It can be alarming to see you brother try to navigate his way through a challenging diagnosis like depression or bipolar disorder. His symptoms may be alarming for you, and while you’re trying to be supportive, he may feel the world is crashing in. His dramatic reactions can be overwhelming, especially when you had a friend with bipolar disorder who had a volatile temper, it seemed, and seemed hypersexed, but she didn’t act like your brother is acting now. Surely they got his diagnosis wrong. But the doctor says that disorders look different in different people…at different times and under different circumstances.
And it’s good to know.
Charlotte might be a good example.
Charlotte first began to show signs of less confidence and depression around the age of 6. She tried so hard to have a stiff upper lip, to invest her effort and perform well at school to please her parents, and to be industrious. Her parents were always so proud of her. But they didn’t recognize depression in herbecause she tried so hard.
Now, Charlotte’s family already showed signs of psychiatric disorders in other members. Her mom had suffered from depression since childhood, her oldest brother had suffered from depression since he was 4. Plus, her other brother received a diagnosis of bipolar disorder. He had actually displayed symptoms since he was a young child. See the similarities?
In addition, Charlotte’s uncle struggled with Narcissistic Personality Disorder. So did her grandfather.
So much going on in Charlotte’s extended family. In fact, so much woven through the whole family.
But in her case, her primary diagnosis turned out to be severe treatment-resistant bipolar disorder. Plus alcohol use disorder, social anxiety, and some phobias.
Happily, her bipolar depression, social anxiety, and alcohol use disorder, eventually improved dramatically. Some aspects reached remission after IV ketamine treatment.
Sometimes depression or bipolar depression expresses itself as anger… even rage. Sometimes it can look like alcohol use disorder. In one person it may look like sadness and despair. In someone else, it may show up as disrespect for others. One person with bipolar disorder may seemed quiet, full of sorrow, and hopeless a lot of the time, but another might feel angry, disillusioned, and seeking revenge. How is it that the same disorder can present so differently? It can look different in different people and with different circumstances.
Lots of people wonder about the same thing. Why does one person with depression act so angry? Then someone else with depression suffers from quiet despair..? One eats carbohydrates in large amounts, and gains weight steadily. While another has no appetite and loses weight at an alarming rate?
Which came first? The chicken or the egg? Disorders have a way of emerging and creating more difficulties. Depression can give way to phobias, weight gain, social anxiety…
Bipolar depression may show up as raging anger at times, unrestrained sexuality at times, and terrible despair in one person. Then, in another person, it may look like self-harming, unlawful behavior, and substance use.
One reason? It’s not uncommon for someone with depression or bipolar depression to also experience anxiety, phobias, hypersexuality, or substance use disorder, alongside the original diagnosis. As a result, you may have a friend or relative who displays a certain cluster of behaviors, and you form the idea that this is what bipolar looks like.
Then, someone else you know is given the same diagnosis, and while they display erratic behavior, it’s nothing like the behavior of your friend.
The same disorder can look really different in different people.
So now you can meet Grayson.
He was first diagnosed with ADHD, then bipolar depression, and finally obesity.
In Grayson’s case, ADHD emerged first when he was a child. About 6 years later, bipolar disorder became a more pressing concern, which SEEMED to lead to obesity. When Grayson is experiencing bipolar depression he tends to eat more, sleep lots, and feel listless and without energy.
Disorders look different in different people.
In Grayson’s family, his own son was diagnosed with ADHD at the age of 7. Then, as he grew he was diagnosed with severe depression. Grayson’s grandmother has suffered from depression all her life. His uncle has struggled with ADHD but learned to manage it in adulthood.
So.
We know that depression, and many other psychiatric disorders, run in families. And these family connections call for us to show compassion for our family members who suffer from their own individual disorders.
If you suffer from depression along with other disorders, and if your current treatment isn’t working, feel free to call us. Or ask your health care team to call us.
We welcome the opportunity to work in conjunction with your healthcare team to help you get better.
At Innovative Psychiatry, it’s true that we see multiple family members who each live with diagnoses and co-morbidities, and it’s true they may sometimes share the same diagnosis … or they may not. Although your symptoms need not necessarily be labeled, they do need to be evaluated as part of your overall self. And then they can be addressed, as needed, with appropriate treatment.
While IV ketamine treatment is not the appropriate treatment for all of the symptoms you experience, we can work with your health care team to try to help you experience your best self.
Does IV ketamine treatment help everyone who tries it? Unfortunately, no. But it does help many achieve remission and build fulfilling lives.
If you suffer from mania, you’ve also experienced the transition that leads to it.
Someone identified that transition emotion over a thousand years ago. Surprising? Here we are in the 21st century, with all the technology and neuroscience we’ve discovered at our fingertips, and we still face that same emotion. And it often plays a strong role in bipolar mixed states.
What is it?
Anger.
So many in our current society speak of various psychiatric disorders as if they’re a product of modern contrivance. Sometimes in psychiatry, our role is not only to treat those suffering from a disorder, but to also defend them against the cruel cynicism of skeptics who discredit their struggle.
For someone who suffers from emotions that plunge so low, so dark, they don’t know how to hang on to a fiber of life… then without warning, those feelings change…shift…and become energized then agitated… with no reason….until they’re replaced by anger then rage….and more energy than can be managed….until they’ve reached a state of euphoria, unlimited possibility, and very high creative energy…. Someone like this knows the helplessness of erratic emotional states.
And if you’ve experienced these wide changes in emotions, you know it’s painful. When it’s happening inside you, it feels normal. It feels justified…because you don’t realize it’s happening because of malfunctioning signals in your brain.
If you feel anger…even rage… it just must be justified, right?
But many people with a disorder like this have to experience it for many years before they can identify those moments when their mood swings in a new direction. It’s hard. Really hard.
So let’s talk about this ancient philosopher and physician from the 12th century, Avicenna.
He saw this disorder, this syndrome… and described it. He talked about how it affected both the psyche and the body. Pretty profound for a guy who lived around the year 1100 AD. He called this condition “melancholia” and in present day mental health we might think of melancholia as depression.
But the syndrome he described included mania. And mania specifically identifies what we now know as bipolar disorder.
In his early descriptions, he divided this condition into two phases, the early phase and the chronic phase. Symptoms of the early phase were described as suspicions of evil, fear without cause, quick anger, involuntary muscle movements, dizziness, and ringing in the ears.
For the chronic phase of melancholia, he described moaning, suspicion, sadness, restlessness, and abnormal fear such as the “sky falling upon one’s head,” or “being swallowed by the earth.”
In our current environment, we would likely consider these last two as delusions, or psychotic features.
Not all people with bipolar disorder have delusions during manic or depressive episodes. But in some cases, it happens.
Avicenna also described some symptoms we might now see in “bipolar mixed states” such as increased libido, involuntary laughter, and acting as though one is king… which we’d now call “grandiosity.”
These can all be symptoms of the manic phase of bipolar disorder.
These are descriptions that are more than 1100 years old. But they describe a condition that we still see today, and work hard to identify and treat. What is so hard is identifying it first. An episode of anger does not mean you have bipolar disorder — not by a long shot. And even if you have bipolar disorder, getting angry could be just… getting angry. It may not mean you’re in a manic, hypomanic or even mixed state.
How to tell? Sometimes it’s difficult. It may take several episodes. Sometimes it can take years.
You don’t have to let it. The good news is that mixed mood states are treatable. If you’ve been ridiculed for the medicines you take, or the psychiatric treatment you participate in… if people around you don’t believe this is not only a valid and debilitating disorder, or think it’s something modern day doctors have dreamed up, here’s proof your struggle is valid.
People can be so… uninformed. You have to just shake your head in disbelief.
According to Avicenna, people have been suffering with this at least since the 1100’s. It’s still the real deal.
And he described bipolar mixed states without using the term itself: a combination of depressive and manic symptoms all tangled together at the same time. With a back drop of depression, and the addition of agitation, grandiosity, heightened sexual drive, anger, and emotions that are easily aroused, changed, that alter quickly.
There are doctors who attempt to diagnose bipolar disorder as specifically depression with at least one clear episode of mania or at least one clear episode of hypomania. But for a large population of patients, this is utterly frustrating. Because what they have–and what you may have–are mixed states, or mixed episodes.
If you’re one of them, you know.
You KNOW you’re not either black or white emotionally. You KNOW you’re not specifically depressed or manic.
While you may be depressed at times, and you may experience mania at other times, you know that you also have all sorts of combinations of emotions in between the two.
It can feel like you are a vertical accordian with shifting degrees of manic and depressive symptoms at the same time and with the ratio shifting throughout the day, or from day to day … over sometimes every few days. So many variations make it hard to identify, difficult to explain, and frustrating to report. Symptoms like grandiosity and anger can signal other disorders, as well.
And you know it’s real, though you may be told something different.
When you suffer like this, you first need validation that there are things happening inside you that you don’t cause.
This is a very difficult condition, and what you experience may be different than what someone with the same diagnosis experiences. But it’s real.
And it’s treatable.
Bipolar disorder can be challenging to treat effectively — and may need patience and determination for you and your doctor to tame — but hang on to hope.
We’ve only talked about bipolar mixed states and mania but there is also depression in bipolar disorder. And bipolar depression is also extremely difficult to endure. It can be terrible.
And these patients often talk about how much easier their condition is to manage since the depression is gone.
While bipolar depression can be tough to break, ketamine treatment can break it. Give yourself the opportunity to see how good you can feel, how productive life can be, without bipolar depression undermining you.
If bipolar depression interferes with your life, call us.
And as such, it’s a good time to talk about symptoms of mental health disorders, don’t you think? We want to increase understanding and dispel stigma which will help people who suffer gain better access to the help they need. Stigma is steeped in ignorance about something someone doesn’t understand. In addition, the global circumstances of these last few months have impacted the mental health status of so many. So let’s use this month to broaden understanding and better equip us to respond to ourselves and those around us. So here’s something to talk about: A new way to differentiate bipolar depression vs. unipolar depression may be emerging.
Leading Cause of Disability
The leading cause of disability in the world today is not heart disease or cancer…it’s depression. Depression is that common. We talk about severe depression and we talk about bipolar depression. When you see someone with either of these conditions, they may look rather similar from your vantage point, but they’re actually two distinctly different conditions.
When we diagnose someone in this depressed state, it can be difficult to determine whether they suffer from major depression or bipolar depression, unless they have a history of mania or hypomania to determine the difference.
Unipolar depression and bipolar depression don’t feel the same…but they do sort of look the same.
Which is why a doctor asks whether you’ve had times when your mood was elevated, you felt energetic, hyperactive, maybe irritable, angry… and overly confident…all at the same time?
For this reason, so many with bipolar disorder are first diagnosed with major depression, especially those with bipolar II disorder, since their symptoms include far more depression than hypomania.
When you first see a psychiatrist about your depression, it’s important to be patient. Because some of your symptoms may not have emerged yet…and you may appear to have unipolar depression. Then later, mania or hypomania emerges, and your doctor may change your diagnosis to bipolar disorder, along with your prescriptions.
Because of the challenge of diagnosing someone accurately who has a low mood, researchers have been seeking a means of using some sort of biological markers to determine scientifically the proper diagnosis and character of the depressive symptoms.
Something that would differ in patients with unipolar depression from those with bipolar depression. Possibly brain activity. Or maybe proteins in the blood? Possibly genetics?
Exploring Bipolar Depression vs Unipolar Depression
An interesting study conducted by Brain and Behavior Foundation researchers, led by Mary Phillips, Ph.D., performed with a relatively small group of subjects, suggests a way your doctor might differentiate the two disorders clinically to aid in accurate diagnosis.
Using functional magnetic resonance imaging (fMRI), full brain scans were conducted on a group that included 18 bipolar patients who were in bipolar depression, 23 depressed patients who’d been diagnosed with major depressive disorder (MDD), and another 23 who were healthy without a diagnosed disorder.
It’s unfortunate that their study involved so few, and also that 90% of those with bipolar disorder were diagnosed with bipolar II disorder, leaving only 10% who had bipolar I disorder. A more evenly distributed group might have told us more.
Even so, they did make some significant observations.
The working memory system is used by the brain to maintain, manipulate, and update information that is associated with tasks that are presently at hand. When the networks of nerves in this system are damaged, learning – reasoning – and decision- making ability can be disabled.
This is particularly true in those with mood disorders, like depression.
So, the researchers gave each participant an easy task and a difficult one, while the participant was undergoing an fMRI brain scan. The design of the tests was to highlight that people form expectations about a task before they fulfill it.
A person might feel the task will be easy, so there’s little stress in performing it. But if he expects the task to be difficult, his stress increases before he begins.
It turned out, that there were patterns of neural (brain cell) activation in the medial and lateral areas of the prefrontal cortex, that were related to how easy or difficult a task would be.
Mechanism Defends the Person with Bipolar Depression From Emotional Pain
The researchers reported that people with bipolar disorder may actually block anticipation of a negative experience to avoid experiencing negative emotion while performing a task. That basically people with bipolar disorder seem to have a built in defensive mechanism to help protect them from negative emotions.
So enlightening. People with unipolar depression don’t do this. They feel what they feel. But those with bipolar experience such damage from their negative emotions.
As I said earlier, unipolar depression and bipolar depression may look similar to someone observing people suffering from these. But they feel different.
Let’s add to that, that both of these disorders can often end in suicide, unfortunately. Even so, it’s more common in bipolar disorder.
There are traditional medicines for people with these disorders. And those medicines do help a lot of people.
But not all.
For that reason it’s important to seek help until you find treatment that helps you feel better, function better, and live a rewarding life.
IV Ketamine Doesn’t Differentiate Between Bipolar Depression vs Unipolar Depression – It’s an Extraordinary and Robust Depression Treatment
IV ketamine treatment isn’t effective with mania or hypomania. But the mania or hypomania is easier to manage and treat without bipolar depression. This treatment can be exceptionally effective for both unipolar and bipolar depression. In fact, it can be utterly life-changing.
And… in regard to the risks of suicidal thoughts, IV ketamine treatment can erase those thoughts in an afternoon. A few hours. And if you’re not plagued by thoughts of death and dying, you’re a great deal freer to work toward healing, restoration, and joy.
In this current global crisis, suicides have been increasing, among those with disorders, healthcare workers, physicians, and more.
IV ketamine can save lives by removing thoughts that lead to suicide.
Cameron pulled back the drape to look out into the empty street. No cars were moving, but an endless row of them lined each side of the street. A recent rain left the pavement dark and glistening. He let the curtain drop and walked into the kitchen for some herbal tea. The house was dark. Quiet. He had to admit to himself, it was lonely, too. Ok there. He said it. He felt lonely…as in alone. The effects of isolation depression were getting to him.
Cam woke up each day wondering what his purpose in life could possibly be. There was no point in this endless endurance. He didn’t have the energy or motivation to do much at all. He’d been to the doctor a few times, only to take medicine that didn’t change anything except make him gain weight.
The more he thought about it the more he wanted to die. His mind focused on how he could help that happen.
He’d been fighting off this wretched despair for weeks … trying as hard as he could to rise above the gloomy, empty feeling that had been trying to drown him. Even though he’d tried cooking, he got bored with that pretty quickly. He’d tried reading. But the constant silence stifled his outlook.
They’d been told on the news to stay home. Some sort of pandemic. But Cam didn’t care …he never went out much anyway.
He kept the blinds closed, the drapes pulled, and the door locked. The idea of seeing someone, or anyone, peering into his apartment made his heart race and the hair stand up on the back of his neck.
To pay his bills, he offered accounting work for people online. You might say a virtual assistant, of sorts. He could work on his own timetable…when he could function. Office hours never had worked for him.
Then, he saw a post on social media. Something about how to reduce your own anxiety and depression.
That caught his attention.
It said to find a way to help someone. Offer to do a favor for a friend or a stranger. That by doing that, it could help lift your own mood.
Cam thought about it a moment. Hmm. The idea seemed far-fetched, even ludicrous. (Like, really ludicrous.) People who feel crummy, who have no energy, and who are miserable around others…have got to be the worst possible candidates for acts of kindness and helpfulness. People with energy should do those things.
Right..??
After digging around in the fridge, he came up with some frozen potato fries and put a generous pile of them on a baking sheet in the oven. He checked for ketchup, confirmed there was half a bottle, and returned to his desk.
While he worked on a customer account, that message about generosity and kindness ran laps around his mind.
Finally, he turned around in his chair and stretched.
Could it be? Is it possible that a melancholy loner could actually do anything that would benefit someone else?
Thoughtfully, he laced his fingers behind his head.
Good grief, he thought. We’re not supposed to leave our homes. How on earth could someone like him do anyone any sort of favor?
Aaaacccckkk! Forget about it. It’s a crazy thought and it’s not happening.
He reluctantly turned back to his work, then the timer sounded.
After serving the hot, steamy potatoes up on a plate, he decided they smelled sort of good. He poured himself a glass of iced tea, and munched away. It was unusual for him to have an appetite at all.
He studied the fried potato in his hand…rolling it to examine it top and bottom distractedly.
Finally, he dipped it in ketchup, put it in his mouth, and then it hit him.
Numbers! That’s something I have to give, he thought. Something I understand. And all the kids are schooling at home. I wonder if they need math tutoring!
Maybe it was a little thing, but for someone who had found no purpose for his life, it was a world-changing revelation for Cam.
He realized he could fight the effects of isolation depression with his own skill with numbers.
Before self doubt had a chance to suffocate his idea, Cam got on the neighborhood social app, and announced that if there were any children or teens needing math tutoring, he would be happy to offer it online. For free.
He pushed send, then his heart sank.
What had he done???
He couldn’t face people he didn’t know. He didn’t feel like they’d like him, and his way of explaining math probably wouldn’t help at all. The effects of isolation depression had intensified his social anxiety… but could he push through ?
After all, he was weird… he knew he was.
Just thinking about someone contacting him for math help — then failing at it — made him die a thousand deaths. He just didn’t need any more failure.
An hour later, he heard the familiar :::BING::: It was a message. Someone in his building had a 12 year-old struggling with math. They were happy to pay him but just didn’t know how to help their son themselves.
Doing his best to sound like he was taking it in stride, he arranged a time the next day to talk with their son.
His heart was beating pretty fast …but it wasn’t as much anxiety, he thought, but maybe more excitement.
And he had discovered something he’d been missing.
PURPOSE.
Suddenly he had the purpose to help a preteen boy develop stronger math skills.
The next morning, he woke up, got his coffee, and sat down at his desk. There were five more messages. People whose kids needed tutoring…ranging in age from 11 to 17.
Oh yikes.
He didn’t know if he should try to work with all of them. What if he had a bad day and couldn’t function? That happened pretty often.
What if he got sick ?
The responsibility for all these kids loomed over him.
But finally, he made himself calm down. He decided he would try to do this a day at a time, and if it got to be too much he’d call his doctor. Or he could quit.
Cameron isn’t alone, is he? You may be in a position a lot like his. Feeling cooped up, dragging from day to day, seeing no purpose in life, and wondering how long you can endure the days.
The Effects of Isolation Depression
If you live in a city that’s been “locked down” it can be hard to fight the isolated feeling of aloneness and despair.
It may be that finding a way to reach out and help someone in a small way could give you a lift, too.
IV Ketamine Serial Infusions Can Help You Fight The Effects Of Isolation Depression
If that’s the case for you,…if you’ve tried prescriptions for many months that just never did help… and you would like to see what
can do for you, we have good news. We’re offering this treatment at our office. Still.
Because it’s essential. Because it can be life-saving.
We’re sympathetic to your situation, and in this climate of lockdowns, isolation, and uncertainty, we want to help you with the equipping to not only face the days, but to enjoy them. To have the initiative and hope to find ways to help others, and to enjoy the reward of it.
This public virus situation is temporary, but for now you need all the help you can get weathering the uncomfortable circumstances that arise, and to have the resilience to help others manage them, too.
Give yourself the chance to rise above these difficulties. Give yourself the strength of resilience. We’re here to help.
Nick walked in after school, slamming the door behind him.
His mom looked up, startled by the noise. “What’s that dirty look about..?? You’re so judgmental!!”Nick was fuming, and with that he headed upstairs. His mom followed him upstairs and spoke softly, knowing her son was apparently volatile. She didn’t realize that what just happened could be repaired by ketamine restoration in the amygdala.
“Nicholas, I’m sorry my face looked judgmental. I wasn’t feeling judgmental…I was startled by the noise the door made, and concerned that you seemed so upset. Did something happen..?”
Nick crumbled.
He didn’t know why he misread his mom, or why he was so angry. Nick hated himself for being hateful. He just felt so angry so much of the time, and when he wasn’t angry, he just wanted to cry… what was wrong with him?
“Sorry, mom. I thought you were mad about me slamming the door. I have a lot of homework and I just don’t want to do it. It all seems pointless.”
Nick’s mom knew he’d been under a cloud since the last school year. He was seeing a psychiatrist, which he always dreaded. The medications didn’t seem to be helping, in spite of the fact he was on his third different medicine.
He’d all but refused to see the therapist any more. As his mom, she just wanted him to feel better and enjoy his adolescent life, but she was hitting a wall. All she knew to do was to encourage him to keep trying and to provide a little comfort where she could.
“Why don’t you come downstairs, and I’ll make you a sandwich. Eating something might help your homework seem a little easier to face.”
Ketamine Restoration in the Amygdala
While Nick ate, he decided to mention to his mom what his buddy in History had told him.
“Mom, you know Zach? He’s been down for a long time…even longer than me. He told me today that he’s getting IV ketamine treatment. He said he took pills for a year and they didn’t help, no matter what brand the doctor ordered. Anyway, his dad read about this treatment, and Zach says it’s already helping.”
“Really Nicholas? Does his doctor give him the treatment?”
“No, he said his dad is taking him to a different psychiatrist who does it. He says his own doctor is all for it. He’ll go for two or three weeks and he’ll be done. So far, he’s finished the first week. I can tell he’s doing better. He smiles and laughs. It’s weird. But I also envy him…”
“I tell you what, Nicholas. You go work on homework, and I’ll see what I can find out about this treatment. IV ketamine you say? We’re going to find help, honey.”
Three months later, Nick walked in the door, smiling ear to ear.
“Hi Mom. Since it’s Friday, is it ok for me to go to a movie tonight with Zach and Tim? Oh and by the way, Chelsea said she’ll go to prom with me.”
Nick beamed.
“Oh that’s fantastic, Nicholas! I’m so glad she said yes. She’ll be on the arm of the nicest and best looking guy at school! And sure, the movie’s fine. Zach and Tim are great guys.”
IV ketamine restoration in the amygdala can make all the difference.
Depression Can Impair the Amygdala’s Ability to Process Faces
To the casual observer, this may all sound a little too easy. And for some people, it might be. Everyone’s different. But for most people like Zach and Nicholas, their misery is reversed by a series of 6 IV ketamine infusions, sometimes a few more.
And in some cases supplements are needed to address low blood levels of certain hormones or nutrients first. But, when you consider the comparison of that to years of traditional antidepressants that aren’t working, it’s an easy choice.
On top of that, the prospect of joy – and hope – in place of the damaged relationships caused by a short temper, a hopeless outlook, and absent motivation, is again…an easy choice.
Humans like to feel good. When you don’t, you’re not very pleasant to be around, you know? Is there anything that makes you feel worse than severe, unrelenting depression complicated by anxiety and phobias? It’s misery.
And the thing is, it colors the way you see everything. You can be looking in someone’s face who’s just preoccupied, and interpret their expression as angry, critical, irritable… then you snap at them about it, and they feel attacked from out of nowhere.
Guess what? There’s a scientific reason you do that. It’s not just your imagination. And the good news is that IV ketamine treatment actually changes something deep in your brain to help you interpret their facial expression for what it’s intended to be.
To understand this, we need to talk about the a wonderful structure in the brain called the amygdala.
Ketamine Restoration in the Amygdala
The amygdala consists of 2 almond shaped structures deep in the sides of the brain at the temporal lobe. It’s one part of the limbic system which processes emotion, records emotional memories, influences behavior, motivation, and the sense of smell, as well.
One key job the amygdala performs is helping you to look at facial expressions in others and determine their emotion. For instance, if you see someone frowning, with their face tense and lips tight, do you assume they’re happy? Of course not. It’s your amygdala that sees their expression and determines they may be angry.
Well, when someone is suffering from a disorder like severe depression or bipolar depression, their amygdala may be malfunctioning.
Study Explores Ketamine’s Effect on Amygdala Function
So recently, a team of researchers led by Joana R.A. Loureiro in Los Angeles and Chicago set out to study what effect two rapid acting depression treatments have on the amygdala’s ability to accurately process facial expressions. Using functional MRIs (fMRI) they tested 44 adults who were all experiencing an episode of severe depression.
They divided the group into two parts: 17 subjects were given an individualized number of treatments of ECT and 27 were given IV ketamine infusions 2 or 3 times a week until they had received 4 infusions.
This was an interesting approach because both forms of treatment affect brain function and emotional processing, so they wanted to see if it worked at the level of the brain cells.
Since interpreting the facial expressions of others is such an important part of social functioning, they focused on the subjects’ ability to accurately do that. The subjects were tested by the task of matching emotional faces on a screen. If the face at the top of the screen was smiling, they needed to match the face at the bottom of the screen that was also smiling.
They found that both modes of treatment improved the accuracy of the subjects’ amygdala function.
When Depression Impairs – Ketamine Repairs
Now, about the type of scenario that Nicholas and his mom experienced. At the moment he walked in the door he believed he saw criticism and judgment in her facial expression, when her look was actually surprise and concern.
When someone is severely depressed, it’s as though they have an affinity for negative feelings and beliefs. So, when they see a facial expression that appears negative to them, it goes to the bone. They feel it so deeply and lightening fast.
It’s easy to see that this type of misinterpretation and reaction only further damages relationships that are already fragile when someone is severely depressed.
And even though both ECT and ketamine improved the amygdala’s function, ECT is a treatment that carries some bias and even stigma for its side effects and history.
Tim dragged himself into the school cafeteria where the photographers had set up equipment to take school pictures.
He felt angry, bitter, sullen, and hopeless. What purpose could there be in school pictures? What’s the point? he thought. Tim hated being at school. He felt like he would self-destruct if he didn’t get out of there. Then it was his turn for his portrait. He stared at the camera. The photographer said, “Smile!” (Does hopelessness accompany suicidal thoughts…or cause them?)
He just stared straight ahead. Enduring. He knew if he smiled it would make him look like a horror-movie character. Click. Flash. And it was over.
Tim got up, and dragged himself out of the cafeteria and out the back door of the school. He shuffled home. He couldn’t stand being there any longer.
Right behind Tim in the line a pretty girl waited her turn. Emily smiled for the camera. She didn’t want to. But she tried to do the right thing. Her sad eyes gave away her despair. Emily lived in a neighborhood where everyone knew each other, got together, barbecued, and enjoyed the community.
The problem with that is that one of her neighbors offered to spend time helping her with her music lessons. Her parents encouraged her to take advantage of the expertise of this “nice man.” Luis was 41, college educated, and very musical.
Emily didn’t know how to tell her parents that every time she went to his house, he had other ideas in mind. She felt ashamed. Troubled. Scared. Dirty.
She tried to be responsible and do everything expected of her. Her parents just knew she was a good student, kind, and obedient. Does hopelessness accompany suicidal thoughts…or cause them?
Once when Emily tried to tell her mom about Luis, her mom corrected her before she could get it out. She told her to be sure to be respectful toward him when she was at his house.
Emily clammed up.
But she was reaching the breaking point. After two years, she didn’t think she could take this any longer. She didn’t know how to stop it. She was feeling more and more hopeless that there would ever be an end to it. And Luis threatened that if she told anyone he would hurt her family.
So Does Hopelessness Accompany Suicidal Thoughts or Cause Them?
Both Tim and Emily were losing their strength to hang on. Of the two, Tim was the most likely to be identified by teachers as one who might need to see a psychiatrist. His facial expressions, attitude, and disposition made him a likely candidate for that kind of help.
Emily, on the other hand, seemed quiet, compliant, and responsible to the school staff. Her teachers guessed she must come from a very nice family. Emily’s depression wasn’t easy to notice because she didn’t let it show. Her goal was to please those in authority in her life.
Tim’s doctor, on the other hand, diagnosed him with bipolar II disorder. He prescribed medication, but Tim did not feel much better.
Tim directed his anger at his dad. Because he felt his dad lacked understanding for his condition. He resented his dad expecting him to function when he felt so bad. He wished he could crawl into a hole and hide from the world.
Emily felt completely alone in the world because she couldn’t talk to anyone about what she was going through. And though her parents were good people, they had no idea she continuously faced such a horror.
We can look at Tim and Emily and draw our own conclusions. But you have to ask yourself does hopelessness accompany suicidal thoughts…or does it cause them?
Tim’s problem wasn’t his dad so much as the symptoms of his illness that weren’t relieved by his medicine. And Tim didn’t know how to approach his dad in a way to help him see what he was going through. His dad just felt he needed to discipline his belligerent son.
In Emily’s case, it seemed that her problems could be resolved by simply blowing the whistle on Luis. That message is plastered on the walls of the school… “Tell someone!”
She’d heard that message all her life. She could go to the school nurse, or a teacher she trusted, or even a police officer. But she didn’t. When she would think about it, all she could think of was how hurt her parents would be that she talked to a stranger instead of keeping their business in the family.
She was also afraid her dad might do something crazy to Luis that would get him arrested, then what would her mom and brothers do?
Every time she thought about talking to someone she hit a wall of all the reasons why she couldn’t…
Then, in a two week period, two students in the high school took their own lives.
Everyone wondered why.
No one dreamed Emily was sad or had any reason to do such a thing. Except her heartbroken parents… because Emily left a note. And Luis was arrested.
Tim’s dad was devastated. He’d been doing his best to help Tim get the treatment he needed, but each new medication required several weeks –sometimes months — to see if it helped him feel better. Talk therapy takes time, everyone said. And he hadn’t heard of a treatment like IV ketamine. He just assumed Tim’s doctor would do what was best for his son.
It was so hard to know the difference between his son’s bipolar symptoms and just a bad rebellious attitude. He worried about it all the time. Just not knowing how to respond to Tim’s responses. He wished he had a guide book. But now it was too late. He just didn’t realize how severe it was.
These two deaths stunned and rocked the school they both attended. Two very different students who didn’t know each other, but who both could have been helped…if only…
Does hopelessness accompany suicidal thoughts…or does it cause them?
If you knew Tim or Emily, you’d likely have been grief stricken by their deaths. Probably baffled. And for good reason. Because hopelessness and despair come in different forms. And you probably wish you could have helped them.
Tim’s hopelessness was within him, as a symptom of a severe and difficult-to-treat illness.
Tim probably spent most of his time in the throes of bipolar depression. When your mind and outlook are so dark so much of the time, you can desperately need a break from it.
But if you know of no medicine that will supply that break for you… if your doctor knows of no medicine that will help without trying one after another… you get your hopes up over and over…only to experience a new type of grim despair. Hopelessness grows after years of this…and it may dawn on you there’s nothing that can help.
And you don’t know where to look for hope.
Emily’s hopelessness was internal, too. She felt trapped by an external force. If that external force could have been removed from her life, she probably could have recovered. Unless conditions like PTSD or severe depression complicated her condition. But even those conditions can be relieved with a novel and advanced treatment like IV ketamine.
Children and teens should be able to live healthy, active, trusting lives in a perfect world. But it’s not a perfect world.
When they’re assaulted, and wounded, they may need special care with a skilled therapist, support from friends and family, and treatment to help them heal. Sometimes that can be treatment with a novel, advanced treatment like IV ketamine.
A group of researchers led by Ilya Baryshnikov, M.D., asked whether the hopelessness people with depressive disorders experience is a crucial predictor of suicidal thoughts and plans.
They guessed that hopelessness was the sign that a person would be having suicidal thoughts, so they conducted an in-depth study which was just published this month in the Journal of Clinical Psychiatry.
They followed 406 people for 10 years, and used diagnostic tools to determine what role hopelessness played, as well as what role the severity of the depression played, in each person’s experience with suicidal thoughts.
Standard tools like Scale for Suicidal Ideation, Beck Depression Inventory, Beck Hopelessness Scale, Beck Anxiety Inventory, Perceived Social Support Scale – Revised, and Eysenck Personality Inventory helped them evaluate the state of mind as well as personality traits of their subjects.
They found that hopelessness served to explain the suicidal thoughts, but wasn’t so much a crucial prerequisite… and that it’s actually the severity of the depression that leads to suicidal thoughts.
In the cases of Tim and Emily, both needed intervention. For Tim, IV ketamine could have possibly changed his whole world.By helping him to achieve remission, and restoring his energy and hope, his world — and his relationship with his dad — could have been transformed.
It’s likely his dad, like so many, had no idea that IV ketamine was an option. Much less understanding about what it could do for his son.
For Emily, it is possible the long term stress of abuse wore down her resilience, undermining her resolve to protect herself and report Luis. To trust her parents and make them listen, so they could help.
In her case, too, IV ketamine could have helped restore her emotional strength to do what was needed to make herself and other girls in her neighborhood safe …to speak up.
At Innovative Psychiatry, we see teens like Tim and Emily — and find the transformative effects of IV ketamine treatment can bring restoration not only to their outlook, but to many aspects of their lives. Relationships grow stronger, energy for school improves their performance, and their hope and joy billow. Not for everyone, certainly, but for most,
If you, or your teen, have been depressed from major depressive disorder or from bipolar depression, and oral antidepressants aren’t working, call us. Let’s talk about whether you’re a candidate for IV ketamine treatment.
If you’ve suffered from a major trauma that other treatments haven’t helped, call us. IV ketamine treatment can restore you if PTSD has impaired your function in life.
Periodically, we’ve added our two cents to the discussion. Since its approval by the FDA in March of last year, we’ve seen a variety of protests from psychiatrists about its value for treating treatment resistant and severe depression. A recent article published in The Lancet provides an overview of the back and forth discussion. A group of physicians wrote a series of editorials published in The Lancet in October 2019, challenging Spravato’s value when weighed against its dangers and modest effectiveness. And the esketamine nasal spray controversy surges forward.
A significant benefit for Spravato is supposed to be that because the FDA approved it, some insurances cover the cost of the medication and the cost of the doctor’s 2-hour office visit to administer it. (Stay with us–more on this later!) That’s a substantial benefit in the eyes of some patients.
There have not yet been head-to-head controlled trials comparing racemic ketamine infusions to Spravato. But there are plenty of physicians around the country who have used both in their offices with patients. And when you compare Spravato with the effectiveness of IV ketamine treatment, Spravato’s benefit is less dramatic, and rather than occurring rapidly and robustly — it seems much milder and more gradual.
In addition, FDA approval requires the use of an antidepressant at the same time as Spravato.
(It’s like Spravato is an adjunctive treatment to an antidepressant you’re starting at the same time, or an add-on to an antidepressant that’s on board but not completely effective.) Hmm. When you think about it, it may be harder and harder to know what the FDA trials really showed.
So let’s look at the objections of these doctors, and the response from a team led by Ella Daly, M.D., associated with Janssen, the maker of Spravato.
A Former FDA Recruiter Expresses Misgivings about Spravato’s Trials
One of the critics of Spravato’s FDA approval was a former FDA reviewer himself. Erik Turner, MD, of Oregon Health and Science University in Portland, OR, made a point in his editorial.
He said that some physicians who had heard that Spravato was a “game-changer” were likely to feel disappointed when they found out that 81% of the response to this medicine was experienced by those who were given the placebo!
Erik Turner, M.D.
As a former reviewer himself, he expressed his concern that esketamine nasal spray was basically approved on only two positive trials, in spite of the failed ones.
In a short-term trial to show effectiveness, the response of reduced symptoms was not maintained for even 24 hours. It’s not hard to see why that wasn’t satisfactory.
In the FDA trials, Janssen used the Montgomery-Asberg Depression Rating Scale (MADRS) to rate change in mood in the subjects who were taking esketamine spray. Surprisingly, there was only a mean 4 point improvement on that scale which has a possible score of 60.
It’s only fair to note that 69% of subjects who were taking the active drug vs. placebo technically responded. However, when we consider that they deemed only 2 points on the MADRS as “clinically significant,” practicing psychiatrists might not see it the same way when evaluating their own patients.
Still, 52% of the placebo group scored 50% or higher improvement on their MADRS rating. So research team labeled them “responders,” (meaning the nasal spray they were testing had made them feel 50% better). But…the nasal spray that the placebo group was using was a placebo….
You can see why Dr. Turner had some misgivings about the accuracy of the conclusions.
Maintenance Trial Findings Distorted..?
Dr. Turner also challenged whether the maintenance trial’s findings were up to par because a single site in Poland was the basis for those results. Trouble was that 100% of participants in the placebo group there relapsed. Which most researchers consider a red flag.
The Janssen team defended their findings, and pointed out that the FDA didn’t see the need to eliminate data from the Polish site. In this recent response published by Dr. Daly and her colleagues, they produced another analysis which eliminated the Polish data. They used updated estimates and concluded they maintained the statistical significance.
Dr. Turner came up with his own calculation based on information openly accessible to the public. His conclusion was that there was a “non-significant difference.” So he made the appeal “in the spirit of open science” that Janssen would provide an unbiased researcher with the patient-level data to hopefully resolve this conflict and try to replicate Janssen’s findings.
Then …there is the issue that 6 people died during FDA trials. Of the six, 3 were suicides. The suicides occurred on the 4th day, the 12th day, and the 20th day after the last dose of esketamine.
There were no deaths with the placebo.
Again …troubling. And confusing for a lot of people.
Right now, the FDA says that Spravato can only be administered in offices, clinics, or hospitals registered with the Spravato Risk Evaluation and Mitigation Strategy (Spravato REMS). Patients must remain in the office for monitoring for 2 hours after each dose.
Another Editorial by Two Experts Fuels the Esketamine Nasal Spray Controversy
Ioana Cristea, Ph.D., of the University of Pavia in Italy, also published one of the editorials in October in The Lancet with Florian Naudet, M.D., Ph.D., of Universitaire de Rennes in France.
Dr. Cristea pointed out that the mild benefits of Spravato should be weighed against its potential for harm.
She also holds that since Spravato is so expensive, has high potential for abuse, and has a troublesome history for safety, the bar for FDA approval for antidepressants should be raised.
And she has a point.
In the real world, our patients suffer severe and complex disorders, and the need for robust and rapid solutions for them has been gaping for 30 years.
Mild benefits that build gradually are only effective in select patients.
At Innovative Psychiatry we do use Spravato for select patients — but we use IV ketamine much more often.
Why?
Because IV ketamine treatment can yield such rapid and robust benefits. And many patients need a treatment that’s both rapid and robust. It’s often life-saving. And we’ve published our results using IV ketamine infusions to stop suicidal thinking in real-world patients and presented our ongoing data at several conferences.
For some patients, the insurance coverage that makes Spravato more accessible to them is well worth the risk of a less robust outcome. And we’re pleased to help them access the treatment best suited to them.
With that said, since Spravato is made with the left-side enantiomer of the racemic ketamine molecule, it’s lacking the attributes of the right-side enantiomer. This is a subject that’s been side-stepped. We need more data about the right-side enantiomer.
Esketamine Nasal Spray Controversy – Was Spravato the Only Alternative to IV Ketamine?
And another thought. Janssen’s stance in developing the esketamine nasal spray was that ketamine was only available in IV form. But was that a real concern? Long before Spravato was approved, compounding pharmacies were already creating nasal sprays for ketamine, so it’s clear that a nasal spray using the full racemic ketamine molecule was a viable consideration. Some doctors have been prescribing that, and oral lozenges (called troches).
So was it really because ketamine was only available in IV form? Or was it because ketamine’s patent had expired? (Hint: The big money is in the patent.)
Is it possible that safety and effectiveness were sacrificed in lieu of monster profits?
There is no pharmaceutical company sponsoring controlled studies of racemic ketamine.
But there are real-world physicians with complicated patients around the country willing to carefully and diligently report what they see in their day-to-day offices. These are retrospective studies of their protocols, their patients, and their patients’ responses. Submitted for peer-review. And published.
We know because we’re one of them. (We’re actually the first one of them. With the largest numbers, and with extraordinary responses to treatment.)
Why do we do this?
Because we know that once insurance companies realize that IV ketamine treatment in the office can rapidly stop suicidal thoughtsand plans in patients with treatment-resistant depression — even those who’ve made attempts before, been hospitalized, been failed by ECT, failed by TMS — those insurance companies are going to be pressured to stand up and listen.
If we can turn these patients around (you? someone you love? someone you know?) so that they don’t have to go to the ER, and don’t have to be psychiatrically hospitalized…. WOW! What insurance company wouldn’t jump at paying for IV ketamine infusions instead of ambulances, ERs, and hospital days??
That’s what I advocate for. Every day. Safe, effective, rapid treatment. Hope. Better lives for my patients.
Imagine that.
Imagine the goodwill gesture — such a small gesture, and such a small cost –for your insurance company to just simply approve payment for the codes we use everyday for office-based IV ketamine infusions for depression.
IV ketamine treatment stands as the most rapid, effective treatment against severe and treatment-resistant depression, as well as suicidal thinking, that we’ve ever seen. In the office, in an evening. In less than an hour.
Which insurance company will step up and pay for IV ketamine to save a life?
A girl can dream …and that goes for psychiatrists and their patients, too.
If you believe Spravato can work for you, call us. We’re happy to provide this treatment for you. Don’t let the esketamine nasal spray controversy discourage you. In some people it works very well.
If you’ve tried Spravato and you were disappointed with the results, call us and let’s talk about what IV ketamine might do that Spravato can’t.
We’ll help you understand the differences in the fixed doses available with Spravato and compare them to what is available when ketamine is used IV.
You can rebuild your life with the motivation, initiative, and energy that’s been missing with restored hope … and joy. What’s more, creativity can return and grow as you invest in your career, your relationships, and your hobbies.
We’re all about seeing you restored, fulfilled, rewarded.
We’ve come so far in ketamine treatment for depression, and we still have so far to go.
KRIYA held the first conference on ketamine treatment for depression in 2015. Now, 5 years later, there are several medical conferences that support the exchange of information in this field. Raquel Bennett,the founder of KRIYA – The Ketamine Research Institute – says that ketamine is a flexible tool and should be used with freedom and skill. She urges clinicians to make the most of the flexibility of ketamine.
This is the last conference by KRIYA that will be held in this format, according to Dr. Bennett. She plans to possibly shift to an online format next year to accommodate the huge numbers of clinicians who wish to be included.
What’s more, KRIYA has supported, from the beginning, the use of ketamine by different routes and for varied conditions, and encourages participation from providers across the gamut of ketamine applications. So we’re a wonderfully diverse crew who come together for these conferences. As for me, I know that I’ve learned so many things and forged new friendships and collaborations from KRIYA conferences.
And…my own contributions have been so warmly received. As far as the educational gathering, there are psychiatrists, psychologists, therapists, ER physicians, pharmacists, anesthesiologists, neuroscientists, nurses, and experts in consciousness medicine.
Raquel Bennet, Psy.D. Stepped Up as a Leader in the Field of Ketamine for Depression
Dr. Bennett reminds us she has created a “tasting menu,” if you will… from
all corners of the field. At this conference, she opted for breadth vs depth to make us privy to all that’s happening in the field of working with ketamine. And she emphasizes that speakers are working from different paradigms. So, she urges us to listen for the paradigm they report from….and learn.
And she’s right when she says that ketamine is a flexible tool that contributes to a variety of needs. When a patient is too depressed to talk, ketamine lightens depression so they can participate in talk therapy. To help manage severe pain and the depression that goes with it. It can help the patient go deeper into therapy, and explore their traumatic experiences gently. It can treat acute suicidal thoughts and prevent hospitalization. And she says, it can induce mystical visions for existential exploration.
Raquel had much, much more to say, but I want to mention some of the other speakers.
Brent Turnipseed, MD and Lindsey Slater, LPC, from Austin, TX talked about their use of EMDR in ketamine-assisted therapy.
In PTSD, the body’s own reaction to a patient’s traumatic memories activates adrenaline , which prevents their ability to process their trauma. Ketamine can calm the body enough that they can process the trauma without the distraction of adrenaline. As a result, it can help relieve their fears.
EMDR works by helping the patient desensitize by brief exposures to the trauma, then by redirecting the patient’s attention, EMDR induces a relaxed neurological state similar to rapid eye movement (REM).
Elias Dakwar, M.D., psychiatrist and the addiction researcher we’ve often talked about before, gave a wonderful presentation.
He presented a thought -provoking talk on meditation and mindfulness as it relates to ketamine in treating addiction.
The field of ketamine for psychiatric disorders, including addiction treatment, continues to wrangle with how to take ketamine into psychiatry but that’s because our paradigms are problematic. Mainstream psychiatry has tried to cut ketamine down to size instead of using this extraordinary medicine as a DISRUPTOR.
Dr. Dakwar entered addiction research after a long time practice of meditation and with great compassion for the patients he sees.
He described his previous and current work in detail–look for it in the journals.
Ian Mitchell, M.D., Emergency Medicine in British Columbia,
spoke about the uses for ketamine in the emergency department. He spoke about its use for sedation during an emergency procedure, such as setting bones, repairing wounds, or the removal of foreign bodies, pediatric sedation for the same types of procedures, sub-dissociative dosing for pain management, especially for neuropathic pain, to prepare a patient for intubation, sedation for the out of control, prehospital pain relief, and to manage an overstimulated patient.
In British Columbia, ambulances are equipped with intranasal ketamine for prehospital pain management as a result of the PAIN-K trial. More of ketamine’s flexibility.
Wesley Ryan, M.D., psychiatrist from Marina del Ray, CA, Parria Zarrinnegar, M.D., psychiatrist in Portland, OR, and Daniel Barton, M.D., psychiatrist from Nashville, TN all presented riveting case reports.
Kelan Thomas, Pharm.D,
spoke about adverse reactions and drug-to-drug interactions that have been documented with ketamine. So important and so well-done.
Annie Oak, a journalist from the Bay area, spoke on the use of ketamine outside the medical setting.
Gita Vaid, M.D., psychiatrist and psychoanalyst, spoke on using ketamine in psychoanalytic psychotherapy in very long session. She talked about how she has witnessed ketamine help patients relax and defenses soften so they can have freedom to talk. The psychotherapist builds relationship with the patient and it can be transformational.
Jason Wallach, Ph.D., is a pharmacologist and neuroscience researcher whose energy and depth of knowledge captivates us every time he speaks. He spoke about the neuroscience and pharmacology of ketamine. Gave an update on some of the other dissociative drugs he’s tested. (I think he’s tested them all!) He made the point that ketamine has been called a dirty drug because of the receptors it hits ex-vivo and in animal models — but that’s not true. It’s really one of the more selective drugs of this class at the doses used in people.
Jessica Katzman, Ph.D., and Harvey Schwartz, Ph.D., spoke about bumps in the road they’ve discovered with ketamine assisted psychotherapy and in the integration work that follows treatment… What is integration? It comes from a latin word that means “to make whole” or “to begin again.” Bring your clinical compass, but don’t forget your humanity. A beautiful duo talk with lots of clinical examples.
Eli Kolp, M.D., a pioneer in ketamine treatment, gave a beautiful talk on the phenomenology of ketamine-induced dissociative states.
There were so many other speakers and so much to absorb–my computer battery kept dying down, so between Surface notes, handwritten notes, and photos, I can’t do justice to the breadth of expertise in the room, and the excitement.
Greg Wells, Ph.D.Sylver Quevedo, M.D., Veronika Gold, M.F.T., Eric Sienknecht, Psy.D. presented as a panel on their model of coordination of care between prescriber and psychotherapist. Peter Koshland, Pharm.D. talked about how to work with a compounding pharmacy for varied compounded preparations of racemic ketamine. Nate Schmidt, A.R.N.P spoke about scheduling and billing logistics.
Sunday was a treasure with a very special presentation by Francoise Bourzat on the Use of Sacred Medicines in the Age of Technology and Medicalization. It was a delight to meet her. She captivated the audience, and her new book, Consciousness Medicine, is a wonderful synthesis of her life’s work.
Kelley O’Donnell, M.D. and Christian Yavorsky, Ph.D. are doing yeoman’s work with KRIYA and presented an excellent (and not dry!) talk on Measuring Clinical Outcomes: Scales and Assessment Tools. And in addition to the training for Ketamine Assisted Psychotherapy that Raquel Bennett presented and discussed earlier in the conference, Jennifer Dore, MD presented a model of training for Ketamine Assisted Psychotherapy developed by Phil Wolfson, MD and Julane Andrews, that they have used around the country.
IV Ketamine can STOP suicidal thoughts fast…Now that’s flexibility of ketamine!
On the last day, and as the next to the last speaker, I took the podium to share my data in working with patients in my own practice, and showing how IV ketamine infusions can stop suicidal thinking, and save patients from having to go to the ER or be hospitalized.
With heartfelt gratitude. These are my people–the clinicians and many of the greats in the field (who were in the audience) who launched my interest, encouraged my work, supported my writing–and showed me how to apply for an IRB. It’s amazing how much can happen in a year. So I saved the newest data and my newest results (using a new protocol and a new rating scale) for my colleagues and my friends here at KRIYA. I wanted them to hear it first.
I wanted to give back to those who have sparked my imagination, nurtured my interests, given wind to my sails.
It gives me such joy to share how this remarkable medicine that can do so much, can also save a life in a short time. And to see clinicians in practice eager to take this information home.
And that’s the beauty of meeting together at KRIYA and swapping stories and describing outcomes and victories that have restored the lives of people we work with.
Looking Back…and Reaching Forward – Preserving the Flexibility of Ketamine
It’s been such a busy fall with travel and speaking engagements each month… along with treating patients. (I’m sure my colleagues are as tired as I am. We need a vacation. Seriously.) But it’s gratifying to look back and know all this information that’s been shared will improve the lives of people we each cross paths with after KRIYA and all the other conferences.
I know these reports “from the front” can seem science-y and vague, but I want you to see how hard clinicians, neuroscientists, and practitioners of all types are constantly working to learn the breadth and depth of what ketamine can do to help people live better, improved lives. That’s really what it’s about. Ketamine’s flexibility allows for treatment that can turn your life around.
And if you’ve been reading along, and wondering if there is help for you, call us. In spite of all the travel and bustle, we’re still in all this to help you get better, live better, and have the ability to build a truly fulfilling life.
You owe it to yourself to try, if you’ve not found a medicine that works for you. It’s not that ketamine is a cure-all for everyone, but it works in so many areas of your brain, that it can restore areas damaged by stress and trauma in most people who are treated with it.
As the holidays approach, give yourself the best chance you can to enjoy the time ahead and the new year that follows.
Just think about it. How far reaching is this one condition?
Sure people talk about being depressed with a casual tone. You get the feeling they feel crummy…but it seems to be their response to circumstances. And when circumstances change, they seem to forget they felt bad. But when you think about who’s affected by severe chronic depression, you think of people who don’t have the energy to get up in the morning. You think about people who are trapped in substance abuse and have grown to hate themselves. You think about people who are just tired. Of everything.
Let’s take a closer look at the people affected by severe chronic depression. Who are they?
Gary is one.
Gary worked hard his entire life. He worked tirelessly to help others improve their lives. He worked to inspire and comfort. But, when you’re in the business of helping people enjoy richer, more meaningful lives, there are always those few who spurn your efforts, and even come back to crush you, if they can. And sometimes it’s the one you believed in the most.
In Gary’s case, there were two of them. They robbed his house when he was away for the evening. Then, spread false stories attacking his integrity. And Gary was cut to the heart. After being robbed and betrayed, he was hurt, angry, disheartened. In fact he was shattered.
Even though he’d always been optimistic, and bounced back after disappointments, this time he utterly lost his footing. Shock and devastation swarmed around and within him. He lost his bearings…and withdrew into the quiet safety of his house.
He found himself acting strangely, behaving in ways he never had before.
Months went by. He ordered food from Amazon and avoided any human contact if at all possible. He didn’t answer the door, and friends gave up, one by one, and became absorbed with their own lives.
A relative helped him get in to see a doctor finally. He was diagnosed with Bipolar II Disorder. The doctor prescribed a medicine to help prevent the hypomanic episodes, but the depression and withdrawal didn’t improve much. Years went by and he settled into a routine of leaving the house maybe once a week. His warm, inviting personality became subdued and cautious.
Something needed to give. To help free him from the box he’d built around himself.
And thankfully something did …but we’ll get back to that in a moment.
And Who ELSE?
Dan is.
Dan had his first drink when he was 14, and was hanging out on a Saturday night with his brother’s friends. They were all 16 and 17, and after getting some six- and 12-packs of beer, they all went to the lake on a Saturday night and drank all they had. Some ended up vomiting, others passed out in the car. Dan did both. But he liked the way the beer made him feel, and he knew he’d be up for drinking more when he had the chance.
High school beer bashes led to frat party blow outs, and while he experimented with some other things when he had the chance, it was alcohol that became his “go-to” in good times and in bad.
At 42, he drank whenever he was free. He had managed to get through college with a degree and land a job that was steady, but nights and weekends were his time to reward himself — whether anyone was with him or not. He worked hard to earn the right to get smashed on Saturday night.
After marrying in his 20s…hoping for happily ever after… he found himself alone and single again in his 30s. So many fights about his drinking. She was just beautiful, and he was so proud to be seen out with her, but she was so critical.
Alcohol Addiction and Depression… A Dangerous Combination
Now in his 40s, Dan began to understand why. And he realized he was likely to spend his life alone and drunk, if something didn’t change. He’d actually tried to stop drinking but something always happened and he was back at it. He felt pretty defeated. It seemed to be bigger than he was.
Every day he dragged himself out of bed, and went to work. He was often hung over, but 25 years of this had helped him develop an armor that got him to work, helped him function well enough to not get fired, and then home again to repeat the habit of every other night of his life. He had come to hate his empty, dead-end life, and his empty, dead-end self.
Dan hadn’t enjoyed anything in his life in at least ten years. He endured, and barely existed. He had no purpose. No joy. He was the chair person for the Dan Hatred Club. It was hard to see any reason to keep living. He wondered how to stop without it hurting too much. He was convinced no one would notice if he was gone.
There’s more to Dan’s story.
And I want you to know what happened. A little later.
While it’s so true that many people are very ill, even disabled in some cases, with severe chronic depression, you can see that many have other illnesses that are complicated by depression.
Some people suffer with a complex combination of disorders, and diagnosis and treatment can be complicated, too. We talked about Gary and his traumatic experience, the depression and phobias that followed and led to his eventual confusing behaviors, and a Bipolar 2 diagnosis.
We talked about Dan, his early introduction to alcohol and the long term impact it had on his brain…and his life. How his drinking gave way to poor social function, and the inability to give his best to his marriage. Eventually he found himself in a self-destructive rut and didn’t know how to turn it around. Then the suicidal thoughts began.
So who else is devastated – and disrupted – by severe depression symptoms?
Cheryl is.
Cheryl is 26. She’d finished college and was working on her masters degree in forensic psychology when she found herself pregnant. She and her husband wanted children, but they weren’t sure when.
Still, she felt like she was carrying a miracle within her, and the couple set about learning all they could about pregnancy, their baby’s development, and child rearing. They wanted this to go perfectly. She would find a way to complete her masters degree. But she was determined to celebrate their child’s life.
Her pregnancy was hard at first, with morning sickness that seemed unrelenting. But around the 13th or 14th week she thought she might be feeling a bit better. She began to browse in baby stores, looking at the tiny clothes and trying to imagine her baby wearing them. Her clothes were also getting tighter, and she shopped to find some pants that were looser and more comfortable. It was all beginning to feel amazing, just thinking about this little person who was safely cradled and growing out of sight….but under her heart.
The weeks dragged by, and her excitement about her baby became almost too much at times. She and her husband began shopping for a bassinet, a crib…and a stroller. She learned about support meetings for breastfeeding mothers and attended as often as she could. There was so much to learn!
Weeks turned into months, and finally she was in her third trimester. Just 3 more months. Through her pregnancy her emotions were filled with excitement and joy. A sense of wonder seemed to give the whole world a glow.
Happy Times Preparing for Baby
She and her husband attended childbirth classes and toured the hospital. They practiced exercises and breathing patterns at home to try to truly equip themselves for the adventure of labor and delivery.
Then, when she was 41 weeks along, those Braxton-Hicks contractions everyone talked about began to get out of hand. Within a couple hours she was in the ER being checked out.
Finally, she was in labor.
Cheryl’s labor progressed normally the first 10 hours. Then, in spite of hard and nearly constant contractions she was no longer progressing. Her doctor confirmed his suspicions: the baby’s head was lodged at an angle in the pelvic region and couldn’t move forward. He called for a C-section.
Within 15 minutes she was wheeled into the operating room, and suddenly asleep. When she awoke, everything seemed strange. Then she remembered the labor, the baby, and oblivion.
Her husband was smiling and told her they have a beautiful baby girl. She felt too groggy to understand what he was saying. She blinked hard to try to clear her head. Her husband handed her a little bundle. She laid it in her lap. What was it?
As the fog cleared her head, her memory of the labor returned. Her new baby slept in her bundled blanket. And Cheryl put the pieces together. She had had a baby. She was sleepy because of emergency surgery. The baby couldn’t get out… But where was that baby?
Traumatic Birth Can Interfere with Bonding Between Mother and Child
She asked her husband, and he told her their baby was in her lap. But the bundle in her lap didn’t look like anyone she knew. It just didn’t feel real…somehow…
She felt no connection to this tiny human, in spite of her husband’s reassurance… She felt sure she would have recognized her own baby, right?
Cheryl found herself detached, stunned, disconnected from feeling like a mother. Her strange behavior puzzled her husband. Why didn’t she cuddle their beautiful baby girl? The nurses tried to help her breastfeed, but the baby only cried. Almost as if this baby girl could sense her mom’s disconnect.
Cheryl and her husband took their new baby home and named her Phoebe Mae. She desperately wanted to feel something good toward the baby. But, she didn’t. She couldn’t. All that anticipation for 9 months, and this is it? Endless exhaustion and sleepless nights? Where was the joy..?
Her behavior worried (and angered) her husband. He just didn’t understand his wife’s coldness. Was this damaging Phoebe? What damaged Cheryl to cause this?
Months went by and Cheryl had long since taken up bottle feeding Phoebe formula. Besides, her husband could help more easily this way.
Then, Phoebe’s first smile was for her daddy. And her first laugh, too. Cheryl felt a bit jealous that she stayed with her daughter all day and fed her and took her on walks, but she really only responded to her daddy.
Who Else is Affected… or should I say, Overwhelmed ?
The family is.
Everyone who loves you. They worry, they try to help, they pitch in, they listen.
And try as they might, they’re helpless. And desperate for solutions. Your severe chronic depression breaks their hearts.
These few examples give only a glimpse of the complex symptom clusters any one person might suffer. There are so many more.
But IF, and only IF, you can safely and effectively reduce or even eliminate, the symptoms of depression, you may be able to see your life restored and functioning again.
Of course, traditional SRI and SNRI antidepressants play their role in helping people with depression feel better. Roughly a third to half of them…maybe a bit more. For those people, antidepressants are enough.
Remember, there is no medicine for depression that is as fast working as ketamine. No other medicine is as widespread in its antidepressant benefits in the brain. And no other medicine helps as many people recover, even achieve remission, and build restored, rewarding and fulfilling lives like IV ketamine treatment can.
Plus, it’s safe.
Ketamine doesn’t cause long lasting side effects. The notorious effects most antidepressants display, like sexual dysfunction and weight gain, don’t exist with IV ketamine. Ketamine doesn’t raise or lower the blood levels of other medicines you’re taking. It just goes to work. And, hopefully for you, it accomplishes the transformative restoration it’s so famous for.
The World Health Organization includes ketamine on its List of Essential Medicines. Respected around the world in ORs, ERs, disaster areas, and war zones, ketamine isn’t new.
Remission Often Replaces Severe Chronic Depression at Innovative Psychiatry
How did IV ketamine treatment impact Gary, Dan, and Cheryl? Did they recover from their own severe chronic depression symptoms?
IV Ketamine Treatment Does Its Best Work When Symptoms of Severe Chronic Depression Seem Untreatable
Remember Gary?
And his boxed-in anxiety-filled existence? The same friend who helped him go to the doctor, also helped him access IV ketamine treatment.
After 7 infusions, Gary bloomed. The warm, outgoing, generous man who had served people in need all his life re-emerged. Gary’s confidence returned along with his energy to participate in the lives of people who needed his help.
His life became rewarding again, filled with activity and relationships. You might say his best self was restored.
Then there was Dan.
Dan was suicidal when a friend told him about IV ketamine treatment. He learned that ketamine not only relieved depression, but could be effective in helping break addiction. And… that it could stop suicidal thoughts in a few hours. Dan wanted to see what it could do for him. He felt like this was his last ditch effort. He didn’t want to die, exactly. But he didn’t want to live like thisany more.
Well, he was not disappointed. The first half hour of the first infusion, those images of death and thoughts of dying disappeared. Almost like poof! gone. He emerged from the infusion smiling. That was a good start alright.
That night, he found he had no interest in a drink, so he skipped it. How about that, he thought to himself.
After the second infusion, he definitely felt less depressed. Improved. NOT great…but better. By the time he arrived for the 4th infusion he was feeling pretty good. Hopeful…motivated.
It’s been six months since his 6th infusion now, and Gary feels like he’s living. He’s stopped drinking completely, sees a few friends, met a terrific woman. His future looks bright.
And Cheryl…?
Well, Cheryl’s husband heard about ketamine for depression from a friend at work. He encouraged her to talk to her doctor about it. Her doctor said that effectively treating the depression could reverse her struggle with bonding.
When Phoebe was six months old, Cheryl received her first infusion. On the way home with her husband she could tell no difference. He encouraged her to keep an open mind. That he’d heard it could take awhile.
By the 4th infusion he noticed she was taking initiative in the kitchen, preparing a new recipe. She hadn’t done that since Phoebe was born. Then the next day she was sitting with Phoebe playing patty cake… and that night rocked her, kissing her on the forehead as she drifted off.
She was expressing joy more and more and laughing with Phoebe. By the end of the 6th infusion she didn’t feel perfect but she did feel happy. The doctor said it would get better and better.
Severe Stress Can Cause a Setback
Then Phoebe got sick. At 8 months she caught her first cold. Cheryl was up all night comforting her, sitting with her near the humidifier to help her breathe. This continued for 4 days until Phoebe started feeling better.
But the lack of sleep and strain took their toll. And Cheryl’s depression returned. Not as severe as it had been. But severe enough. A couple weeks later her husband asked her to call the doctor, who told her she may need another “booster” infusion. So she complied.
She felt much better again after the infusion, and Phoebe stayed well all summer. They had daily walks in the sunshine, and Cheryl and Phoebe both had rosy cheeks and and a tan.
The next time Phoebe got sick in the fall, the stress didn’t affect Cheryl adversely at all. She had the resilience to go without sleep as she cuddled her baby girl through the illness.
Before long, Phoebe turned a year old. Cheryl and her husband threw a big party for all their friends. It was a celebration of their little girl’s milestone, and for the joy Cheryl and her husband were enjoying again.
This Can Happen for You, Too
These stories all have happy endings. But low dose IV ketamine isn’t for everyone. Is there any medicine that is? Nope…not a one. But the response rate to ketamine treatment is remarkably high.
Still, that remarkably high response rate relies on skilled administration. Low dose IV ketamine treatment is not a one-size-fits-all treatment. It requires careful titration, identifying specific responses in the patient, and finding the sweet spot in dose and rate that yields the best outcome for each individual.
Unfortunately, many providers of ketamine don’t understand this, and give the same dose at the same rate to every patient, then schedule them to come in for regular maintenance infusions, indefinitely.
In other cases, they try a different dose with each successive infusion, because they don’t really understand how to achieve the therapeutic response.
Find Restoration from Severe Chronic Depression
Innovative Psychiatry is the premier provider of IV ketamine treatment in Connecticut for safe, effective treatment of depression and other psychiatric disorders. We offered the first ketamine treatment center of Connecticut for severe chronic depression and other disorders.
Innovative Psychiatry offers you a most extraordinary psychiatric treatment, IV ketamine. Some people require booster infusions now and then for awhile, and others achieve remission with the initial six infusions.
Every brain is different, just as every person is different.
We can’t predict what it will be like for you, but we can promise to provide the most effective administration of this remarkable treatment that can be found anywhere.
Can you relate to Gary, Dan, or Cheryl..? Or maybe to their loved ones? If you have similar symptoms or variations of your own, that have not responded to the treatments you’ve tried, call us.
Like the people we’ve talked about here, you can have restored joy, renewed initiative and motivation, the energy to pursue your dreams, and to rebuild relationships.
We’re here to help. Let’s work together to help you live a fulfilling and rewarding life.
“Sure, I want to feel better. I’ve tried so many medicines and treatments. I don’t even know what it’s like to enjoy something, anything…or to feel happy. I don’t have the energy to even get out of bed half the time, much less get anything done. But…the cost of ketamine treatment is way out of reach for me. I don’t even know if it’s worth it?” That’s Ann Marie, out loud.
“When I go to work, my mind is plagued with images of people dying… or me dying. Dark, hopeless thoughts and pictures in my head. Sometimes gruesome…
“But we all know IV ketamine treatment is for people who’ve got money…. right?”
……….
This is what people say to themselves, and to their family…comments like this, or others similar…
And since IV ketamine treatment can restore your hope, your motivation, and initiative, you’re likely to be far more able to make those payments after you’ve benefitted from the treatment.
So, maybe they aren’t seeing the big picture… in fact, maybe you aren’t seeing it either. It’s something to think about.
Because, you know, you don’t have to have the free cash to pull the payment out of your wallet on the spot. You know that, right? Countless companies offer medical financing to pay for medicines and procedures over time. Advance Care Credit, United Medical Credit, and M-Lend are a few.
For example, have you thought about the benefits of investing in IV ketamine treatment ? Yes, there’s an initial investment, but have you thought about this..?
Discontinue Medications and Save $$
For one thing, you’ve likely been taking medications for your depression or other disorder for years…haven’t you? And even though they haven’t helped, you may still be taking them.
But, the beauty of ketamine is that it works independently of SRIs, SNRIs, anxiolytics, etc. So by investing in as few as 6 ketamine infusions, or a few more as needed, you may find you’re well enough to think about eventually tapering some of the add-ons that didn’t add anything.
Some of your medicines may not be expensive, but some may be pretty pricey. In some cases, people have found that IV ketamine treatment paid for itself in 3-6 months. Even when you have insurance, your treatment costs can be exorbitant. Now it seems like everyone has a huge deductible to pay before insurance even kicks in. How much money would you save if you were able to stop taking those …. add-ons that maybe aren’t adding anything? Well, that money could go toward paying for your IV ketamine infusions.
Then, there are those calls for extra appointments with your doctor when your symptoms flares.
Fewer Doctor Visits
If you’re not having symptoms, you may find you don’t need to see your doctor as often as you were when your symptoms were so persistent and so severe. What a relief that would be–if you didn’t need to call to be fit in for extra appointments when you took a dive, didn’t have to reach out to an answering service on the weekend. You’d probably prefer to spend that time and money doing things you enjoy, right?
Why pay for a parking garage and sit in a waiting room when you’d rather be hiking in the woods, or playing tennis, or shopping? When ketamine goes to work on your brain systems, and restores the circuitry there, you regain the power to enjoy. And if you’re enjoying yourself, it’s likely you may not feel the need to check in with your doctor nearly so often.
Add to that the expense and the hassle of lab work. Some medications require that regular lab work be done to monitor your liver, or your kidneys, or your blood sugar and your cholesterol.
To spend more of your time enjoying your life, your work, your hobbies, and your relationships is a far more fulfilling way to spend your time than having blood drawn in a lab on a Saturday…don’t you think?
And money spent on co-pays and fuel, as well as wages lost from missed work and days you take under your FMLA for symptom flares and doctors’ visits…well, those funds have such better uses when you feel really well. Baseball tickets, funnel cake, or…a picnic in the park!
Cost of Ketamine Treatment Improves the Quality of Your Life
But most of all, it’s the quality of your life. While the costs can be reclaimed in countless ways by a happier, healthier you as time goes on, can you put a price on your improved, deeply rewarding, utterly fulfilling new life?
James comes to mind. A patient of mine who couldn’t remember everfeeling happy, or having fun, or enjoying those little moments in his life. Ketamine worked for him. And now, he enjoys a fragrance he notices in the air, the way the meat responds to the fire when he’s cooking, the clear blue of a mountain spring.
Things he never noticed before because of the dark gray cloud that hung over him, suffocating him. He arranged financing for his treatment, and that monthly payment feels easy, because he lives every day the life he had wished for as long as he could remember.
And his life has bloomed, because he has the energy to step out and live. He has a family that’s growing and his mind is on his family’s future…in fact, he realizes his whole life is ahead of him. He invested himself and the cost of ketamine treatment was part of that.
Then, there’s Lisa. She grew up in a home where she never felt understood. She was sensitive, intelligent, and meticulous. Her parents were hard working, confident, and not so tuned-in. Not really understanding their daughter’s sensitive nature, they made a plan for her from earliest childhood. She would be a doctor, and would make them proud.
But Lisa’s heart turned to music, and she sang like an angel. From the time she was losing her front teeth, she could feel her parents’ pressure to be who they wanted her to be. She wanted so much for them to appreciate her for who she really was.
Lifelong Depression Wears Down Brain Circuity
By her 6th birthday, she would arrive at home after she got off the bus, and enter the dark house frightened, alone, and shaken. The anxiety from those long afternoons alone in a dark house grew to a dread that followed her wherever she went.
Depression drained her energy, and her hope in life. Adolescence turned out to be a cruel time, and she felt she didn’t fit in anywhere. College was a chance to excel. Getting married was a no-brainer. And though she had transient reprieves from the trudging existence she endured, the dark hopelessness and choking despair always returned.
Pregnancy after pregnancy…she could conceive, but had no energy to care for the children, and would just go back to bed. The kids spent a lot of time at their friends’ houses while she slept on the couch. They learned how to make their own mac and cheese.
Hospitalizations didn’t make much difference. Medicines her doctors prescribed brought no relief. The kids raised themselves.
The Cost of Ketamine Treatment
But finally, when her first grandchild was on the way, and Lisa wanted the ability to build a relationship with this child, she heard about what ketamine treatment was doing. She learned that she would need at least 6 infusions, so she needed to be prepared to pay for them.
Those who knew her and loved her wanted to help. Eventually, a friend offered to help her pay for the treatment.
For Lisa, it got unreal right then. There was an unreal-ness about suddenly having a way to get real help…to maybe have an opportunity to feel good for the first time in her memory.
And as she’d hoped, within a week she was improving. Little beams of hope penetrated her cold damp tomb of anxious despondency …one little beam at a time. It was slow. She started taking walks, just because. Then she started reading books and meeting friends for lunch.
A friend’s help made the cost of ketamine treatment manageable.
Now, Lisa is a rosy-cheeked, very active grandmother. She takes her granddaughter on picnics and to the zoo, for ice cream, and to play in the park and feed the ducks. Her grown children watch in disbelief–where was she when they were little?–but they’re relieved that she is finally functioning, happy, productive, and interested.
She has the energy to share all kinds of experiences with her grandkids…both the physical as well as emotional energy. They play games and she teaches them about good sportsmanship and the competitiveness to win, too.
Lisa made little payments to her friend for three years to repay the loan that gave her back her life. She says that loan was the greatest gift she’s ever received. She has the power to love again. To dance and sing and play ball with her family.
Ketamine Treatment Must Be Available to Those Who Need It
Is there anything more important than the power to live your life well? Happily, generously, joyously?
When people ask me how they can afford to pay for this treatment, I wonder. A lot.
I wonder how we can afford to stand by while our sisters, our friends, our kids, and our husbands slowly shut down.
I wonder how we justify the days lost, the jobs lost, the unpaid FMLA’s, the lost opportunities. The kids’ games that we missed, the holidays we suffered through, the long agony of a weekend that was empty.
I wonder how our insurance companies so readily deny payment for an infusion that could stop suicidal thinking and save a life –but quickly fork over $1300 for an ambulance ride to the ER and another $1500 for the night spent on a gurney, waiting to see if the crisis worker will hospitalize you or send you home?
Insurance will pay for that, and refuse to cover ketamine infusions? The procedure exists, the billing code is there, the diagnosis is clear …the results speak for themselves.
I wonder, sometimes, not about affording ketamine, but about how we can afford this: to live like this, day after day. What’s it costing us? What’s it costing our kids?
In the light of the transformative effect of ketamine at its best, you owe it to yourself to find a way to give yourself an opportunity to live – and live well. To enjoy your life, to invest in it, to learn and grow, to stop the suicidal thoughts, to get rid of the depressive symptoms. To be happy.
It’s true that IV ketamine treatment can’t offer a 100% response rate, but no medicine can do that. The cost of ketamine is an investment… But there are few investments available to us with the return that comes from this extraordinary treatment.
James made this comment, “Instead of spending all my energy trying to figure out how to survive the week and how to ignore the suicidal thoughts that are always there, I’m excited about figuring out my next step, and I’m looking forward to good things happening. I’ve never experienced anything like that before.”
Everyone should have the opportunity to live free of symptoms, and to have the energy and hope to invest in the things you believe in.
At Innovative Psychiatry, we’re investing in you and your future. If you’ve suffered and treatments haven’t helped, call us. The cost of ketamine treatment? We think it’s worth it. It can make real living, fulfilling engagement, rewarding relationships, available to you.
