shows promise for enabling severely depressed people to function, he added that “the results are concerning about side effects.”
Janssen, a Johnson & Johnson subsidiary, is charging $590 to $885 per dose for the medicine. This does not include costs charged by providers for administering it. Veterans who receive it at the VA will not be charged. Medicaid and Husky will cover it, according to the state Department of Social Services.
Janssen refused to provide a list of Spravato-certified treatment centers and applicants in Connecticut but said that nationally about 1,600 sites have been certified. Restrictions imposed on Spravato sites include: prohibiting it from being sent home with patients; requiring patients to remain at the site for at least two hours and not drive for another day; and specifications for dosages, screening and monitoring patients, and labeling and handling of the medication.
Dr. Michael Twist, Wheeler Clinic’s medical director, said Spravato can be a replacement for electric convulsive therapy. “This is going to be a way of getting someone much better much quicker,” he said. “It’s huge.”
Diminished suicidal thoughts
Esketamine is a derivative of ketamine, an anesthetic that has been abused as a party drug called Special K. Yale School of Medicine pioneered research on ketamine for depression starting in 1995. It has not been approved by the FDA to treat depression because as a generic drug, it doesn’t have the profit-making potential to attract research funding, several doctors said.
Ketamine is FDA-approved as an anesthetic administered intravenously or by intramuscular injections. The chemical difference between the two drugs is that ketamine is comprised of two mirror-image molecules and esketamine (Spravato) is comprised of one of those molecules.
Dr. John Krystal, psychiatry chair of the Yale School of Medicine.
Calabrese, a psychiatrist, said she will continue to offer intravenous ketamine in addition to Spravato. She said an analysis of 144 of her suicidal patients showed 68 percent no longer had suicidal thoughts after ketamine treatment and 82 percent had diminished suicidal thoughts. She said there were no suicide attempts, emergency room visits, or hospitalizations from the time of treatment through follow-up four weeks later. She charges patients $502 for ketamine.
Dr. Vincent Carlesi, an anesthesiologist and pain management specialist in Stamford and Ridgefield, is among other physicians who offer intravenous ketamine. Patients with depression are referred by psychiatrists, said Robin Asken, the practice’s manager. She wouldn’t provide numbers, but reported seeing “a marked improvement in quite a few of the patients.” The charge is $850 per infusion, which is typically not reimbursed by insurance, Asken said.
, said that “it is very moving to hear the stories of people who have been depressed for many years, who have tried multiple treatments without success, and then to hear how they had their first good clinical response to ketamine, often within 24 hours of their first doses.”
He said people have told him it saved their lives.
Yale medical school’s first ketamine study was at a clinic it ran at the Connecticut VA in 1995 and 1996. Five years ago, it established a ketamine clinic at Yale New Haven Hospital and last year, it opened a new ketamine program at the VA, Krystal said.
This story was reported under a partnership with the Connecticut Health I-Team, a nonprofit news organization dedicated to health reporting. (c-hit.org)
