Lori Calabrese, MD

Tag: IV ketamine

IV Ketamine and Treatment-Resistant Mood Disorders

IV Ketamine and Treatment-Resistant Mood Disorders

After reading today about a beautiful young man – let’s call him Tom – whose life ended tragically at the crossroads of despair, I started thinking.

Like many of my own patients, he had a wondrously warm and giving heart — and a compassionate heart the size of Montana for homeless animals.

His talent for music generated moving, exquisite collections of melody and lyrics that stunned listeners with its charm.

Such sensitivity, such beauty for the world to enjoy.

But his life ended far too soon, because he could find no relief for his illness.

Bipolar disorder.

Tragedy Without IV Ketamine

I’ve treated many people with similar stories in my office. I’ve offered the best that we had–medications, combinations, the latest research, the newest adjunctive treatment, supplements, recommendations for lifestyle changes, collaboration with the the best therapists in the area, resources, articles, support–everything I had. I never stop trying. But until a few years ago, we had little to offer those who didn’t respond to traditional treatment. Or who were just sick of it.

And that’s tragic. Really, really tragic. But more common than we can bear to think.

It’s not just about bipolar disorder or treatment-resistant depression. We’re talking about postpartum depression, PTSD, and other psychiatric mood disorders.

I thought about Jacie. Jacie wasn’t expecting to get pregnant when she did, but she was happy about it, and enjoyed the feelings of wonder about this tiny new person growing inside her.

But around the time her second trimester began, she noticed her initial lilting emotions weren’t lilting anymore. In fact, she felt gray…dull…and couldn’t seem to relate to the idea of a baby.

Once the baby was born, everything was a struggle. She felt angry, frustrated, and exhausted beyond belief. And guilty that she wasn’t enjoying this innocent baby girl. In desperation, she talked to her doctor honestly about how she had been feeling. And her fear she might do something to hurt herself or her child.

He referred her to a psychiatrist he trusted, and she began seeing her. Her depression had gone on a long time — untreated.

IV Ketamine and Treatment-Resistant Mood Disorders

When depression comes during pregnancy, it can be so much worse than postpartum depression that begins after the baby is born … and so hard to treat. In Jacie’s case, her depression didn’t budge, and the persistence of it affected her relationship with her baby, and her marriage.

She was surrounded with people who loved her. She was fortunate in that sense. But nothing seemed to ease the agitation and misery she endured. Or her self-hatred and guilt that she resented her baby and didn’t know how to change it, or feel better. To be the kind of mom her baby needed.

Traditional antidepressants and psychotherapy just aren’t effective for some people. If you’re one of them, or you know one of them, you know what I mean. Since depression is caused by a complexity of changes in the brain, there’s no simple solution.

And in my musings, another man came to mind — Dan. He’d suffered with PTSD for over 15 years. War time trauma, loss of friends in combat and the powerlessness he felt to save or protect them; it all tormented him.

He’d been told he should be “getting over this” by his friends and his family. Oh, they meant well. But they had no idea what they were saying. And suggestions like those didn’t help. Not at all.

He struggled just to get through the day … to have a relationship with his wife … to work at a job, to pay the bills.

He wanted to be productive, but every time he had a few good days or weeks, it didn’t last because of the dreams, the night terrors…the reactions to noises or touch. Then he’d lose his confidence, walk off the job, and withdraw again.

The loss of life, of peace, of relationships, of fulfillment, for people like these has been unavoidable till now.

For those who couldn’t benefit from the traditional treatments for mood disorders, there just weren’t any solutions. IV ketamine and treatment-resistant mood disorders went to war.

Your treatment-resistant mood disorder won’t win over IV ketamine.

These stories are just examples, but they represent multitudes of individuals whose lives have been interrupted, oppressed, tormented, or in some cases cut short, by symptoms of disorders that remained unaffected by traditional treatment.

And that’s why I thought of all of these people.

Because the ineptness of so many antidepressants left me feeling powerless to help; too many of my patients were crippled by their disorders, but desperately wanted the same chance at building happiness and fulfillment as anyone else.

Too many.

And that’s why I’m excited now and so full of hope.

That’s why I talk so often and so enthusiastically about this emerging frontier of new therapeutic uses for that anesthetic-turned-antidepressant, IV ketamine.

Because for all all the Toms, Jacies, and Dans who found no help at all from previous treatments, 80% now experience relief, restoration, and often total remission after IV ketamine treatment.

We’re still working to find solutions for that other 20%, and we won’t stop. But we’re helping 80% of those for whom we had nothing, nada, zip…zero… that would help.

All my training didn’t prepare me for the heartbreak of those who are so desperate for relief and can’t find it. But hope is growing, and ideas are flourishing for ways to use this new knowledge to spawn more solutions.

Relief and Solutions are RISING

So after my musings about those who weren’t helped, and the sadness I feel that we didn’t find solutions soon enough, it’s exhilarating to know there’s an entire frontier opening. A new world of treatment for those who weren’t helped before, through the discoveries surrounding ketamine for depression and other new solutions that will spring from it.

IV ketamine and treatment-resistant mood disorders … it’s a fight to the finish, and ketamine is winning.

Are you wondering if you’ll ever be able to have a life…? If you’ll ever get to feel stable — emotionally, financially, socially?

You really aren’t alone. Sometimes you just can’t see there’s support at your fingertips… help just beyond your line of sight.

Reach out and let’s talk about the things in your life and feelings that interfere with the power to live life the way you want to.

Power to find your best self, and share it with those around you.

Power to enjoy.

To the power for finding your best self,

Lori Calabrese, M.D.

April 3, 2017
NBC News: “Doctors Say ‘Club Drug’ Ketamine Rescues Suicidal Patients”

“Special K,” a psychedelic drug popular in dance clubs, is being used to treat severe depression when nothing else works. Watch the video below!

March 30, 2017
IV Ketamine: Doing What Prozac Can’t

Excitement about IV Ketamine

Recently, I shared my perspective about the consensus statement released by the American Psychiatric Association’s Council of Research on Novel Biomarkers and Treatments Task Force. Their statement was about the use of IV ketamine for treating mood and other psychiatric disorders.

That Task Force, in its consensus statement, assured members of the APA that there’s compelling evidence that IV ketamine has the ability to provide rapid and robust antidepressant effects in patients with treatment-resistant mood disorders.

Well, I was delighted to see that NPR published an article this past Monday, March 20, 2017, about Gerard Sanacora, M.D., Ph.D., Professor of Psychiatry at Yale School of Medicine, and his personal reflections on IV ketamine for mood disorders. You should read the article, too.

Gerard Sanacora is a member of the same Task Force. He says he’s treated hundreds of patients who are severely depressed with IV ketamine and is excited about the results in these patients’ lives.

He says doctors have asked him how he can use a medication when there is still unknown data about long-term use.

What Would You Do?

His answer?

“If you have patients that are likely to seriously injure themselves or kill themselves within a short period of time, and they’ve tried the standard treatments, how do you not offer this treatment?” he says.

Well, that’s how I feel, too, and why I offer IV ketamine infusions. In good conscience, with what I know about ketamine, how could I not? It’s what growing numbers of other psychiatrists are feeling, too.

Ketamine has an effect no other medicine has had before. Within hours it can erase the suicidal thoughts of someone who’s been on the verge of suicide for some time.

It removes the self-destructive thoughts, and the terrible mental images of death. And it happens fast.

This one extraordinary effect is changing the way we approach severely depressed individuals. There is something we can do to bring our patients relief from this dangerous, life-threatening symptom. And it succeeds in bringing them relief in 80% of cases.

Dozens of doctors responded to surveys in the US and Canada, reporting that over 3,000 patients have been treated for mood disorders with ketamine. The good news is spreading, as well it should be!

Even so, as we’ve discussed before, IV ketamine treatment has still not been studied in enough depth to answer some questions that remain unanswered. And that’s because of the lack of large-scale trials. Large-scale trials are needed. And with the attention ketamine is receiving from pharmaceutical companies, I expect those trials are just ahead.

More Questions

James Murrough, M.D. at Icahn School of Medicine at Mt Sinai in New York, worries that because of the lack of large trials, it’s not yet known how long a treatment regimen can be continued safely. And it’s true that it will take years of studies to establish that.

From his perspective, that’s troubling because IV ketamine can wear off in a few days or a few weeks. Repeat infusions are necessary to prevent the return of depression. So, unless a form of ketamine is developed that lasts a great deal longer, we’ll need to continue giving those treatments to those who need them… until they achieve remission.

But in spite of that, he strongly feels the case for IV ketamine is warranted and justified…much stronger than a few years ago. And so do we.

Most Promising Since Prozac

“There’s warranted caution that’s balanced with an optimism that says we’ve never had a new medication for depression since the era of Prozac,” Murrough says.

IV Ketamine: Doing what Prozac Can’t

No new medication for depression since Prozac!!!

So just a quick review: Prozac emerged in the 1980’s and was the first of a “new class” of depression drugs targeting serotonin, one of the neurotransmitters.

Prozac opened a world of possibilities in psychiatric treatment. But there have been far too many who suffered from mood disorders and were never helped by Prozac and its offshoots.

Since then, sure, there have been new medications and new neurotransmitters that have caught our fancy — mine, too. But no drug has has been more effective, more rapid, and more transformative — with an entirely novel mechanism of action — than IV ketamine.

Period.

IV Ketamine – Doing What Prozac Can’t

Because ketamine acts on a different neurotransmitter than Prozac and other common antidepressants. Instead of Prozac’s focus on serotonin, ketamine acts on glutamate, another neurotransmitter that acts on a different system. Murrough says that because ketamine’s been so remarkably successful, the pharmaceutical companies are pulling old drugs off the shelf that act on the glutamate system.

They’re as excited as we are at the possibility of creating a whole new class of more effective drugs for depression.

So, there is actually a possible contender in the ring for ketamine being developed. Related to ketamine chemically, it’s called esketamine and is in testing. It’s not been considered by the FDA yet, but that’s not far off.

And it’s one of a mountain of medicines in development that are related to ketamine, according to Gerard Sanacora.

He also said, “This is probably the most interesting and exciting new development that I’ve seen in my career, and probably going back over the past 50 to 60 years.”

And that’s certainly the case for me, too. For all of us who are seeing our patients doing better, looking better, and feeling better – after decades in practice.

These are such exciting times in psychiatric medicine. I’m so thrilled to be a part of this life-changing and life – saving historical time. And I’m thrilled you are too.

Until recently, our patients with treatment-resistant mood disorders weren’t getting better.

Now they are.

IV Ketamine is Changing – and Saving – Lives

They’re living again, building fulfilling lives again, looking to the future with HOPE.

If you know someone who’s been lost, sad, full of shame and despair, and just doesn’t seem to get better, there’s new hope now.

Encourage them to call us, or call us yourself for an in-depth evaluation. There is specific lab work we can do that will actually help us know if IV ketamine is likely to work and work quickly. It’s been successful with about 80% of our patients who have received infusions.

IV Ketamine isn’t for everyone, but with appropriate screening, it may be exactly right right for you. It may be exactly what you’ve been waiting for. And if you’re struggling with a treatment-resistant mood disorder, you owe it to yourself to find out.

You can feel better.

Much, much better.

To the release of your best self,

Lori Calabrese, M.D.

March 22, 2017
Ketamine IV, IM, or IN for Depression: Which is Best? (Does It Matter?)
Why do we always talk about IV ketamine for treatment-resistant depression, rather than just ketamine? Can’t we give it any old way…ketamine IV, IM, or IN for depression?

Why is it so important that it be given as an intravenous infusion, rather than as an intramuscular injection or an intranasal spray?

Ketamine IV, IM, or IN for Depression

Like lots of medications, ketamine can be given in a variety of ways. But are they all advantageous to you?

We don’t think so.

Not all physicians insist upon IV administration of ketamine, if they offer ketamine as a treatment for psychiatric disorders at all. But at Innovative Psychiatry, this is the only way we provide this medication.

We’re finicky. We’re perfectionists. We want to make sure we know the exact dose your brain receives so that we make sure you get the absolute best possible results from your treatment.

Did I say that right? Exact. Absolute. Best. That’s what intravenous ketamine offers as an advantage over any other method. It makes your best – or getting back to your best self – possible.

This is where we start swimming with sharks. And this is where the research and the experience and the opinions about what to do and how to do it get interesting.

Bioavailability

What’s bioavailability anyway??

It’s the amount of medication that your body is actually able to use. Not how much you’re given, but how much your body sees and can use.

So … it means the active portion that reaches your blood stream and that can actually be useful to you. The portion that treats what’s bothering you. The rest is altered, digested, excreted, or otherwise discarded by your body.

Make sense?

Why IV Ketamine?

OK. Basically, we want to be sure we know the exact dosage you receive, so we can know you’ll get the very best results. And intravenous infusion is the ONLY route where 100% of the ketamine you are given is 100% available to your body and 100% able to get to your brain. Which is exactly where it needs to be.

So how can we predict the exact dosage your brain will see?

Well, with an IV infusion, your ketamine dose is determined by your body weight that day and calculated down to a tenth of a milligram. Then it’s mixed with saline and slowly “infused” directly into your blood stream the same way that fluid is given to someone who’s dehydrated. (We love the word infusion — as in “infused with hope.”)

With an IV infusion, there are no obstacles preventing that perfect entry into your bloodstream and on to your brain. Anesthesiologists have known this for decades. Ketamine was designed to be given IV.

Why Intranasal Ketamine Is Unpredictable

But that’s not the case for other routes, which do present obstacles to the drug before it reaches the blood stream. I’ll show you what I mean.

When ketamine is given as an intranasal spray, it has to pass through your mucous membranes to reach your bloodstream. So first, it has to be suspended perfectly and evenly in a mist, and then the mist has to evenly saturate the mucous membranes of your nostril. And — it has to land high enough to not drip out your nose so that you don’t lose it and straight enough not to not run down the back of your throat. On top of that, it must be well-aimed enough to not get wasted on plain air and gentle enough to not get sneezed back out.

If that weren’t tricky enough, in addition to that, the ketamine spray delivers a mist that gives a concentrated dose over just a very few brief seconds of contact with mucous membranes, and just minutes of contact with critical and delicate brain systems … systems that need time to change for the better.

It’s just a bit too iffy …  whereas intravenous infusions are slow and precise and we can calculate, predict, and control. They allow very slow, controlled exposure of critical pathways to a medicine that stimulates neuronal growth and rearborization.

IM Ketamine: The Problems with Timing and Side Effects

In the case of intramuscular, or IM injections, ketamine must enter the muscle then find its way to the blood vessels and be absorbed.

Because the muscles contain dense blood vessels, a large portion of the drug makes it to the blood stream, but not all. There’s no way to determine how much time it will take the ketamine to leach out of the muscle, or how much of it will leach out, and reach your bloodstream so it can reach your brain.

From the time it’s injected, it depends on the circulation in that muscle and the condition of that muscle in terms of fitness.

To put it simply, your guess is as good as mine as to the total amount that makes it to the bloodstream and the rate at which it reaches the tissues in the brain to effect the changes we want to see.

Once again…way too iffy.

For ketamine, you need a route that ensures that ketamine reaches its target effectively, and you need a dose that will deliver the precise amount your brain needs to receive the optimum benefit from it. You also need it to reach the brain in a slow, controlled way. It needs to work, not frighten.

Because that’s another problem we’ll talk about in a bit. SIde effects … they just can’t be controlled once the medicine is in the muscle.

Bioavailability Comparison

Take a look at the differences in bioavailability of ketamine through these different routes:

Intravenous   100%

Intramuscular approximately 93%

Intranasal approximately 45%

Sublingual approximately 19-50%

Approximately?? For your brain??

As you can see, a range of 19-50%, as seen with sublingual use, is just far too uncertain. And approximating the dose, as seen with IM and intranasal ketamine, especially when we’re seeing numbers as low as 45%, just isn’t the best way to ensure solid, safe, predictable benefits.

Exquisite IV Ketamine

But when the ideal low dose of ketamine is precisely measured and administered directly into your bloodstream by an intravenous infusion, you get the benefit of all its anxiety-smashing, depression-relieving qualities in full measure.

There is none lost through dripping, sneezing, swallowing, digestion — or sloppy spraying or poor coordination. There’s just nothing getting in the way.

It’s a beautiful thing.

Add to that the fact that IV ketamine has been used in anesthesia since the early 1960’s. It’s backed by decades of data confirming its bioavailability, safety, and tolerability.

Effectiveness

Now think about this:

When you take ibuprofen for a headache, how long do you expect to wait to experience relief? 30 minutes? 45?

Have you ever been given an IV medication in the hospital? If so, you know that you start to feel relief pretty quickly. It can be a lifesaver when you really need it.

That’s because medications given by IV are available to the body so quickly … faster than any other route. There’s some benefit almost immediately, and it continues until you feel better and better as the medication circulates. With IV ketamine, the benefits keep growing.

Another factor is that the physician should give ketamine at a controlled rate. This is to create certain conditions in the brain to trigger a waterfall of actions…like the proverbial falling dominoes… that relieve the symptoms of the psychiatric disorders we’re treating.

Ketamine Research

Ketamine for depression has been a topic of scientific and clinical study for some time. The best research on ketamine over the past few years for the treatment of suicidal thoughts, depression, bipolar depression, PTSD, and OCD has used very precise IV infusion protocols.

It’s IV ketamine which–over and over–has been so startlingly effective. Intranasal sprays are being studied now, and one pharmaceutical company is sponsoring studies on a version of a ketamine spray it wants to turn into a brand-name patent, but there’s just not enough research on the spray technology, effective dose, or protocol for administering it to know what’s effective. One spray or two? one nostril or two? how strong? exactly how much? and how often? every 10 minutes? or every 15? why not every day? twice a week?

And intramuscular ketamine injections–forget about it. They can be such a nightmare of erratic absorption and side effects that can persist for hours that there’s no clear way to judge what dose might be effective or tolerable for you.

But by giving ketamine IV, we’re able to give
- - the most precise dose (recalculated to a tenth of a milligram each time you lose or gain a pound)
- - the most precise rate (calculated down to the minute using sophisticated infusion pumps)
- a drug your body can utilize 100%
We create optimum conditions. You experience the most benefits in the fastest way possible. It’s a win-win.

Safety

Two words: Side effects and drug abuse. (OK, so it’s 4 words.)

We associate ketamine with potential side effects, no matter how it’s given. This is the case with the majority of medicines. But the range and severity and duration of those side effects vary tremendously depending on whether ketamine is given IV, IM or intranasally.

Keeping an Eye on Side Effects – Just in Case…

In an outpatient office setting, low dose IV ketamine infusions can be administered in a beautiful, comfortable environment. High tech. Soft touch. Low lights and warm blankies (our patients love this!) with all of the medical monitoring and all of the important safeguards in place. Not the least of which is having a psychiatrist and infusion nurse right there to address any possible side effects.

In case of side effects, the psychiatrist can stop the infusion within seconds.Then she can administer a small dose of medication to treat the problem. Within minutes after the infusion, you can be ready for tea, snacks, conversation, and the ride home.

This isn’t true with intramuscular ketamine. In this case the full dose is administered in about a minute instead of slowly over 45, and there is no way to stop or slow the absorption once it’s already been injected into the muscle. And if strong dissociative side effects occur, as they often do with IM, the continued absorption of ketamine from the muscle can’t be interrupted– and the nightmare can last for hours. In one report, patients were kept lying down for at least 4 hours after an IM injection of ketamine for depression…just for monitoring.

If you use an intranasal spray mist at home, you administer it to yourself. There is no physician right there to address side effects.

Preventing Abuse

Unfortunately, ketamine has been shanghai’d by those seeking illicit experiences. It’s not just necessary, it’s critical to guard the way it’s distributed. It’s a shame, but a fact of life in the world we live in.

Think about this: If patients have ketamine available as a nasal spray for “as needed” use, what’s the risk? Clearly, if ketamine spray is available at home, there’s a much higher risk of outright abuse, sharing, or sale on the street.

It’s just so clear: right now, IV ketamine infusions are the best and most reliable approach we have. They allow precision dosing, instant responsiveness by the physician, almost-instant control of any potential side effects, and no risk of drug abuse or sharing in the community. .

At Innovative Psychiatry, we provide ketamine exclusively by IV infusion because it’s the best method for providing rapid, maximum benefits in the safest environment for you.

If you have not experienced relief from antidepressants, or if you’re tired of trying one thing after another, give us a call and let’s work together to evaluate what might be more effective for you.

To the recovery of your best self,

Lori Calabrese, M.D.
March 2, 2017
How Ketamine Turbo Boosts Brain Compost to Improve Your Mood
In a recent post, we talked about the impact of Brain Derived Neurotrophic Factor (BDNF) on the prolific development of neuronal synapses, or nerve connections, in the brain. BDNF is like a rich, organic compost that spurs dense growth. And we talked about how IV ketamine turbo boosts brain compost and multiplies the connections in your brain that improve your mood and sense of well-being.

Ketamine Turbo Boosts Brain Compost to Improve Your Mood

We described how BDNF creates an environment like “compost” for increasing these synapses to upgrade communication throughout the brain. It stimulates neurons to grow and branch out, and it increases the complexity and density of these branches. It’s like stimulating little saplings to develop into strong, complex riotous oak trees. BDNF increases the density of the forest and the density of the forest canopy. When the synapses are weakened, thinning out, and breaking down in the brain, depression and suffering is usually involved, one way or another.

So, if you want to clear out your darkened mood, then you need to clear out weak and broken down synapses. Replace them with healthy neurons loaded with abundant branches, which are called dendrites, and loads of connections, called synapses.

You’ll need to take a proverbial rototiller to your “brain garden” and clean out the deadwood, weeds, and broken roots. Mix in new soil, fertilizer, mulch, and compost, and let new tender neurons begin to leaf out.

That heavily “treed” neuronal forest will just naturally bring bright thought patterns and stimulation, just like all that new soil, mulch, and fertilizer would bring new growth and beauty in a garden. Because brain derived neurotrophic factor – BDNF – “brain compost” – improves your mood by providing a rich growth environment for your neurons and synapses. The more healthy synapses your have in your brain, the better you will feel.

BDNF on Steroids

In that previous post, we also featured the extraordinary result of IV ketamine on our “brain garden,” and that rich “compost” seemed to multiply the BDNF like gangbusters… which fostered remarkable multiplication of synapse connections…as if in a fast-motion animated cartoon.

That rich and deep synapse vegetation results in a high-speed and dramatic improvement in exchange of information throughout the brain:
- - improving cognition
- - relieving depression
- - removing thoughts of suicide
  - and equipping the brain to ‘reset’ itself with brighter and better thought processes, mental and emotional hygiene, the adoption of exercise, and more productivity going forward.
Since BDNF helps neurons and their connections grow, like fertilizer helps plants do the same, they become stronger and healthier. But even more dramatic is the appearance of new branches that that emerge, proliferate, and multiply, especially in the hippocampus and pre-frontal cortex.

Picture a bean plant you gently cover with fertile soil. You add a little water and set it in the sun. When you wake up the next morning, you hope and expect to see a tender shoot already poking through the earth…right?

We do, too. But we try to be patient, and give it several days, at least.

Take a Look at Your Beanstalk, Jack!

IV ketamine treatment is so powerful in its effect on BDNF that it’s as if your brain wakes up and within days you begin to have a dense forest growing where that little bean plant was.

BDNF obviously contributes dramatically to the “landscape” of the brain, and IV ketamine gives it a turbo boost.

But then, does that change as time goes by?

Ramshackle, Rundown Garden

We’ve made the point that IV ketamine puts BDNF on steroids — increasing the density and complexity of neuronal branching in the brain and increasing the number of connections between one cell and another.

But what happens to someone who’s depressed and has been stressed for a long time? Then BDNF is depleted, the dendrite branches get severely pruned back, the synapses break down, and and the hippocampus shrivels.

That’s a serious state, and a perfect description of what it’s like in the brain of someone with chronic depression. What it’s like in your brain if you’re chronically depressed.

It feels like a wasteland.

IV ketamine treatment can change that.

IV ketamine infusions work in a number of different ways, but the most striking thing they do is increase the rich compost of BDNF–to proliferate neurons, leaf out dendrites, increase synaptic connections, and re-establish a rich network of communication in your brain that can return you to your best self.

In some people, a series of IV ketamine infusions will return their “brain garden” to its optimal state … and they may not need further infusions.

But others may find after a time that they feel depression or other symptoms returning — their neurons and synapses have dwindled and shriveled again — and they need a new infusion to breathe new life into their garden of connections.

It’s Individual…One Size Doesn’t Fit All

No one knows in advance what will be needed, but to find a way to bring their brain to life is such a rejuvenating joy that most are beyond delighted to tap into this wonderful opportunity for energy, connection, and hope. For new growth.

And how about you?

How is your brain garden?

Is it prolific with verdant life and freshness?

Or does it need a turbo boost?

Unlike your bean garden, we can actually test your DNA to help determine the likelihood that you’ll benefit from IV ketamine.

Come join us to learn about you, and what can help you be the best YOU you can be. Contact us so we can give you a thorough evaluation. It’s the kindest thing you can do for yourself.

To restoring you to your best self,

Lori Calabrese, MD
February 23, 2017
IV Ketamine Infusions Restore Your Power to Enjoy

IV Ketamine Infusions Restore

Jacob couldn’t remember the last time he was really at his best self. He’d struggled from day to day since he was about 4. Getting out of bed, getting dressed, and going to school, from first grade through high school… every day had been awful and just exhausting. As he got out of the car for school each day, he’d look at his mom with pain in his eyes–and then drag himself into school, throughout his day, and through the night.

His parents didn’t know how to help. They talked with him and tried to do things that would cheer him up. But his inner pain seemed suffocating, and they felt helpless.

One day when he was 14, they found him on the floor behind the sofa, wedged against the wall in a fetal position.

He just disconnected…ran out of the energy to endure any longer…from the dead emptiness inside. The anxiety. All of it.

He thought about how to end his life every day. Some days he was obsessed with visual images of that final act.

Treatment-Resistant Depression

His doctor prescribed an SSRI, an SNRI, and then different combinations of medications, but none of them worked. Not really.

Eventually he refused to take any more, or attend any more therapy sessions.

School was something he just endured, or avoided, until he graduated.

College was a roller coaster–and life had been too hard for too long. He was exhausted. Isolated. Disinterested. And he eventually dropped out.

A Drug Called Ketamine

Then he read an article online about a drug called ketamine that was helping people recover from severe depression.

And he started looking for more information about it–studies, information, and just about anything he could find about this anesthesia-turned-club-drug-turned-antidepressant.

He found a few interesting articles, a few sensational titles, a lot of talk…and fascinating research that had been going on for years on using IV ketamine infusions to restore life for people with severe depression.

Who knew?

Was it possible there was a treatment for crippling depression and anxiety that could work when nothing else did?

His parents were pretty skeptical. They looked for hard science, research studies he could participate in, or a doctor he could see who knew something about this kind of treatment.

Turns out it’s pretty hard to find a psychiatrist who gets the devastation of depression and anxiety and hopelessness. One who can sift through the complexities, discuss the risks and benefits of all of the available treatment options, in order to provide the best possible options for someone whose symptoms just haven’t gone away.

Jacob’s first infusion of ketamine was extraordinary. The terrible heaviness that had weighed him down since he was four lifted for the first time about half way through the infusion.

And when his parents met up with him, they saw a lightness in his expression that they hadn’t seen in years. His treatments continued…his symptoms faded.

He had missed most of his childhood, and he spent most of his young adulthood wanting to die. But when IV ketamine infusions restored his ability to enjoy and experience beauty in life, it changed everything. He couldn’t believe it, but he actually wanted to live now. And was so glad he could.

How Effective Are IV Ketamine Infusions?

Before we go on, it’s important we point out that ketamine infusions don’t work for everyone. Every one’s brain is different. Everyone’s needs are different. And for some people, IV ketamine infusions don’t work.

But we see a lot of Jacobs.

Because IV ketamine infusion therapy does produce remarkable results in 80% of patients who have suffered with treatment-resistant depression, and the terrible, persistent depressive episodes in bipolar disorder, and for large numbers of patients with unrelenting anxiety disorders.

What is it about ketamine that delivers such dramatic, fast results? How does it affect your brain that it causes this wonderful, fresh relief…?

First, let’s talk about growth factors. The brain has its own special growth factor, called BDNF–brain-derived neurotrophic factor. That growth factor is like really rich, earthy compost. And we think that one of the really remarkable things about ketamine is that it turns on signals and opens up pathways so that the brain begins to manufacture and release more BDNF.

This is kind of radical news.

Most people don’t know that the brain continues to grow new cells all throughout life–and when there is rich compost, these cells, called neurons, grow new branches, and form more and more connections.

The Role of Glutamate

Glutamate is the most prolific neurotransmitter in the body. It operates throughout higher levels of the brain, so it’s especially effective in a widespread and quick proliferation of synapses. It causes them to branch like trees in fast motion, creating a virtual forest producing abundant relief, especially in a part of the brain called the mPFC (the medial prefrontal cortex).

Some neurotransmitters bring a calming balance to the brain and mood, others bring a stimulated excited balance. Serotonin is one of the calming ones… Glutamate is one that excites the neurons.

Because glutamate is so prolific and widespread, when it’s stimulated to increase, the impact on mood is fast to take hold and spread.

Now, when uptake of glutamate from the synapses is disturbed or blocked, you experience less of the feelings of reward…like for instance the enjoyment of a sunrise, or the fragrance of a rose. This impaired ability to “enjoy” is a symptom of depression.

However, and this is great news, when glutamate is released, there’s a prolific blooming and branching of synapses, which quickly connect different parts of the brain to each other. It’s almost like watching a film in fast motion as the synapses branch into more and more neural connections. The result is a rapid improvement in communication between networks of cells in the brain. And your ability to feel good quickly improves.

So how to get glutamate to be released??

Enter IV ketamine.

Ketamine Stimulates Budding New Branches in Brain Cells

Low dose IV ketamine infusions cause a burst of glutamate.

Those bursts of glutamate trigger the branching of dendrites (the branches on the tree) and the budding of bunches of synapse communication junctions, and in a short time, you feel better and better.

So how does it do that? We think that IV ketamine infusions cause bursts of glutamate that very quickly stimulate AMPA receptors, which activate calcium channels, which lead to the release of BDNF (good compost), which turns on the mTOR pathway, which — voila! — increases protein synthesis right in the brain. Neurons are made of protein. So dendrites branch. Synapses form.

New growth. New connections. Not just in the structure of your brain but in the very fabric of your life.

Psychiatrists get really excited about these things. You should get super excited, too. Geez.

Think of a brain cell like a tree in springtime that explodes with the stretching and unfurling of new branches, new growth, new buds, all stretching towards the sun. That’s what happens. If you have been so tied up in knots, wound up with tension and anxiety, and deadened to the joy of life…you can feel your shoulders relax for the first time in years.

Second, a study by the National Institute of Mental Health in August of 2015, revealed that ketamine reduces suicidal thoughts, as an independent and parallel benefit to the antidepressant effect it provides. And studies at Yale, Oxford, NIMH, Houston’s Baylor College of Medicine and New York’s Mount Sinai School of Medicine provided overwhelming evidence of the remarkable effectiveness ketamine demonstrates against treatment-resistant depression.

How?

Because of glutamate, and the richness of BDNF, and the fast-growing synapses branching out on neurons throughout the prefrontal cortex, causing relief to bloom along with them.

Breakthrough Innovative Treatment

Isn’t this amazing?

If you’ve suffered from depression, or bipolar depression…or crippling anxiety, you KNOW how amazing this is.

You’ve known the desperation, misery, and despair.

Maybe you’ve forgotten what it’s like to feel good, or even to feel ok.

You’ve lost touch with enjoying yourself.

But all that can change now.

Now you can feel good in ways you’ve forgotten.

Find your love of music, or art, or reading.

You can feel again.

Because of glutamate.

Because of flourishing synapses.

And because of ketamine.

Let us help.

Call us for a thorough evaluation so we can discuss innovative treatment options for you. IV ketamine infusions restore your ability to enjoy your life, and we’ll help you with whatever it takes to accomplish that.

To the emerging of your best self,

Lori Calabrese, MD

February 1, 2017

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