Lori Calabrese, MD

Tag: IV Ketamine Treatment for Panic Attacks

PTSD Can Make You Sick. Can Ketamine Stop That Before It Does?

Studies Imply PTSD is a Gateway Condition That Can Lead to Other Critical Illnesses.

Ketamine treatment can bring PTSD to remission, and hopefully prevent these other illnesses.

Bang! A sudden loud noise breaks the stillness.

“What tha…??!! Your companion jumps with a startled exclamation, missing that you’re standing there frozen, pale, and in-one-motion spun around with fists raised and ready for a right hook.

In a flash, you’ve advanced from calm, to terrified, to ready-to-fight-for- your-life.

Your friend laughs at his own jumpiness. But you’re not amused. With adrenalin coursing through your body, you’re angry.

It’s awful to be so angry, when “nothing” has happened.

It’s just not that easy to calm yourself when the deafening sound turns out to be a slammed door, rather than a life-threatening attack.

Your hands are shaking, it’s hard to speak … you clench your jaws, trying to hold onto the thread of self-control that’s keeping you from doing serious damage. A thread that grows thinner by the second.

Your friend slaps you on the back in a good-natured gesture, to snap you out of it. That was the worse thing he could have done. In a fraction of a second, you’ve swung around and your powerful fist connects with his not-so-solid jaw.

He groans and hits the floor.

And suddenly you realize you may just have lost the best friend you’ve had all year.

You never told him about your PTSD. You didn’t want to start the friendship out with shame. You wanted to be on even ground. Now this.

PTSD Can Make You Sick

PTSD has been called “a life sentence” according to a review of large cohort studies by a team led by KC Koenen in the Journal of Psychological Medicine in January, 2017. This “sentence” is derived from the multitude of health conditions that accompany PTSD symptoms.

Several large studies have shown a link between PTSD and metabolic as well as cardiac diseases, such as myocardial infarction (commonly called “heart attack”), stroke, Type 2 diabetes, and coronary heart disease. Of these conditions, it seems that those hit hardest are African Americans and Hispanics.

Having PTSD increased their risk over other combat veterans from the same war zones…veterans who even had other psychiatric disorders. Over 660,000 veterans were studied. Compelling, isn’t it?

Another study led by A. O’Donovan and published in the Journal of Biological Psychiatry in February of 2015, showed that combat veterans from Afghanistan and Iraq diagnosed with PTSD were more likely to develop autoimmune and endocrine disorders.

They had a greater risk for IBS, thyroiditis, rheumatoid arthritis, multiple sclerosis, and lupus erythematosus.

Terrible diseases.

See the diseases and conditions piling up?

But there’s still more.

Genome studies of trauma and PTSD have identified specific genes that are linked to dysregulation of the immune system. Michael Breen led a team to write a mega-analysis published in Psychopharmacology of five studies that focused on genome effects from types of trauma and PTSD.

They found that there was lower expression of cytokine-related genes in men who’d been exposed to interpersonal trauma or combat… than was found in women.

With the collection of all the data, they identified the common pathways of inflammation in PTSD, and painted a picture of extensive dysregulation in the immune system in people with PTSD.

More Studies, Please, about PTSD and It’s Relationship to Illnesses

Researchers recognize that more study is needed to understand whether activation of these inflammatory pathways are caused by PTSD, or whether they’re a natural consequence of the behaviors and lifestyles of people with PTSD, or something else.

For example, people with PTSD reportedly often smoke tobacco, have erratic sleep patterns, lack of physical activity, poor diet choices, etc.

But if the associated illnesses are actually a result of the trauma itself and the conditions it triggers, it implies that PTSD is part of a broader systemic illness triggered by psychological trauma.

I’ve pointed out for a very many years that I’m not a fan of the term “mental illness” — as though psychiatric disorders are not part of the body, not physical, not legitimate. Something woo woo… Kind of unbelievable given that there are so many complex brain structures, processes, and functions involved.

Your brain is physical. Your heart is physical. Your kidneys are physical. We refer to illnesses of the heart, of the lungs, of the kidneys, as physical illnesses. Well disorders of the brain are physical, too.

So in this research that suggests that these psychiatric disorders are actually larger systemic illnesses, I’m surprised that’s not obvious but glad we’re talking about it.

How the Brain and The Body Interact

Let’s look at some simple examples, just to illustrate.

If you have anxiety, you probably have some sort of physical symptoms that express it. For some people, it may be that they break out in hives. In others, it may be a sick pit in your stomach, or intestinal cramps and watery stool. In someone else, it may be shaking.

When you’re in love… remember those butterflies? That’s a physical sensation that accompanies an emotional experience.

If your heart is broken, it can feel like your chest is ripping apart.

Rene Decartes was a French-born philosopher in Sweden who purported the theory of dualism. The idea that the mind and the body are utterly separate. But the simple act of shedding tears shows that the two are quite influential on each other.

This is another important step in vanquishing stigma, and getting help for those who suffer.

With that said, it’s vital we understand more about PTSD and what it triggers in someone who has it. In fact, perhaps with deeper study, we could see insurance companies beginning to pay for all aspects of the disorder… autoimmune, cardiac, lung, kidney, Type 2 diabetes…and psychological terror and pain.

PTSD Can Make You Sick. Can Ketamine Stop That Before It Does?

Multiple trials with ketamine treatment for PTSD have demonstrated its rapid and robust effectiveness in treating symptoms.

One of the ways it works is by influencing cytokine production. And since cytokine-related genes seem to be expressed less in certain men with PTSD, improving the expression of cytokine may be one of the reasons for ketamine’s effectiveness in PTSD.

There is so much to learn and understand about ketamine and how it works as well as it does. It doesn’t work with everyone…of course not. No medicine works for everyone. But, it works better and in a higher percentage of people than any medicine that’s ever been available for treatment-resistant mood disorders.

Ketamine for severe depression.

Ketamine for PTSD.

And ketamine for bipolar disorder, ketamine for social anxiety… plus ketamine for OCD, and ketamine for addiction… and yes, ketamine for suicidal thoughts.

At Innovative Psychiatry, we treat people every week with ketamine treatment for all of these psychiatric disorders.

We’ll take an in-depth history of your symptoms, treatment course, health and family history, and evaluate whether you’re a candidate for ketamine treatment.

We use only the best and most thorough practices when we provide your ketamine infusions. With a cozy and appealing environment, a comfy recliner or soft leather sofa, and warm blankets, the lights will be low and many people bring their own soft music to listen to.

You’ll be monitored continuously during the infusion, and treated for any uncomfortable side effects. Most patients tell us they have never felt so relaxed.

But what they really love is how they feel … better and better as the series of infusions advances.

Most leave our office with a new lease on life, and report later they can enjoy hobbies, work, friends, again, and that they have initiative and motivation to tackle projects they’d put off for years. They enjoy their family and their friends — and have the energy to build relationships and make them strong again.

Put simply, they have the power to build a rewarding and fulfilling life.

PTSD is a serious disorder that can lead to serious, even critical, additional illnesses. Can ketamine stop that before it happens?

If you wonder, how do I find a psychiatrist near me who can give me a good chance at getting better..??

We sure understand.

And if you suffer from PTSD, and no other treatment has helped you to function, call us. Call us now.

Let us help you get your brain working again as it should, so the nightmares fade, the flashbacks melt away… and you can enjoy loving your family and your life. You can even have fun again.

If you suffer from any of these conditions and haven’t improved with at least two other medicines or treatments, call us. We want you to live the life you wish for, the best life you can live.

To the restoration of your best self,

Lori Calabrese, MD

October 29, 2018
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

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.

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.

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.

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.

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.

To the reinvigorating of your best self,

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October 1, 2018
Dissociation: Is It Key to Ketamine’s Antidepressant Response?

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 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, 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 the 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 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 hours 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 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.

To the reinvigoration of your best self,

Lori Calabrese, MD

September 24, 2018
Biological Psychiatry Stamps Out Stigma and Old Wives’ Tales
When Your Loved One Needs Treatment –

The Stigma of Old Wives’ Tales Can Cause Crisis… or Tragedy…

A mother’s heart is broken when she finds her 19 year old son dead in his car…apparently from carbon monoxide poisoning. She knew he’d struggled for years, saying things like he wished he was dead…or about how he wanted to jump off a bridge.

She’d wanted to help him, wanted to relieve his sadness, but didn’t want to take him to a psychiatrist because of the stigma… she didn’t want him labeled.

Believing he’d grow out of it… she didn’t want him hampered in life by a psychiatric diagnosis. She had the best intentions…

Meanwhile, she signed him up for riding lessons at a nearby stable, tried to get him interested in basketball. Helped him participate in Boy Scouts.

All because she thought a new interest would captivate him and help him overcome his sadness, poor self-image, and low energy. He seemed to have no initiative, motivation, or courage to fight it off.

So she kept trying… unwittingly missing the fact that these very symptoms were the reason why he needed help… and lacked interest in much of anything…

Stigma About Psychiatric Illness Can Blind You to a Loved One’s Need

A middle-aged man watches his wife of 23 years from the corner of his eye. What’s happened to her? he thinks to himself.

She’d always been a highly-motivated, creative person who took pride in herself and her contributions to their family and the community. But now she seemed to have lost interest in her appearance and her family.

She was taking a lot of naps and had gotten behind on the laundry. In fact, he’d been running the washer and dryer in the evenings to just catch up, make things easier. Last week he started cooking meals because they’d gotten sick of carry-out.

What happened…? Had she gotten lazy…? Or was it something else…?

He tried to talk to her…to learn if something had happened to her friendships or if she needed more supplies for her hobbies… but she showed no interest in that subject.

The truth is, he was growing more and more concerned.

After mentioning this to a trusted friend at work, his friend suggested an appointment with a good psychiatrist might shed some light. He was shocked.

A psychiatrist???

“My wife may be bored…or maybe she has the flu. But she doesn’t need a psychiatrist…! That’s for nut cases!!”

His friend shrugged. “I went to one a couple years ago, and to tell you the truth, it really helped.”

Pshhhhhh. Psychiatrist. Ridiculous.

Or is it?

Neuroscience Research is Shining a Light in Darkness

Most of us realize that psychiatric disorders carry with them a stigma that’s sometimes associated with terms like, “nut jobs,” “looney tunes,” and “crazies.”

However. Not only do neuroscience and psychiatry know there’s a mountain of information about the brain and how it works that we don’t know yet, but society in general knows even less.

We’ve talked in past articles about the exciting things that are being discovered in neuroscience research, like G proteins on lipid rafts that must be slid off to play their role in signaling between parts of the brain.

And neuronal bursts in the lateral habenula that seem to accompany depression, and how ketamine can dampen those bursts, and by doing so, relieve depression.

We’ve talked about how siblings of someone with bipolar disorder are 10 times more likely to also develop the same disorder. But…we don’t know exactly why. Just pieces of it.

Biological Psychiatry Stamps Out Stigma by Helping Us Learn to See the Cause of Suffering

So, in terms of actively exploring and learning and developing treatment, you might say the brain is the last real frontier in the human body. Since psychiatric disorders still carry lots of stigma in society, it’s important to learn all we can about what actually causes them, and what can be done to relieve them.

It’s only been a few decades since “bad parenting” was considered the root of so many disorders, not to mention blame on the sufferer who was considered “weak.” It’s pretty commonly known now that these were fallacies.

An interview published last week in Psychiatric Times by two psychiatry residents with Carol Tamminga, MD, shed more light on the quest to get to the basis of the biology of these conditions.

Dr. Tamminga specializes in biological psychiatry and its effort to find neurobiologic reasons for disease through brain imaging, genetics, and circuits. With her team, she searches for biologic confirmation of DSM diagnoses like schizophrenia, bipolar disorder, and schizoaffective disorder.

But her research from that perspective didn’t really make the connections she thought it would. They had expected to find biomarkers for each diagnosis, but they weren’t there. So the team started over.

They had about 1000 participants with psychosis symptoms across 5 states, and 500 people who had none of these symptoms.

They tossed out the diagnoses and looked only at brain imaging, EEG brainwave analysis, eye tracking analysis, and cognition. And without information about diagnoses or signs and symptoms to influence their findings, they found these patients each fell into one of 3 clusters, based on these findings.

Here’s a rundown of the 3 groups:
- First – Biotype One: People who have low cognition, very low hyporeactive EEG, and the highest amount of gray matter of all the groups.
- Next – Biotype Two: Modestly low cognition, very high hyper-reactive EEG
- Finally – Biotype Three: The most interesting of all — “barely abnormal at all,” but just as severe psychosis as the other groups.
So they scratched their heads to try to understand why this group didn’t have the biologic features of the first two, although their psychosis was still very severe. And they discovered the common denominator was cannabis use during adolescence.

… What?

Stigma Is Born in Old Wives’ Tales

Obviously, there is lots to talk about and learn from their findings, but for this conversation let’s focus on the point that stigma is born in wives’ tales…it’s not based on fact. And many people — more than we realize — still believe the archaic views that were passed down to them from older family members about psychiatric illnesses.

So you can see where those wives’ tales came from, right…? They came from a time when neuroscience was as baffled by the brain’s behavior and disorders as anyone else … so there were theories …theories that are now being disproved because we have the technology to learn what’s really going on … piece by piece.

Since false theories have fueled so much of the stigma, and connected it to diagnoses, maybe it’s a good thing for research to pave the way to do without the diagnostic labels… eventually… and instead to replace them with biotypes. You think? And then, perhaps, treatment could be according to biotype … ?

Biological Psychiatry Stamps Out Stigma and Old Wives’ Tales

Let’s hope we can see a fresher perspective now…in ours. Because the whole purpose in knowing what’s causing the disorder — which is usually a combination of biologic conditions in the brain, environmental influences that can alter the expression of DNA (we call those “epigenetic factors”) and learned behavior that makes it worse — is to find out how to treat it. To bring relief.

And there lies the reason for both the fields of psychiatry and psychology.

At least, there are all sorts of new questions to answer.

At Innovative Psychiatry in South Windsor, CT, we seek answers every day for our patients who suffer from various psychiatric symptoms. We use the latest research to find solutions that will help you rediscover the best you can be.

And among those solutions, the most powerful and widespread that’s been discovered is ketamine treatment.

If you’ve suffered from severe depression that other treatments haven’t budged, as well as bipolar disorder, OCD, PTSD, social anxiety, panic disorder, or suicidal thinking, call us.

We provide ketamine treatment in the most therapeutic way that’s currently been found through neuroscientific research. And we stay closely connected to current research as it happens to be sure we’re providing every opportunity for you to make the best possible recovery.

Our goal is not to put a bandaid on your pain, but to help you achieve remission.

It’s true that not every patient we treat achieves remission. And we’re still learning from researchers as well as our own patients’ experiences to help more patients.

We see more remission with ketamine treatment than has ever been seen with any other psychiatric treatment. But for reasons we don’t yet understand, ketamine doesn’t seem to be for everyone.

But odds are it will help you feel better and function better than you have in a very long time.

If your psychiatrist doesn’t offer ketamine treatment, call us. We love working with your healthcare team to help you achieve the very best results for you.

Give yourself the opportunity to be the best you you’ve ever been.

To the rediscovery of your best self,

Lori Calabrese, M.D.
September 3, 2018
Marti’s Story: How 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 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, 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. 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. 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 in 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 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 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 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 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 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 disorder, PTSD, 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.

To the restoration of your best self,

Lori Calabrese, MD

August 27, 2018
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…smells…darkness… 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 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.

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, 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 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!

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.

To the emerging of your very best self,

Lori Calabrese, M.D.

June 25, 2018
Remission by Ketamine Treatment: How You Can Hold On to the Benefits

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. 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, 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 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 been 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.

To the realization of your best self,

Lori Calabrese, MD

June 18, 2018
Mental Health Issues in College Students — Prepare Early

Does Your College Student Know Where to Find Mental Health Support?

Jonathan stood at the curb, watching his parents drive till they were out of sight. He felt lost. Vulnerable. Tired. He didn’t know much about mental health issues in college students … or even first graders, for that matter.

Jonathan had been depressed most of his life. His parents noticed the pain in his eyes from the time he was a preschooler, and tried to help in every way they could. He was their first child, and they didn’t recognize he needed professional help.

His sadness and social anxiety held him back in countless situations. He was very bright and did well in school, but socially he was isolated much of the time. He searched early, and visited colleges with his parents. But contributed very little to the decision.

They chose a small private college, where student/faculty ratio was intimate and friendly. And when it was time to go, they packed him up and drove the 4 hours to the campus. He followed as they carried his belongings to his dorm room. Afterwards, they all went to dinner, then back to the dorm. Hugs all around with words of encouragement. And they left.

Jonathan had no idea what he would do. As time moved on, he tried very hard to do well in his classes. But his energy for it eventually faded. And after a year he told his parents he wanted to leave school. He withdrew, packed up his belongings, and drove away.

Treating Mental Health Issues in College Students – A BIG Problem

A rising problem in the US education system is the minimal attention given to the mental health of students — especially college students.

Since 80% of incoming freshmen are 18, some 17 or younger, and others 19 or older, most of these students are still very much adolescent. Add to that the fact that 75% of psychiatric disorders are diagnosed before the age of 24, and you can see that the college years are predisposed to turmoil for many kids.

And if you don’t really believe your student is susceptible to mental health issues, think about this: 45% of parents say their child has been diagnosed or treated for a psychiatric disorder. Add to that: those who need help but haven’t sought it. Those who are afraid … of stigma, cost, and the rumors they’ve heard about psychotropic medications. Or children of parents who are misinformed.

Do the math, and you’ll see that your daughter or son has more than a 50/50 chance of needing psychiatric treatment in the years ahead.

Yikes.

How Common are Psychiatric Symptoms in Teens?

A survey was conducted with 712 parents of children in grades 9-12 and first year of college this past fall. The question asked if their child had been diagnosed or treated for anxiety disorders, stress, mood disorders, learning disabilities, self injury or suicide attempts, and more.

A full 20% reported anxiety disorders, 18% reported stress, 17% reported mood disorders, and 17% reported learning disabilities. These are parents whose children have been diagnosed or treated.

Of the same group of parents, 54% said their children had not been diagnosed or treated for a psychiatric illness.

Not because they hadn’t seen symptoms. But because they had not sought treatment. Some percentage of that 54% includes families with psychiatric suffering that they’re not recognizing or acknowledging.

Some People Don’t Believe in Psychiatric Illness…Still

There are still factions of society in this 21st century world who still don’t believe in the validity of psychiatric illness.

So, if they’re faced with it in a child, they consider these disordered behaviors as a lack of discipline, or misbehavior, or rebellion. So they apply more discipline to the situation. Consequences maybe. But nothing that treats the very real symptoms in the brain.

When teens from that kind of home environment enter the university environment, we see symptoms emerge that often require attention. The stress, the social pressure, and exhaustion from disordered sleep patterns sometimes lead to a crisis … sometimes even a need for hospitalization.

And again, by the way, the years a student spends in college coincide with the years the largest number of people in the 15-24 age group are diagnosed with a psychiatric disorder. Is there any wonder why…?

The Need for Diagnosis and Treatment in College is Steadily Rising

The Center for Collegiate Mental Health reported in 2017 that the demand for mental health services on college campuses has increased continuously over the last seven years. Hands down, the most often repeated request is for counseling for anxiety and depression.

Parents who were surveyed listed their top criteria in choosing a university with their child. Those criteria included things like affordability, distance from home, academic reputation … but mental health services weren’t included on that list.

While it may not be all that unreasonable that parents don’t automatically explore availability of mental health services in the colleges they consider, you probably should place these services high on your list. It’s just smart.

Get Your Student in Touch with Mental Health Services Near His Campus

If your son or daughter is already seeing a counselor or psychiatrist, continuing treatment or finding mental health professionals they can trust on campus or nearby could make the difference in their academic success or failure. Cradling the idea that he or she can just “wing it” is not a recipe for satisfactory outcomes.

On the other hand, if your child has shown no signs of psychiatric stress or disorder, just be aware, and stay informed. The student with the highest performance in high school can still develop depression, anxiety, or bipolar disorder in college. That’s not to say your child will fail. Not by a long shot.

But in far too many cases, parents are caught by surprise when a child with excellent performance falls into severe depression … and just withdraws and shuts down.

High Performance Students May Suffer Burnout

Sarafina was voted Most Likely to Succeed in high school, along with Class President, Homecoming Queen, and president of the honor society. She was hard working and disciplined, and maintained a 4.0 GPA even with a part-time job. When she started college, she got a work-study job on campus from the very beginning, and secured loans for her tuition.

She worked tirelessly toward her goal of acceptance into medical school.

But during her third year, something began to go wrong. Stressors that included unstable family members, a volatile political environment on campus, and the pressures of school and work finally capsized her ability to function. She had to withdraw from classes to seek psychiatric treatment for bipolar disorder, complicated by way too much drinking.

She just couldn’t do it any longer.

This is not an uncommon scenario with high achieving students. In some cases, the years of strain to get ahead, the sacrifices… and the pressure, culminate in an overwhelmingly bad place.

There Is Effective Treatment Available Now

If your child struggles with psychiatric mood disorders like depression, anxiety, bipolar disorder, social anxiety, PTSD or OCD, there is treatment that can help – therapy, and medications like SRIs.

And…even if they don’t, there is IV ketamine treatment.

Ketamine Treatment..?

Ketamine treatment for psychiatric mood disorders uses a tiny dose compared to the small amount used for anesthesia. We give these doses 3 times a week for a 2-3 weeks, depending on your individual needs.

Ketamine turns on mRNA to switch on DNA that turbo boosts the Brain Derived Neurotrophic Factor (BDNF). BDNF is like a rich compost…that infuses dendrites and stokes neuronal (brain cell) connections, called synapses.

These dendrites branch out in fast motion to create dense dendritic spines, causing the signaling system in your brain to bloom like tomatoes at the county fair. When that happens, the signals start flying around in your brain connecting your thoughts, emotions, and well-being and bringing healthy, alert stimulation and balance.

At the same time, ketamine can erase suicidal thinking. Why is that important? Because there is no medication besides ketamine that has been shown to stop suicidal thinking in 4 hours or less. This is life-saving for someone in crisis, intent on suicide.

Your son? Your daughter? …You?

The second highest cause of death in college-age students? Suicide.

This is serious, and can mean life or death for the child you love. The best protection for your child is prevention. And after that, treatment. Ketamine treatment can prevent suicide now.

Innovative Psychiatry Treats Your High School or College Student

And, if you do have a teen who exhibits signs or symptoms of anxiety, depression, social anxiety, panic disorder, bipolar disorder, PTSD, OCD, or thoughts of suicide, call us. The earlier they receive effective treatment, the higher their prospects of recovery.

At Innovative Psychiatry, we see 80% of treatment-resistant psychiatric mood disorder cases achieve remission with IV ketamine treatment. Eighty Percent!

There’s never been such an amazing medication for depression and anxiety before.

Let us help you and your family restore, rejuvenate, and rebuild on solid, healthy ground.

To the restoration of your best, happy self,

Lori Calabrese, MD

February 24, 2018
2018: Neuroscience Breakthroughs like IV Ketamine Treatment Mean Breakthroughs for YOU

Neuroscience breakthroughs like…IV ketamine treatment..?

Exactly.

2018 lies before us, like a valley that spreads to the horizon. And while it’s impossible to access the future, you can move forward knowing that each “today” you live has promise that was unheard of until recently.

Especially if you suffer from untreated or treatment-resistant depression, anxiety, bipolar disorder, PTSD, or anxiety — social anxiety, OCD or phobias.

Neuroscience researchers have been discovering more and more about treating psychiatric mood disorders that has transformed our approach to treatment — and the outcomes, as well.

The 21st century breakthrough of IV ketamine treatment for depression is transforming psychiatric medicine. Studying the effects of this treatment has revealed that depression and other mood disorders wear away at the signaling structures in the brain, leaving synapses, dendrites and dendritic spines broken, weakened, and sparse.

Neuroscience breakthroughs like IV ketamine treatment can bring breakthroughs to you … to your life.

The clearing away of those broken down structures, and the rebuilding of new ones in a denser, more prolific, forestation turns out to be key to treating depression. The old theory that depression was caused by levels of serotonin or dopamine that were too low … well they’re ancient history now.

Neuroscience Breakthroughs like IV Ketamine Treatment means Breakthroughs for You

Actually, so far we know of four ways ketamine clears away depression and erases suicidal thinking so quickly. And we’re watching with anticipation to see if research this year will reveal even more.

So another intervention ketamine performs is related to the G proteins that are piled on lipid rafts in the cell membranes of the neuron cells in the brain. Depressed people have these G proteins piled up on lipid rafts, where they can’t do their job to enhance signaling from synapse to synapse.

For those who are helped by traditional antidepressants, it takes several hours for those G proteins to slide off the rafts and become productive.

This is one reason it takes so long for traditional antidepressants to work for those they help. But when ketamine is given, they slide off the rafts within minutes. Remarkable.

Yet another healing action of ketamine is its effect on DNA. Turns out it also switches on mRNA which in turn flips the DNA switch to “ON” and that fire hoses BDNF across the synapse network.

BDNF is a growth factor like the richest of composts, and it empowers the dendrites and dendritic spines to burst into blooming branches like a giant oak tree. When the BDNF is fueled by ketamine, it turbo boosts that prolific branching of synapse structures, and your brain lights up like New York City. Unprecedented.

A well-lit brain is a happy brain.

Quoting from our earlier post entitled, “Breaking News: Another Way IV Ketamine Smashes Depression,”

As new synaptic connections are built, and greater communication between brain cells develops, the brain gains the ability to see things in a different perspective, and your outlook becomes brighter and healthier.

IV ketamine can jump start that process. Wait. No. It can turbo-charge it.

Extraordinary.

And the fourth action IV ketamine treatment performs is increasing glutamate levels to equip synapses to send more and faster signals across the brain, which traditional antidepressants don’t touch. Brilliant.

APA Task Force Issued a Consensus Statement in May 2017

What a year it’s been!

Four actions of ketamine we know about so far. The outcome is so extraordinary, so successful in such a large number of treatment-resistant cases, the American Psychiatry Association assigned a task force to issue a statement about the use of ketamine, this anesthesia medicine, off-label for treating depression.

Their statement was one of the most momentous and widely read articles of the year. In fact, it’s listed as #3 on JAMA Psychiatry’s “Most Talked About Articles of 2017.” Suffice it to say that those who were on the task force are true experts in our field. They’d seen ketamine’s power to lift depression right out of the water.

So they offered guidelines and cautions, and expressed their elation when interviewed that such a thing has happened in their lifetime.

They also specify that ketamine should be administered under a psychiatrist’s supervision.

TheHealthSite.com featured a list of the 6 best medical achievements of 2017 that everyone should know about…. Ketamine for depression stood strong on that list.

Of course, we know ketamine’s discovery didn’t happen this year. Many years of studies and clinical trials laid the groundwork for ketamine’s popularity now.

Thousands of patients have experienced the relief, the return of joy, initiative, creativity, and energy without side effects that ketamine provides.

Never before has there been such a medicine that treats so many disorders in such a huge percentage of the population as ketamine.

Ketamine has delivered HOPE.

At Innovative Psychiatry, we see 80% of patients who’ve suffered for years with treatment-resistant depression, crippling panic attacks, suicidal thoughts that won’t stop, severe bipolar disorder, PTSD, social anxiety, and OCD experience relief, restoration, and relaxation after treatment.

Another neuroscience breakthrough that means breakthroughs for you is Transcranial Magnetic Stimulation or TMS. It uses a coil to create a focused magnetic field over the front left side of your head. Specifically the left dorsolateral prefrontal cortex region.

Then it sends tiny repetitive pulses deep into the brain to the emotion-regulation region. This stimulates the nerve cells and wakes them up. When they wake up, they begin to function again and give you better emotional regulation and function.

With TMS treatment, you sit quietly for anywhere from 16 to 37 minutes, five days a week for 6-8 weeks. About halfway through the series of treatments, depression begins to lift, and you begin to feel better and better. Again, faster than traditional antidepressants, and without any of the weight gain, sexual dysfunction, fatigue, or GI side effects they can cause.

The sophisticated technology of TMS continues to develop. Even 5 years ago TMS seemed experimental and wasn’t widely available. But, like ketamine,TMS built a strong reputation for effectiveness.

In general terms, clinicians and hospitals report 60-75% success with TMS around the US. We see 75% of our patients consistently respond — and often remit — at Innovative Psychiatry.

Again, HOPE.

Curcumin has gained an ever stronger reputation for its use as an adjunct in treating depression. Plus the connection between the brain, mood, and the strengthening of the microbiome is growing and gives us more and more opportunities to work with your diet and lifestyle to improve your mood.

No known treatment lifts depression, anxiety, bipolar disorder, PTSD, or OCD in 100% of cases at this point. But these innovative treatment options prove successful for 75 – 80% of people who suffer in spite of traditional treatments. Obviously, hope soars for you if suffer with depression.

If you suffer from suicidal thoughts, depression, bipolar disorder, PTSD, social anxiety, OCD, you can feel better. The age of despair for sufferers is quickly dissipating. This has never been the case before. You really can feel better….lots better….as in really good.

If you’d like to start 2018 on a brighter, fuller, more functional, and happy path, call us. We live one day at a time, because “now” is all we really have. But live well. Live as the best you you can be.

To your very best self in 2018,

Lori Calabrese, MD

January 1, 2018

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