Lori Calabrese, MD

Tag: IV Ketamine for Treatment Resistant Depression

How Do You Disrupt a Fearful Memory? Learn to Erase a Conditioned Fear Response

We’ve been talking lately about how neuroscience researchers explore for possibilities for better medicines.

Group therapy for combat veterans suffering from PTSD

Lately, there’s been more work exploring fear and memories of fearful experiences, and how to erase those memories…or at least make the memories weaker. Those memories play a big role in anxiety, PTSD, and bipolar disorder. We talked about AKT. Now, a team of researchers at Texas A&M University led by Stephen Maren, Ph.D. recently published their work in Nature Neuroscience, and used prolonged exposure therapy in an effort to extinguish to erase or weaken conditioned fear response memories.

These methods often work well for awhile…but in time about 50% of patients relapse and over the long-term the fear memories take hold with a vengeance.

Briefly, the way these therapies work is to repeatedly expose you to situations, sounds, or other associations with the trauma, over and over and over… with the hope that, in time, the trauma is no longer triggered.

But, unfortunately in many patients, remission from PTSD doesn’t last.

So, knowing that these efforts don’t prevent relapses in some patients, Dr. Maren and his team have designed innovative experiments (in rodents) so they can test the possibility of disrupting the original fear memory… this is the memory that we think starts all the suffering in a person who develops PTSD.

How do you disrupt a memory?

Because here’s the thing. The memory forms at the moment of the trauma…or in the 4-6 hour window that follows. This is a crucial time period.

Keep in mind that the 4-6 hour period from the moment of trauma or shock is the period of memory consolidation, or when the memory forms.

These skilled researchers sought to intervene during the period of time when memories are recalled due to a key stimulus …like a car backfiring… that might trigger a traumatic fear memory of assault, or combat…or a vehicle crash. This little window of time after a sound or other stimulus in the environment triggers the traumatic memory is called re-consolidation. The stimulus can result in reaction behavior… like hiding under a table… or striking someone nearby… or grabbing a weapon.

Think of triggering memories by this method, like noises, as indirect retrieval.

But keep in mind that retrieving memories this way – by indirect retrieval – can help retrieve the traumatic memory but without an attempt to manipulate or otherwise change the original memory. The researchers’ intention is to retrieve that person’s response to it. To weaken or erase a conditioned fear response.

…So back to the rodent experiment.

Backward conditioning was a key intervention the team used. It’s a unique and fresh method to get the rodents to retrieve their own trauma — a conditioned, context-dependent fear memory….without the subject being aware of the experience.

Ok, so this is where it got reeeeeally interesting.

With all this accomplished, they were facing 2 questions:

1) Could they use neural tracing technology to identify basic circuits that were activated in this process?

2) Could they intervene in such circuitry to see if they could alter the process of memory re-consolidation..to the extent they could alter or eliminate the fear memory and its potential to negatively impact behavior.

Then, the team switched on cells in the hippocampal fear memory circuit, which caused the rodents to “freeze” because of prior conditioning to react with fear.

And, in the final stage of this experiment, the team used rapamycin to disrupt this particular circuit associated with conditioned fear memory. (Rapamycin is used to coat heart stents and to prevent rejection of transplanted organ tissue. Weird, huh? )

Rapamycin interrupts the neuron’s ability to produce proteins that are necessary for the circuit to function. As a result, the inclination of the rodent to freeze in fear is weakened or erased altogether.

And it worked. And they did succeed in associating fear memory reconsolidating with circuitry in the hippocampus. They did it!

Basically, these researchers successfully interfered in a circuit to change an original fear memory… which is what begins and is key in trauma-related conditions like PTSD. By forcing the circuit to “forget” the fear, the “freezing” behavior can be weakened or erased completely.

Like, gone.

If you or someone you love suffers from PTSD… a painful fearful memory, that’s triggered by little noises, a sight or smell or other cues, this can be life-changing.

Such an important step toward developing a new way to treat PTSD, or perhaps even substance or alcohol use disorders. Cues that trigger relapse might feasibly be interrupted in the circuit, to prevent it.

Heady, exciting stuff!

Thankfully, as we watch this development unfold, we have IV ketamine treatment NOW. IV ketamine treatment that’s effective in treating PTSD, substance use disorder, alcohol use disorder, social anxiety… all cue-related conditions. And of course, it is robustly effective for treatment-resistant depression and bipolar depression, and there is new exciting evidence of how ketamine is effective in teenagers.

It’s encouraging to see how research is exploding as we continue to seek treatments that can resolve devastating relapse and suffering.

At Innovative Psychiatry, we are meticulous about our outcomes, present our data at scientific meetings, publish our own findings in peer-reviewed journals, and stay up nights and weekends reading. We are on the cutting edge for breakthroughs in psychiatry and neuroscience. You deserve to be treated by experts dedicated to excellence.

If you suffer from any of these conditions, you would probably like some support, some help, and probably some treatment. We’ll schedule an appointment for you to come in and talk about your history, your current difficulties, and the possibility that you might be a candidate for IV ketamine treatment. We won’t be able to make a judgment about that until we talk.

If you’re a candidate, you can come to our practice with confidence that you’re sa fe even in this ongoing pandemic. Our plasma cell technology for removes 99.99% all viruses, bacteria, and molds from our air and surfaces means you can relax and focus on your treatment… and getting better.

Better days are ahead for you to live, dream, build, and hope.

We really want that for you. And we’re ready to help.

To the restoration of your best self,

May 17, 2021
Suffer from Postpartum PTSD? Ketamine Can Bring Back Your Joy

We say that childbirth is utterly natural. But the experience of giving birth doesn’t always go as planned. Sometimes there are surprises, disappointments, unexpected changes, fears, and excessive pain.

A terribly painful labor or delivery can become a traumatic memory for a postpartum mom. Loss of the baby during the process can also create an unbearable trauma for the mom. Especially in situations where the infant doesn’t survive, the mom can be so deeply affected that the smell of baby powder or lotion can trigger a cascade of PTSD symptoms. Or the cry of a newborn baby. Mothers who suffer from postpartum PTSD can have severe reactions to triggers for months after delivery.

Leanne has five children. The first four of her deliveries were increasingly traumatic. In one case, the baby’s head was lodged at the side of the pelvis and after hours of pushing with no progress, she was moved to surgery for a C- section. This was the fourth delivery. More about that one in a bit.

With the first, she labored for 38 hours and when the baby was finally born, she tore through her rectum. Bonding with her baby didn’t go well, because she was in so much pain. Plus, she felt beat up, traumatized, exhausted, and unable to find any warm feelings for her newborn. (And too ashamed of this to say it out loud.) Eventually, over months, she began to improve.

But within 7 months of that birth, she found out she was expecting again. She sat down and cried. She didn’t feel ready. The pain in her rectum had only recently subsided.

Then, the circumstances of her second baby’s birth were also excessively painful. (We’ll leave out the details.) She began to feel like she just had terrible luck… or just wasn’t supposed to be a mother.

From that time, she cried anytime her husband tried to touch her. She couldn’t separate the suffering of the two births from amorous times with her husband. Leanne couldn’t face the risk of another childbirth. One day she was so angry, she slammed the dishwasher door hard over and over, then sat down and cried.

Leanne’s husband quietly slipped out of the house and bought a new set of dishes.

Leanne talked with her doctor, and he said that she suffered from Postpartum PTSD.

Then, one day Leanne and her husband went to visit friends for a backyard cookout. They took the babies with them and really had a wonderful day. That night, they were both relaxed, and enjoyed cuddling. One thing led to another…

And soon enough, Leanne was pregnant with her third child. She’d been in therapy for 2 years at that point, so she was guardedly optimistic…but on shaky ground.

This time, unfortunately, the crisis was placenta previa… specifically the placenta was overlapping the opening of the womb to the birth canal. Once she began to dilate, portions of the placenta broke free, causing a rush of blood loss. She started to hemorrhage. She panicked, called her husband, called her doctor, called her mom. ( If only she had called 911…but she was too shaken to think clearly.) Of course, her husband was on his way, and told her to call 911 NOW. She called 911 then called a neighbor to come stay with her little toddlers. She was rushed to the hospital, unconscious when she arrived. Doctors went to work hoping beyond hope they could save both mother and child.

Thankfully both mother and child survived, but again, Leanne was exhausted, shaken, and shut down. She just couldn’t relate to the baby. She was overwhelmed with guilt that her mistakes had come so close to causing the baby’s death.

Even though Leanne and her husband were committed to living a natural lifestyle, and had never used birth control, she just felt she couldn’t go through this again. But he stood strong about not using birth control. So she used the best form of preventing pregnancy she could think of. Anytime her husband touched her or was affectionate, she pushed him away…or sometimes she just fell to the floor in a heap, weeping her heart out.

She had times when she just began to tremble and couldn’t stop. One day she dropped a jug of milk that spilled and splattered all over the kitchen. Then she had to pull herself together to clean it up. Who else would?

By this point, she tried to be a good mom to her innocent babies, but so much of the time she felt vacant. Other times she felt angry. Then, there were times when she had such anxiety that she didn’t dare drive, even to the grocery store.

She managed to avoid pregnancy for two years. Her marriage had become volatile. She just couldn’t be calm to communicate with her husband. Everything was falling apart.

Her husband suggested they let the 3 kids stay with Grandma and Grandpa, so they could take vacation to somewhere peaceful. They took a week in Jamaica. It was wonderful with swimming, great food, walks on the beach, and local music. (And those drinks with umbrellas! She loved them!) So many sites, smells, and friendly people. They both believed this was just what the doctor ordered.

On their 5th night, they danced to local music, and drank more umbrella drinks than they realized… They found their way to their room and collapsed in bed. The next day neither of them remembered how they got there. In their inebriated state, their celebration led to baby-producing activity. So rare for them, at this point.

You guessed it…baby #4 was on the way.

Leanne home-schooled her children, so by now she was doing lessons with babies #1 and #2.

At least on the days she was functioning. But her anxiety was pretty high. How could she take care of these children when she was so shaky? A few times during the pregnancy she experienced a panic attack. Her therapist was working with her to help her work through the anxiety.

Bless her heart. This was the delivery we mentioned earlier. The baby’s head seemed to be stuck to the side in her pelvis and they couldn’t get the baby to move into the birth canal. It was the last straw for Leanne. She had a full out panic attack during the latter portion of her labor. She was standing up in her bed and screaming and crying. No one could calm her. She just wasn’t rational. She was terrified. So they did an emergency C-section after putting her sleep.

When she emerged from the anesthetic, she was disoriented, surprised to learn her 4th baby was born and doing well in the nursery. Her doctor encouraged her to rest before they brought the baby to see her. But she just withdrew.

Leanne had had dreams of being such a natural “earth mom” …she’d started out wanting to give birth to her children at home. But each childbirth had been too risky to continue at home. She felt cheated. Angry. Beaten. Each labor and delivery was a nightmare.

All her plans for meaningful home births had been vanquished. She knew she suffered not just from postpartum depression but from postpartum PTSD … and she just didn’t know what to do about it.

Her doctor had advised Leanne and her husband to consider a tubal ligation during this C-section but she had been far too distraught for a decision like that. So he encouraged them to consider it later, to give her a chance to recover.

While they were “thinking” about it, she got pregnant once again. She told her doctor she definitely wanted the tubal ligation done during her final C-section. As it happened, this 5th birth went smoothly as a C-section, and the tubal ligation was completed in the same procedure.

She was able to bond with her new baby peacefully, and she enjoyed him so much.

A wonderful, simple, easy, planned C-section — with no crash carts, hemorrhages, horrible images, horrible fears, horrible pain. Why couldn’t it replace all those awful memories? Why did they shake her up during the day, and infiltrate her dreams at night? And why did every little thing seem to be a trigger? The kids were healthy, right? They were OK, right? She was OK, right? Well on that one, no…she was really not ok. She still suffered from postpartum PTSD symptoms — and all the treatment she had had over the years hadn’t made a dent in it.

So when a friend encouraged her to consider IV ketamine treatment, Leanne grabbed her phone, and started trying to learn what ketamine can do for postpartum depression and postpartum PTSD. She made the call.

Scheduled her appointment. And left the children with a babysitter.

After the first infusion, she felt no different. Same after the second. After the third she decided to cook a new recipe for supper. Such a little thing, right? But it was such a big deal—she hadn’t done that for months. (Ketamine can restore initiativ e and motivation.) After the fourth, she could feel rays of hope inside her. Almost like rays of sunshine, she said. By the time she went for the 5th infusion, she was calmer. No longer shaking. And although there was still anxiety, she was becoming hopeful. She had good days and bad days. But there was improvement. She could feel it. She just wasn’t there yet.

So she went for a 7th infusion…and then an 8th. By this time she went for her 8th infusion, she had joy. She felt free of the fear and anxiety. And as the days passed, she felt more resilient all the time.

She became her old self over the next several weeks — felt happy, calm, fun-loving. (Oh wow, when was the last she she’d felt that?) She had patience with her children, she had creativity in home schooling them, she enjoyed socializing. She also had the initiative and motivation to clean up the house and invite another couple with kids over for dinner — outside, on the patio.

Leanne hadn’t felt this good since her first baby was born.

She also found the patience, wisdom, and determination to work with her children in family therapy in hopes of improving their security with her and building the bonds that suffered with these pregnancies and deliveries.

And she was thankful that her husband was still at home so they could work together with a marriage counselor to strengthen their relationship.

IV ketamine treatment has developed a track record for helping women who suffer from postpartum PTSD to achieve remission. Choosing to seek out this treatment was a wise move for Leanne to make. At the same time, it’s important that you understand that ketamine is not for everyone. (There isn’t anything that works for 100% of people 100% of the time.) But ketamine can be transformative for most people who are suffering from severe postpartum PTSD, depression, social anxiety, bipolar depression, postpartum depression, and more.

At Innovative Psychiatry, we’re experts in psychiatry, in postpartum disorders, and in all the treatments available for them—including IV ketamine—and we work with you to map out the best course of treatment for you. We have the protocols and — incredibly important — the technology to protect you from viruses including COVID-19, bacteria, and molds, so you can come for your treatment with peace of mind. You can breathe easy…even if you haven’t for months.

If you suffer from postpartum PTSD, don’t keep toughing it out. Call us.

We’ll set up an appointment to talk about your history and current symptoms and all the things we need to know to determine if you’re a candidate for IV ketamine treatment. You deserve the care of a specialist.

Don’t hesitate to call. Get your hope back. And the power to enjoy your family.

We want to help.

To the restoration of your best self,

May 3, 2021
Is Dissociation Important for Ketamine to Work?

The Big Question

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

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

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

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

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

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

And that’s what happens in dissociation.

Science blooms in the mind.

Let me tell you what that means.

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

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

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

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

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

Is it important?

You betcha.

Can we prove it?

Ah. That’s another story.

Prominent Ketamine Researchers Seek Answers

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

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

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

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

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

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

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

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

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

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

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

Extraordinary Restoration in Treatment Resistant Conditions

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

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

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

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

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

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

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

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

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

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

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

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

How exhilarating that can be!

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

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

So what is dissociation, really?

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

Yes…but what’s important about dissociation??

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

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

Stick with us here.

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

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

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

Infusion. Infused with hope.

There really is hope.

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

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

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

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

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

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

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

To the restoration of your best self,

April 19, 2021
IV Ketamine for Teens ? Ya gotta be kidding me, right?

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

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

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

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

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

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

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

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

Why?

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

IV ketamine for teens to put a stop to loss.

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

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

That’s why IV ketamine is so important.

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

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

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

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

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

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

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

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

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

IV Ketamine for Teens

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

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

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

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

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

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

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

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

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

Oh, the beauty of it.

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

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

Because you’re depressed.

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

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

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

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

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

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

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

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

We live on that line all the time.

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

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

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

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

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

We’re here to help.

To the restoration of your best self,

March 22, 2021
Don’t Let Stressors You Can’t Control Hurt YOU: Add Resilience

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

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

Take Janeen and Carole, for example:

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

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

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

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

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

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

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

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

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

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

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

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

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

So she didn’t.

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

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

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

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

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

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

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

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

Another Perspective on Stress

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

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

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

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

And all this stress is dangerous.

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

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

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

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

We all need to give. We all need to receive. And we all need feedback. When we give, receive, and participate in feedback…well, those are stressors we can control…so they help.

When the things we need as humans are accessible and balanced in our lives, it’s easier to maintain a certain equilibrium.

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

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

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

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

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

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

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

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

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

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

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

We look forward to talking with you.

To the restoration of your best self,

February 15, 2021

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