Lori Calabrese, MD

Tag: IV Ketamine Treatment for Substance Use DIsorders

Where Can You Find Real Help for a Suicidal Person?

What is a suicidal person like? How do you find help for a suicidal person? Can you describe the profile of someone who wants to die? Are they melancholy? Irritable or agitated? Are they funny? Always making people laugh when they’re dying inside? Do they present themselves one way in public and another way in private? Are they sad…do they fit in …or are they misfits?

Yes. The answer is YES. And NO.

A suicidal person can be any of these people, or none of them. Someone like you …or me. Or different than both of us.

Anyone is capable of suicide given the wrong set of circumstances.

Someone who can’t remember a time when he wasn’t sad… or just vacant. A person who’s had a series of deep losses, major stressors, and profound disappointments: all in a row…or all at once.

Someone who just finished medical school. A young mother; a 9 year-old child. An elderly field laborer. A mail carrier.

The pastor of a mega church. The owner of a multimillion dollar consulting firm. A thirty year-old single father. A world-famous performer. The head of a university medical department. A kindergarten teacher. A 14 year-old girl.

Sister, father, son, daughter, grandmother.

WHO is a Suicidal Person?

For every person you find who ends his or her life, there are thousands with similar circumstances who don’t.

Why? What makes the difference?

What causes one person who seems to have “everything to live for” want to die, and another whose life is similar want to live and not even consider dying…? Why is it that two people can face shame, humiliation, failure; and one wants to die and the other bounces back and moves forward?

One thing is for certain. It’s not about one person being weak and another being strong.

Or about one being flawed and another being “normal.”

The complexities of suicidal thoughts as symptoms of a deeper, more complex underlying condition cannot be completely explained yet…certainly not here. But, somewhere in it all you’ll find genetic links, brain circuitry, complicated response mechanisms, and more.

Why does one person bear the burden of kidney malfunction or lung disease and another doesn’t? Or Type 1 diabetes? Or liver disease?

One person’s genetic makeup provides a tendency toward more resilience and another’s genes lean more toward less resilience. One woman’s genes map out a future with breast cancer while another’s don’t.

How Many In a Week..?

Last week was Suicide Prevention Week. On last Monday, September 9, 2019, a beloved associate paster of a prominent church in Riverside, California, officiated over the funeral of a lady who had ended her life. Before the day was over, he had ended his own, too.

Don’t ask why. Ask, “How can I help?”

We Need to Supply Real Help for a Suicidal Person

Then, two days later, the director of psychological services at a prominent state university jumped from his 17th- story balcony.

The gentle and caring pastor was a devoted, loving husband and father of two. He founded Anthem of Hope in 2016, for those who suffer from depression and suicidal thoughts. He had always been open about his own struggles with the same.

Jarrid Wilson was a kind-hearted, vibrant, encouraging person, with two beautiful children, and an amazing wife. He’d suffered from depression since childhood. His depression and suicidal thoughts became too much to bear for him that day.

His wife is grief-stricken, suffocating with the loss of her best friend, and his church is stunned.

Our hearts go out to his family, his church, and all who knew and loved him.

Jarrid’s life didn’t end because of something that was wrong in his life, but because of something that was malfunctioning in his brain. This is why we promote treatment for suicidal thoughts.

When you hear someone say, “She had so much to live for,” remind them that this is an illness. It’s not about hating her life.

Gregory Eells, Ph.D., was accomplished and a strong, capable leader. Was there a reason, or was his death also the symptom of an underlying disease..?

That’s the thing about suicide. Since we don’t know what his thoughts were, we can only guess. But it’s important to understand that stress…too much of it for too long…can lead to depression.

Prolonged Severe Stressors Can Result in Depression and Lead to Suicidal Thoughts

Stress breaks down those signaling structures and interferes in other areas of the brain. When that happens, the connections between brain cells become pruned and sparse… and signals are reduced in strength and number. The more severe the depression, the more profusely suicidal thoughts may grow.

Crisis on top of crisis; death and loss; financial difficulty; illness; divorce; foreclosure; …all of these things together can prune away those connections and lead to deep and overwhelming depression.

Then come the thoughts. Maybe a desire to escape the torture? Possibly. But more likely they’re somehow related to the poor communication of signals within the brain. The darkness. The silence. The void. The vacancy of any reward.

These thoughts tend to intrude in your mind when your depression and anxiety are most severe. Some people experience these intrusive thoughts of death and dying no matter what they’re doing. The more their condition worsens, the more these thoughts bombard their minds.

Suicide is Reaching Epidemic Proportions

In 2017, 1.4 million people attempted suicide, succumbing to those intrusive thoughts. Of those, 47 thousand people died. We talked last week about how this means that suicide is the 10th leading cause of death in this country alone.

And we haven’t even scratched the surface of all the people who have suicidal thoughts, plans, or intentions. Most of us are unaware of the numerous people around us who struggle with suicidal thoughts, because they maintain a brave mask.

This is why IV ketamine treatment is so vitally important now more than ever. As suicide threatens to take more lives, we need more and better ways to prevent it. And to do that, we need treatment that stops those thoughts.

IV Ketamine Can Provide Extraordinary Help for a Suicidal Person

By a mechanism that’s separate from what ketamine infusions do to relieve depression, they also can stop those intrusive suicidal thoughts in an hour or two…or an afternoon. So even those patients who might not feel relieved of depression symptoms after ketamine infusions, may still be relieved of those thoughts of death…and dying.

IV ketamine infusions are a life-saving treatment, and nothing else comes close. Other medicines that have been used for this purpose required weeks or months to be effective. And, well…with someone severely suicidal, that may be too late.

Ketamine acts in a multiple areas in the brain, and in a variety of ways. We do know some of the ways it works, but we suspect neuroscience researchers will continue to uncover more and more of ketamine’s handiwork going forward.

Ways IV Ketamine Goes to Work in Your Brain to Lift Depression

We know that as a NMDA receptor antagonist, ketamine increases levels of the excitatory neurotransmitter glutamate, the most prolific neurotransmitter in the body.

We know that ketamine turns the mRNA switch to “ON” which turns on DNA, that turbo boosts BDNF (brain-derived-neurotrophic-factor). Then the BDNF acts like a rich compost, stimulating growth of the connections between neurons, or brain cells, called synapses…and their branches of dendrites and dendritic spines.

These synapses, and dendritic branches proliferate abundantly throughout the brain, building superhighways for signaling to be high speed and abundant, lighting up the brain like a Christmas tree.

The slow, dark, sluggish signals that crept along during depression, explode with speed and efficiency as the brain comes alive.

When this happens, your thoughts become creative, extensive, and bright. Your outlook soars, and so does your initiative and sense of purpose. Resilience replaces despair, and hope sets down roots. THIS is real help for a suicidal person.

While all this is going on, there’s a change in the lateral habenula, that tamps down that bursting of cells that prevents you from enjoying reward. Your ability to enjoy moments, scenery, beauty, appreciation, and love is restored.

Then, there are those G cells stacked up on lipid rafts in the cell membrane. They lazily while away the afternoon. Then IV ketamine comes along and slides those G’s off the lipid rafts and puts them back to work moving signals down the highway.

These are the things we KNOW about. We’re sure there are more actions we don’t know yet. But we will.

The result is joy. And hope. And the energy and motivation to take initiative and build relationships, strengthen bonds, improve productivity at work, creatively advance in all you do, for a rewarding and fulfilling life.

Spread the Word and Stop the Torment to Provide Real Help for a Suicidal Person

At Innovative Psychiatry we see people like Jarrid and Gregory often. And we see so many others. People who don’t want to die…but who don’t want to keep living like this, tormented by pain and suicidal thoughts, images, and ideas. People who want to enjoy life, enjoy their families, and invest their energy in their careers, hobbies, and interests.

We’re thrilled and relieved to see the majority of them walk out without suicidal thoughts at all, confident they can get better with therapy and medication. Or they walk out in remission.

That’s the beauty of IV ketamine treatment at work. We’re trying to get the word out that there is now a treatment that can rapidly stop suicidal thinking. Help us spread the word.

We’d like to help you.

Are you tired of living like this? Do you ache for the freedom to build your relationships, your career, and your hope?

Protect yourself from those thoughts of death that try to lure you to an action you don’t want to take. Call us. Let us help you tap into the life you hunger for.

You’re not alone, and we’re here to help.

Please, if you have suicidal thoughts, call us. Or call the Suicide Prevention Lifeline: +1(800) 273-8255. Those intrusive thoughts are symptoms of an underlying condition and treatment can help.

IV ketamine treatment can erase those thoughts in an afternoon. We want you to live and to discover what life can be for you. We want to help you heal.

To the healing of your best self,

September 16, 2019
The Pain and Marginalizing of Stigma

Stigma Isolates, Humiliates, and Separates

As I think about what to write today, my thoughts are filled with a comment I received from a man who’d read last week’s blog, which you can read here. He wrote that he also suffers from bipolar 1 disorder and was upset and hurt by the description of the young man in the story who showed signs of violence. For him, a description like the one I wrote perpetuates stigma because it portrays someone suffering from a psychiatric disorder as a “dangerous” person.

Pause. Deep breath here. Not what I intended.

My concerned reader made the point that he takes medication to manage his symptoms and works hard to keep them from dominating his life. He emphasized that he had never thrown a lamp or a table (like the young man I’d described) … which is often the case. Most of the time, mood dysregulation is not accompanied by physical explosiveness or violence. He was right.

And he felt that last week’s blog misrepresented him and others like him.

It was heartbreaking to me that this reader felt hurt by my story. I never want to cause pain to anyone with my writing. But it can be hard to prevent. My readers come from a wide variety of backgrounds and experiences. My practice, on the other hand, consists primarily of the most ill, treatment-resistant patients for whom medications have failed.

So today, I want to go a little deeper and talk about stigma and the damage it causes.

And I want to explain why I write the accounts I do of severely ill patients and how they suffer.

The Pain and Marginalizing of Stigma

So what is stigma anyway?

We get the word “stigma” from the ancient Greeks, who used it to describe a mark made on the body that signaled to others to avoid or shun the bearer of the mark. And, we use it the same way today. Except in our present culture there’s no need for a mark on the body… with our words we make a mark on the soul.

Stigma creates shame, disgrace, humiliation…and the bad reputation that goes with certain things in our society. It’s associated with anything in someone’s life that labels them. A label that results in judging someone by the label rather than on their own merits.

Labels like this separate people from the group just as lepers were separated from the city in ancient times.

An example might be the experience of prison. When someone breaks the law and is sentenced to prison, that label hangs over them, as much within themselves as from the outside. This person might feel they’re “less than” others, that they deserve less respect. And they’ll almost certainly run into narrow minded people who will hold that fact from their past over them… impose upon them the pain and marginalizing of stigma to bring them shame and humiliation.

But the fact is, that some of those who spend time in prison continue a lawless lifestyle and others use the opportunity to improve their lives and accomplish great things. Still, it’s fair to say that improvement isn’t easily won. That person has to work very hard to rise above the experiences from his or her past.

Another example of stigma seems to accompany psychiatric disorders. There are those in our society who still associate the need for psychiatric treatment as a sign of weakness, “craziness,” and/or questionable character.

Working to Reduce Stigma and Increase Enlightenment

As we work to reduce stigma, and open conversations about brain disorders, behavior disorders, and the medications we use to manage them, we have to look honestly at individuals, and who they are. And we need to try to understand each other.

Because not all diabetics are alike. Not all the people with bipolar disorder are alike. Not all the people with PTSD are alike. Each one is an individual — with their own unique needs, symptoms, challenges, and vulnerabilities.

Most of us know someone who suffers from diabetes, either Type 1 or Type 2. There is some amount of stigma associated with diabetes. If you’re well informed about this condition, you know that while diet and exercise can help improve the condition for people with Type 2 diabetes, there is nothing someone with Type 1 can do to make this condition go away.

It’s pretty short-sighted of anyone who tells a person who suffers from this disease that they just need to stop being so sloppy about how they take care of themselves.

While it’s true that diet and exercise can improve their control of symptoms, it’s a disease that progresses and is not preventable.

Words can cut deeply … and we never really know the story that people keep hidden in their hearts.

In both cases, diet and exercise help in its management, but that’s true in a wide variety of illnesses. People with coronary artery disease, arthritis, hypertension, asthma, obesity, as well as depression, bipolar disorder, PTSD, and more…all can enjoy improved symptoms through diet and exercise. Improvement. Not cure.

The cruelty of stigma lies in the cutting words and attitudes the “unenlightened” use to build a box around an individual without knowing his story.

Pain and Marginalizing of Stigma ISOLATES

Disorders like bipolar I disorder, bipolar II disorder, major depressive disorder, PTSD, substance misuse, dependence and addiction, eating disorders, OCD, panic disorder, ADHD — are not understood…and are not familiar….to a very broad segment of society. And what human nature doesn’t understand, human nature too often misjudges.

But what we DON’T want to do is marginalize individuals no matter what their experience is.

And just what do I mean by “marginalize” exactly? I mean that I don’t want anyone to feel shut out, alienated, trivialized, or ignored in any way by my words or actions. Whether you use all your strength to hold your symptoms under control or whether your medication helps you do that, your experience is important. You are important. And you matter.

When someone suffers from one of these disorders, but has no outward symptoms — because of medication or their own unique disease process — they can feel blocked out and unheard…misunderstood and not represented.

(By the same token, if you only know someone who takes medication that’s working, and never has any symptoms that show, it’s super easy to think that people with psych disorders should have their symptoms under control. Nothing should show.)

Maybe you know someone with kidney disease who looks and acts like anyone else. And maybe I know someone with kidney disease who is thin, pale, with only patches of hair. When I meet your friend I may believe there is no way your friend is ill. And you may believe that my friend has something much worse than kidney disease because she looks so terribly ill.

But in fact, they both have the same disease but it differs in severity.

Why Assume Everyone’s the SAME?

This is the case with disorders that are related to the brain. Why is a disorder more severe in one person than another? I don’t know. I may know some factors that could affect its severity, but I don’t know why one person has bipolar I disorder and another has bipolar II, or a third person has cyclothymic disorder.

None of these three got off scot-free. They all suffer.

And why does one person respond to medication and another doesn’t? If I knew the answer to that, I’d go on vacation more often! These are questions I’ve been studying to find answers to all the years I’ve been a psychiatrist.

For those who respond to medications, I’m very glad and thankful. For those who don’t, I search and read and research and seek hope for those patients. And when I write about people with severe cases of their illness, it’s to show others who suffer in this way that they aren’t forgotten. That there is no shame in their symptoms. Because in their case, the medicines aren’t working. And the symptoms run rampant.

It can be devastating.

Don’t Misinterpret Symptoms: Hollywood vs. Reality

And I want to add –quickly– that a table or chair that is flung out the window is not necessarily a sign of danger to others. It signals dysregulation, sure, and warrants a very careful assessment. Because often, even someone who is markedly dysregulated can draw the line between hurling an inanimate object and hurting another person.

Hollywood has a way of exploiting the human suffering of mental health problems, to intensify fear. That’s Hollywood. Get to know individuals and take note of how they differ from what you see on the big screen.

Coronary Artery Disease

One of my neighbors has coronary artery disease. He took medications, but eventually had to have open heart surgery. Does that mean that everyone with coronary artery disease needs open heart surgery?

No. In fact, I have a relative who has coronary artery disease, who manages to live a full life with medicines, diet, and exercise and has never needed surgery.

These individuals tell their own personal stories. And report their own personal symptoms.

Words can be so hurtful even when they’re not intended to be. We’ve all done it. Without realizing someone’s personal story we tell the story of someone else that’s too close to their own…and it sounds to them like we’re judging them.

Pain and Marginalizing of Stigma… is Cruel

By the same token, when a treatment or clinic pops up that seems to promise a world of wonder to everyone, (which nothing can do, by the way), people can feel trivialized and ignored. Because they may not fit in that “slot” for a variety of reasons.

Let’s put up our antennas and notice when the pain and marginalizing of stigma has someone walled off from the world. Alone. Isolated.

Psychiatric disorders marginalize people, and we marginalize them, too. Every doc-in-a-box or one-size-fits-all protocol marginalizes your individual experience of suffering by suggesting there is a panacea.

Of course, there’s no universal cure, but there IS hope in a jar. Remember that story?

That was the story of ketamine treatment as a medicine prescribed “off label” because of its unique healing abilities in addition to the purpose it was FDA-approved for.

One Size Fits Some

ONE SIZE DOES NOT FIT ALL. Each patient needs to be custom treated for his own individual version of disorders. Each person also needs to be ACCEPTED and supported for who he is, and what he manages in life.

Let’s vanquish the pain and marginalizing of stigma. Let’s stop leaving people isolated in their suffering. And let’s look people in the eye and seek to understand their struggles.

If you don’t know what he manages, ask him. Let’s try harder to get to know each other, and respect each human for the life he or she manages.

And you know what? If you suffer greatly, or if your struggles are partially managed by medication, I want to hear from you. Not that I can solve your challenges, but you matter to me. And you matter to a lot more people than you may be aware. You are included here. And your experience can help someone else feel less alone in the world. Please share your comments below.

And if you’ve read about ketamine treatment and you want to see if it can help you, call us.

We want to help you experience some degree of relief from your symptoms, whether it be a little or a lot.

To the recovery of your best self,

Lori Calabrese, M.D.

August 5, 2019
Are There Biomarkers for PTSD and Suicidal Thinking?

Know someone who’s suicidal? Or…how about this? Do you know someone you think might be?

Is there someone in your life who’s always down, irritable, short-tempered… even jumpy, maybe? Maybe you wish they’d adjust their attitude, or take a chill pill. Sometimes, people can be like this and the problem is that they might be depressed. Or they may suffer from PTSD and even be suicidal. There are some researchers at Yale who are trying to identify biomarkers for PTSD and suicidal thinking. More about that in a moment, but first let’s talk about PTSD.

Some 8% of people will meet criteria for PTSD at some point in their lives. Those who have fought in active combat have roughly a 40% likelihood of receiving a PTSD diagnosis. But there are other life events that can also lead to PTSD such as sexual assault, domestic violence, cancer treatment, a child’s devastating illness, or a serious transportation accident, for example.

The DSM-5 sets the criteria for diagnosis of psychiatric disorders. It says there are several criteria required to diagnose someone with PTSD:

First, you must have been exposed to the threat of death or serious injury or sexual violence directly, or by witnessing it, or learning someone close to you experienced it. Or by indirect exposure as a first responder.

Second, you have to re-experience this traumatic event by reliving memories, or in nightmares, or maybe you suffer distress when you’re faced with a traumatic reminder of what happened.

Third, you likely make effort to avoid situations that would remind you of the traumatic event, or to think thoughts that pull you back into the painful memories of it.

Fourth, you have negative thoughts or feelings that resulted after the trauma. Like blaming yourself or others, shaming yourself, holding a negative attitude, and isolating yourself. You have lost interest in doing things you used to enjoy or getting out with friends. Does any of this sound familiar? Stay with me…because there’s hope coming…

Further, you find that you react to things that happen differently than you used to. Like you feel irritable and aggressive, or you may embrace high risk activities, or you may feel hyper-vigilant…always on edge for something to happen. Plus it’s hard to sleep or stay asleep, and it’s hard to concentrate. You’re likely to experience depression, anxiety, possibly substance abuse in an effort to avoid thinking about the traumatic experience.

Obstacles to Functioning

And all these things often result in problems with friends, with family, with your job, your education…and even with taking care of yourself and your own needs.

If you’re diagnosed with PTSD, these symptoms have lasted awhile and your doctor must know that you haven’t used other medications or illicit drugs that could have caused this.

PTSD isn’t just feeling bad about something that happened. It’s a reaction inside you to something terrifying that changes the way you think and feel and respond to life. It changes your body… and your environment. Because it changes the way your mind interprets what you see, smell, hear, taste, and feel.

How Fear is Connected to Suicidal Thinking

The Brain and Behavior Research Foundation recently offered a webinar about the work they’re funding with regard to PTSD, suicidality, and IV ketamine treatment. Lynnette A. Averill, Ph.D., Assistant Professor of Psychiatry at Yale University, explained the link between the fear and anxiety people with PTSD have and how it’s connected to suicidal thinking.

Three Regions of Your Brain are Key

So let’s talk about your brain, and how PTSD affects it. There are multiple parts of your brain that play a role in your experience as part of this disorder. And the trauma that caused this disorder triggered multiple changes in your brain. The prefrontal cortex, the amygdala, and the hippocampus are the primary areas involved, and what Dr. Averill’s team focused on.

The prefrontal cortex regulates our emotions and helps us make decisions related to them. The amygdala helps us with fear processing. And the hippocampus helps us interpret emotional context.

These three regions aren’t the only regions involved in PTSD, but they’re the most consistently significant.

The hippocampus loses volume when you’re traumatized. So as PTSD increases and its symptoms increase, too, the volume of the hippocampus decreases.

The prefrontal cortex thins in the presence of trauma. In fact, the more severely traumatized you are, the thinner the tissues in the prefrontal cortex. It makes the decision whether you’ll fight, run, or chill.

And the amygdala hyper-reacts. So it goes like this. Let’s say a T-Rex stomped down your street and through your yard. You look out the window and see his knees. Immediately, your amygdala sends out the alarm and calls upon adrenalin to scream, “FIGHT or FLIGHT!!”

PTSD Changes Brain Function

The job of the prefrontal cortex (PFC) is to call up the amygdala on speed dial…and tell him “Nothing’s wrong... It’s a hologram. Go back to your cable show… Everything’s ok.” And the amygdala settles back into his recliner.

Because PTSD doesn’t just change the way the brain areas look, it also changes the way they function…and so, in turn, the way YOU function.

Now here’s the thing. People who are suicidal have impaired executive function. This means that the organization, ability to focus and pay attention to others, as well as regulating emotion and disciplining yourself in a way that helps you meet goals…well, none of that is working well enough.

It means you’re likely scattered, and probably unpredictable. Maybe impulsive. The impairment of these abilities sets you at greater risk for making a tragic and impulsive final decision.

Is Suicide Rare?

Suicide is the 10th leading cause of death in the US across all age groups. To make that a little easier to grasp, think of it this way: 129 people take their own lives every single day in this country.

In 2016, suicide was the 2nd leading cause of death for people aged 10 to 24. More than leukemia, or fire, or overdose.

This is aside from the numbers for middle aged adults or the elderly. This includes children only 10 years old! And we need to better understand any biomarkers that can help us identify those who are at higher risk to even attempt suicide.

And it gets worse. Veterans are 1.5 to 2 times at higher risk for suicide. Sexual minorities are also at increased risk for suicidal thoughts and behaviors. The numbers include those individuals who suffer from bipolar disorder and have a 5 times greater risk for suicidal behaviors.

So this brings up this point. We need something to point to that’s common to all these conditions. Dr. Averill believes the link is synaptic growth.

Actually, it makes sense, doesn’t it? When synaptic growth stops, and synapses break down and thin out, you’re more likely to experience depression, anxiety, and PTSD along with other disorders that are stress-based. And when you treat this synaptic deficit, the symptoms of these disorders tend to dissipate.

Ketamine Treatment Restores Synaptic Growth and Just May Be a Biomarker for PTSD and Suicidal Thinking

The most effective treatment for these disorders is likely something that restores synaptic growth. Furthermore, that something needs to act rapidly, because there is the risk these patients may make suicidal attempts.

It just stands to reason, doesn’t it?

Well, it so happens that IV ketamine treatment does just that, and fast.

It switches on mRNA which turns on DNA to turboboost brain-derived-neurotrophic-factor (BDNF) to rapidly proliferate new synapse connections with their dendrites and dendritic spines all through the brain. It also slides the G proteins off their lipid rafts in the brain cell membranes, so they can productively go to work enhancing signaling along these new synapse connections. And within 24 hours you can feel amazingly better. Or it might take you a few days depending on your brain and genetic makeup.

But traditional antidepressants take weeks or even months… in many cases it can be three or four. And far too many people struggling with intrusive suicidal thoughts have ended their lives by then. That’s why it’s so extraordinary that ketamine is a RAAD (rapid-acting-antidepressant) rather than a SAAD (slow-acting-antidepressant).

Ketamine treatment is life-saving for a LARGE percentage of treatment-resistant cases. Ketamine doesn’t work for everyone, but we’re learning every day how to help more people benefit from it’s restorative actions.

At Innovative Psychiatry, we work with people who suffer from PTSD and with people who suffer from suicidal thoughts. We’ve been so gratified to watch them walk out of the office with a smile, and energy, and a joy for living.

If you suffer from PTSD, depression, bipolar depression, social anxiety, addiction, or other disorders that make life seem hopeless, or if you have thoughts about ending your life, call us. Let’s work together to help you find your joy, your hope, your fulfillment, and your relationships again.

We want you to see how appealing life can be.

To the emerging of your best self,

Lori Calabrese, M.D.

*****If you or someone you know is contemplating suicide, call the National Suicide Prevention Lifeline at 800-273-8255. There’s someone available to listen 24 hours every day.*****

July 22, 2019
Ketamine Restores Brain Circuitry Damaged by Depression – FAST

In a world where things go wrong and people get sick, every once in awhile something comes along that makes things right again. I’m talking about something that’s so dramatic in its solutions we’re tempted to call it a “miracle.”

But we won’t.

We’ll call it a game-changer.

Because IV ketamine treatment is changing history.

Nothing elicits our excitement like a tool that helps people to the degree this one does. So many people with complex co-morbid psychiatric disorders drop their shackles of symptoms …and discover they’re free to live rewarding lives.

IV Ketamine Restores Brain Circuitry

Ketamine does exactly that in the vast majority of those who were before hopeless in their condition. People whose severe illnesses prevented them from working, from building relationships, from enjoying anything. People whose lives were at risk because symptoms like suicidal thinking were made worse by their own despair.

The World Health Organization (WHO) declares depression and other severe mood disorders the leading cause of disability throughout the world. And yet, until the last several years, at least a third of these people could not be helped.

But, in the last decade, an often-abused anesthetic has emerged as a game-changer that millions were searching for.

Ketamine — so safe and effective that the WHO lists it as one of its 10 essential medicines — is now rising as one of most effective and extraordinarily restorative treatments we’ve ever had.

But to be clear — and to be fair — there are still some who don’t benefit. We continue to watch for more research that helps us understand why. And to look for and learn ways to possibly help them and more.

New Study Throws Open the Shutters on Synapse Restoration

Conor Liston, M.D., Ph.D

A study just released this month by Conor Liston of Weill Cornell Medicine, and colleagues, revealed yet more than we knew before about how ketamine works to achieve this remarkable restoration.

Dr. Liston is a leading researcher in the field of circuitry specific to the prefrontal cortex and its impact on cognitive and emotional processes. It’s the dedication of researchers like Dr. Liston, and a host of others, that has helped us understand and use the benefits of ketamine for our patients. We never take our neuroscience researchers for granted.

The combined effort of research teams like Dr. Liston’s in the U.S. and Tokyo resulted in expanded understanding of just what happens when ketamine reaches the brain in someone who’s stressed and depressed.

Of course their work is performed in the laboratory with lab animals, but gives insight about what happens in the brains of people, and how ketamine restores brain circuitry for them. Insights like this are changing the course of psychiatric treatment.

Ketamine’s Active Role with Neurons and Dendrites

The researchers used a “cutting-edge” technology that included light microscopes and allowed them to view the tiny dendrites and dendritic spines of synapses (in the medial prefrontal cortex) over time, so they could see what happens there over several hours, and then what happens after more than a day.

It turned out that the neuronal circuits changed first, with a readily observable change in behavior, in the initial 3 hours after ketamine. (Hold that thought: the circuit activity changes first.)

Then, over the next 12-24 hours, they saw that the number of spines had increased by well over half of those that had been lost during stress.

So they realized that the new spines and synapses were the result of the improved circuit activity.

Extraordinary.

New Technology Opens New Doors

This is the first time we’ve had an inkling into the timing of the effects and repair instigated by ketamine. The improvement seems to be a one-two punch. Once the spines survive a few days, they form new connections, and then within another 2-7 days, improved behavior and function became apparent.

This brand new discovery of ketamine’s effects helps us understand that there can be an immediate response to ketamine, and then a longer lasting reversal of symptoms that occurs a little later.

Both of these functions are important.

Old Treatment Replaced by New Insights

Remember that the old premise for treating depression was to increase the availability of neurotransmitters like serotonin to improve the movement of signals in the brain. For some people this was enough to help relieve the depression.

But in too many others, it did very little to relieve anything. We know now that stress prunes the signaling structures themselves. Stress from life, illness — whatever — breaks down, weakens, and destroys the synapses. The dendrites, dendritic spines, and synapses that are the highways the signals travel must be rebuilt. Without these structures, neurotransmitters like serotonin, dopamine, and norepinephrine can’t do their job.

Ketamine comes along and reverses this destructive process. It repairs damaged circuits, rebuilds new dendritic spines and synapses, increases connections, and lubricates signals with neurotransmitters … in the medial prefrontal cortex and in other key parts of the brain, too.

This revelation about how ketamine restores brain circuitry will most likely contribute to the ongoing development of new psychiatric drugs. We’re excited about the possibility that new medications can be designed to do all of this before they’re used by physicians for our patients.

Getting Closer to Bigger Breakthroughs

So we have a new paradigm, a new pattern to build upon. We may see over 80% response in patients with ketamine now, but we’re shooting for the time when researchers can improve upon this across the board… to be able to truly relieve psychiatric suffering — hopefully in our lifetime.

And we keep getting closer.

The Modes of Response Vary

As it stands now, there are some people who are so responsive to ketamine treatment that they feel remarkably better after the first infusion, and with each treatment, they become more and more hopeful, brighter, more joyful, more creative, and more resilient.

There are others who sense nothing for 3 or more infusions, then finally experience improvement, relief, and eventually joy just like the first group. These may require a few more than six infusions to reach that point.

Then there are those who may have 8 or 9 infusions. They may experience a few days of improvement throughout the process, but seem to keep losing the beneficial effects. In those cases, we explore other body systems and serum levels to find areas that need to be treated so the “treatment-resistance” can be penetrated, then with another infusion or two they finally achieve the same joy and resilience. We call it remission. And we fight for it.

Still, of course, there remains that small group who don’t seem to improve, so we continue to press on, to explore reasons…and possible solutions.

Science …and ART

IV ketamine treatment is the most remarkable treatment for mood disorders we’ve seen. And clinicians and researchers are looking beyond “mood disorders” all the time. Addictions and substance use disorders, for example, were considered to be disorders of motivated behaviors and treatment focused on teaching behavior control. We’ve learned so much, and while treating these disorders is complex, we’re finding IV ketamine can play a dramatic role in reducing craving and contributing to abstinence. “Dramatic” is an understatement.

Overall, the administration of IV ketamine treatment is both a science and an art.

Ketamine Treatment is a Process Toward Restoration

At Innovative Psychiatry in South Windsor, CT we encourage our patients to have patience with the process. To hold a commitment to see it through to fulfillment. And to consider a “booster” infusion if benefits subside or fade — whether it’s once every year or two, or twice a year…or every 3-4 months, if necessary.

Because every brain is different, and every life has its own unique character and pitfalls. It may be necessary to build and improve the infrastructure in your life. To accept yourself and others as they are, and learn to embrace the joys of life and ignore the stressors. All of this can help strengthen your remission and help it last longer.

If you’ve suffered the symptoms of a disorder without relief from treatments or medications, call us.

We’re committed to your restoration and eventual joy.

To the rediscovery of your best self,

Lori Calabrese, M.D.

April 29, 2019
Behind the Buzz: How Ketamine Changes the Depressed Patient’s Brain

The anesthetic-cum-party drug restores the ability to make connections among brain cells. The Food and Drug Administration’s approval last month of a depression treatment based on ketamine generated headlines, in part, because the drug represents a completely new approach for dealing with a condition the World Health Organisation has labelled the leading cause of disability worldwide. The FDA’s approval marks the first genuinely new type of psychiatric drug—for any condition—to be brought to market in more than 30 years.

Although better known as a party drug, the anesthetic ketamine has spurred excitement in psychiatry for almost 20 years, since researchers first showed that it alleviated depression in a matter of hours. The rapid reversal of symptoms contrasted sharply with the existing set of antidepressants, which take weeks to begin working. Subsequent studies have shown ketamine works for patients who have failed to respond to multiple other treatments, and so are deemed “treatment-resistant.”

Despite this excitement, researchers still don’t know exactly how ketamine exerts its effects. A leading theory proposes that it stimulates regrowth of synapses (connections between neurons), effectively rewiring the brain. Researchers have seen these effects in animals’ brains, but the exact details and timing are elusive.

A new study, from a team led by neuroscientist and psychiatrist Conor Liston at Weill Cornell Medicine, has confirmed that synapse growth is involved, but not in the way many researchers were expecting. Using cutting-edge technology to visualize and manipulate the brains of stressed mice, the study reveals how ketamine first induces changes in brain circuit function, improving “depressed” mice’s behavior within three hours, and only later stimulating regrowth of synapses.

As well as shedding new light on the biology underlying depression, the work suggests new avenues for exploring how to sustain antidepressant effects over the long term. “It’s a remarkable engineering feat, where they were able to visualize changes in neural circuits over time, corresponding with behavioral effects of ketamine,” says Carlos Zarate, chief of the Experimental Therapeutics and Pathophysiology Branch at the National Institute of Mental Health, who was not involved in the study. “This work will likely set a path for what treatments should be doing before we move them into the clinic.”

Another reason ketamine has researchers excited is that it works differently than existing antidepressants. Rather than affecting one of the “monoamine” neurotransmitters (serotonin, norepinephrine, and dopamine), as standard antidepressants do, it acts on glutamate, the most common chemical messenger in the brain. Glutamate plays an important role in the changes synapses undergo in response to experiences that underlie learning and memory. That is why researchers suspected such “neuroplasticity” would lie at the heart of ketamine’s antidepressant effects.

Ketamine’s main drawback is its side effects, which include out-of-body experiences, addiction and bladder problems. It is also not a “cure.” The majority of recipients who have severe, difficult-to-treat depression will ultimately relapse. A course of multiple doses typically wears off within a few weeks to months. Little is known about the biology underlying depressive states, remission and relapse. “A big question in the field concerns the mechanisms that mediate transitions between depression states over time,” Liston says. “We were trying to get a better handle on that in the hopes we might be able to figure out better ways of preventing depression and sustaining recovery.”

Chronic stress depletes synapses in certain brain regions, notably the medial prefrontal cortex (mPFC), an area implicated in multiple aspects of depression. Mice subjected to stress display depression-like behaviors, and with antidepressant treatment, they often improve. In the new study, the researchers used light microscopes to observe tiny structures called spines located on dendrites (a neuron’s “input” wires) in the mPFC of stressed mice. Spines play a key role because they form synapses if they survive for more than a few days.

For the experiment, some mice became stressed when repeatedly restrained, others became so after they were administered the stress hormone corticosterone. “That’s a strength of this study,” says neuroscientist Anna Beyeler, of the University of Bordeaux, France, who was not involved in the work, but wrote an accompanying commentary article in Science. “If you’re able to observe the same effects in two different models, this really strengthens the findings.” The team first observed the effects of subjecting mice to stress for 21 days, confirming that this resulted in lost spines. The losses were not random, but clustered on certain dendrite branches, suggesting the damage targets specific brain circuits.

The researchers then looked a day after administering ketamine and found that the number of spines increased. Just over half appeared in the same location as spines that were previously lost, suggesting a partial reversal of stress-induced damage. Depression-like behaviors caused by the stress also improved. The team measured brain circuit function in the mPFC, also impaired by stress, by calculating the degree to which activity in cells was coordinated, a measure researchers term “functional connectivity.” This too improved with ketamine.

When the team looked closely at the timing of all this, they found that improvements in behavior and circuit function both occurred within three hours, but new spines were not seen until 12 to 24 hours after treatment. This suggests that the formation of new synapses is a consequence, rather than cause, of improved circuit function. Yet they also saw that mice who regrew more spines after treatment performed better two to seven days later. “These findings suggest that increased ensemble activity contributes to the rapid effects of ketamine, while increased spine formation contributes to the sustained antidepressant actions of ketamine,” says neuroscientist Ronald Duman, of the Yale School of Medicine, who was not involved in the study. Although the molecular details of what happens in the first hours are not yet fully understood, it seems a restoration of coordinated circuit activity occurs first; this is then entrenched by neuroplasticity effects in synapses, which then maintain behavioral benefits over time.

[To prove that new synapses were a cause of antidepressant effects, rather than just coinciding with the improved behaviors, the team used a newly developed optogenetic technique, which allowed them to eliminate newly formed spines using light. Optogenetics works by introducing viruses that genetically target cells, causing them to produce light-sensitive proteins. In this case, the protein is expressed in newly formed synapses, and exposure to blue light causes the synapse to collapse. The researchers found that eliminating newly formed synapses in ketamine-treated mice abolished some of the drug’s positive effects, two days after treatment, confirming that new synapses are needed to maintain benefits. “Many mechanisms are surely involved in determining why some people relapse and some don’t,” Liston says, ” but we think our work shows that one of those involves the durability of these new synapses that form.”

And Liston adds: “Our findings open up new avenues for research, suggesting that interventions aimed at enhancing the survival of these new synapses might be useful for extending ketamine’s antidepressant effects.” The implication is that targeting newly formed spines might be useful for maintaining remission after ketamine treatment. “This is a great question and one the field has been considering,” Duman says. “This could include other drugs that target stabilization of spines, or behavioral therapies designed to engage the new synapses and circuits, thereby strengthening them.”

The study used three behavioral tests: one involving exploration, a second a struggle to escape, and a third an assessment of how keen the mice are on a sugar solution. This last test is designed to measure anhedonia—a symptom of depression in which the ability to experience pleasure is lost. This test was unaffected by deleting newly formed spines, suggesting that the formation of new synapses in the mPFC is important for some symptoms, such as apathy, but not others (anhedonia)—and that different aspects of depression involve a variety of brain circuits.

These results could relate to a study published last year that found activity in another brain region, the lateral habenula, is crucially involved in anhedonia, and injecting ketamine directly into this region improves anhedonia-related behavior in mice. “We’re slowly identifying specific regions associated with specific behaviors,” Beyeler says. “The factors leading to depression might be different depending on the individual, so these different models might provide information regarding the causes of depression.”

One caveat is that the study looked at only a single dose, rather than the multiple doses involved in a course of human treatment, Zarate says. After weeks of repeated treatments, might the spines remain, despite a relapse, or might they dwindle, despite the mice still doing well? “Ongoing effects with repeated administration, we don’t know,” Zarate says. “Some of that work will start taking off now, and we’ll learn a lot more.” Of course, the main caution is that stressed mice are quite far from humans with depression. “There’s no real way to measure synaptic plasticity in people, so it’s going to be hard to confirm these findings in humans,” Beyeler says.

[Read the Original Article]

April 23, 2019
Cerebral Folate Deficiency and Its Impact on Treatment-Resistance

“If I see far, it’s that I stand on the shoulders of giants.”

If you find yourself feeling alone and forgotten in your symptoms, feeling that there’s no one who really cares, please let me emphasize that there are hundreds, even thousands, of neuroscience researchers, medical doctors with PhDs, biochemists, psychopharmacologists, and psychiatrists who have been painstakingly searching for the answers you need for your suffering for generations, and millennia. You can feel alone, but there’s a host of people who have your back.

After eons of exploration, and hundreds of generations have suffered without remedy, we are living in an amazing time when solutions are emerging.

We’ve learned that the mild-mannered anesthesia medicine, ketamine hydrochloride, has been hiding in plain sight for nearly five decades, all along carrying within it the power to potentially transform your crippling depression, PTSD, and social anxiety into resilience, remission, fulfillment…and a rewarding life.

It was right under our noses, but we were missing it…

What else is lurking in plain sight that may hold the secret to relief for millions of people?

More to Learn to Relieve Psychiatric Disorders

While the vast majority of severely ill patients has been enjoying a life they’d not been capable of enjoying until they were treated with IV ketamine, there were still those who seemed to be unaffected and un-helped by it. We haven’t known why.

And even some of those who seemed unaffected and un-helped by ketamine treatment, began to improve in a slowly spreading glow until they too achieved remission months later.

And we learned about genetic alleles for BDNF that may indicate an individual’s responsiveness to treatment, and clinical indicators associated with treatment response.

Now we’ve been learning even more. About deficiencies of nutrients that can cause depression and other disorders. One of these deficiencies has been exposed as a key factor in autism. And when the deficiency was treated with high doses, the symptoms of autism diminished!

Who knew?

Right under our noses. Sometimes it takes generations of exploration passed down through generations of researchers to find the answers we’re looking for … which were lurking in plain sight.

We’ve talked about how a deficiency in testosterone can be a culprit blocking remission from depression.

Another BIG player is cerebral folate.

Cerebral Folate Deficiency

Folate is vitamin B-9, and provides important services throughout the body. In the brain, it plays an important role in neurotransmitter production. So when it’s deficient, the neurotransmitters tend to be produced more slowly.

You can read the label on your breakfast cereal box and see that it contains folic acid. But folic acid can’t cross the blood-brain barrier, which is there to protect the the brain from fluctuations that can interfere with its function.

Only in the form of folinic acid or methylfolate can folate reach the brain. And to do that it has to have a transport, called the folate receptor alpha, to take it there.

So to get B-9 into your brain to do its part in the neurotransmitter factory, it has to be in a certain form that can get through the security gate of the brain, known as the blood-brain barrier. Plus, it has to hitch a ride on a specific type of truck, and that truck has to be a specific model – the “low affinity folate transporter.”

It’s not hard to picture that a brain can get low on this stuff. So many hoops to jump through!

How Cerebral Folate Deficiency Can Affect You

And interestingly, most of the research about this has involved infants and children. In fact, the story of folate in the brain has a gripping history. It involves autistic children and infants with severe neurological disorders..but as those discoveries made their way into adult psychiatry.…

Well, we’re talking about it now because it turns out that adults have deficiencies too…and this is a deficiency that may contribute to why your depression seems treatment-resistant — but the problem is not that hard to treat. Which is good news…really good news.

In fact, if we find you’re treatment- resistant because of folate deficiency, we can prescribe folinic acid or l-methylfolate to treat the deficiency. Then, you may find you’re not treatment-resistant any more. Sound like a plan?

This is BIG news.

What this means is that some people who don’t get better with ketamine treatment, may just need their folate deficiency restored so their neurotransmitter factory can crank up again and turn out those much needed neurotransmitters.

Then, ketamine has what it needs on hand to help you get dramatically better.

Isn’t that amazing??

Researchers Paved the Way

In 2005, Dr. VT Ramaeker defined cerebral folate deficiency as “any neuropsychiatric disorder involving problems getting enough folate into the brain.” He was referring to the infants he treated. They had severe neurological illness, and happily, many of them responded to high doses of folinic acid.

Then, in 2013, Dr. Richard Frye studied 93 pediatric patients with autism and found that 75.3% had cerebral folate deficiency. He also found that those patients who had a cerebral folate deficiency also had antibodies to the folate receptor alpha — that specialized transport truck that takes the folate into the brain.

The following year, we’re back to Dr. Ramaeker, who measured cerebral folate in 18 patients with treatment-resistant schizophrenia…and you guessed it! 15 of them had cerebral folate deficiency. He treated 8 of them with high doses of folinic acid and 7of them got better.

Now, I should explain that finding the level of folic acid in the brain is a bit more involved than lab work. It requires a lumbar puncture so the folic acid in the cerebrospinal fluid can be measured. The measure of folic acid found in the cerebrospinal fluid is then multiplied by 1.5 to find the level in the brain.

Then, in 2017, Dr. Lisa Pan measured folic acid in 33 patients with treatment-resistant unipolar depression. 12 of these had cerebral folate deficiency and 10 out of those 12 responded after high doses of folinic acid.

Google’s Take on Folate and Cerebral Folate

When you google “folate,” you get all sorts of links about how folate is needed in your body. It helps make red and white blood cells in the bone marrow, convert carbohydrates into energy, and manufacture RNA and DNA.

(Hmmmm, makes you stop and think about BDNF. How it turns on mRNA to switch on DNA so the synapses proliferate and rebuild circuitry in the brain… interesting…)

But when you google “cerebral folate,” you find yourself reading about autism, and about treating it with folinic acid.

Cerebral Folate Deficiency Causes Tragedies

Cerebral folate is so important in the brain, that the lack of it causes all sorts of tragic results…. in infants, neural tube defects, spina bifida, cleft palate…

To think that autism, schizophrenia, and depression show links to cerebral folate deficiency — in at least some people — pushes us and the psychiatric and neuroscience research community to learn more about the central role that l-methylfolate and folinic acid play in the the central nervous system and in the genesis of psychiatric disorders.

These early important studies should prompt more extensive clinical studies. And they should prompt more interest in testing our patients with treatment-resistant disorders for this deficiency so that we can treat it sooner rather than later, don’t you think?

Unfortunately, that’s not as easy as it sounds. But it’s a start for us to realize this B vitamin is essential to our health and wellbeing. And just might be the key to your treatment-resistant disorder.

Treating Deficiencies in Vital Nutrients Helps You Thrive

At Innovative Psychiatry we test for cerebral folate deficiency when we suspect it could be a cause of treatment-resistance. We prescribe treatment for it to help improve your response to your treatment, including ketamine, and in turn, potentially improve your resilience and remission.

If you suffer from treatment-resistant depression, and think you might be a candidate for ketamine treatment, call us. We’ll do an evaluation to learn more about you and your illness. We can also order testing to help ensure your best outcome with IV ketamine treatment.

With so many who have gone before us, shining the light brighter so we can better see the obstacles to your joy, we’re here to help you find the life you ache to live.

April 22, 2019
Low T in Men Causing Your Treatment Resistant Depression..?

Since low testosterone in men has long been presumed to accompany aging, it can be overlooked as a cause of TRD in young men.

John had gained 75 lbs (!) through the stressful and exhausting project at work. He’d come to hate the way he looked.

Co-workers had turned on each other, undercutting rather than supporting each other as a team. John was a team player, and while his skill was beyond the skill of others on the team, he could feel himself slipping into depression…again. And his skills were slipping, too.

Because he was losing his edge, it was getting harder and harder to think through to solutions, much less articulate them to the others. He knew he was doomed. As long as his mind worked he could maintain his position in the department, but as depression returned, he became sluggish, he felt dense, and hopelessness rose like water in a submerged car.

To add insult to injury, his girlfriend was complaining that they never went out anymore, and that she felt he’d lost interest in her. He knew he hadn’t lost interest in her any more than anything else…he just didn’t have the energy to face restaurant crowds…or even show her what she meant to him. In fact, he hardly had the energy to get out of bed on lots of days.

And to make matters worse, his sex drive was shot. He just didn’t care about anything, but also felt like a failure as a man.

Before the project began, he had a few suicidal thoughts at night… But through the tormented road at work this year, the suicidal thoughts were cramming into each hour of the day at about 40/hour. He winced to himself… almost sounds like the speed of a car rather than an obsession to die.

This had been going on most of his adult life. Why couldn’t it be fixed? Why oh why did he keep trying…going to work…diving into the hopelessness again and again day after day? Why not just get off…?

What was wrong with him? Where could he find a doctor who could help him..??

Treatment Resistant Depression

Major Depressive Disorder (MDD) is complicated by a discouraging rate of relapse, even with those who achieve remission at some point. Studies of long duration have shown that patients who have residual symptoms after treatment have a worse prognosis. Which is why we do all we can to help our patients achieve remission, if possible.

Treatment resistant depression (TRD) causes immeasurable suffering. Because the symptoms don’t improve with traditional medicines, the ongoing struggle to find relief only seems to worsen symptoms. And untreated depressive symptoms that go on in spite of treatments can be debilitating and costly.

Treatment resistance occurs in 45% of depressed patients. These are patients whose symptoms have not improved after at least 2 medicine trials… or some combination…for 12-16 weeks each. This condition increases risks because of higher prevalence of suicidal thoughts, attempts, and tragically, death. Nearly a third of treatment resistant patients attempt suicide in their lifetime.

For years, most people thought that there were far more depressed women than men. That women are more prone to depression because they are more expressive of their emotions. But it turns out that isn’t true.

Depressed Men Don’t Act Like Depressed Women

However, studies emerged revealing that many men display different depression symptoms than women, and as a result their depression can be overlooked. Rather than sadness, they sometimes exhibit anger, irritability, and aggression. As such, those around them may pull away, rather than recognizing their loved one is actually depressed.

Another factor is that men are less likely to talk about how they’re feeling or seek help. So that creates the idea there aren’t as many depressed men as women, because their families can’t read their minds, right?

So a man who’s irritable and autocratic may actually be depressed, rather than just a difficult guy. (Surprising, sometimes.) This is good news for those friends and family members who love them. Because, if he is, he needs treatment… but he may not ask for it. Even if he does, there is a strong chance the treatment won’t help, or at least, not much.

If we’re to know what to do for him, we have to consider other things first.

So what causes depression in men?

Low T in Men

Honestly, the same things that cause depression in women, for the most part. Chronic stress, genetic factors, environmental factors, biological events like heart attack, stroke, chronic pain, or amputation, and other illnesses like diabetes, Parkinson’s, heart disease, or cancer.

But, there’s another condition that’s often overlooked. Low testosterone, or low T, is seen with hypogonadism.

The testes produce most testosterone (90-95%). But a small portion is produced in the adrenal gland. And studies have established that testosterone treatment can help men feel better emotionally, so a deficiency of testosterone can erode their mood and outlook.

Some men receive the diagnosis of hypogonadism. This is a condition that causes their bodies to produce too little testosterone.

It’s been said that hypogonadism, or low T, is a malady of elderly men. But, that’s a generalization that doesn’t take into account the many men between ages 18-40 whose testosterone level is below 10.4 nmol/L and who have treatment resistant depression.

Low T in YOUNG Men

Low testosterone is a leading cause of treatment resistant depression in older men, but many overlook that it’s a big cause of treatment resistant depression in younger (age 18-40) men, too.

Stanley Korenman, M.D., and his team published their work about the link between low T in young men (ages 18-40) and depression in a paper published November 2018 in the Journal of the Endocrine Society.

They studied 186 young men who made visits to a university medical center for any reason between the years 2013-2015. These men had symptoms of treatment resistant depression.

The prevalence of hypogonadism was present in 22.6% of these men.

The authors called for more research to determine if the hypogonadism causes the treatment resistant depression or if the treatment resistant depression causes the hypogonadism…maybe both?

Because to neglect this connection may be to ignore a condition that’s reversible. One that turns treatment resistant depression into treatable depression. And treatable depression can be transformed to remission.

We Strive to Treat YOU in YOUR Own Uniqueness

Our approach at Innovative Psychiatry is to treat each underlying condition and its own symptoms, then watch to see how the /improvements in function combine toward resilience and remission. It can be a tedious process but it’s all worth it when your symptoms finally dissipate.

A key component of your recovery may include IV ketamine treatment, if you have a treatment resistant disorder. Ketamine does its best work in patients with the most complex treatment resistant illnesses. But for ketamine to do its best work in restoring your brain cell connections prolifically, you need to treat other conditions like low T that may get in the way.

For this reason, we also may encourage you to see a specialist as we work on the process of treating your depression. We always love to work with your specialized health care team to help you get the most personalized care so you can feel really good again.

There is no one-size-fits-all remedy for everyone and every complexity of illnesses. But we must work together, exhaustively, and explore your disorders, your nutrient imbalances, your social and work life, your family life, your exercise, your diet…every aspect of your health…to tease apart those elements that may be contributing to the way you feel.

And while it may require an investment of time, effort, treatments, and re-evaluations for awhile, it will all be worth it when you look in the mirror and love the person you see there. Better days are ahead.

You will never hear me say, “There’s nothing more we can do.” Those days are over in psychiatry, I hope… but you will hear me ask, “What was the very best YOU you’ve ever been…? That’s the you we’re going to help you find again – together.”

To the restoration of your best self,

Lori Calabrese, M.D.

April 15, 2019
Ketamine May Relieve Depression By Repairing Damaged Brain Circuits

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Ketamine appears to restore faulty connections between brain cells, according to research performed in mice.

The anesthetic ketamine can relieve depression in hours and keep it at bay for a week or more.

Now scientists have found hints about how ketamine works in the brain.

In mice, the drug appears to quickly improve the functioning of certain brain circuits involved in mood, an international team reported Thursday in the journal Science. Then, hours later, it begins to restore faulty connections between cells in these circuits.

The finding comes after the Food and Drug Administration in March approved Spravato, a nasal spray that is the first antidepressant based on ketamine.

The anesthetic version of ketamine has already been used to treat thousands of people with depression. But scientists have known relatively little about how ketamine and similar drugs affect brain circuits.

The study offers “a substantial breakthrough” in scientists’ understanding, says Anna Beyeler, a neuroscientist at INSERM, the French equivalent of the National Institutes of Health, who wasn’t involved in the research. But there are still many remaining questions, she says.

Previous research has found evidence that ketamine was creating new synapses, the connections between brain cells. But the new study appears to add important details about how and when these new synapses affect brain circuits, says Ronald Duman, a professor of psychiatry and neuroscience at Yale University.

Studying ketamine’s antidepressant effects in mice presented a challenge. “There’s probably no such thing as a depressed mouse,” says Dr. Conor Liston, a neuroscientist and psychiatrist at Weill Cornell Medicine in New York and an author of the Sciencepaper.

So Liston and a team of scientists from the U.S. and Japan gave mice a stress hormone that caused them to act depressed. For example, the animals lost interest in favorite activities like eating sugar and exploring a maze.

Then the team used a special laser microscope to study the animals’ brains. The researchers were looking for changes to synapses.

“Stress is associated with a loss of synapses in this region of the brain that we think is important in depression,” Liston says. And sure enough, the stressed-out mice lost a lot of synapses.

Next, the scientists gave the animals a dose of ketamine. And Liston says that’s when they noticed something surprising. “Ketamine was actually restoring many of the exact same synapses in their exact same configuration that existed before the animal was exposed to chronic stress,” he says.

In other words, the drug seemed to be repairing brain circuits that had been damaged by stress.

That finding suggested one way that ketamine could be relieving depression in people. But it didn’t explain how ketamine could work so quickly.

Was the drug really creating all these new synapses in just a couple of hours?

To find out, the team used a technology that makes living brain cells glow under a microscope. “You can kind of imagine Van Gogh’s Starry Night,” Liston says. “The brain cells light up when they become active and become dimmer when they become inactive.”

That allowed the team to identify brain circuits by looking for groups of brain cells that lit up together.

And that’s when the scientists got another surprise.

After the mice got ketamine, it took less than six hours for the brain circuits damaged by stress to begin working better. The mice also stopped acting depressed in this time period.

But both of these changes took place long before the drug was able to restore many synapses.

“It wasn’t until 12 hours after ketamine treatment that we really saw a big increase in the formation of new connections between neurons,” Liston says.

The research suggests that ketamine triggers a two-step process that relieves depression.

First, the drug somehow coaxes faulty brain circuits to function better temporarily. Then it provides a longer-term fix by restoring the synaptic connections between cells in a circuit.

One possibility is that the synapses are restored spontaneously once the cells in a circuit begin firing in a synchronized fashion, says INSERM’S Beyeler, who wrote a commentary accompanying the study.

The new study suggests not only how ketamine works but also why its effects typically wear off after a few days or weeks, she says. “What we can imagine is that ketamine always has this short-term antidepressant effect, but then if the synaptic changes are not maintained, you will have relapse,” Beyeler says.

If that’s true, she says, scientists’ next challenge is to find a way to maintain the brain circuits that ketamine has restored.

[Read the Original Post Here]

April 12, 2019
Weekly Ketamine Infusions Show Initial, Repeated Depression Benefits

A new study shows that weekly ketamine infusions are associated with continued and maintained reductions in depressive symptoms among patients with treatment-resistant depression.

The findings, which are considered novel among studies assessing ketamine administration for patients with treatment-resistant depression, evidence the promising role the controversial drug could play in psychiatric care.

A team of investigators, led by Jennifer L. Phillips, PhD, an associate scientist in the Mood Disorders Research Unit at The Royal’s Institute of Mental Health Research, conducted a randomized, double-blind crossover comparison of single ketamine infusion versus active placebo control midazolam. The assessment, held with 41 participants with treatment-resistant depression at single treatment center, observed patients receive 6 open-label ketamine infusions 3 times per week over 2 once patients had a relapse of depressive symptoms.

Patients who reported a decrease of at least 50% in the Montgomery-Åsberg Depression Rating Scale (MADRS) received another 4 additional infusions once weekly in a maintenance phase.

Those administered a single ketamine infusion reported significantly reduced depressive symptoms at the primary efficacy endpoint of 24 hours post-care versus those treated with midazolam. The therapy showed cumulative antidepressant effects over repeated infusions, as well a doubling of antidepressant response rate in patients, according to linear mixed models.

Investigators found that 59% of patients met the response criteria following repeated infusions, with 3 infusions serving as the median dosage required to reach achieved response. In patients receiving weekly maintenance infusions, no further improvement in MADRS scores were reported.

The first-of-its-kind findings come just 1 month following the US Food and Drug Administration (FDA) approval of esketamine nasal spray (Spravato) for the treatment of patients with treatment-resistant depression. At the time, the therapy made history as the first novel treatment indicated for depression in 30 years—and headlines as one of the first hallucinogenic drugs to reach indication for a common condition.

Dennis Charney, MD, Dean of Icahn School of Medicine at Mount Sinai and a member of the Yale University team that led pioneering antidepressant ketamine trials in the 1990s, told MD Magazine® that microdosing or implementing controversial therapies for psychiatric care require what any other trial requires: control, safety, and a carefully-assessed standard for efficacy.

“No matter what treatment is being assessed, you have to follow those scientific approaches,” Charney said. “For conditions that don’t have effective treatments available, there should be an open mind.”

Adversely, Dan Iosifescu, MD, associate professor of Psychiatry at NYU School of Medicine, director of Clinical Research at Nathan S. Kline Institute for Psychiatric Research, and prominent ketamine investigator, told MD Mag that—among other reasons—ketamine will never reach at-home therapy use due to its prominent abuse as street drug Special-K. He anticipated the marketed therapy will be costly, and prescribed as long-term therapy for only a small depression patient population.

“For the majority of individuals that benefit from it, it will be essentially buying them time for other treatments—be them pharmacotherapies or device-based treatment, or psychotherapies, because those are beginning to work much more slower than ketamine does,” he said.

Whatever its marketed use entails, Phillips and colleagues concluded positively that ketamine showed both initial and repeated benefits for antidepressant effects as a once-weekly infusion.

“These findings provide novel data on efficacious administration strategies for ketamine in patients with treatment-resistant depression,” they wrote. “Future studies should further expand on optimizing administration to better translate the use of ketamine into clinical settings.”

The study, “Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial,” was published online in The American Journal of Psychiatry.

[Read the Original Article Here]

April 9, 2019
RESILIENCE! It’s the New Buzzword Among People with Mood and Anxiety Disorders

Too much screen time? Let yourself have 2 more minutes of it right now: because if you’ve been tooling around reading anything related to mood disorders or anxiety disorders, IV ketamine, and other advanced treatments, you’ve probably noticed that there’s buzz about resilience.

Because of the world that has opened up since IV ketamine began treating depressed patients with its ability to create new branches and connections, the expectations of these patients have soared.

No longer are patients satisfied to have a little relief from their depression. They’ve learned they can feel good. Feel “normal.” Enjoy participating in life the way others do.

So now the question you hear on the internet isn’t this: “Will any medicine help me feel at least a little bit better…?” No.. now it’s this: “Will this medicine help me feel resilient again?” Or “What can I do during this treatment to help it work… improve my chances of remission… develop more resilience?”

Now before we go on, I want to clarify that no doctor can promise or guarantee remission of symptoms from disorders like depression, bipolar disorder, PTSD, addiction,social anxiety, or to promise or guarantee that suicidal thinking will go away. There just isn’t any medicine in psychiatry that helps 100% of people get well.

But, even so, there are many people who’ve suffered for years, even decades, with these disorders who are now living lives they never dreamed possible. They’re painting, excelling at work, meeting the loves of their lives, enjoying their families, and contributing to their important relationships. They’re investing in hobbies, socializing with friends and family, and feeling good about themselves and their accomplishments.

This doesn’t happen overnight, but resilience has freed them to invest in their lives, and provides the energy for things they could never do before.

Resilience Protects You From Falling in the Ditch

And when hard times come along, they have the resilience to grieve a bit, then brush themselves off and keep moving forward. This may be the most remarkable change of all.

Resilience is the ability to adapt when a crisis comes along… to adapt to whatever the situation may be. To bounce back, recover, and move forward after an onslaught of difficulty.

Since psychiatric mood and anxiety disorders often develop as a response to some degree, to something environmental or an upsetting/traumatic event, if you can adapt to that event or force in your environment, you can remove that response from your psyche.

Adaptation is the way organisms throughout your world survive. When there’s a strong wind, if trees don’t bend under the wind they’ll be splintered and destroyed. But their ability to bend is their means of survival and the way they develop resilience.

The same is true of you.

If you have a continuous source of stress in your world, one that assaults your senses, emotions, or body, you can eventually be beaten down and weakened or destroyed by those assaults.

But if you can find a way to bend like a tree does, to adjust yourself to accommodate those assaults, hurts, and winds of fury without being damaged, it will help you avoid being traumatized. And that’s how you’ll develop resilience.

This brings up the story of a friend of mine.

Jillian grew up in a small town in the midwest, and was a faithful member of a tiny congregation there. The pastor had served in her church for 40 years, and unwittingly preached a serious sermon every Sunday that reflected the smallness of his own tiny world in that tiny town.

Jillian, like the rest of the church members, worked hard to live up to the expectations her pastor laid out in his sermons. Her town was small, her world was small, and those expectations left her view of life small, too.

Culture Shock – From Small Town to Big City

As she approached her thirtieth birthday, her husband broke the news to her. He’d been transferred to Chicago.

So they packed up their belongings, and moved into a pretty little apartment in that big, new city. Her birthday was anything but a celebration. The traffic overwhelmed her … the variety of people she saw at the grocery store, the post office, and everywhere else were just so different than any she’d ever seen before.

Hairstyles, clothing styles, and the way people just talked made her feel more like she was on another planet than just in a different city. She felt afraid to meet people or make friends. She was afraid she looked like a fool and she couldn’t imagine how you could trust anyone.

The more time she spent alone, the more isolated she felt. And the sadder she became. She was lonely. She missed the comfort of her home town.

Her husband asked her often if she was making any friends. But she just told him that the people she ran into on the street weren’t “her kind of people” — and she felt safer alone.

One day he arrived home from work and announced they’d been invited to dinner by one of his co-workers. She was excited to meet this co-worker and his wife. Surely they’d be a good match socially, too.

The following Friday, Jillian and her husband drove to the address her husband pulled from his pocket. The front yard was alive with a variety of blooms that reminded her of English gardens she’d seen in books at the library. It was just beautiful.

Jillian Adapts and Learns Resilience

They knocked on the door — and it was opened by the strangest-lookingpeople she’d ever seen. She immediately wanted to go home, but her husband held her hand firmly as he warmly greeted the couple.

Her husband’s co-worker had jet black hair that was shaved on the sides with a narrow path of hair from his forehead to his crown, pulled into a ponytail. His wife had bright pink hair with spikes on top enhanced by a shag that softly fell on the left side of her head; the right side was shaved from her temple to her ear.

Jillian’s alarm choked her. Then Cass, the pink-haired woman, spoke up and told her how glad she was to meet her. That most of her co-workers were middle- aged or nearing retirement, and she ached for friends her own age.

When she spoke, Jillian began to relax. What a warm and genuine person, she thought.

“May I help you in the kitchen?”

“Yes, I’d love the help!”

So the two of them disappeared into the kitchen to finish up with dinner, and their husbands settled in to talk shop and about their hobbies outside of work.

Jillian and Cass had so much more in common than she could have dreamed — and by the time they called the guys to sit down and eat, she had forgotten about the “strange” hairstyles. She realized that her perspective of the world in her small town had apparently been pretty sheltered. And she was thankful she had found someone who could be a true friend.

Resilience is Adapting to Your Situation, Which Helps You Bounce Back After Surprises, Disappointments, and Hardships

The point is, that Jillian adapted. She was experiencing a stressful situation, and it was affecting her emotionally. Sadness was growing as well as isolation and loneliness. If she’d remained unwilling to bend, she might have eventually plunged into depression.

But, after exposure to a stressor that felt threatening to her, she was instead willing to look beyond her distaste, and read the heart of a person who was ready and able to offer her real friendship. And many great adventures lay ahead as a result.

Resilience! It’s the new buzzword for a reason. Beyond reduced depression symptoms, resilience protects your life from being interrupted by a trauma or disappointment.

While this is an oversimplified example, it shows you how important it is to bend, rather than break. To change the way you think in a stressful situation so you can bounce back from disillusionment, disappointment, or betrayal.

Resilience! It’s the New Buzzword for Adapting and Growing Stronger

But, here’s the thing. Sometimes you face stressors that feel threatening to you when you don’t feel equipped to respond with resilience. In fact, sometimes you may not feel resilient at all.

Sound familiar?

Times when you’re drowning in depression or terrorized with PTSD. When you don’t have the energy to get out of bed, much less “bend with the wind.” What do you do then?

Ketamine Treatment Enhances Resilience

Well, that’s when you may need treatment. You need to get the help of your psychiatrist to get those symptoms under control. To empower resilience. And if the medications that have been prescribed for you haven’t helped, then you may need something more targeted, more potent.

One medicine we use at Innovative Psychiatry for exactly this is IV ketamine treatment. We’re experts in ketamine treatment and we’ve offered it for years–way before most doctors–and most people–ever even heard about it.

You may need something like that to help you enjoy resilience and to make it stronger. Because from its vantage point, ketamine has a list of actions that can help you develop the resilience that will see you through stressors and losses that may come along in the future.

Neuroplasticity Helps You Build Resilience

Ketamine stimulates neuroplasticity, which is the ability of the cells in the brain to change and adapt. That neuroplasticity can enhance your psychotherapy, especially when your therapy is 24 hours after your infusion.

It can also help you change your perspective of life and people. In doing that, it can help you learn how to “bend with the wind,” or whatever crosses your path. You can create and build up a level of resilience that empowers you to roll with the punches in life.

Numerous studies have shown that the more often you adapt to small stressors in your life, the stronger you’ll be at adapting to big calamities. And the more you change your thinking to adapt to difficulty, the stronger your resilience can be.

So, you can do things to strengthen your resilience…by choosing adaptive behaviors in smaller crises day by day.

For example, you don’t have to succumb to the same old habits when something frustrates you, or makes you angry. With the help of ketamine stimulating your neuroplasticity, you can choose to think a different thought. Then practice it.

I’m never going to get out of this job or this company. I’m doomed to a future of misery and mediocrity…

You have the choice to accept that thought…or to grab the wheel and change its direction, like so:

I’m not going to succumb to that thinking. I WILL excel at this job because I’m working hard to perform well. And I will be rewarded with promotions that will give me the resume that will promote me when I apply to new jobs. Bottom line, I’m not giving up..!

You have choices when thoughts come to you, and when your choice is empowered by the neuroplasticity of IV ketamine treatment, you CAN overcome.

Resilience helps you build a stronger remission of your symptoms... In fact, resilience is the reason so many people can undergo tremendous stressors, and bounce back.

People like you, and those you love. Because resilience isn’t something you’re born with or NOT born with. Resilience is something you can develop with practice, determination, and persistence.

That’s so important that I want to say it again: resilience is something that can be developed. You can develop it. And we can help you.

We want you to live as the best YOU, you can be. And you can with the ability to adapt, and to apply resilience.

April 8, 2019

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