Tag: IV Ketamine Treatment Erases Suicidal Thoughts

  • PTSD in Trauma Survivors: Let’s Prevent More Suicide

    PTSD in Trauma Survivors: Let’s Prevent More Suicide

    PTSD in trauma survivors can lead to suicide.

    Two survivors of the Parkland high school shooting on Valentine’s Day 2018 took their own lives a couple weeks ago.

    Sydney Aiello, a senior and cheerleader at Marjory Stoneman Douglas High School, struggled to restore normalcy in her life after the terrifying experience.

    Her trauma, of course, included the loss of friends who were killed in the shooting. She enrolled in college classes in the fall, but found it almost insurmountable to attend them, because of the terror she felt sitting in a classroom.

    Sydney was diagnosed with Post Traumatic Stress Disorder (PTSD) in the months that followed that massacre, and struggled with guilt that she had survived the shootings, when friends like her close friend Meadow Pollack, had died.

    This “survivor’s guilt” is a devastating symptom that makes survival after such a traumatic experience terribly painful. Sydney never reached out for help with her struggle, but suffered silently. On March 17, 2019…just a couple weeks ago…Sydney took her life.

    A Second Suicide from PTSD in Trauma Survivors in Parkland, FL

    This young man is suffering in silence following traumatic experience, and is at risk for suicide.

    Only 6 days later, Calvin Desir — a 16 year-old boy from the same high school — took his life. Calvin was a sophomore, and had also struggled silently… until that day. Little is known publicly about his story, but we can know those who are left to mourn his loss are as numerous and heartbroken as any of us would be after such a terrible loss.

    Some of the students vented their terror, grief, and rage after the shooting by speaking out and forming March for Our Lives, that drew hundreds of thousands of protestors to Washington, DC and around the world.

    It gave them a place to channel their energy, to at least try to prevent more shootings in the future.

    But, far more students than those who participated in the protest, struggled with their pain, terror, grief, rage, and guilt in silence and isolation.

    As time goes by, and they relive the memories of that terrible day, the fear of being found and shot, the horror of hearing their school mates scream…well, the stress of the memory can wear away at their confidence, their sense of safety, and their stability.

    Don’t you wonder if PTSD in trauma survivors of the shooting could have been identified and whether these suicides might have been prevented? And most importantly now, is it possible to prevent any more?

    Tragedies following Traumatic Events – Let’s Prevent More Suicides

    While 3 of the 17 victims of the Parkland high school shootings were adult teachers, the other 14 were teenagers. How do teenagers, with their limited life experience and coping skills, resolve such fear, confusion, ill-founded guilt, anxiety, and pain?

    PTSD in trauma survivors must be treated to prevent suicide
    Layer upon layer of tragedy, loss, and sorrow…eating at their security. The more time they spend alone, the more the memories loom, and the harder it is to break free of them. Anxiety and the stress of it all can drive their thoughts to despair and then sometimes desperation.

    But… these students who grieve for their friends… they’re intelligent, resourceful people, right? Kind, smart, connected, well-spoken, artistic, athletic, healthy. Going places. So why didn’t these kids ask for help if they were becoming depressed, despondent, and so isolated and alone in that frame of mind?

    But that’s the thing. When someone is traumatized, they may not show it like you would expect. The trauma of it all… in their thoughts… may be trapped in a cloak of private torment.

    They may not have wanted to draw attention to themselves. They may have convinced themselves that they don’t “deserve” to live. If we don’t talk with them…listen to them…we can’t know what their thoughts were.

    And that’s why it’s so important to engage the people you know who have been exposed to trauma — to the “big T” traumas and to the “little t” traumas…talk to them and listen. Help them open up about what they’re thinking and feeling — because more than likely, it’s not what you or I think they might be thinking and feeling.

    Airing dark or haunting feelings just might be enough to lessen their torment and divert dangerous decisions.

    Unbearable Guilt over Living Through the Event

    For one thing, survivor’s guilt added to the suffocating, unrelenting grief, and elusiveness of relief. “I don’t deserve to live, if they had to die…Why wasn’t I shot? The pain of the loss I feel is so much worse than death…I wish I’d been shot, too!”

    These are complex feelings, without clearly defined solutions. And though possibly not logical, they’re far too weighty for an adolescent mind and heart to untangle. 

    Let's prevent more suicide with PTSD trauma survivors like this haunted young man.

    In short, these kids carried a load too large to manage. While it seems likely many of their parents got them into a psychiatrist’s care, that may not have helped enough soon enough.

    We can’t conjecture on the parts of these two who’ve left us, but we can look for ways to prevent more suicides going forward by recognizing signs of PTSD in trauma survivors and helping them get treatment.

    Because the chances are, all 3300 of the students at that high school were traumatized by the experiences of that day. 

    And they’re at risk. Not just in Parkland, FL, but in every high school across the country. Students are in pain, and are traumatized by events they hear on television or the internet, plus events that happen in their personal lives or the lives of others near them.

    Helping Them Vent Their Private Pain

    One thing to consider is that anyone who has undergone such a great shocking loss, probably needs to talk about it. To unload the confusion and uncertainties to a listening ear … and to do that, they probably need to be invited to do so.

    It can be so difficult for a teenager to voice fears and dark secrets, especially if they include thoughts of suicide. They don’t know how the listener might respond.

    If the listener is a peer, they may fear ridicule or betrayal of confidence.

    If an adult, then maybe fear of anger, punishment, dismissal or hysterics.

    PTSD trauma survivors like this boy, are at high risk for suicide.
    No matter what they fear, it may seem easier to brood in silence about their thoughts, as well as possible plans.

    The risk of divulging private thoughts also can move the thoughts from fantasy or vague consideration to full throttle.  A move they may not want to feel rushed about.

    So it’s important to ask. Just ASK.

    “How have you been feeling lately? It would be easy to imagine that you’d struggle over your friend’s death…  I’d like to listen when you feel like talking…”

    “Do you ever think it would be a solution if you didn’t have to have worries like this anymore…?”

    “Do you ever have any thoughts of ending your life, or hurting yourself in some way?”

    “Have you thought of how or made any plans to end your life?”

    Just ask.

    What to Do with Their Answers

    These questions can help give a direct, clear opportunity for conversation and expression of pain, loss, anger…

    And their responses can clue you as to the next steps. If they have thought about it, or mention feeling less hope about the future, or less purpose…or increased rage, or wrecklessness… don’t leave them alone.

    You can say, “let’s get help.” If you see or hear them express increased substance abuse, this can also be a sign of high risk. Again, seek help.

    At the very least, write down this phone number for them. 

    National Suicide Prevention Lifeline

    1-800-273-8255

    But that’s just the first step.

    How to Respond to PTSD in Trauma Survivors

    Next, what can be done to relieve them of these tormenting thoughts, and protect them from an irreversible decision?

    Ketamine treatment can erase suicidal thoughts in an hour.

    In my practice, the safest, most effective treatment of choice for serious suicidal risk is IV ketamine treatment. This can erase suicidal thoughts in as little as an hour and return someone who’s struggling with thoughts of suicide or thoughts of death as a relief to a state that’s safe for further treatment of depression, PTSD, and other psychiatric conditions.

    But, no matter what, seek immediate psychiatric care. With parents, teachers, and friends of traumatized students on the alert for signs of suicidal thinking, we can all work together to avert tragedies and save lives.

    Because of the limited life experience an adolescent has to draw from, as well as the impulsiveness that goes with a brain that’s not fully developed, irreversible decisions can be rampant during crisis.

    The finality of death is difficult for these young people to grasp, and protecting them from making such decisions is paramount.

    We can help protect them from these dangers.

    It all starts with conversation. And trust.

    To the highest hopes of your best self,

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
    Lori Calabrese, M.D.
  • 2018 Innovative Psychiatry: Ketamine Developments

    2018 Innovative Psychiatry: Ketamine Developments

    2018 Innovative Psychiatry ketamine developments show 80% response in treatment-resistant disorders.

    What a year it’s been!!

    As this busy year creeps toward its end, it’s fun to look back on all we’ve accomplished in our hard work to help find more effective treatment for those who suffer with symptoms that don’t respond to traditional treatment.

    Since the early beginnings in my work as a psychiatrist, I’ve been devoted to staying on the leading edge, and to finding solutions for those whose symptoms persist despite their best efforts.

    2018 Innovative Psychiatry ketamine developments demonstrated 80% response in patients with treatment resistant disorders.
    As I’ve added innovative and advanced treatments to my practice to extend our effectiveness. And I’ve discovered that IV ketamine treatment in a series of infusions given closely together, is the most exciting, effective treatment for depression that just won’t lift.

    So, we’ve invested time, money, and staff to help us learn more about this treatment for those who need it, and about what it can do.

    Interventions and Adjustments

    At the beginning of the year, we explored a variety of schedules and extended hours. We’ve continued to adjust them all year.  It’s always a moving target as we try to offer an opportunity for everyone to be seen and treated.

    Since I began providing ketamine treatment 3 years ago, we’ve been compiling data to learn more about the outcomes with our own patients here, as well as with those who come to us from outside Innovative Psychiatry.

    And we’ve consistently been amazed at what we see. But more about that in a bit.

    Then, in March, I had the opportunity to attend the International Conference on Ketamine and Related Compounds for Psychiatric Disorders 2018, in Oxford, England.

    2018 Innovative Psychiatry ketamine developments included attendance at the Oxford Conference.

    This conference was the first gathering globally of neuroscience researchers, psychiatrists, and psychopharmacologists specializing in ketamine research for psychiatric use.

    This momentous academic gathering explored the rapidly emerging data on the history, development, and use of ketamine, and related compounds in psychiatric treatment — in basic neuroscience, neuroimaging, and clinical studies. How does it work? Why does it work? How can we know? What does neuroimaging tell us about ketamine and the default mode network (DMN)? What’s in the pipeline with esketamine and related compounds? These are some of the questions research has been answering about ketamine. We’re gaining confidence in it as a viable and extremely useful treatment, as opposed to just an experimental treatment that would soon dissipate (as naysayers claimed). 

    I presented some of my data on treatment of suicidal thinking, and what ketamine can do to erase it in a poster session.  

    Next, came the first annual American Society of Ketamine Physicians (ASKP) Conference in September, where I saw a number of the same professionals I’d seen in Oxford…again meeting to share insights and experiences with the use of ketamine treatment in psychiatry and in pain management.

    Again, we talked about the broad applications of ketamine.  And the openness among us sharing information and insights helped to broaden the horizon for all present regarding what ketamine can do to relieve suffering in our patients.

    Suffering that, for far too many, had remained unrelieved before ketamine.

    Friendships were building at both of these conferences as we learned from each other, asked questions, and exchanged information. I took notes as fast as I could type. The information was compelling, exciting, and clinically useful.

    Then, in November, along came KRIYA Conference 2018. Many of the same medical professionals gathered along with a host of others, and something magical happened.

    These celebrated and deeply experienced experts in the field of ketamine treatment for psychiatric disorders left any pretense (they might have justifiably possessed) at the door.

    Deep connection happened. And a light bulb turned on. 

    2018 Innovative Psychiatry ketamine developments included a well-received presentation at the Kriya conference in San Francisco.

    We took notes voraciously, exchanged ideas generously, talked intensively, asked questions of each other, and utilized every second we were together.

    We gathered for coffee before the speakers began. Chatted on the steps. Talked on the way in and out, and everywhere in between. And lingered even after we were ushered from the building at the end of the day … then met at restaurants and continued far into the night. 

    I presented from the podium this time, and appreciated the enthusiastic response my data received. But I have to say, when it comes to the feats of ketamine, it’s hard to not be excited.

    In fact, Raquel Bennett Ph.D., the founder of KRIYA, declared in her opening remarks that we’re witnessing, and are also players in, the birth of a new field: ketamine for psychiatric disorders. And that this time will go down in history as a renaissance of psychiatric treatment.

    As the year has progressed, those of us in this new field are collaborating and continually refining and improving our methods of treatment as we probe more deeply into the potential of this extraordinary treatment.

    The Birth of a New Field

    If you or someone you love suffers from depression that has not responded to treatment, this collection of researchers and doctors understands, and we’re all working tirelessly to find answers for you.  

    You really aren’t alone.

    We’re also watching research for more evidence about new areas of ketamine research to show us more ways to apply it.

    2018 Innovative Psychiatry ketamine developments include ongoing research and collaboration globally.

    At the same time, ketamine’s actions inspire more research into why it’s so effective, and pharmaceutical companies are developing new and related medications with the advances in this frontier.

    Ketamine treatment consistently shows a strong response rate for treatment-resistant depression and bipolar depression; plus there is exciting emerging data for those with disorders like OCD, social anxiety, and substance use disorders that haven’t responded to other medications. 

    2018 Innovative Psychiatry ketamine developments include research opportunities.

    We continue to collaborate and follow research to find ways to increase those numbers. To make a rewarding life available to more people.

    I’ve been busy behind the scenes reviewing new research for upcoming new treatments– like esketamine, rapastinel infusions, and brexanolone infusions for post-partum depression and the exciting work done by the scientists at Neuro-Rx.

    Our Experiences at Innovative Psychiatry with You Provides Useful Aid to Other Patients in Other Practices

    My experiences with my patients in the last few years inspired me to respond to a Request of Information from the NIH/NIMH on the use of ketamine for suicidal patients — hopefully to help shape future research directions. And … to write an article that we plan to publish in a scientific journal. More information about this should be coming in the weeks ahead.

    As a result of all these new connections, I’ve had the opportunity to collaborate on an international level. 
    2018 Innovative Psychiatry ketamine developments include ongoing research in my practice to allow new drug trials.

    Over the summer, we began exploring how to serve as a potential study site so we could offer patients the opportunity to participate in clinical research trials with new medications — more on that to come. 

    This would give people an opportunity to get treatment with a new agent long before it’s available to the general public.

    Exciting, isn’t it?

    As you know, we’re all about educating our patients.

    In addition to our Ketamine Blog, we offer The Ketamine Library for our patients. (Who does that? I can tell you, from my trips around the country and into Europe … no one we know.)

    Extraordinary efforts at education. It’s one of the things we’re known for. 

    2018 Innovative Psychiatry

    And we’ve also added Instagram to reach more of our readers. We’re getting the word out about new breakthroughs in treatment.

    And have you noticed the facelift to our website menu bar

    You’ll notice a new menu along the top emphasizing our Ketamine Blog.  (It should really be called the Ketamine and So Many Other New Things Blog –but that didn’t fit very well!)  Seriously, we’ve been busy writing all year. 

    If you haven’t explored the blog much, jump in — we write about everything from science to heartache, from fear to gratitude, from children to aging gracefully, from friendships to loneliness, from narcissism (STILL such a hot topic!) to ketamine wannabees.

    And… we also offer advice, recommendations, and insights on the topics that are hard to find anywhere else — from how to screen a ketamine clinic to why your doctor might not yet be offering ketamine treatment. Check it out!

    We write about stories, successes and failures.

    I look forward to telling you more about all that and about other new initiatives we have planned, coming up in the new year ahead.

    This has been such an exciting year in the advancement of better and more effective treatment for our patients. The ground is rumbling with new breakthroughs for 2019.

    Enjoy your holiday season as it unfolds, and remember to take a moment to show kindness to those around you. It’s one of the most important things we can do for each another.

    Ketamine Inspires Hope

    Lots of inspiring news here. The purpose in all we do is to help you get better. And with the hundreds of medicines at our disposal, only about 2/3 of people psychiatrists treat with all those medicines actually improve. 

    Ask your psychiatrist to help you get better. But if you’ve tried a couple of medications…or even if you’ve tried 30!…and you don’t feel better, ketamine may really help you. 

    Ketamine treatment is amazing. It can smash depression, relieve social anxiety, dismantle PTSD, break addiction, and erase suicidal thinking within a couple hours. That’s why we’re celebrating the 2018 Innovative Psychiatry ketamine developments that are saving and restoring lives. 

    Ketamine treatment seems to demonstrate its greatest power with those who are the most ill, who’ve had the least amount of hope.

    If this sounds like you, or someone you love, call us. 

    2018 Innovative Psychiatry ketamine developments help more people achieve a fulfilling life.

    We are most thrilled by the opportunity to help you get better, really truly better, and to feel well and able to build the life of meaning you’ve always wished for.

    To find the motivation and initiative to pursue, and invest in, those things that are important to you. To build relationships that have the depth and longevity to add strength to your life. Basically, to have the energy to live well, rather than endure.

    Give yourself your best hope.  Call for an appointment to see if ketamine treatment is right for you.

    To the release and restoration of your best self, 

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
    Lori Calabrese, M.D.

  • ASKP Meeting Notes:  The 2018 Inaugural Conference of the American Society of Ketamine Physicians

    ASKP Meeting Notes: The 2018 Inaugural Conference of the American Society of Ketamine Physicians

    New Advances in Ketamine Treatment

    2018 has been a good year. A very good year.

    In this fall season of harvest and bounty which surrounds us outdoors, we find ourselves as ketamine physicians with wonderful gifts to work with:  in our world of neuroscience and psychiatry, the soil is rich, the seeds have been planted, and hard work has been done – sometimes for years! – by experts who have paved the way, and brilliant emerging experts whose work and insights inspire us all.

    I’m talking about the 2018 ASKP Meeting in Austin, TX.

    Ya shoulda been there

    It was the Inaugural Meeting of the American Society of Ketamine Physicians – hence, ASKP – and it was a conference that fueled excitement, embraced inquiry, acknowledged the need for temperance … and left all of us thirsting for more opportunities to work, study, collaborate, and publish.

    I want to tell you about the meeting.

    Especially if you or someone in your life suffers from a mood disorder. If you’ve been struggling for a terribly long time. If you’ve begun to think of yourself with symptoms that have become “treatment-resistant.”  Sound familiar? Then dial in to learn about IV ketamine treatment advances.

    What you learn may help you think outside the box you’ve found yourself in.

    Hard Pruning Can Leave You Unable to Recover

    Ketamine treatment advances help more people escape depression.

    As you know, it’s terrible to struggle to live your life when your confidence, your hope, your ability to think and perform, are all dulled, impaired…broken down.

    Major depression, panic disorder, social anxiety, PTSD, OCD, bipolar disorder, addiction … the list goes on …  all of these can make it nearly impossible to reach the goals you may have for your life.

    You’ve probably seen your doctor and tried some different medicines, but if you’re not feeling better, you may be part of the large group of depressed or anxious people for whom conventional medications don’t work.

    If you’ve heard of ketamine, you may know that it’s showing great promise for helping a majority of people who weren’t helped by antidepressants.

    But, you may not have been able to find someone who administers ketamine treatment properly. Because until recently doctors have just been on their own offering ketamine the best way they know how.

    Sometimes their methods don’t work very well.

    So physicians who provide ketamine treatment are beginning to organize into groups to exchange their ideas, experiences, and discoveries, in hopes of solidifying some of the true “best practices” that provide the best outcomes for their patients.

    An important organization that’s doing this is the American Society of Ketamine Physicians, or ASKP — and we just held our Inaugural Conference September 20-22, in Austin, TX.

    Let me start by saying how grateful I am for the many opportunities to meet with other medical pioneers who are committed — like we are — to helping people who suffer with treatment resistant psychiatric disorders.

    Ketamine treatment advances lead to more remissions.

    Conferences are a festival for the mind.  Ideas spark, slides fly by, data positively crackles in the air — and so does good humor, agreeableness, collaboration, and humility.  We are humbled by the pain our patients experience, and inspired by our colleagues to learn more, think critically, design carefully, proceed with integrity.

    We are privileged to have ketamine in our toolbox and to be able to offer ketamine treatment to patients whose suffering has become unbearable.

    ASKP is helping us do just that. 

    IV Ketamine Treatment Advances: Leaders

    We were treated to a lineup of seminal leaders in the field. Steve Mandel, M.D., the President of ASKP and Ketamine Clinics of Los Angeles, James Murrough, M.D., of Mount Sinai and Sam Wilkinson, M.D., of Yale, Steve Levine, M.D., of Actify Neurotherapies, Carl Bonnett, M.D., of Klarisana in San Antonio who has been working with veterans for years treating depression, PTSD and pain; Rupert McShane, M.D., whom I met at KRIYA and Oxford, Raquel Bennett, Ph.D., the founder of KRIYA Institute and the KRIYA Conference, and Jason Wallach, Ph.D, of University of the Sciences, a brilliant synthetic chemist and expert on the pharmacology of ketamine and related novel NMDAR antagonists. 

    Dr. Mandel’s opening address caught everyone’s attention when he opened with statistics about suicide. He reported that 44,000 people die by suicide each year, and 25 times that number attempt to end their lives. There are more suicides among physicians than any other profession.

    Ketamine treatment advances can transform depression to joy.

    He stressed that there are so many people who need this medicine and not nearly enough doctors providing it — if for no other need than to help prevent suicide. But of course, we shouldn’t stop there.

    He also pointed out that in his practice, he’s seeing more and more patients who have a delayed response, just as we see at Innovative Psychiatry.

    Because of this, it’s so important that if you don’t feel better after your series of infusions, that you must not give up. You may be a late responder and we’re learning more about this all the time.

    Extensive Research That Began During Residency

    James Murrough, M.D., Ph.D., was next and he talked through the history of ketamine’s research for treating psychiatric disorders. He spoke of Carlos Zarate’s work in 2010 which was the first study in patients with treatment-resistant bipolar disorder.

    He got involved in ketamine research as a resident  in a study of 47 patients led by Sanjay Mathew, MD who, with Zarate, co-authored the book Ketamine for Treatment-Resistant Depression. It was a difficult study, and ketamine treatment was surrounded by skepticism at the time. (For some people, it still is.) But it was the largest number of patients studied clinically at that point.

    Dr. Murrough did a beautiful, comprehensive review of the clinical literature on ketamine’s effectiveness. He and his team published a study in 2015 that demonstrated that ketamine’s effect is rapid and robust.

    Then, studies accumulated that showed ketamine’s effect lasts longer when given in a series. (Which is why we give a series of 6 – 9 at Innovative Psychiatry.)

    Groundbreaking studies…over and over and over. 

    Steven Levine, M.D., talked about what he’s learned through 30,000 ketamine infusions with 3000 patients over the past several years.

    And he made the point that stress itself is a risk factor for relapse.

    Raquel Bennett, Ph.D.

    I don’t have room here to tell you enough about every presentation, but really quickly I want to tell you about Raquel Bennett’s presentation. 

    Raquel Bennett, Ph.D., spoke about the varied ways ketamine is used in psychotherapy and the importance of selecting patients appropriately for each type of treatment.  

    She also chaired a panel discussion with Eli Kolp, M.D., Robert Grant, M.D., and Jeff Becker, M.D., about their varied therapeutic approaches and their work with ketamine in psychotherapy.

    Sandhya Prashad, M.D., spoke about the hallucinogenic potential of ketamine. While many physicians have been reluctant to delve into this aspect of ketamine, the dissociative symptoms patient experience are key to their improvement.

    This wonderful gathering included research scientists, clinical researchers, full-practice physicians, and psychologists who explained their own discoveries for us to assimilate.

    So many luminaries, so little time…

    Rupert McShane, M.D.

    Sam Wilkinson, M.D., explained the challenges of research and reviewed key studies. Rupert McShane, M.D, presented data on oral ketamine and abuse concerns. I first met Rupert at the KRIYA conference and he encouraged me to attend the Oxford International Conference on Ketamine for Psychiatric Disorders 2018 conference last March. He chaired the Oxford event, which was spectacular. He’s been generous with his mentorship in so many ways. Such a lovely man.

    Rachel Dalthorpe, M.D., talked about hormonal factors in ketamine infusion treatment. She referred specifically to premenopausal women and proposed an ideal time during the menstrual cycle for scheduling follow up infusions. Such valuable information.

    I was delighted to see so many of the luminaries there who have previously spoken at Kriya… like Jason Wallach, Jeff Becker, and Steve Levine … and from the Oxford Conference like Rupert McShane and Jenny Southgate … Such friends … and such a hall of fame!

    Benjamin Keizer, Ph.D., talked about pain and the impact it has on the brain. Jennifer Southgate, Ph.D., spoke about her work with urothelium and bladder inflammation, and how ketamine can affect the bladder. 

    Ronald Hertz, M.D., explained his important work on the use of ketamine for treating severe and chronic pain…and CRPS. Randall Malchow, M.D., talked about his own studies treating pain. Jason Wallach, Ph.D., spoke on the pharmacodynamics of ketamine, expounding on the history of derivatives of PCP. He also discussed the difference between r-ketamine and s-ketamine. He is brilliant, engaging and makes chemistry fascinating.

    Ketamine Advocacy Network Helps Physicians and Patients Alike

    Finally, Dennis Hartman, who founded the Ketamine Advocacy Network, spoke about the extreme importance of patient advocacy. I was delighted to meet Kim Juroviesky. Kim hosts a Facebook group for ketamine patients, which is growing fast and helping so many.

    Ketamine treatment advances help you perform in your job.

    The entire two days was chock-full of data, expert opinions and suggestions regarding clinical use of ketamine.

    What an inauguration! Ketamine treatment is growing rapidly in use and in its positive effects. The more we can learn, the better able we are to effectively treat more patients with bright outcomes.

    IV ketamine treatment advances help you transform.

    At Innovative Psychiatry, we administer ketamine and other treatments for treatment-resistant mood disorders. And we align our methods with best practices to help you achieve the most favorable outcome.

    If you suffer from severe depression, social anxiety, bipolar disorder, PTSD, OCD, substance abuse disorder, and suicidal thinking, please call us.

    And know that you don’t have to suffer with your symptoms. Let us help you find the life you want to live, and discover the best you, you can be.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the reinvigorating of your best self,

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  • Dissociation: Is It Key to Ketamine’s Antidepressant Response?

    Dissociation: Is It Key to Ketamine’s Antidepressant Response?

    Ketamine's antidepressant effects may be predicted by dissociative experiences.That Floating Sensation May Predict Ketamine’s Healing At Work

    Know anyone who’s depressed?

    I don’t mean someone feeling blue or disappointed, but really depressed. The hard-to- function type of depression. The hard-to-think-hard-to-get-out-of bed kind of depression. Where everything looks dark and hopeless, and you doubt yourself and your value…and it continues and gets worse for months or years.

    Severe depression. The kind that makes you want to die, and you can’t see any value in your life…and those thoughts start coming… that everyone who knows you would be so relieved if you were gone. Lies that kill.

    Depression like this messes with your outlook, your decisions, your abilities, your energy, your motivation, your perception of your own value… and it’s almost insurmountable to get out of bed.

    We Call Your Disorder “Treated” Only If You Feel Better

    In some cases we call this Major Depressive Disorder, or MDD. In others, it Ketamine's antidepressant response may be predicted by dissociative experiences.may be the depressive part of the cycle in bipolar disorder. Depression of this magnitude can be debilitating. And it needs to be treated effectively. In fact, no matter what treatment is used, if you don’t feel better, then it’s the same as if your depression weren’t treated at all.

    No matter how many pills you’ve swallowed or how many therapy sessions you’ve attended —

    Treatment must produce results you can feel and confirm. Or else it’s not effective. And if you aren’t feeling better and functioning better … well, what’s the point?

    Ketamine is a medicine that was developed in the 1960’s and ’70’s as an anesthesia medicine. It’s been used for 50 years safely with children, adults, and senior citizens. It regulates glutamate in the brain, and blocks the NMDA receptor which prevents it from causing you to feel depressed.

    AMPA Gives You Power to Adapt and Develop Flexibility

    It also fires up AMPA , which is another glutamate receptor that is responsible for most of the fast excitatory transmission in the brain.

    In other words, it’s the AMPA receptors that are behind the synaptic plasticity, Ketamine's antidepressant response may be predicted by dissociation.which means they empower the connections between brain cells to grow and flourish and move signals around the brain much more rapidly.

    Plasticity basically means changeability. Or…changeableness.  (Are those even words…?)

    So, synaptic plasticity changes the connections in your brain and makes them grow and bud and sprout like crazy…which helps you to develop more and more ability to adapt the way you think, the way you respond, the way you see events and circumstances so you can develop flexibility, healthier thinking habits and more resilience, too.

    This is one big part of what makes ketamine work so well.

    Ketamine’s Antidepressant Response

    Then it tells the cell to make more and more AMPA fast, so you feel better and better rapidly. And this is just one action ketamine performs to fight depression. There are lots of others, but let’s focus on this one for now.

    We’ve talked often about ketamine treatment, provided in tiny doses roughly equal to 0.5mg/kg given IV over 40 minutes by a psychiatrist who is adept with psychopharmacological methods that make the most of each infusion.

    Ketamine is a molecule that modulates the excitatory neurotransmitter glutamate.

    We’ve talked about how important close supervision by a psychiatrist is to determine the rate and dose needed specifically for you, and your brain, so you have the quality of response to the medicine that will provide the best outcome for you.

    And…we’ve pointed out that some providers have popped up in the landscape who give the same dose to every patient, or the same protocol, or varying doses to every patient with little attention to precision rate or infusion length. This is super easy for the provider, easy for the clinic. There is no infusion pump, and the only rate control is the rolling wheel on the IV tubing.

    You see where I’m going.

    Care in Ketamine Administration Yields Better Results for You

    We’ve hypothesized that this less precise administration of ketamine may be theKetamine's antidepressant response may be predicted by dissociation during infusion. reason that non-psychiatrists and psychiatrists alike who use this one-size-fits-all method for treating depressed patients was resulting in a lower percentage of remission from mood disorders across the board. 

    We know that we’ve seen an 80% response in treatment-resistant patients by using this precise and remission-focused approach.

    Well, researchers published a study in February this year in the Journal of Affective Disorders along this line. It demonstrated how the various dissociative effects can predict how much antidepressant effect a person will receive from a ketamine infusion.

    Led by Mark J. Niciu, a team of researchers including Carlos Zarate (a leader in ketamine research), conducted a followup study to their previous work to determine whether the quality of dissociation was correlated to a positive antidepressant response.

    Dissociation…and Ketamine’s Antidepressant Response

    We’ve all been interested in this. Is dissociation “just a side effect,” or does it Ketamine's antidepressant response restores the power to enjoy.MATTER? Is it necessary to have dissociation for ketamine to “work?” Or for depression to lift? For anxiety to dissolve? For trauma to heal? And what dissociative features, exactly? How intense are we talking about? And for how long?

    The researchers took a group of 126 people from 18 to 65 with mood disorders – 84 with major depression and 42 with bipolar disorder and asked them to complete rating scales just after their treatment about what they experienced during their ketamine infusion.

    Dissociation is basically a detachment from reality, but it can include detachment from yourself (depersonalization), detachment from your surroundings (derealization)…and sometimes a sense of amnesia.

    The Study:

    Now, each patient involved in the study was currently experiencing a full episode of depression that had been going on at least 2 weeks. Prior treatments had failed all of these subjects. In some cases just one, but many had tried multiple treatments.

    Researchers selected the subjects very carefully.  None of them had psychotic symptoms and none of them had dissociative symptoms at baseline.

    Some patients received a ketamine infusion (yep, just one, not a series) at a prescribed dose of 0.5mg/kg over 40 minutes and others received a placebo…

    And guess what?

    People who experienced dissociation during their ketamine infusions had much more improvement in their depressive symptoms – the more intense the dissociation, the better the improvement.

    And the specific dissociative feature (remember there are 3:  depersonalization, derealization and amnesia) that was most strongly associated with responding to ketamine?  Depersonalization.

    The antidepressant effect was strongest at Day 7, not 3-4 hoursKetamine's antidepressant response may be predicted by dissociation. after or a day later.
    You Can’t Know Without Testing – There’s So Much to Learn

    Isn’t that interesting? You’d think the response would have been strongest during the first 24 hours, but not so in this study. You know… the miracle WOW that everyone seems to expect. (Boy, do we have to explain and help reset expectations here.) When you think about how ketamine restores signaling structures as well as all the other things it does, it does stand to reason that as the structures in the brain improve, so would the antidepressant effects.

    The research team encouraged more studies to pin down and confirm their findings. And we do, too. But it’s exciting to consider that the very dissociative experience you feel during a ketamine infusion is actually connected to the wonderful restoration it does. 

    Understanding Your Treatment and Your Healing

    It’s important to know that the experience itself is important… important for your improvement and healing.

    When you understand this, it’ll help you not be afraid.

    And it’ll help you understand that the dissociative experience during treatment is not something we see as bad or unwanted or as an adverse event that needs to be avoided or abolished. It’s an integral part of the treatment itself, and something that we have come to understand is critical for transformation.

    With proper treatment, and fine control of the dose and rate of your infusion, we work towards just the right place for you … where your treatment, and your dissociative experience during your treatment, fuse together in the best possible way, to give you the best possible outcome. 

    Now that’s a sweet spot!

    When you’ve felt trapped by a disorder, you’ll do just about anything to live a fulfilling life and wake up every morning with hope.

    Every single step of research that shines another light on ketamine’s Ketamine's antidepressant response may be predicted by dissociation during infusion.extraordinary impact on depression and other mood disorders brightens the path for all of us who treat patients with ketamine, and for those who suffer from all these mood disorders and haven’t been helped by anything else before.

    There really is hope!

    We Want You to Enjoy a Rewarding Life

    Here at Innovative Psychiatry we continue to see people like you who suffer and have given up. Then, after a ketamine treatment series, we often see them achieve remission and enjoying their restored ability to create, to invest themselves, to build relationships, and to savor life’s moments. We see this everyday.

    If you’re struggling with a psychiatric mood disorder that has not improved with other treatments, call us. We’re here to help you find the relief thousands of others have found.

    This is a new era, and you really can feel better…you can even feel well.  Kick that disorder to the curb…  let’s work together to help you live again.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the reinvigoration of your best self,

    Lori Calabrese, MD

     

     

  • Marti’s Story: How Ketamine Smashes Treatment-Resistant Depression

    Marti’s Story: How Ketamine Smashes Treatment-Resistant Depression

    Ketamine smashes treatment-resistant depression.Ketamine Can Eradicate Severe Depression

    Do you know anyone who’s severely depressed?

    I want you to meet Marti. If you’ve never experienced severe depression yourself, learning about Marti’s journey may give you a glimpse into what it’s like. And if you have…well…I hope Marti’s story helps you feel less alone…and helps you find hope for your future, too.

    Marti was a sparkling preschooler, obviously intelligent, and full of charm and spunk. But the spark disappeared when she was about six years old. She was also diagnosed with Type 1 diabetes that same year…which only increased the stress in her young life.

    In spite of the depression, she pushed through the best she could Ketamine smashes treatment-resistant depression.and performed well in school…receiving all sorts of academic awards.  School was her refuge and solace. Even so, her immunity to infection was reduced by the diabetes and she seemed to get sick with every bug that floated through. That made things worse…and pushed her stress higher.

    Family Crises Can Trigger Greater Severity in Symptoms

    Then, when she was in 8th grade, her dad collapsed and had to go to the hospital by ambulance.  Long QT syndrome they called it… basically a heart attack but he survived. However, he was in the hospital for 2 weeks…and because she was sick she couldn’t visit him. The helplessness of the diabetes, the constant double workload at school, her brothers’ illnesses, and her dad’s near death event, became the final straw.

    A darkness began to build inside her beyond anything she’d known before. Her mind seemed to become numb…vacant… she seemed unable to think. Things like motivation, initiative…or even the energy to do anything… had disappeared. She felt lost, but that wasn’t all.

    There were new fears. Fears of people, places, leaving the house, Ketamine smashes treatment-resistant depression.answering the telephone. School became an insurmountable mountain to climb. She began to hide under her bed for the school day so no one would know she didn’t go. She couldn’t go. 

    That was on the worst days. On the days she could muster the courage to get on the bus, she sat silently in class…looking at her desk. Holding onto her chair with all her might to keep herself from running out.

    Classmates would watch her behavior and assume she was using drugs. They’d ask her…and she’d tell them no, horrified that she gave that impression.

    Academics Suffer When Medications Fail

    Her parents took her to regular visits with an acclaimed psychiatrist. After 18 months he was amazed she wasn’t doing any better. Concerned their intelligent and awarded student would not graduate from high school without close support, her parents took her out of school and homeschooled her during her senior year. She was able to make up the credits she’d lost and graduate, mostly due to the decreased stress of the public school atmosphere.

    But…her condition worsened. She registered in a university hoping the new routine would help her improve. But it wasn’t that simple.

    She had intermittent periods of working at school and making top grades, then falling back into the abyss of darkness that had become her  constant prison. A good semester then a terrible semester. Ketamine smashes treatment-resistant depression.Finally, she was placed on academic suspension for a semester… and eventually dropped out.

    Her doctor continued to increase her dosage, and change her medicines. But nothing really worked. She slogged along in the proverbial mud, losing her hope, her self respect, and adopting a new outlook that was angry, bitter, and critical… an outlook she called “realistic.”

    These changes in her view of herself and others resulted in friendships with others who were also angry and despondent. The motivated and emotionally-healthy friends she’d had during her childhood and early teens all but disappeared.

    Treatment-Resistant Depression Spreads DOOM

    Marti wore “toughness” like an overcoat, and functioned well enough to be sullen and angry with her friends. Her social circle was a tough lot, but she tried her best to fit in with them.

    Then she met “him.”  He was handsome, weathered, and wore chains and black leather. Her epic bad boy.

    Within 2 weeks, they’d had their first big fight.

    Shattered by his dirty and cruel tactics, Marti realized she was in over her head. But she was determined to live up to the challenge. Ketamine smashes treatment-resistant depression.The verbal abuse and horrific scenes deteriorated to physical abuse, but just reminded her that she knew what it was to suffer. And he’d been alone without support, so she was determined to be that support and “help him heal.”

    This pattern continued, with periodic breakups, apologies, and a patched-up relationship for two or three years. Marti’s depressed condition deprived her of the energy, the judgment, or the initiative to improve her situation. And she told herself magical stories about how her love and loyalty – no matter what he did – could heal his wounds…and they’d enjoy a happy life together forever.

    So she trudged.

    A Disordered Brain Obsesses on Death

    And there were suicidal attempts. And interventions that saved her life. But if you know anything about depression, you know that suicidal thinking or attempting doesn’t stop because you want it to. Your disordered brain creates images of death and darkness…and compulsions… It’s the very opposite of a healthy, imaginative  brain that creates beauty and joy.

    Marti’s nightmares became a constant torment. Waking up in a cold sweat over and over in the same night, with visions of cruel and terrifying demons destroying her… and as soon as she fell asleep again they were back.

    Insomnia kept her awake for 5 or 6 days at a time…she’d feel brittle, reactive, hysterical at the smallest provocation. Screaming and cursing when the dog barked or the doorbell rang. Her coordination was also brittle, so she’d accidentally break a glass or stub her toe and fly into a screaming, cursing rage.

    The phobias increased. Marti loved photography and was given an all expense-paid trip to Thailand with a professional photography group who would help her learn more artistic techniques for her craft.

    An Opportunity Becomes a Crisis

    She’d acquired outstanding equipment for her photography business, but the depression made it nearly impossible for her to follow through on opportunities.

    Meeting with clients, doing a shoot or a sitting, became too difficult to manage, as social anxiety, fear of failure, and agoraphobia stripped her of the confidence to follow through.

    She boarded the plane to Thailand with her gear, and on a layover inKetamine smashes treatment-resistant depression. Bangkok she suffered a gargantuan panic attack. She couldn’t think to find her luggage, her gear, or her phone. Finally, she called her family collect and asked them to help her get home. Knowing her fragile state, they readily complied.

    Once home she slept for days as she recovered.

    Her Own Worst Critic

    Then the shame set in. How could she squander such a life-changing opportunity? How irresponsible could she be? She’d always hated herself, but now she LOATHED herself. How could she bear the disgust she felt for her inept failure?

    You know, when you’re struggling, you need a best friend… and if no one else…you need to be your own best friend. But sadly, whenever life got hard, Marti would use that moment to beat herself down into a shriveled nub.

    And that’s how it goes, isn’t it? When we feel awful, we tend to make it worse. And we usually need an intervention from outside ourselves to turn the disastrous tide.

    A final year with “him” was packed with physical abuse and cruel unspeakable torment that resulted in injury for Marti in her spine, her pelvis, and her neck.

    From Abuse of Herself to Assault by Someone Else

    The stress of her life led to muscle cramping in her neck and Ketamine smashes treatment-resistant depression.shoulders that left her left shoulder 3 inches shorter than her right one. She was unable to move her upper body without extensive treatment.

    But those wounds were just physical. It would be years before physical therapists and chiropractors could help her body recover from the damage.

    Still, the worst was the emotional damage. The silent scars that held her in a vice of fear.

    Chronic hospitalizations plagued her life as the multitude of terrible stressors triggered vomiting spells that lasted for days at a time. Every 5-10 minutes…around the clock.

    And those vomiting spells threw her body’s pH out of whack…and triggered diabetic ketoacidosis…a potentially fatal condition that won’t correct itself without emergency medical intervention in an ICU.

    Over. And over. And over.

    Then, it got worse. The repeated diabetic ketoacidosis and the high blood sugars that accompanied it, caused damage to the nerves in her stomach.

    Gastroparesis… a condition where the stomach’s ability to empty itself is paralyzed… led to deteriorating nutritional absorption. Basically, she was starving because her body couldn’t absorb nutrients.

    Depression Can Kill and Must Be Stopped

    It all began with depression. But depression is just the beginning… and when it’s severe, it can trigger a cascade of circumstances that can suffocate life.

    One day late in the summer, on one of many days when “he” tried to kill her, she grabbed her shoes and keys and fled.

    And she never went back.

    In the aftermath of that day, she spent more and more time in the hospital intensive care unit. A year and a half later, she was transported to the ICU so often, she was in the hospital more than she was home. A lot more. And she knew she was dying…

    She also knew she was losing her ability to see. What began as foggy-out-of-focus  moments in the early fall, progressed to full blindness by Christmas.

    A retina specialist was called in and she went for surgery the day Ketamine smashes treatment-resistant depression.she got out of the hospital.  Within two days she was back in ICU…but the surgery had succeeded in repairing the retina in her right eye. Her left eye was not reparable. But it was a start.

    Then, her doctors recommended she undergo surgery for a feeding tube placement in her intestine, and formula was pumped into her body through that tube 24/7. After another week in the hospital, she was beginning to improve. The vomiting stopped. And she began to feel a little stronger.

    A Mysterious Joy Begins to Bubble Up

    But there was something else. She was feeling better. In barely perceptible ways at first. But little by little, joy was growing. In spite of her intestinal feeding tube. In spite of her blindness. She had hope. And she didn’t know why.

    She would wake in the morning, remember she was blind…and cry. She grieved the loss of her eyesight. And facing that each day was so difficult.

    But then she would launch into the day with a spring in her step.  Initiative to move past this disability and build a new life. She had not had initiative since she was in 8th grade. She’d not felt joy since she was in kindergarten. What was causing this?

    Ketamine Smashes Treatment-Resistant Depression

    She heard about ketamine treatment… and someone suggested she check her surgery record to see what anesthesia she’d been given in surgery… so she did.

    When the surgery record arrived in the mail 10 days later, she was astounded to find out she’d been given ketamine as an anesthesia in surgery. Could that be why she was feeling so much better??

    Marti danced across the room just to consider that ketamine might be the reason she was coping so much better, and enjoying so much again. She set out to learn all she could.

    That first IV ketamine infusion in surgery restored her wellbeing for 7 Ketamine smashes treatment-resistant depression.months. Then she began to feel the old depression returning, the critical thoughts, the anger, the hopelessness…but for the first time since she was a little girl…she didn’t want to die anymore. 

    6 IV Ketamine Infusions + A Couple Booster Infusions

    So she set out to find a way to pay for a series of 6 infusions, as she’d learned that stacking infusions would produce more lasting results.

    Within a couple weeks, her parents were able to help her with the money for a treatment of 6 infusions over 2 weeks. She’d heard that ketamine was available IV, IM, or intranasally...but she’d been convinced that IV was the best route for ketamine’s full benefits.

    After the first infusion she felt no better…but that night her mother noticed she was folding clothes…for the first time in four years. Initiative.

    Then, after the second infusion she thought she had a glimmer of hope. A lifting of pressure…of the weight that had been crushing her. Decreasing anxiety and diminishing sadness…she could tell she felt a bit lighter.

    After the third infusion, she laughed a little, and talked a bit more freely… And from there her outlook grew better and brighter day by day through the last 3 infusions and over the next few weeks.

    A few months later she’d been hospitalized more times (and with  the intense stress of severe illness) she started “sinking” again…and called her doctor for a booster infusion of ketamine. She’d heard that sometimes that’s necessary. And she was glad she got it… it helped.

    But four months later she needed yet another. Even so, that infusion of IV ketamine has held her remission steady for a long time.

    She’s learning Braille, training to work, and excited about the life that’s ahead. She’s 32, in love with a wonderful guy who stood by Ketamine smashes treatment -resistant depression.her through the illnesses and surgeries, and life is working for her now on an exciting new level.

    Marti believes in herself now and in her potential. And she’s eager to contribute to the lives of others. She’s joined the board of a non-profit blindness advocacy group. She has new friends who also have bright outlooks on life. Who are also productive and contribute to the community and to each other.

    By the way, remember those terrifying nightmares that plagued her? They’re gone. Her dreams are bright and beautiful now…or at worst a little frustrating. The terrors that beat her up through all her nights for so many years are gone.

    It All Began With Depression

    And a co-existing illness. But treating the illness didn’t resolve the depression. Ketamine treatment did.

    Marti feels transformed. Her family says she’s finally the person she was when she was 3 years old, before the assault of life hit. Her cleverness, wit, spunk, and joy for life has returned.

    Marti is one of those people for whom the 6-infusion ketamine protocol wasn’t enough. She had researched extensively to understand how ketamine treatment ought to work and what to watch for. She also understood that to stay better required building a stronger infrastructure that would support her remission from depression. 

    And she actively worked to put that in place, through friendships, attitudes, and improved health. Active cooperation with her team of doctors, and doing the work in her outlook about her career and her relationships all helped strengthen that infrastructure.

    And today, she’s in full remission. She sings every morning, dances a jig of her own design when she thinks no one is looking.  Her life is full of promise.

    She’s attracted to upbeat, healthy-minded people, and she loves herself. She enjoys life in a way she’s never been able to, and marvels at the frame of mind that held her captive 25 years.

    Severe Depression Affects Every Aspect of Life

    For those who have never experienced major depressive disorder in its severity, the fallout in Marti’s life may seem outlandish.

    But Marti’s story demonstrates how all-encompassing and Ketamine smashes treatment-resistant depression.dangerous depression can be.

    And why ketamine treatment is the golden child in psychiatric treatment these days. There’s no other treatment available that is as effective, potent, and all-encompassing for restoring life, hope, motivation, initiative, and a bright outlook to this degree.

    At Innovative Psychiatry we’ve watched thousands of patients with treatment-resistant disorders follow the path Marti has in full remission.

    Relief from social anxiety, depression, panic disorderPTSD, OCD, bipolar disorder, addiction, substance use disorder, and suicidal thinking.

    (Did I mention ketamine can stop suicidal thinking in 4 hours or less?)

    If you suffer from severe depression that other treatments haven’t helped, call us. We can help you rediscover the life you’ve lost, just like Marti did. You, too, can enjoy remission from the crippling throes of mood disorders.

    Give yourself the opportunity to live again, or even for the first time, and develop a fulfilling and productive life. Because you can.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the restoration of your best self,

    Lori Calabrese, MD

  • Ketamine Boost Infusions: When You Feel Better-ish, But Not Better Enough

    Ketamine Boost Infusions: When You Feel Better-ish, But Not Better Enough

    Ketamine Boost Infusions Combined with Infrastructure Changes May Help You Sustain Remission

    What do you do when the symptoms return?

    You spent years in that condition. The sadness, the hopelessness…the numbness.  That terrible shame. Unable to participate. Shut down. Withdrawn.

    Or, maybe the symptoms were reactions to sudden noises…smellsdarkness… or touch.

    They may even have been obsessive thoughts…and compulsive actions that follow. 

    Or the old dreaded cravings…and relapse close behind.

    You even wondered if you could go on much longer.

    Then, you heard about ketamine treatment, and you found a way to pay for the treatment series of 6+ infusions. Afterwards, you came alive and felt so much better.

    For once, you had hope, motivation, initiative. There was energy to live, invest Ketamine boost infusions bring back the joy like these colorful balloons floating in the sky.your effort, build healthy relationships. You enjoyed your job and began to really excel. You actually felt happy. It was exhilarating to not just barely hang on.

    Then it happened. …out of nowhere…those old symptoms began to return.

    Maybe your job performance led to more responsibility. And the higher level of stress began wearing down your synapses…those connections between the cells in your brain. It’s possible that after awhile those cells in your lateral habenula began bursting too much and too often.

    Plus all those G proteins that had slid off the lipid rafts in your cell membranes may have started piling back up on those rafts. The numbness that had gone away, came back.

    Why?

    Could it be because your wife’s cousin is living with you, taking advantage of your hospitality, rather than trying to find a job or her own place. And you keep stuffing your feelings…you don’t want to upset your wife.

    Or maybe your boss takes credit for every innovation your create. But you? You keep working long hours and your husband is fed up that you’re never home.

    Stress.Ketamine boost infusions can calm the storm once again.

    You’re so mad at yourself for not accomplishing more, so you carry your feelings on your sleeve, and jump down the throat of anyone who crosses you.  You KNOW they don’t deserve this treatment…but you’re too ashamed to apologize.

    Or, perhaps you got a little cocky with your sobriety, and began hanging out with friends who still use the substances you’ve broken away from… ? Any type of hard and stressful situation can make you think back to the old days…

    It also might even be that this disorder is in your genes…that your whole family fights depression and it’s like a heavy gray blanket covering everyone around you. It could be to get better you might have to purposefully surround yourself with more positive, uplifting people …?

    Or separate yourself from obligatory situations

    Sometimes we can’t see the nose on our proverbial face. We need someone to point it out and help us see specifics like these in our own complicated lives.

    And we need to take action.
    Tell your spouse what you really feel. Stand up to your boss even at the risk of getting fired. Because your self respect is too important to just silently bow to his abuse and dismissal of your value. That might reduce your stress.

    Sometimes it doesn’t take much…just a step… to stand for what’s right. But when you do, the chains fall off.

    And your own personal infrastructure – the things that make your life yours – is freed up to support your well-being.

    So back to the causes. All of the mechanisms associated with stress can go into play, and undo some of the work the ketamine treatment had accomplished.

    This is why it’s important to find ways to improve the “infrastructure” in your life,Ketamine boost infusions help you rebuild the infrastructure in your life and lay groundwork for peace. to reduce stressors that wear down your resilience.

    Without making healthy changes in the areas most critical to your wellbeing, the same stressors that caused you to need ketamine treatment in the first place may cause you to need it again.

    But…let’s be clear: there are no published studies about “booster” infusions

    Can you believe that?

    None.

    But in all fairness, it can take years to gather data on recurrence of symptoms and how to best treat them.

    Still. We need research!

    Meanwhile, what do we do? The best we know to do is to use our clinical judgment if symptoms try to creep back in. We collaborate with you, and your treatment team, about the best way to proceed.

    Lifestyle changes? Any improvement in the stressors in your life that you can make…well, that can be a big help.

    A medication change perhaps? Some people continue their medications while receiving ketamine infusions. A change in medication might help…

    Or is an additional ketamine boost infusion what’s called for? Perhaps so. If nothing has ever worked for you before to control your symptoms, you may know that ketamine infusions are your “go-to” solution.

    Those of us in clinical practice have learned that additional infusions down the road can help refresh the work ketamine began.

    Many patients…and their doctors…take a shortcut straight to ketamine because of their experience that it worked so beautifully after all those failed rounds of Ketamine boost infusions are the beacon in darkness for those who have recurring symptoms.antidepressants and other treatments.

    But we still don’t have research to show us in those cases how often we should prescribe a booster infusion or whether maintenance is inevitable for the foreseeable future.

    My experience says that ongoing maintenance doses really aren’t required in many, if not most, cases. There is no research to guide us at this point. I do wonder why? …and hope that changes soon.

    For now, I think it’s premature to make a blanket recommendation for ongoing maintenance “booster” infusions every few months indefinitely.

    There are too many cases of patients who only need one or two or three after the initial series… then no more for a year or more. Psychiatrists need to work with their patients and the health care team to guide the best recourse for each individual patient.

    But remission is the goal. Helping you feel truly good and able to live productively.

    One or two ketamine boost infusions at a time can support and sustain remission. Especially if the patient’s infrastructure is in place and strong.

    So…maybe you still feel better than you did before you knew about ketamine…but you don’t feel as good as you did a few weeks ago.

    What do you do?

    When you feel better, but not better enough, you may need a ketamine boost infusion to get your brain working well again and get you back on track.

    Kick It Up a Notch!Ketamine boost infusions kick up your resilience a notch.

    Every brain is different, just as every person is different. Dosage and frequency can vary.

    Another point… for the purpose of rebuilding and strengthening your personal “infrastructure,” you might benefit from therapy with a skilled therapist after each of your ketamine infusions.

    This is when the neuroplasticity in your brain is very high, and it’s easiest to consider new ways of thinking, of reacting, of decisions…that make your life more functional, less stressful, and more rewarding.

    Some people don’t need additional infusions at all. When you feel better, really so much better you’re empowered to build the life you want, there’s no need for boosters. And there’s no need to schedule them in advance.

    But when you feel better but not better enough, you need to take action and find ways to get completely better. Start with another ketamine infusion.  And take an inventory of your daily life. What do you need to change to make it better?

    It might be taking action to change something. Or it might be taking action to change your attitude about something. But use those extra ketamine infusions to explore your life, your heart, your attitudes. And with the help of your therapist, make some solid decisions that renew hope in your life.

    Renew your wellbeing.

    Slash that powerless feeling and remove it…put yourself back in control.

    It may require additional infusions every few months for awhile to get your life on track, your infrastructure in line with your purpose, and to create a life you enjoy. But it’s worth the effort.

    And by the way, there’s no shame in additional ketamine boost infusions. No one but you knows what’s working for you. This is not a competition.

    The goal is for you to live life as your best self, rather than a shadow of that. That you can enjoy your work, your hobbies, your relationships, and your purpose.

    At Innovative Psychiatry we work closely with you and your health care team to help you find the most productive and fulfilled you.  Call us.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the emerging of your very best self,

    Lori Calabrese, M.D.

  • Remission by Ketamine Treatment:  How You Can Hold On to the Benefits

    Remission by Ketamine Treatment: How You Can Hold On to the Benefits

    Remission by ketamine treatment allows these girls to play in the surf.IV Ketamine is a Most Extraordinary Medicine 

    Here Are Some Ways to Hold On to Its Benefits

    This ONE medicine can relieve a wide array of psychiatric disorders. Remission by ketamine treatment is at center stage of the mental health world.

    The same medicine that lifts depression and restores creativity, initiative, and hope, also stops suicidal thinking in 4 hours or less and relieves social anxiety.. and, oh yes, OCD. It restores balance in bipolar disorder, and dramatically reduces cravings in substance use disorders…it helps PTSD heal and may also prevent PTSD in first responders.

    Ketamine isn’t just an anesthesia medicine any more.

    It’s changing lives and taking the world by storm.

    It can restore your power to enjoy the beauty of a yellow warbler as it sings among the cherry blossoms. Remission by ketamine treatment empowers you to enjoy the beauty of this yellow bird in these cherry blossom branches.Remember when you felt nothing…? A void. Empty. Isolated. But remission with ketamine treatment changes everything.

    You’ve never seen a medicine like this. While pharmaceutical companies are testing other forms of the ketamine molecule, or other molecules similar to ketamine, there is so much more to be learned about ketamine itself!

    These other molecules don’t rival ketamine in effectiveness — well, actually, nobody’s doing head to head comparisons. 

    Because ketamine itself has become the gold standard. Its broad reach and widespread actions relieve suffering in so many different disorders that for so many it has become hope in a jar.

    Who could have ever dreamed the day would come when a few infusions could lift a new mother right out of postpartum depression and empower her to bond and enjoy her newborn…?  Those heartbreaking stories you hear in the news … can be averted.  

    Think what ketamine could have done for Vincent Van Gogh if ketamine treatment had been available in his world. Of course, it was unheard of, but it could have saved not only his ear…but his life.

    Because it’s saving lives.

    Remission by Ketamine Treatment: Antidote for Psychiatric Misery

    The terrible anguish that depressed persons suffer has an antidote now.  Six treatments (or a couple more) and you can live again, create again, enjoy people again, come out of the terror of darkness again.

    You can feel love, hope, initiative, motivation, and creativity. In the morning, you can spring out of bed, Remission by ketamine treatment empowers you to enjoy the flavor of a fresh tomato.and sustain energy and productivity all through the day. Enjoy the taste of a flavorful tomato right off the vine. Tackle long forgotten projects again, complete them, and look at your work with deep satisfaction.

    You no longer have to be trapped in a vacuum, unable to connect, lost in the shadows of your mind. You don’t have to fear your own reactions to unexpected noises, or insensitive comments someone drops in your presence.

    Feel whole again, find out you can have self-control, and build a life you’re proud of. For many who suffer with depression anxiety that just won’t cut them a break, such a concept is an elusive dream.

    But it’s time for us to take a step further, and learn more.

    For instance, what factors influence how effective ketamine treatment is for you?

    Infrastructure for Optimal Wellbeing

    Without question, one factor is simply all those unknowns. Because we’re learning daily about what ketamine can do, as well as the unique genetic, environmental, and other factors that may prevent one brain from responding to ketamine when the next one responds so dramatically. There are factors we just don’t know or understand yet.

    We have so much to investigate and learn.

    But there are some factors we do recognize.

    For instance, it appears that there are environmental factors and personal ones, too, that may determine how long a series of ketamine infusions will benefit you.

    Remission is Most Enduring when Your Personal Infrastructure Is in Place

    When we speak of infrastructure, we’re referring to all the things in your life that play a part in your outlook and productivity. Things like your attitude, your response to stress or conflict, your nutrition.

    To get the most out of ketamine treatment, it helps to do the work to learn and practice healthier Remission by ketamine lasts longer if you do the work, practice self love, and embrace change.reactions and responses, so you don’t pull the same old problems in after you.

    It helps if you’ve learned to practice self-love along with respect for others. To manage your anger, and avoid the pitfalls of co-dependency. It helps to feed your microbiome to help maintain your emotional balance.

    Because even if ketamine’s wonderful repair work brings you to peace, if you haven’t done repair work in your thinking, your attitude, your outlook, your view of yourself…as well as your view of others… the destructive habits that may have crept in with the misery of your disorder in the first place will slowly tear down the work your ketamine treatment accomplished in your brain.

    Not what you want.

    You could, then, get a booster infusion to refresh the good repair.  

    On the other hand, if you’re actively participating in therapy to help you change your attitude and outlook, as well as your responses to the things that happen in your life, you may find your outlook stabilizes after you reach remission… and lasts.

    This, of course, is not to say that if remission doesn’t last, it’s your fault. It’s not. There are far too many factors involved in what you’ve experienced to blame your symptoms on any one thing, especially something within your control.

    But consider this.

    Choices You Make Can Strengthen Remission

    If a stressful life has found you reacting and angry in response to small frustrations, or if you’ve beenRemission by ketamine treatment lifts the feeling of abandonment, isolation, despair. in a toxic relationship where you know you’re being abused and exploited, and stressors like these aren’t changed, you can see why you’d become more and more worn down and stressed…even despondent…all over again.

    But let’s say you found the courage to leave that destructive relationship…or you figured out how to change the way you perceive small frustrations so you’re able to be unruffled by them (and ketamine can help you accomplish these things)…you can see how the peace and emotional health in your life would benefit.  Don’t you think..?

    That’s the thing about ketamine. It can do its part to restore those brain structures that have been worn down and broken by stress, but it can’t force you to get some distance from those factors.

    That’s a step you must take … and ketamine treatment can help you get there.

    Hard Decisions Lead to Better Living

    Here at Innovative Psychiatry we’ve seen this happen in our patients time and again. Sometimes, a patient reaches remission and has a new lease on life. But in a month or two she’s so disappointed because she thinks the ketamine treatment has “worn off.”

    However, rather than the treatment wearing off, it’s far more likely that new damage is happening because of her unchanged thinking or environment. When our patient understood the impact of those things, and she entered counseling, her need for booster or refresher infusions seemed to disappear. We have seen this process in many patients.

    Many patients have been able to enjoy remission for over 2 years once they learned to make healthy changes in their lives.

    There really are things you can do – with ketamine’s help – to maintain the joy of remission by ketamine treatment.

    Medical Skill with Ketamine Treatment Can Turn B- Results to A+ Results

    Another important factor in achieving and maintaining remission seems to unmistakably be tied to the methods used in administering this medicine. The outstanding and life-saving benefits of ketamine treatment have changed the way the world views depression, social anxiety, bipolar disorder, PTSD, OCD, substance abuse disorders, eating disorders…and suicidal thinking.

    But, to get the most out of your ketamine infusion, in addition to building your infrastructure, you need to choose a psychiatrist who is most skilled in administering ketamine to your best advantage. 

    We use precision infusion pumps, state-of-the-art monitoring equipment, and we’re adept at titrating dose, rate, and frequency to achieve optimal outcomes.

    Our goal for you is remission of your symptoms with ketamine treatment. 

    There’s no question that ketamine treatment can renew your hope if you or your loved one suffers with stubborn symptoms.

    Know that you can feel better, live better, and restore what your symptoms have taken from you. You can find your real and best self, and enjoy the world you’re in.

    If you suffer from symptoms that medicines and treatments haven’t helped, call us. We can help you turn your emotional and mental chaos into order through ketamine treatment. You can enjoy new hope and purpose for your life.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV KetamineTo the realization of your best self,

    Lori Calabrese, MD

  • When Your Loved One Plans to Die: How to Prevent Imminent Suicide

    When Your Loved One Plans to Die: How to Prevent Imminent Suicide

    Depressed lady floating in water needs to know ketamine treatment erases suicidal thoughts.

    Suicidal Thoughts…?

    “Nah, she’s not going to kill herself. She’s too afraid of pain.”

    “He’ll never follow through…he just keeps threatening… he’s just looking for attention…”

    …“I’m so shocked he did this.  I had no idea he was thinking about suicide… I feel so bad…”

    If you’re depressed, or you know someone who is, your heart may break when you hear people say things like this. Or…maybe you say these things yourself. 

    Let’s talk about how depression leads to thinking about suicide… and how thinking about suicide may lead to attempting it – or worse dying.

    If you ever think about suicide yourself, I hope this discussion will give you new hope and you’ll reach out for help.

    And if you love someone who thinks about suicide, I hope we can help you help them.

    Suicide is the 10th leading cause of death, according to the National Center for Health Statistics, and it’s rising.  If you love someone who’s depressed, and has spoken of death or wanting to not live, you and your loved one have both suffered from this epidemic.

    The higher the statistics climb, the greater urgency we all feel to find ways to stop these tragedies. But to do it, we must understand how to recognize the signs and help those caught in suicide’s web to break free, and live… really live.

    Clearly this is a multi-faceted quest for everyone in healthcare, as well as families and friends of people at risk.

    So, how do we know that someone near us is at risk..? 

    That in itself is complicated.  Because there are those with suicidal ideation, and there are those who progress from ideation, or thinking about suicide …toWoman in despair needs treatment because ketamine treatment erases suicidal thoughts. doing it. 

    How can we know when someone is thinking about death and suicide…and how can we tell if they’ve moved on to planning to take action…?

    How can you even know who’s really at risk?

    Risk Factors for Depression that Lead to Suicidal Ideation

    If someone has these risk factors in place, you can know they’re at risk for eventually thinking about suicide unless something changes.

    So risk factors signal a possibility of danger for this person within the coming months or years. The danger to their life isn’t imminent at this point. 

    Risk factors for suicidal thoughts include depression, hopelessness, the presence of nearly any psychiatric disorder, and impulsiveness.

    These risk factors certainly herald the likelihood of someone thinking about death and suicide. However, they’re no help in differentiating between someone who just thinks about it, and the person who will follow through. Of course, it’s possible that any person who thinks about death and suicide, who wishes for an escape from their pain, may advance beyond the thinking stage to taking action…tragic action.

    So how do we identify that person?  How can we get them help before it’s too late…?

    Suicidal Ideation vs. Intent

    What’s suicidal ideation? “Ideation” is a weird word, and no one really uses it, to speak of. Except in psychiatry. It means the “formation of ideas or concepts.” So it means that thoughts about suicide begin to form where they didn’t exist before. And over time those thoughts may continue to evolve.

    As they unfold, sometimes they progress to more dangerous ideas and concepts, like how to commit suicide… and even when.  So it’s vital to learn to recognize the difference between when someone you love has passive thoughts of death as a relief (like if I didn’t wake up … was killed in an accident…or had a heart attack, it wouldn’t be a relief), or active and intrusive thoughts about suicide, or has active, increasingly frequent, intrusive thoughts about suicide with a detailed plan or date. Someone who has added purpose and decision to those thoughts.

    As a friend or family member, hearing someone you care about talk about such terrible things can be unsettling… shocking… alarming. But it’s important to recognize these signs, pay attention to them. Give them the credibility they deserve, because shocking or not, they’re real.

    E. David Klonsky and his research team published a review of the recent research about warning signs for someone likely to attempt suicide soon.  These are warning signs in someone who has the risk factors we talked about. Depression, other psychiatric disorders, hopelessness, and impulsiveness.

    This focus is to go a step – or maybe two – deeper. And it’s laid out like this. Does he or she:

    1. Think about death and suicide, or about hurting himself

    2. Seem isolated, withdrawn, disconnected from important relationships

    3. See no purpose or meaning for his life

    4. Seem obsessed with death, and writes about it 

    5. Display sudden changes in his personality, his sleeping patterns, his eating patterns

    6. Use an increased amount of substances

    7. Struggle with guilt feelings

    8. Show loss of interest in academics or work

    9. Exhibit paranoia and irritability

    10. Feel trapped

    Capability for Suicidal Action

    Klonsky makes an important distinction about determining if the suicidal person is in imminent danger of taking deadly action. In addition to the warning signs above, does this person have the capability to take a decisive action to end his life or to end her life, such as: 
    • High tolerance for pain

    • Diminished fear of pain

    • Increased fearlessness about pain

    • Persistence through pain and distress

    • Knowledge of and access to a lethal means of committing suicide

    • Experience with self-inflicted injury

    Pay attention, because this is huge. These traits and features, when paired with all the other risk factors we’ve talked about, indicate not only the serious warning of imminent deadly action, but also the capability to follow through. This is the person who sees no reason to live and is equipped to end his life when he decides to. Within minutes. Or hours. Or possibly days.

    Now is the time to intervene.

    But…how?

    Start with calling 911 if the situation calls for it.

    If calling 911 seems like an over reaction, think about the items on the lists above. If he seems isolated, withdrawn, if she seems disconnected from important relationships, step up and engage them in conversation. Look for ways to connect with him, show him he’s loved and that he matters.

    If he has access to a method for ending his life, find ways to remove items that he might think of using. Reduce his capability.

    At the very least, encourage him to get help. Immediately. And encourage him to not give up. If needed, encourage him to allow himself to be treated through admission to a psychiatric hospital unit to help him stay safe and stabilize on treatment.

    As long as he stays alive there is hope.

    So let’s talk more about that hope.

    But first… there’s another element you might need to consider.

    Rethink Your Trite Empty Words

    What do you say to him once you intervene?  What hope can you offer?  If she’s been depressed, tormented, troubled…even agitated…for a long time, you’ve probably told her before that this situation will pass.  That their symptoms will eventually subside. That life is worth living.

    He may not believe that at all anymore. At this point he may have become resigned to the belief that there is just no hope.This young man contemplates jumping and needs to know IV Ketamine treatment erases suicidal thoughts.

    And quite honestly…for some there really was NO HOPE. They couldn’t see it.

    But the horizon for people who battle severe depression, intractable bipolar disorder, crippling PTSD, and terrifying panic disorder… has changed.  There is new hope now.

    IV Ketamine Prevents Imminent Suicide

    IV ketamine treatment erases suicidal thoughts. Now that’s some HOPE for you!  It’s a 50-year-old anesthesia medicine that has all kinds of history in operating rooms, war zones, and emergency rooms around the world. This remarkable medication still hasn’t tapped all its talents.

    In the last 15 years it’s been at the center of great victories and outstanding therapy for treating psychiatric mood and anxiety disorders in all ages. By applying different actions in the brain, it rejuvenates and restores synapse connections throughout the brain and helps rebuild the very structure of brain cells themselves — called dendrites and dendritic spines — prolifically branching a dense communication system between nerve cells to turbo boost the signals that make the brain function and come alive.

    For children with the Fear of Harm form of Bipolar Disorder, ketamine treatment has dramatically reduced symptoms and allowed these children to feel joy, happiness, love. To have the ability to do their homework and contribute at school without torment. Some of these children feel happiness and joy for the first time with the help of ketamine. It’s like a child who’s been blind seeing for the first time.

    In men and women with PTSD, it has calmed the fear, restored peace, balance, and in enjoyment in life.

    For those deeply depressed, it has restored their energy, creativity, initiative, and hope.

    And for those with suicidal thoughts or imminent suicidal plans, it has erased suicidal thinking fast. In minutes or a few short hours. Once those thoughts disappear, treatment can proceed to relieve depression.

    No medication has been shown to erase suicidal ideation in less than 4 hours.  Well, nothing except IV ketamine. IV ketamine prevents imminent suicide so you can pause, catch your breath, and work on treatment and recovery.

    IV ketamine stops suicidal thoughts.

    When you help your loved one stop suicidal thoughts, there’s hope for relieving the depression, too. If he’s been taking ketamine erases suicidal thoughtsantidepressants that haven’t helped, he’s likely a candidate for IV ketamine treatment.

    No longer do you have to say, “It’s going to get better someday, I promise…somehow…”

    You can say, “Dr. Calabrese has advanced treatment options. You’re going to feel so much better very soon.

    And what about you?

    Suicidal Thoughts vs. Intent to Act

    Do you have thoughts about death…suicidal thoughts… or even a strong plan for suicide?

    Do you think about death, or about yourself dying…?

    These thoughts…these images… are a sign of severe depression and your need for treatment.

    IV ketamine treatment provides relief, restoration, and relaxation for 80% of patients with treatment-resistant depression at Innovative Psychiatry. We see it every day.

    We know that the literature speaks of 70-75% positive outcomes with IV ketamine treatment. But keep in mind those are studies conducted to learn about ketamine using strict protocols. Research protocols don’t allow for the many adjustments we make to fit your need like we can as your doctor.

    Our goal is to achieve the best outcome for each patient — taking into account all of the complexity that comes with your history, your biology, and your previous treatments. And we’ve learned that some patients need varied adjustments in dose, or perhaps a slightly longer infusion time or longer infusion series in order to achieve remission. For these reasons, some private practices are able to achieve better outcomes than larger published studies. We consistently see excellent outcomes, relief, restoration, and enjoyment of life in 80% of our patients, even when nothing else has worked.

    There are the naysayers.

    Who believe IV ketamine treatment is a “passing fad” or has too many “side effects.” (There is no weight gain, no sexual problems — or other side effects antidepressants are known for.) That we should wait. That it hasn’t been studied enough. And some who say that using it is premature.

    Here’s what’s premature: dying before your time.This happy lady in the snow knows that ketamine treatment erases suicidal thoughts.

    IV Ketamine Treatment – A New Frontier

    IV ketamine treatment is a new frontier in psychiatric treatment.

    We’re also learning that some of the 20% who aren’t helped immediately by ketamine treatment can get better over time. Weeks or months later, ketamine seems to take hold and they emerge better than ever.  We have some theories working as to why that happens.

    So there’s still so much to learn, and that’s why it’s important that you communicate with us during and long after your infusion treatments are over, so we know how you’re doing. It helps us learn more about how IV ketamine treatment works for you. We offer state-of-the-art daily mood monitoring tools to make it easy. To keep you well. So you feel safe. And connected. 

    If you experience visual images of death or of yourself dying, if you think about it, if you find yourself planning it…there is hope, and a way out without harming yourself. Hang on. Find safety. And call us.

    IV ketamine treatment can give you relief and erase those thoughts from your mind. You can have an opportunity to redirect your life and your treatment.

    We offer innovative treatment options for those with treatment-resistant mood and anxiety disorders like depression, panic disorder, bipolar disorder, PTSD, social anxiety, and OCD. If you’d like to see if IV ketamine treatment can pull you up out of despair, schedule an appointment and let’s work together to help you get better.

    We’re eager to work with you and your doctors to help you achieve a healthy, balanced, restored life, and the desire to live it. 

    To the healing of your best self in 2018,

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

     

    signature of Lori Calabrese, M.D.

     

     

     

    Lori Calabrese, M.D.

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