Lori Calabrese, MD

Tag: Ketamine for Postpartum Anxiety

  • Chronic Stress Pathology: IV Ketamine Kicks It to the Curb

    Chronic Stress Pathology: IV Ketamine Kicks It to the Curb

    Is depression common ..? 

    Is it something suffered only by the rare individual…? The World Health Organization says it’s the leading cause of disability.  Have you heard that? Not those rare people no one ever sees… but people all around you struggle to function, and paste on their “upbeat faces” … while feeling more alone than words can say. Likely as not, chronic stress pathology is at work wearing them down.

    And it’s not just depression. It’s bipolar depression, and generalized anxiety disorder, and PTSD, and social anxiety… These conditions are all different, and the way their symptoms present in each person can be really different.  

    But all these disorders also have something in common. Something called chronic stress pathology or CSP. They may have been triggered by a traumatic event, or a terrible loss, and just a constant nagging of unrelenting heaps of difficulty that wear away at your ability to cope.

    There’s something else they have in common. They tend to clump together …why?  Because of what happens in your brain. We call it comorbidity.

    We’ve often talked about how long and severe chronic stress prunes the dendrites and dendritic spines of the neurons in the prefrontal cortex and the hippocampus, breaking down synapses (or “synaptic connections”).

    Well …it turns out that there is a cascade of changes during these chronic stress situations that also increases brain derived neurotrophic factor or BDNF to increase synaptic connections in the amygdala and nucleus accumbens in another area of your brain.  The nucleus accumbens is part of the basal ganglia located near the hypothalamus.

    Oh dear…this is getting a bit tongue-twisting. 

    But get this: in one part of the brain, the synaptic connections are SHRINKING from chronic stress while in another area, they’re EXPLODING where they shouldn’t be.

    You heard right.

    This creates a vicious cycle that continuously drags you back into this disordered condition over and over…making it terribly difficult for you to recover. In the amygdala, the hippocampus, the prefontal cortex, and the nucleus accumbens, nerve connections (called neuronal connections) are being changed and damaged because of long term chronic stress.

    That condition may be major depression. It may be PTSD. It may be an anxiety disorder. But it goes on and on. And on.

    These Disorders are NOT a Chemical Imbalance

    You can see why the old idea — and people still talk about it like it’s a thing — that this is “a chemical imbalance”…is archaic, mistaken, and doesn’t even describe what’s going on at all. 

    We’re talking about dramatic changes in structures in your brain. Damage. Not just chemical changes.

    Misinformation Feeds Stigma… But Knowledge is Power

    This idea of chemical imbalances is leftover from 30 years ago, before neuroscience understood these structural changes and thought depression was the result of changes in serotonin alone….a neurotransmitter that turned out to be a only a component in the overall process.

    Ketamine Research has Taught Us So Much More… About Chronic Stress Pathology And Its Effects on Your Brain

    As we’ve talked about before, evidence has been accumulating for years showing that ketamine treatment can reverse the pruning of synaptic connections in the prefrontal cortex and hippocampus – caused by stress – by robustly increasing them — turning on your mRNA to switch on your DNA… and that releases BDNF. 

    And you know what BDNF does. It TURBO boosts those synaptic connections in those areas, which in effect turns the light on in the darkness. You feel better, function better. Your creativity flourishes. And you have the patience and capacity to build and repair your relationships. Hope surges and futility morphs into purpose.

    But you know what? We don’t talk very often about ketamine’s effect on the synapses in the amygdala and nucleus accumbens. There, it turns off the production of BDNF and reduces those connections there which helps to reduce your symptoms. 

    Chronic stress pathology wears you down when stress goes on too long.

    It also tamps down the cell bursting in the lateral habenula to help you relax and enjoy yourself. So you can revel in the fragrance of honeysuckle, and the aroma of burgers on the grill. 

    The fact is that chronic stress pathology is at the root of much of your suffering. Your body is intricately balanced, your emotions are influenced by a complicated series of changes in your gut through your microbiome, in your brain cells, as well as your muscles and organs.

    If you have a severely broken leg, the pain, repair, and convalescence of that injury can have a significant effect on your emotions. And symptoms of chronic stress, depression, and anxiety can make your muscles and joints ache.

    Which is why I’m on a mission to eradicate the term “mental illness.” Because your whole body is affected when something is malfunctioning in just one part of it. 

    For example, diabetes can predispose you to depression. And so can open heart surgery.  Your brain is part of your body…not a separate entity. And when one part of your body is affected, other parts are affected, too.

    So, the more we learn about our brains and bodies, the more we understand about the intricacies of how we function on every level.

    Now… what if you do have chronic stress pathology working against you?  What if you’ve been traumatized… or what if you’ve weathered a long, repetitive, unrelenting assault of stressors?

    Cheryl’s Story

    Cheryl did. Cheryl’s husband began complaining about the family’s budget..insisting they needed to make changes or there would be nothing to retire on. He finally became harsh about the need to find a less expensive house. Cheryl worked 60 hours a week…and the kids had needs, and schedules, and practices, and uniforms….  When could she look at houses..?  Or worse…when could she possibly pack?

    But since her husband Ben was so adamant about it, she tried to cooperate. She looked at houses during her lunch break, and after she dropped her sons off at practice.

    She stayed up late searching the internet for houses she could look at, but she and her husband couldn’t seem to find the time to look together.  Finally, she found one that could work, and Ben took a look on his lunch hour and agreed it was just fine. 

    Working late, marriage problems, and mom with cancer cause severe stress.

    After frantically packing every free minute for weeks…they closed on the house and moved. Cheryl was exhausted and the rooms packed with unopened boxes in the new house just made her want to cry.

    Then as soon as she moved, her mother asked her to go to the doctor with her. At the appointment, the doctor told her mother she had breast cancer. She explained the details, the treatment, and prognosis to both of them.

    When they got back in the car they cried together. 

    Cheryl knew her mother would need her extensively through this process. And she was committed to be at her side as much as she could.

    She rearranged her schedule, her children’s schedules, and approached her boss about shortening her work hours for the next several months.

    Unpacking the new house was a mountain to climb…and Cheryl kept wondering why Ben wasn’t on hand to help…

    And why was his job so demanding through all this, anyway??

    Then she found out…  Ben told her he wanted a divorce.

    “A divorce??  NOW?? IS THIS WHY YOU WANTED TO MOVE…??”

    Cheryl felt herself coming apart.. 

    There was nothing to do but keep moving. Her children needed her to be reliable through this. To be a safe haven…a comfort.  

    Her mother needed her support as she looked a life threatening condition in the face.

    Cheryl couldn’t think about how she felt…she had to keep going.

    But 8 months later, after the divorce was final and her mother’s treatments were complete… Cheryl couldn’t get out of bed.

    Over the weekend…Cheryl just felt like she was in a long dark tunnel.  She called in to work on Monday. Her sister came over and got the kids on a bus…

    Sometimes it’s just too much.

    Chronic stress pathology is the damage caused by long term unrelenting crises.

    And what about you?

    Have intense stressors piled up in your life and worn down your hope? Have you taken prescriptions that just didn’t help? 

    Do you feel like the crises just keep pelting you without mercy?

    Sometimes we’re subjected to repeated stressful assaults in life that we can’t control. But there is something you can do about your ability to cope with it. Reach out for IV ketamine treatment.

    At Innovative Psychiatry, we offer IV ketamine treatment expertly titrated and see resilience return to our patients every week. We also have published research that you can read about our results. We’re serious about what we do.

    Titrated Serial Ketamine Infusions Stop Outpatient Suicidality and Avert ER Visits and Hospitalizations. Lori Calabrese MD.

    Things have changed since the days of “chemical imbalance” thinking. (That’s so 20th century!) Neuroscience is making 21st century discoveries that offer better treatments than we’ve ever known before.

    And you get to take advantage of those advances.

    If you can relate to Cheryl and prescriptions haven’t helped, call us. If you have symptoms of PTSD, call us.

    Ketamine treatment can give you relief from the damage of chronic stress pathology.

    IV ketamine treatment can reverse the damage caused by chronic stress pathology. Chronic stress doesn’t always result in this damage, but it does all too often.

    And when you’re the one suffering, you need a solution. You need to cope. While ketamine doesn’t work like this for everyone, it does provide rapid, robust relief for most. And chances are, it will transform your life to allow joy, hope, and resilience.

    Give yourself the opportunity to live well again. To enjoy a fulfilling and rewarding life.

    Lori Calabrese, M.D. is on the front end of the race to stop PTSD in its tracks using IV ketamine treatment.

    To the restoration of your best self,

  • Antepartum and Postpartum Anxiety: Moms Who Suffer Without Feeling Sad

    Antepartum and Postpartum Anxiety: Moms Who Suffer Without Feeling Sad

    Ketamine treatment helped this mom restore from antepartum and postpartum anxiety.

    Treatment can help anxious moms relax and enjoy their babies.

    Jill was so excited to be pregnant.  She’d waited for 4 years after she and Joe were married to start trying.  She was just elated three months later when a home pregnancy test showed those two little lines.  She was pregnant! Even the slightest thought of antepartum and postpartum anxiety never crossed her mind.

    In spite of waves of nausea off and on the first couple months, by the time she got through her first trimester, she was feeling better.  Her excitement to see and hold her precious baby was bubbling up like crazy. How could she wait six more months??

    But as she moved through the 4th month, she began to feel… uneasy.  

    Just this vague sense that something bad could really happen… maybe something about her pregnancy wasn’t going as it should? She worried that something was going wrong with the baby. What if there was something wrong that they couldn’t see? Or a problem with his development?  What if he was in that 3%? What if something went really wrong during delivery?How would she take care of him?  

    Day by day the dread grew worse. She asked her doctor about her concern, and she assured her that everything looked good. Told her that she should enjoy her pregnancy.

    That was the problem. She couldn’t. She was worried sick.

    Then, when she reached her third trimester, the dreams started with a vengeance. Night after night she’d dream she gave birth … to an alien.  Or a forest creature.  Or a monstrous murderous demon. She was so ashamed that these were her nightmares that she couldn’t tell anyone. No one.

    When something is so terrible, who can you tell? Who can you trust?

    The nightmares were so cruel, so vivid, that she’d wake up in the wee hours sweating, heart pounding, and screaming. Her husband would try to comfort her, then she’d go back to sleep. And the nightmare would continue. It was as if she couldn’t escape. 

    By the time the baby was born, her joy was gone, and in its place loomed a terrible dread. She feared for the baby, and what he would grow to be.  Not who…but what.  She tried to nurse him in the hospital but would break down and cry and ask the nurses to take him for awhile to give her a break.

    Going Home From the Hospital Didn’t Help

    It wasn’t supposed to be like this!  What was happening to her?  Why couldn’t she enjoy her newborn son?

    The first 6 weeks or so she tried. She really tried. She was exhausted, and wondered if she’d ever get enough sleep to feel better. Waking every hour or two around the clock took a toll she didn’t anticipate. Her thoughts about her baby seemed irrational, even to her. She couldn’t imagine why she ever thought she wanted a baby.  Now here she was, stuck in a permanent nightmare. She felt cheated.

    Then her worries about what she might do to him if she let her guard down overwhelmed her.  She mentioned her concerns to her pediatrician during a routine visit, and he explained that this could be postpartum anxiety and gave her a card to see someone he trusted.

    Within a few months after her treatment began, she was beginning to see life, her son, and herself in a new light. She could sort of imagine now that it was possible she could have a good and loving relationship with him. 

    It helped enormously to know all this was a condition her hormonal imbalances and stress created. To fully realize that neither she nor her infant son were to blame. She read all she could find on antepartum and postpartum anxiety.

    There wasn’t much.

    But where, oh where, did it come from?

    We’re all familiar with postpartum depression, but you rarely hear people talk about postpartum anxiety. While the two often join forces, they’re actually individual disorders.  Since postpartum depression is often associated with sadness and anxiety, postpartum anxiety is sometimes overlooked.

    It’s actually possible to feel overwhelmed, severely stressed, and have thoughts of harming your baby or… of ending your own life… without feeling sad.

    When a woman gives birth, several changes go into high gear in her body. Pregnancy hormones drop, lactating hormones kick in, and the sudden changes in her brain give way to mood swings.  

    This woman suffers from antepartum and postpartum anxiety and needs treatment to feel relief and to bond with her baby.
    Add to that the painful engorgement in her breasts as milk comes in, lack of sleep from her baby’s waking every hour or two to eat, the soreness in her perineum from stitches, (or in her abdomen from a C-section) and cramping of her uterus as it recovers from pregnancy and childbirth, and this new mother is enduring substantial stress.

    Stress + Fear = Anxiety

    Even though many people are more familiar with postpartum depression, roughly 6% of all pregnant women and about 10% of those who are postpartum develop anxiety that’s severe enough to need treatment.

    It’s natural for a new mother to have mild worries or nervousness about whether her baby is eating enough, whether the baby’s stool is like it’s supposed to be…and wonder if she’ll ever feel rested again.

    But when mild worries become more intense, concern becomes a constant dread that something bad is going to happen, or intrusive thoughts begin of harming the baby or yourself, it’s time to seek help.

    So why do some mothers seem to adapt to the new addition to the family, along with hormone changes, the lack of sleep, and the new routine, while others feel and think things they don’t want to feel or think, struggle to bond with the baby or enjoy her, and wish for a way to escape … either temporarily or permanently…?

    There are a number of factors. And none of them are the anxious mother’s fault. 

    Risk Factors for Antepartum and Postpartum Anxiety

    First, mothers who have relatives with anxiety disorders –or have had anxiety disorders themselves in the past — are at higher risk for postpartum anxiety than woman with no family history of anxiety at all. In addition, women with thyroid imbalance are at higher risk, also. 

    Most of the time when we refer to postpartum anxiety, we’re talking about a generalized anxiety disorder that develops during or after pregnancy. Symptoms like nervousness, constant worry, difficulty sleeping, racing thoughts, tension…

    But there are a couple more types of postpartum anxiety that are important to highlight.

    Postpartum Panic Disorder

    Panic disorder doesn’t mean being panicky, or having anxiety that escalates easily until you feel wound up. It means having frank, out of the blue, and unprovoked panic attacks. You’re not just worried all the time about whether the baby is eating enough, whether you’re capable of being a good mother, or whether the baby will get sick, you begin to get random episodes of sheer panic.

    Sometimes multiple times a day.

    Shortness of breath, fast heart rate, chest pain, dizziness, and tingling along with feeling confined or like you’re suffocating can make it extremely difficult for you to take care of your baby, yourself, or the rest of the family. These sensations can come and go, but you may need professional help to cope with them and reduce their impact on you and your new family. 

    Postpartum Obsessive Compulsive Disorder (POCD)

    Symptoms of OCD can emerge during or after pregnancy, too. They’re similar to general symptoms of OCD but tend to be focused on the baby. Intrusive thoughts  about harm coming to your baby can crowd your mind, and even shock you.

    The next thing you know, you find yourself checking things over and over and repeating things over and over to try to avoid a circumstance that would allow your thought to come true. 

    And…you’re probably horrified at the thoughts that pop into your mind. But this is why we call them “intrusive” thoughts. They intrude into your thoughts without you inviting them.

    They’re a result of disordered circuitry, and misfiring signals, in your brain as the result of relentless and overwhelming stress, shock, and genetics.

    Of all of the antepartum and postpartum anxiety disorders, this may be the most difficult and the most upsetting of all. Even though you probably know in your head you would never follow through on the thoughts, and you also know that the repetitions and cycles of checking don’t really help, you probably feel powerless to stop. But treatment can do what you can’t by yourself.

    Because this condition is treatable, and you need to not endure these symptoms alone. Seek help and treatment so you can get your life and your relationship with your child back on track and in a healthier, brighter place.

    Postpartum anxiety disorders are not your fault.

    You’re not to blame for the intrusive thoughts, the fears, the compulsive reactions. These are a result of your genetics, your circumstances, your stress, and your family history. But treatment is not only available to you, it also can return your world back to its right and rewarding function.

    Antepartum and postpartum anxiety disorders come in various forms with a variety of faces.  But it’s vital that you not confront this alone. Rather, seek treatment. And please know that this is not your fault. Even so, you may not get better without help outside yourself. 

    Treatment for antepartum and postpartum anxiety is vital so mom and baby can bond and enjoy each other.

    If you’re pregnant and feeling feelings and thinking thoughts that aren’t what you wish you they were, there is help available. If your baby has been born, and those feelings are just starting or are getting worse, call us. We can help you feel better, or refer you to someone who can.

    Don’t face postpartum anxiety disorders alone.  

    You and your baby deserve a loving and happy relationship together. 

    Can we stop suicide? Yes, with a series of IV ketamine infusions.
  • Omegas: The Very Real Effect of Fatty Acids on Your Brain

    Omegas: The Very Real Effect of Fatty Acids on Your Brain

    The very real effect of fatty acids like omega-3s help your brain function at its best.

    Eat a diet that supports your positive mood and mental health.

    We’ve talked about the microbiome, or “second brain,” and how we can weaken or strengthen it with what we eat. We’ve talked about eating fresh vegetables of all colors. And how fermented foods like sauerkraut, pickles, kimchee, and kombucha introduce healthful organisms into our intestinal DNA system. We’ve talked about curcumin, and its benefits against depression. Now let’s talk about the very real effect of fatty acids on your brain.

    Did you know that some of the most important, even vital, foods you can ingest are fatty acids? Maybe that sounds a little creepy… But it’s true.

    The World Health Organization estimates that major depression is the greatest single cause of disability worldwide.

    A study by JR Hibbeln showed that around the world, countries that consume the least amount of fatty fish show the highest levels of major depression (MDD) in their population. And countries where fatty fish is the main diet show the lowest incidence of MDD.

    You Have a FAT Brain

    You think I’m kidding..??

    The effect of fatty acids on the brain turned this miserable man to a happy fulfilled one.

    I’m telling you, your brain is 60% fat.  60% !! Shocking fact when you step on the scale. But don’t try to lose that excess weight from your head, because THAT fat is pretty important. 

    Fats reside in the neuronal membranes–the brain cell membranes–and in the myelin sheaths that surround them. And they’re important for delicate synapses. Remember that synapses are the connections between neurons.

    The saturated fatty acids are combined in what’s called a lipid bilayer and that lipid bilayer forms the membrane that surrounds each brain cell. It’s made up of straight chain carbon atoms so the membrane is more firm like butter is firm at room temperature.

    Now–this is where it gets interesting– unsaturated fatty acids are made of bent chain double bond curvy molecule structures. Because of this, there’s more space between molecules so when unsaturated fats are incorporated into the cell membrane, the membrane is more fluid. So, if you compared oil to the firmness of butter, these are more fluid like olive oil, for example. 

    The omega 3 fatty acids are fluid ones.

    Another remarkable characteristic of omega-3 fatty acids is that they’re precursors to eicosanoids like prostaglandin which can reduce inflammation. Super important for psychiatric disorders, which are associated with increased inflammation.

    Eicosanoids go by the nickname ‘local hormones’ because they act on cells close to their site of production. So fatty acids in your brain cause the release of prostaglandin, which reduces inflammation that contributes to depression.

    That’s a mouthful! But it tells a promising story.

    Get the effect of fatty acids by eating more fatty fish.

    The effect of fatty acids on your brain results in wellbeing for you.

    Fatty acids like omega-3s are considered essential fatty acids, and you can only obtain them from your diet.

    So to maintain a healthier, more positive outlook, decrease inflammation that can lead to depression, and actually fight depression symptoms, increase the amount of mackerel, salmon, oysters, sardines, and trout in your diet. Make sense? I hope so, because doing that can make a real, tangible difference for you.

    In addition, seaweed is a nutrient dense food that’s rich in omega-3 fatty acids. Nori seaweed typically presents itself in sushi, and is a tasty snack on its own.  Also spirulina and chlorella are also in the algae family and are a good source of omega-3s that you can add to shakes and smoothies.

    Fatty Acids Are Essential for Your Brain Health

    In a presentation at the annual meeting for the Society of Biological Psychiatry in NYC last year, Dr. Roel Mocking spoke about the critical requirement of fatty acids in psychiatric wellness.

    He demonstrated that Omega 3 fatty acids reduce inflammation, reduce the release of cortisol from the hypothalamus-pituitary-adrenal-cortex-axis, and activate the amygdala. 

    This family love to hike together and enjoy life together.
    The amygdala is one part of the brain that contributes significantly in processing emotion and decision-making. When someone’s amygdala is damaged, or destroyed, they tend to be fearless, and don’t use the necessary caution to make safe decisions since the caution the amygdala would create is absent. 

    So, by multiplying your fatty fish consumption, you provide your amygdala the fuel to be activated to process fear and enhance circumspect decisions. You can also reduce the release of cortisol, the stress hormone that has a negative impact on your health. And you equip your brain to reduce inflammation…all of which improve your mental and emotional functioning.

    The Effect of Fatty Acids on Your Brain

    Dr. Drew Ramsey, a nutritional psychiatrist, and author of 3 books on foods that feed the brain, is an assistant clinical professor at Columbia University. Dr. Ramsey promotes better nutrition for the brain with his patients. He laments that most Americans overfeed themselves in calories but starve themselves of the critical micronutrients the brain needs to thrive.

    He prescribes antidepressants and other medications for his patients, and engages in psychotherapy with them, too. And he teaches that fresh and nutrition-packed foods help make other treatments more effective.

    It’s a shame, according to Dr. Ramsey, that it’s so rare for Americans to eat foods that meet the needs of the “most complex and energy consuming organ in the body” which is the human brain.

    Eat the Rainbow

    This meal can contribute to the effect of fatty acids on your brain.

    He recommends “eating the rainbow,” as in eating all the colors of fruits and vegetables. Fresh foods like oranges, apples, bananas, pineapple, bell peppers, tomatoes, avocados, kale, sweet potatoes, and blueberries. 

    Combine these with fish like mackerel, salmon, trout, sardines. And walnuts, pecans, and almonds.

    These can help prevent harmful inflammation, and feed your brain, your heart, and your digestive system.

    They can reduce symptoms of depression and anxiety, and promote mental clarity. 

    Ketamine Treatment Can Help Give You a Fresh Start

    So, if your diet changes and medications aren’t bringing the relief you hope for, then let’s talk about ketamine treatment. Because this remarkable treatment of at least 6 infusions within 2-3 weeks has been changing lives across the country.  It just may change yours, too.

    At Innovative Psychiatry, we encourage brain supporting foods that improve your outlook and emotional wellbeing. 

    While we don’t center an entire treatment program around food, we do work with patients and guide them in supporting their brain function by avoiding food dyes and preservatives.

    In addition, we show them that by adding healthy foods, micronutrients, and lifestyle changes, they give their brains and emotions an optimal environment for restoration.

    This young woman is upbeat because of the effect of fatty acids in her diet.

    If you suffer from depression, symptoms of anxiety, or other mood disorders, and other treatments have brought no relief, call us.

    We’ll talk with you and determine whether you’re a candidate for ketamine treatment. We’ll guide you to eat foods that improve your well being. And please do follow the links in this article to read more information about your microbiome and your restoration.

    It’s all about getting better. Enjoying your life. Watching symptoms fade and your strengths rise. 

    Call us, and let’s create a plan to help you restore joy and fulfillment in your life.

    Can we stop suicide? Yes, with a series of IV ketamine infusions.
  • OCD: Better Treatment Targets For a Happier You

    OCD: Better Treatment Targets For a Happier You

    OCD: better treatment targets can relieve this girl's intrusive and upsetting thoughts.

    Obsessive-Compulsive Disorder or OCD is a term that is sometimes thrown around mistakenly. It’s sometimes used to describe someone’s careful behavior… you know, like careful organization, attention to detail, or a tendency toward cleanliness, which of themselves are actually normal behaviors. Many of us may be particular about these things without giving them a second thought. So to use the term in jest to poke fun at someone’s distinctive tidiness, for example, should be discouraged. You know why? Because doing so fuels stigma for one thing, and trivializes a serious medical condition. But neuroscience research is showing us that with OCD better treatment targets can give you a happier, more fulfilling life.

    People with OCD have recurrent, intrusive, unwanted thoughts that just occur—like cardiac arrthymias—out of the blue and over and over, upsetting them, plagueing them and precipitating compulsive behaviors they use to relieve the anxiety spiked by their obsessive thoughts.

    Obsessive thoughts can fall into certain categories — such as fear of harm coming to you or someone you love, fear of harming others or yourself, fear of illness or contamination, or preoccupation with things like patterns, numbers, morality, or gender identity. Insecurity about the future. Fear of throwing up.

    And so many others.

    The thoughts can have a certain theme for weeks or months… and the themes can vary within a day or over time. How often they occur can vary dramatically even for the same person. Their intensity can vary, too — and really affects the degree to which they intrude in your life.

    These thoughts — and the behaviors they invoke — can be so upsetting and time consuming that they interfere with your ability to be on time, and be present, and function at work, school, or in your social life. In fact, they can interfere to such a degree that they cause intense discomfort and distress. And it’s the intensity and distress that sets apart those who have OCD and suffer from a disorder compared to those who are just a bit more hygienic or meticulous than their friends. There’s a BIG difference.

    If you have OCD, unpleasant or fearful thoughts can fuel a reaction–and if the reaction is a behavior, we call that behavior a compulsive behavior. That reaction always starts and intends to relieve your anxiety. Right? But it becomes so repetitive and time consuming, it distresses you even more.

    Compulsions can range from excessive doubting or asking (did she have an accident? is he cheating on me? did I do that right?) to excessive hand-washing, skin picking, or excessive safety checking — checking and rechecking the door knob, the knob on the stove, or locking and unlocking your car, or something else potentially dangerous. You could meticulously clean, re-read, re-write, or arrange objects. You do … and redo.

    And there’s so much more.

    There are also some other subdivisions of this disorder that you may not have even heard of: like harm OCD, obsessive slowness, tic-related OCD, and even pure obsessional OCD — where there are no observable compulsive actions but obsessive thoughts that just won’t stop.

    Bottom line: many people suffer from a complex mixture of these types of obsessions and compulsions.

    It’s surprising how often the diagnosis is missed.

    It may surprise you to know that many people with OCD are aware that their intrusive thoughts aren’t true and that the compulsive actions they take don’t help. But they still can’t make them stop. And this causes them severe distress.

    OCD: Better Treatment Targets Are Desperately Needed

    Brain and Behavior Research Foundation presented a talk recently regarding the work of researchers to find more treatment options for those with OCD who are not helped by current available medications or psychotherapy. Because there’s a HUGE need.

    Treatments for OCD

    Serotonin Reuptake Inhibitors (SRIs) have been the only proven monotherapy, or singular form of medication treatment.

    The serotonin system is pretty extensive. It’s involved in many different parts of the central nervous system: From the hippocampus, cerebral cortex, cerebellum, basal ganglia, thalamus, limbic cortex, and temporal lobe, to the rostral raphe nuclei, caudal raphe nuclei, and the spinal cord. Exhaustive, isn’t it?

    Remission with SRIs is only 10-15% which is wonderful for those who achieve it, but the other 85-90%, need more help than that.

    Those who achieve a partial response to an SRI experience a decrease in symptoms in 20-40% of cases… but only 20% still enjoy improvement after ten years.

    Not great.

    So it goes without saying how seriously we need to explore OCD better treatment targets that are effective. So here are some possible options on the horizon…

    Augmentation strategies

    OCD: better treatment targets can dispel the fearful obsessions this girl experiences.

    Glutamatergic agents like Ketamine

    Studies continue to investigate IV ketamine treatment for OCD. One study may show good responses, then another shows it’s less effective. Researchers are guessing this may be due to different types of symptoms needing different treatments. You can see that it’s so important to research more deeply — and study different patient populations — to see which ones do respond and which ones don’t.  And to learn why.

    Is it based on the types of symptoms the patient experiences? Fear of harming others vs. Fear of contamination? Or is it based on comorbidity, such as cognitive rigidity or the presence co-morbid depression or anxiety? Researchers continue to explore these questions.

    A common augmentation strategy is with dopaminergic blockade agents, such as atypicals, as they’re called. (A shortcut for atypical antipsychotics–we often avoid saying the “antipsychotic” part and just call them atypicals.) Interestingly, these medicines fast-tracked for FDA approval treat psychotic disorders often have promising results with a variety of neuropsychiatric conditions.

    They’re pretty amazing. They can get you unstuck, and get your thoughts unstuck. They’re like Goo Be Gone–you don’t quite know where all of those repetitive stuck thoughts went. They just seem to dissolve.

    When the meds work.

    Exposure and Response Prevention (ERP)

    This form of therapy can be extremely effective, but it’s hard for some patients to see it through. It requires patient and consistent steps to bring about progress.

    The steps required can cause so much anxiety that patients sometimes decide it’s not worth it to them… so they quit. It’s also hard to find enough skilled therapists to meet the needs of patients who need this kind of treatment. Here at Innovative Psychiatry we’re not able to offer this therapy to new patients. But we can offer other treatments.

    For those who have not improved with medicine or therapy, surgery can be a consideration.

    We don’t offer that either. Just sayin…

    Ablative Neurosurgery

    When medicines and psychotherapy bring no improvement, an option may be ablative neurosurgery. This involves surgically interrupting precise connections between the cortex and striatum.
    The cortex is the part of the brain where you make decisions and decide what action you’re going to take. The striatum is important for carrying out those actions. So creating a disconnect between the two interrupts the cycle. This procedure can be 50-70% effective.

    The problem with ablative neurosurgery is that it’s surgery…. and its non-reversible

    It’s non-reversible. 

    Deep Brain Stimulation

    Deep brain stimulation is high-frequency stimulation achieved by implanting electrodes deep into the brain that are powered by a device planted in the chest…something like a pacemaker for the brain.

    When there’s a disturbance in the reward system of the brain it can lead to addiction, depression, and/or OCD.

    And good outcomes have been achieved with deep brain stimulation.

    For instance, the most common target site that’s been used for DBS is the ventral capsule/ventral striatum (VC/VS) and the nucleus accumbens (NAc) area. This area is approved for deep brain stimulation and is also being investigated for other purposes.

    A newer target was utilized in a recent and exciting study. Keep reading…

    A recent study (March 2019) seeking an alternative to ablation neurosurgery was conducted by Tyagi et al., and compared the effectiveness of deep brain stimulation at the ventral capsule/ventral striatal (VC/VS)  region and the anteromedial subthalamic nucleus (amSTN) region in the same patients. They tested to determine the differences on mood and cognitive flexibility and associated neural circuitry. They also used cognitive behavioral therapy throughout the process. 

    Each patient received DBS in one region at a time, then at a separate time in the other region. Each patient received significant improvement of OCD symptoms following DBS to each site. But they didn’t get any real additional improvement after having stimulation to both sites at once. 

    Hand washing by someone with OCD: better treatment targets will restore a rewarding life to so many.

    But listen to this – It was so exciting to find that when patients received DBS to the VC/VS region, they experienced improved mood. When they received DBS to the limbic STN area, it improved their cognitive flexibility without affecting their mood at all.

    Better Treatment Targets

    So while DBS was effective for OCD symptoms at both targeted sites, this implies that if a patient is having more difficulty with co-morbid depression, then she might receive relief for both conditions following DBS to the VC/VS region. However, if the patient’s greatest difficulty is with rigid cognitive thinking and needs more cognitive flexibility, then the NAc region might be the preferred target for DBS. Very cool. How many more sites can be mapped for this?

    All in all, this study opened up more possibilities to be investigated for treating OCD by isolating the specific sub-symptoms different people endure. Just imagine how much more effective OCD treatment could be if we were able to identify the targets in the brain where stimulation would relieve each OCD symptom.

    OCD: Better Treatment Targets Will Improve Quality of Life

    At Innovative Psychiatry, we’ve worked with a variety of treatments for OCD including SRIs, Transcranial Magnetic Stimulation (TMS), and IV ketamine treatment. Both TMS and ketamine treatment continue to be studied to improve outcomes for patients with OCD. There’s lots of work to be done still. And so we keep a close eye on advancements in neuroscience research to help us provide the most personalized care possible at this point.

    With each passing year, we hope for more discoveries to guide us to more and more finely-tuned options.

    Effective Treatment Includes Tools to Restore What’s Missing

    Depression can be treated with IV ketamine treatment and brought to remission. But it doesn’t always happen that way. Your treatment might be challenged by underlying variations in serum levels or cerebrospinal levels of a certain folate or of hormones. In the same way, OCD treatment can be deterred by individual symptoms and the brain regions involved in a given person’s disorder.

    This is why personalized treatment and care is so important. So let’s say it again:

    One Size Doesn’t Fit ALL!!

    We want to help you get better. We want you to have the freedom to pursue the life you want, the career you believe in, and build the relationships that will fulfill your life.

    If you suffer from a disorder that has not responded to multiple treatment strategies, call us. We specialize in finding effective treatment for your individual symptoms. No matter what advances are being made in psychiatry and neuroscience, if you don’t feel better, it’s hard to see the relevance. We get that.

    Call us. We’re here to help.

    Lori Calabrese, MD explains esketamine FDA approval and what it involves.

    To the liberation of your best self,

    signature of Lori Calabrese, M.D.

    Lori Calabrese, MD

  • Can Genetic Clues Really Predict Bipolar Disorder and Schizophrenia?

    Can Genetic Clues Really Predict Bipolar Disorder and Schizophrenia?

    Can genetic clues really predict bipolar disorder in people like this young woman, who doesn't understand her disorder.

    If you struggle with bipolar disorder, and the symptoms that seem to dominate your life, it may help you to know that many psychiatric disorders don’t really come with a list of predictable symptoms.

    If you have times when you’re short-tempered, highly energetic, sure of yourself, and quick to argue, you may have a mood disorder…or you may have had a frustrating week at work… And so goes the conundrum. You may feel like you’re low on energy most of the time, or find it hard to identify purpose for your life. How do you know if you’ve got something going on? How can you get a clue? It may seem far-fetched, but can genetic clues really predict bipolar disorder and schizophrenia?

    We look for clues all the time–little signs and symptoms that herald bigger problems to come. If you have all that going on… and it seems to run in cycles…  depression interrupted by periods of energy, over-confidence, a strong drive to win arguments… then periods when you can only think about dying…or ending your life yourself… Well, chances are, this may be more than a bad week at work. In fact, you should probably see a good psychiatrist in your area to help sort it out — because you may have a disorder. And if you do, treatment can help.

    So, let’s say maybe you feel intrigued to talk someone you just met into having risky sex with you…or maybe you’ve lost touch with the limits of your credit cards and feel inspired to do lots of shopping or travel and splurging. Maybe spending money gives you exhilarating feelings, but you feel like you’re accomplishing so much– and …you don’t notice this is out of character for you. You think it’s great.

    Oh boy.

    Your Disorder May Display Different Characteristics Than Someone Else’s

    Fighting cranes depict the unexpected conflict from someone with bipolar disorder.

    People with bipolar disorder don’t usually display all the symptoms, but they do display some of them. Whether it’s something like getting frustrated that leads to a major blowup and rage…and display of super human strength… or something like feeling untouchable and indestructible that leads you to do things that are so risky (so incredibly fun!) that the adrenaline just courses through your veins. Rather than feeling fear per se, you feel exhilarated — and want more of that feeling.

    Let’s look at it this way…

    If you contract a virus, something like the common cold, it’s easy to predict your symptoms, isn’t it?  

    Sneezing and a runny nose is how it starts.

    Sound familiar?  

    If it’s a particularly nasty cold, you might even have a fever. Then, the runny nose gives way to a stuffy head, maybe a cough or a scratchy throat, and you just feel awful. So predictable. We can pick up on the first inklings

    But some psychiatric disorders aren’t quite so easy to pick up on. 

    So Many Symptoms – Who Can Tell?

    Sure, there’s depression.  Everyone knows what that is…right? Or maybe not…  If you broke a nail right before a black tie event, that may seem depressing. But we’re not using the word appropriately when we say that. Because major depressive disorder (MDD) is a disorder… i.e., an illness. Grab your file and smooth out that nail. It won’t interfere with your fun at all. But if you have MDD, it’s not likely you’ll be able to have a very good time. Depression just takes the fun out of everything.

    Shopping can be fun, but sometimes spending way too much can be a sign of bipolar disorder.

    At the same time if you shopped for the event, spent your entire month’s earnings on an outfit for the affair, and left yourself with pretty much nothing to live on or pay bills with until your next paycheck, it’s pretty clear you used poor judgment. And poor judgment is not a disorder. It’s merely doing something risky that seemed like a good idea at the time …but a tough decision to live with the rest of the month. On the other hand, poor judgment can be a symptom of a disorder.

    Oh. Like when?

    So can explosive outbursts. Fits of rage. Or destruction of property. Again, they can be, but of themselves aren’t necessarily signs of a disorder.  So it begs the question: are there clues that predict whether a disorder is in the making? Are there genetic clues that really predict bipolar disorder and schizophrenia? Well… the answer is sometimes. And maybe.

    (This is where we tear our hair out.)

    You do need a psychiatrist to figure all this out. 

    Thirty years ago, a psychiatrist may or may not have been able to help. But chances were much better than they were 100 years ago, you know?  At that point, psychiatrists stumbled in the dark and devised theories to explain patients’ behavior, with little scientific evidence. There was so little we knew about the brain. Sometimes they helped their patients, but often they couldn’t. 

    In the absence of neuroscience discovery, psychiatrists did what all scientists do: they hypothesized. And they looked for evidence to see if they were right.

    Is it any surprise this branch of medicine was cloaked in stigma? 

    Can Genetic Clues Really Predict Bipolar Disorder and Schizophrenia?

    Now we’re advancing into the 21st century, and we’re still fighting the stigma that began in the dark absence of clear scientific evidence.

    So, let’s talk about where we’ve come in psychiatry.

    Now we can separate the genes on the chromosomes.

    You know what chromosomes are, right? Your DNA. But that tiny microscopic structure – that’s a map of who we are – is made up of genes. Now those are really tiny.
    We know what many of the chromosomes actually do. We also know that a tendency to develop various diseases can be found in specific positions on certain chromosomes.

    By the same token, certain clusters of genes in certain locations on the chromosomes can indicate personality traits that emerge in someone who has not yet developed a disorder. Genetic clues that can perhaps predict the later onset of bipolar disorder and schizophrenia… and the list goes on.

    Nicholas Pediaditakis, M.D.’s article in Psychiatric Times under the title, “The Dog That Did Not Bark,” explains how this might work. Sometimes, certain clusters of genes are missing… like if the “barking” genes are missing, it could result in a dog that doesn’t bark. 

    A child's temperament can be a clue to bipolar disorder or schizophrenia through genetic personality predictors.

    When that happens in people the genes that express themselves as personality traits, can create a “lopsided” personality, as he put it.  So the genes that would express themselves as socially outgoing may be missing or sparse, which can show up in the person as aloofness or an aversion to social situations along with a sense of autonomy. 

    Of course, this is an oversimplification for our purposes in this post, but the point is that this person is “premorbid”(in the sense that he doesn’t have signs of a disorder yet), but his “lopsided” personality can be a signal of schizophrenia or bipolar disorder that may be lurking in the future.

    Dr. Pediaditakis goes on to say that this premorbid asocial trait may result in a group of individuals who may be vulnerable and later turn out to develop schizophrenia or bipolar disorder. It’s sort of like a preview in the developing brain. He says,

    “This synchrony is an emergent property of complexity. This probabilistic shift heralds the expression of the disorders and results in the development of characteristic symptoms for both schizophrenia and bipolar disorder.”

    The Give and Take That Leads to Gifting and Brilliance

    He also says that while both of these disorders tend to include psychosis at some point, there is also some trade off with traits that can be quite favorable.

    For instance, since their personality doesn’t include social traits, it’s as though they’re able to think in terms of unconventional alternatives and distinguish original and revolutionary patterns …whether scientific, mathematical, artistic, or musical. 

    Basically, since they have some freed up space in their head, they can also be remarkably gifted. Sound familiar?  

    Can genetic clues really predict Can genetic clues really predict bipolar disorder? This brooding man wants to know.

    It brings to mind the book and movie, “A Beautiful Mind,” about John Nash, Jr., the gifted mathematician who suffered from schizophrenia. And Vincent Van Gogh, the brilliant but tormented artist. And entertainers like Carrie Fisher, Mel Gibson, and Mariah Carey (to name just a few) who’ve struggled with bipolar disorder along with their creative brilliance.

    There’s a physiological reason, one only identifiable by neuroscience, that these great talents are simultaneously struggling with a severe disorder, while also displaying their creative gifts. The two might actually be linked, if indirectly.

    Neuroscience Leads the Way to Understanding More About These Disorders

    Molecular genetics, functional neuroimaging, and translational neuroscience has made great advancements in the diagnosis and treatment of both bipolar disorder or schizophrenia. Stigma about disorders like these is dying a slow death… we hope, in time, it will disappear altogether. 

    And we hope that time comes soon.

    Modern medical and neuroscience breakthroughs are exploding. And they raise the question: Can genetic clues really predict bipolar disorder and schizophrenia? There’s so much more we’re learning about brain circuitry, the hippocampus, the amygdala, the lateral habenula… and what is called translational neuroscience, where we take basic science research and translate it into clinical applications that help people. Like you, and the people you love.

    In the meantime, if you’ve been diagnosed with bipolar disorder, and if the medicines prescribed for you haven’t helped, you need treatment that works.

    You Deserve to Feel Better

    Ketamine treatment can make a dramatic difference in managing your bipolar disorder by wrangling bipolar depression. Scores of people in your position have been relieved to discover the difference ketamine treatment makes. 

    If your medicines are helping, you’re in a wonderful position. You’re finding you’re able to live your life with less difficulty and build upon the things that matter to you. But if your medicines aren’t working, if you’re tormented, living in chaos, and unable to invest in your job or relationships because of your symptoms, call us.

    Can genetic clues really predict bipolar disorder? Ketamine treatment can can give you great relief, if it does..

    At Innovative Psychiatry, we see people with bipolar disorder get much better all the time. Because lifting them out of depression that just hasn’t wanted to budge is a game-changer. When ketamine relieves depression, there is so much more time and energy left for managing your life. 

    We’re here to see that you get the help you need to enjoy your life, build up what’s broken down, and relish your friends, your family, and your work, as well.

    It can get better for you.  You’ll see.

    Can we stop suicide? Yes, with a series of IV ketamine infusions.
  • Ketamine and Depression Treatment-Time Marches On

    Ketamine and Depression Treatment-Time Marches On

    Ketamine and depression treatment is the subject of this Time magazine special edition.

    Time magazine recently offered a Special Edition on mental health… Did you see it?

    The article about depression treatment – and ketamine specifically – by Mandy Oaklander published in July 2017, was reprinted for this special edition. The title of the special edition is “A New Understanding”…but since the article Oaklander wrote is two years old, I’m concerned this special edition may be misleading.

    Her cover article two years ago touted ketamine as an “anti-antidepressant.” This same term is repeated on this Special Edition cover. But, since Oaklander’s article created some misunderstanding when it was first printed, I’m not sure it’s accurate to refer to the contents of this edition as “a new understanding.”

    In fact, some of her representations of ketamine treatment border on archaic.

    Ketamine and Depression Treatment

    The field of ketamine for depression treatment is a new field in the “psychiatry and neuroscience universe” that’s been growing at break-neck speed. A wide variety of healthcare professionals offer this treatment in a wide variety of places and using a wide variety of methods.

    Ketamine and depression treatment as a whole is developing as a field and is helping people with treatment resistant depression enjoy their lives.

    Still, because we’re on this quest together, you and me, I want to take a few minutes to express my perspective on this reprint of her article.

    What quest?

    Well, that would be our passion to find more ways more people can be relieved of the symptoms that impair their lives.

    We talked about this after this article was published in TIME two years ago. But we’ve learned so much since then. Through neuroscience research as well as in private psychiatry practice and in meeting and collaborating with other healthcare professionals at national and international conferences since then.

    What Have We Learned Since TIME Published That Cover Story?

    Lots. About ways to prolong the effects of ketamine, ways to prolong and maintain remission, more of the actions of ketamine in the brain… We focus on ketamine treatment. So let’s talk again now about how she framed ketamine treatment in a less accurate light than we might wish.

    Because if you suffer, you want to know. You try treatments and medications for months – and years – in vain. You want to know that you’re getting the best possible information you can get your hands on. 
    Is TIME telling truth ketamine?

    Regarding the route of administration

    This article spoke of a lady named Barbara Reiger who’d been depressed since childhood. It said that since no other treatment helped, she goes monthly to a ketamine clinic. And there she has “a needle full of ketamine plunged into her deltoid…” 

    This route of administration for ketamine treatment is only one of many. In the 2 years since the article, there has been much more research about IV ketamine infusions. The intramuscular route is less predictable than an IV for getting the medicine on board. In addition, it’s more difficult to manage the onset of action or the experience once ketamine is sealed into muscle. You can’t slow its absorption or effects, or stop it.

    We later read that Ian Hanley, another person with treatment resistant depression, received ketamine infusions. I assume these are intravenous (or IV).  The term “infusion” speaks of the IV route. (Though surprisingly, I hear there are those who use this term to refer to IM injections.  This isn’t correct, and can be so misleading to patients who don’t know the implications.)

    Is Ketamine and Depression Treatment a “Trip?”

    Another point is the experience itself:  Is it a “trip?” What does the patient experience with ketamine treatment? Oaklander calls these treatment experiences “ketamine trips” as though the concept of a psychedelic trip is the foregone conclusion with ketamine treatment.  While it’s true that there will be a variety of experiences between various patients, and that ketamine is a visionary medicine, ketamine treatment for depression should not be confused with people who use ketamine for a psychedelic trip. 

    Oaklander’s perspective focuses on ketamine as a psychedelic drug. Such characterization draws a narrow crowd of people interested in psychedelic exploration, but can alienate the larger population of patients who have no interest in psychedelic anything. It’s a misunderstanding of ketamine and its properties to limit the characterization of it.

    Who’s in Charge? The Medicine or the Doctor?

    Ketamine for depression has changed the face of psychiatry.

    And it’s the responsibility of the physician administering the medicine to use a route, a rate, and a dose that allows the patient to know the ketamine is actively working. And to prepare and protect the patient from an overwhelming experience. 

    As it takes action in (1) her brain circuits, (2) her BDNF to proliferate synapse connections, (3) her lateral habenula, and (4) those G proteins on lipid rafts in the cell membrane, the patient will experience sensations, feelings, and possibly visuals as a result. (Amazing, isn’t it? These are just a few areas of action we know about ketamine! There may be far more!)

    Because the brain is made up of nerves that connect with each other, and complex systems that perform vital functions of all types, impacting these circuits gives you certain sensations, thoughts, and experiences.

    The sensations feel overwhelming if the dose is too high. And the patient can feel alarm if the rate is too fast or uncontrolled. In fact, the experience might even advance to something you might call a “trip.”

    But … a closely monitored infusion should prevent the overwhelm, while allowing full restorative freedom for the medicine to do its work.

    Ketamine Can Erase Suicidal Thoughts in an Afternoon

    Ketamine treatment lifted depression from this young man.

    Oaklander also pointed out the rapid and dramatic ability of ketamine to stop suicidal thoughts in a few hours, whether it relieves depression or not.

    This is a shining benefit of ketamine — that its ability to erase suicidal thinking is separate from its antidepressant benefits. Lifesaving.

    Now about how ketamine lifts depression.  Oaklander wrote that the “ketamine trips,” as she called them, help people disconnect from their bodies and thoughts. Her idea was that this experience changes the mindset so completely that the depression lifts. 

    However, while we know the experience is important as part of the ketamine and depression treatment, research presented at the American Psychiatric Association Conference in San Francisco a couple weeks ago shows it’s not enough to lift the depression by itself. In addition, if that were true, those who have had these “trips” would all be depression–free … and that’s not true either.

    Even so, the dissociation the patient experiences during the infusion does serve as a sign of what’s actually going on in the brain. This is ketamine at work, restoring synapses, turbo boosting BDNF. This process is not for entertainment but rather it signals the restorative properties at work, just as pain signals something wrong in the body.

    How Ketamine Works… There’s More to Learn

    Oaklander’s statement that “experts aren’t sure exactly how ketamine works…” is still true, but we know far more than we did when she wrote the article two years ago. It seems this one medicine has spawned its own frontier, and we keep learning. Research on ketamine for psychiatric disorders presses on around the world.

    And real-world practices also present data to give the medical community, and our patients more information that ketamine has taught us.

    Learning more about what we already know is paramount. A recent study revealed how ketamine restores brain circuits. We understood that it did… or believed that to be so. But now a two-step process in restoring dendrites and dendritic spines has been revealed through a special laboratory process. This is the tip of the iceberg.

    There is so much more we want to know about this extraordinary treatment.

    Ketamine and Depression Treatment in General: Keep the Research Coming

    And this is where I’d like to see journalists like Mandy Oaklander and her contemporaries use their influence to call for more research. It’s wonderful that pharmaceutical companies continue to search for new possibilities in drugs to target more areas of the brain. The more the better.

    Ketamine and depression treatment helped this mom to enjoy her daughter and build a stronger relationship.

    But, as Oaklander pointed out in that article, the concern and caution about ketamine lies partly in its potential for abuse, but also in its potential for damaging side effects.

    Our concern is that it may be damaging eventually if it’s used too often for too long. 

    For those who receive ketamine infusions every few weeks or every single month with no end in sight, there may be risks. Since ketamine can help such a large population of people with treatment resistant disorders achieve resilience and remission… isn’t it worthy of the research to find out more that it can do? To build our body of knowledge…?

    How many more people can be restored with ketamine infusions if we find out what their physiological and psychological obstacles are? What do we need to learn to remove more of the hindrances to an individual achieving resilience… and even remission?

    It’s true that not everyone responds to ketamine treatment.  We’ve talked about how preliminary research suggests that those with the VAL-VAL allele respond so quickly, and those with MET-MET can respond more slowly, or sometimes not at all.

    But there are also those who respond within the first three infusions, but then their response dissipates. These are responders, and yet not remitters. There are studies that suggest differential responses in certain groups, like the Taiwanese. Let’s find out what we don’t know about why. 

    Ketamine and depression treatment can change an angry man to a happy man like this.

    In some cases, there’s a cerebral folate deficiency that hasn’t been treated, in others it’s Low T, in others it may be deficiencies only found in the cerebral spinal fluid… 

    And if deficiencies that cause depression are there, they need to be teased out and treated, so ketamine can do more to restore those lives.

    But..what other obstacles are there that can be treated so our patient can get the most out of his ketamine infusions…and enjoy resilience… and get the most out of his life?

    We applaud all efforts to find more treatments that will be effective for more patients. But rather than focus on ketamine’s potential danger in the long term, why not invest our resources in finding out how to get more people to remission so they’re NOT exposed for the long term?

    What if that pot of gold at the end of the rainbow is not in fact another medication we also don’t fully understand, but rather a better understanding of the one that works so well already?

    Thank you, Mandy Oaklander of TIME magazine, for spreading the word about this new frontier in treatment two years ago. While your characterization seemed to stray from our perspective through neuroscience, we have appreciated that TIME magazine helped to make this breakthrough treatment a household word. We’re learning so much and the more we learn, the more we see that we NEED to learn.

    Knowledge really is power against psychiatric symptoms.

    Man with peace in his heart is thankful ketamine treatment restored his life.

    Here’s hoping we can all walk together to get effective treatment to more people. Several years ago, studies showed that “60-70% of people with treatment resistant depression respond to ketamine” … but we’re making progress.

    A number of doctors in private practice are learning to get more out of each infusion for better outcomes for our patients. And we’re seeing responses much higher than 60-70%.

    At Innovative Psychiatry, we see extraordinary outcomes in our patients every week. Patients who were too ill to work, who had withdrawn from their relationships, and lost hope in their jobs, their lives, and themselves…go forward to find initiative, resilience, joy, and bushels of hope for a fulfilling and rewarding life after they receive carefully supervised ketamine treatment.  

    If you suffer and endure with symptoms of depression, PTSD, bipolar depression, addiction, social anxiety, and suicidal thoughts... give yourself the opportunity to feel better and live better. Call us and find out what joy feels like. 

    Ketamine KRIYA Conference 2018
  • Study Finds Ketamine Nasal Spray Effective For Treating Depression: What You Should Know

    Study Finds Ketamine Nasal Spray Effective For Treating Depression: What You Should Know

    A new study finds that a nasal spray formulated from the anesthetic ketamine is a safe, fast-acting and effective treatment for treatment-resistant depression. Researchers presented the findings this week at the annual meeting of the American Psychiatric Association.

    Esketamine, the intranasal formulation of ketamine, recently received FDA approval as a depression treatment when used with an oral antidepressant, based in part on findings from this study. The results open the door to a potential new alternative for the estimated 30% of depression patients suffering from treatment-resistant depression.

    The study included 197 adults from 39 outpatient centers over a two-year period. All of the participants had either moderate or severe depression and hadn’t responded well to at least two antidepressants in the past. Participants were randomly assigned to one of two groups: The first switched from their current antidepressant treatment to esketamine nasal spray and a new oral antidepressant; the other switched from their current treatment to a placebo nasal spray and a new antidepressant.

    The results showed significant improvements in depression symptoms among those in the esketamine group compared to the placebo group four weeks into the study, with signs of improvement starting much earlier.

    “The study supports the efficacy and safety of esketamine nasal spray as a rapidly acting antidepressant for patients with treatment-resistant depression,” the study concluded.

    “Not only was adjunctive esketamine therapy effective, the improvement was evident within the first 24 hours,” said Michael Thase, M.D., one of the study authors. “The novel mechanism of action of esketamine, coupled with the rapidity of benefit, underpins just how important this development is for patients with difficult-to-treat depression.”

    The researchers reported that most of the negative side-effects in the esketamine group, including dissociation, nausea, vertigo, dysgeusia (impaired sense of taste) and dizziness, disappeared within a couple of hours. A small percentage of patients dropped out of the study due to side effects.

    Ketamine has been in headlines for more than a decade as the party drug (aka “Special K”) with promise of becoming a next-generation depression treatment. Early studies showed patients with a history of treatment-resistant depression responded well to ketamine almost immediately. Those studies generally used intravenous ketamine at a low enough dose to not deliver anesthetic effects (what ketamine was originally designed to do in humans and animals), but intravenous ketamine for the treatment of depression hasn’t been approved by the FDA. The intranasal formulation (brand name Spravato) received FDA approval in March of this year but is only available through a restricted distribution system with a certified clinic or doctor’s office.

    The news isn’t entirely upbeat, however, with some researchers urging caution as the drug moves closer to pharmacy shelves. In commentary accompanying the study in the American Journal of Psychiatry, Alan Schatzberg, M.D., from Stanford University School of Medicine, cautioned that while this study shows potential benefits of using the drug, “there are more questions than answers…and care should be exercised in its application in clinical practice.”

    Schatzberg pointed out that clinicians don’t have adequate information about how often the medication should be prescribed, how long patients should use it, or what the correct course of action should be if patients eventually stop responding to it.

    He also highlighted the potential for abuse, echoing concerns raised by many health professionals all along the drug’s road to approval. Using the history of opioids as an example, he added, “We have witnessed four decades of supposedly new and safer opioids that have turned out often to be, if anything, even more abusable and lethal.”

    “Still, the agent [esketamine] could be helpful to many patients with refractory depression,” Schatzberg said, ending on the positive, “and efforts to develop rapidly acting agents for severely depressed patients need to be applauded.”

    The study was published online in the American Journal of Psychiatry.

    You can find David DiSalvo on Twitter, Facebook, Google Plus, and at his website, daviddisalvo.org.

    [Read the Original Article Here]

  • Opinion: The New Ketamine-Based Antidepressant Is a Rip-Off

    Opinion: The New Ketamine-Based Antidepressant Is a Rip-Off

    Johnson & Johnson patented a form of the psychedelic with less research and a ridiculous price tag.

    In a popular and public move, the United States’ Federal Drug Administration recently approved intranasal esketamine, one of the components of the psychedelic ketamine, for treatment-resistant depression. The nasal spray costs nearly $900 per dose—or roughly $7,000 for the first month of treatment, and each treatment takes at least two hours in a clinic. (It has yet to be decided how much of the cost insurance plans will cover.)

    Esketamine can be unwieldy to use and carries a number of significant potential side effects. Shockingly, it was no better than placebo in two of the three short-term Phase-III studies submitted to the FDA for approval.

    But the biggest problem at hand is not the drug itself. It’s the fact that instead of representing a revolution in mental health treatment, as it has been touted to do, esketamine is not a breakthrough at all. It’s just a way for pharmaceutical company Johnson & Johnson to make a significant profit off gullible insurance companies and vulnerable patients.

    Generic Ketamine Works

    Generic ketamine is available for a fraction of the price of esketamine, has been shown to work—and work safely—in small-scale single-dose and multidose trials for treatment-resistant depression, can be administered in a variety of ways, and has already been used off-label for decades to treat thousands of patients with depression and suicidality.

    It’s currently difficult, if not impossible, to provide generic ketamine treatment in public clinics, even to patients who need it, because there haven’t been any large-scale, randomized trials, both with and without psychotherapy. Without these trials, and resources, physicians can’t be reimbursed by insurance companies for ketamine treatment like they will be able to do with esketamine.

    Ordinary ketamine is a racemic medication, meaning it is made up of two molecules that are mirror images of each other. Because ordinary ketamine is generic, Johnson & Johnson simply isolated one of the two molecules in regular ketamine so that it qualified as “new.” The reality is that we don’t know whether esketamine is more or less effective than regular ketamine because there have been no head-to-head trials between the two. Johnson & Johnson only tested esketamine against a placebo, likely because they feared esketamine might actually perform worse than the generic version.

    As many critics have pointed out, this strategy has become the bread and butter of drug development in the United States today. Largely because of the influence of pharma on the FDA itself, our drug approval process rewards copycat variation of already-available drugs instead of truly innovative pharmaceutical design.

    When Psychotherapy Is Missing

    The trials for esketamine also reveal a larger issue in the field: they de-emphasized the importance of psychotherapy while focusing solely on its chemical effects. The most effective treatment strategy for treatment-resistant depression is intensive psychotherapy along with the use of medication, but the FDA esketamine trials didn’t include therapy at all.

    Getting insurance companies to pay for psychotherapy is already difficult, and without it as part of the protocol, they will likely offer no reimbursement for patients interested in receiving a psychotherapy session after their esketamine dose in order to process the experience.

    Our colleagues who offer ketamine-assisted psychotherapy say that this is a vital part of the process. One such session can require upwards of three hours of one-on-one treatment in order to prepare patients for the experience, take care of patients while they are under the influence of ketamine, and then integrate the effects afterwards. Ironically, insurance companies would save more money paying for generic ketamine-assisted psychotherapy rather than esketamine treatment alone, as the former is both cheaper than the latter and can lead to long-term remission of symptoms.

    Alternatives

    Private ketamine clinics currently do exist, but they have to fight the stigma of the drug, and sporadic cases of malpractice. Some private clinics do not properly screen patients prior to initiating treatment and often charge outrageous sums of money—one reason that both patients and medical systems have been hesitant to implement it more widely. Those clinics that are providing ketamine responsibly, however, offer a potentially lifesaving treatment for patients living with depression who have exhausted all other available options.

    Although there are no quick fixes for the broken drug-development and approval process that led us to esketamine, it is possible to take concrete steps to address the most glaring problems. Insurance companies and the FDA ought to require head-to-head study designs of clinical trials to investigate generic and patented medications. Additionally, current research on medication-assisted psychotherapy with other psychedelic substances such as MDMA and psilocybincan serve as a model for future research that explores ketamine-assisted psychotherapy, instead of the drug alone.

    While Johnson & Johnson rakes in the profits from esketamine, patients dealing with depression and trying to navigate our struggling mental health system will bear the cost. Fostering the development of mental health treatments that are novel, effective, and affordable will require a critical examination of the undue corporate interests that drive drug approval in American psychiatry today.

    Dr. Michael D. Alpert is a psychiatrist and clinical faculty at Harvard Medical School. He is also a therapist with the MAPS Clinical Study of MDMA-Assisted Psychotherapy for PTSD.

    Dr. J. Wesley Boyd, MD is a psychiatrist and associate professor at the Center for Bioethics at Harvard Medical School.

    Dr. Marco A. Ramos is a psychiatry resident at Yale University.

    [Read the Original Post]

  • Revitalize Psychiatry: Disrupt – Include – Engage – Innovate !! – The APA 2019 Conference

    Revitalize Psychiatry: Disrupt – Include – Engage – Innovate !! – The APA 2019 Conference

    Disrupt, Include, Engage, Innovate was the theme of the 2019 APA Conference.

    I just returned from the American Psychiatric Association’s 2019 Conference in San Francisco.

    This is the 175th Anniversary of the APA, and look how far we’ve come. The theme this year was: Revitalize Psychiatry – Disrupt – Include – Engage – Innovate. and it certainly provided fodder toward those goals. It was an informative and eye-opening conference with a wide array of talks and poster presentations. Plus, I was privileged to make a presentation, too. More about mine in a bit.

    The attendance at this conference exceeded them all, with thousands of attendees from around the world and new research presentation abstracts which spread out over 800 pages!

    You may not be aware that the APA is the oldest medical organization in the nation. (We’re proud of that.) The venue was enormous and the camaraderie rich, inclusive, and restorative.

    The presentations flowed from every aspect of psychiatry, including geriatric issues as well as issues specifically relevant to children, and adolescents, too. There were talks from ADHD to dementia and addiction to psychosis.

    From Saturday through Wednesday the venue was chock-full of courses, convocations, lectures, symposia, talks, and media presentations by the hundreds. There were more than 360 new research presentations every day in the poster sessions which went up every morning and every afternoon.

    There’s no way I could ever provide a synopsis here of all the findings presented. But there were a couple I do want to mention.

    My own focus was on those presentations specifically related to suicide, depression and other mood disorder treatment, and especially ketamine treatment. I drank up all the information and data I could hold. (That and espresso kept me going.)

    Here we’ll talk about two of the presentations focused on ketamine and the one I presented on suicidal thinking.

    Ketamine’s Effect on OCD

    I was so pleased to see there has been more work focused on ketamine for obsessive-compulsive disorder (OCD). Clinical Psychiatry News featured this article with the title: “Ketamine may help OCD, but much work remains.”

    Young woman suicidal thoughts are gone since her ketamine treatment.

    The author, Carolyn Rodriguez, MD, pointed out that the symptoms of OCD are severe, and 1 in 7 people with OCD attempts suicide at some point in their lives. She said that there is a significant and painful delay between the time of diagnosis and the time when the patient experiences benefits from the medicine — 2-3 months or even longer.

    She talked about her interest in looking at therapies that worked much faster, and were more thorough. This is so important so that patients could feasibly experience more complete eradication of symptoms.

    Since more and more evidence indicates that glutamate seems to contribute to neuron communication as an excitatory chemical messenger, she chose to see what ketamine could do, considering it blocks the glutamate receptor.

    The only study using ketamine with OCD was conducted by Dr. Rodriguez and her team in 2013. Not surprisingly, she’s planning a new one now which will compare ketamine with midazolam, to study the effects of ketamine on the circuits associated with OCD. 

    She Called for More Studies On Ketamine’s Effects on OCD

    She says a larger study is needed to learn more about how long ketamine’s effects on OCD symptoms lasts. It’s also important to see if the effects seen in the 2013 study can be replicated.

    This is exciting work, as we need more information about what ketamine does for OCD so we can help more patients.

    Dr. Rodriguez commented on the FDA approval of esketamine this past March. She made the point that those OCD patients with “contamination OCD” are likely to be unwilling to use a nasal spray. 

    Disrupt – Include – Engage – Innovate …

    Ketamine and Opioid Receptors

    Another talk, presented by Nolan Williams, MD, from Stanford University, discussed ketamine’s mechanism of action. Since there’s wide recognition that stress is directly related to a buildup of glutamate outside the cells which causes unwanted effects, ketamine blocks the NMDA receptors, blocking glutamate, and reverses these unwanted results.

    Dr. Williams made the point that ketamine affects many neurotransmitter systems and has a wide variety of effects, both good and bad, as a result of that.

    Ketamine can eradicate chronic pain like this man on the bus suffers from.
    Researchers know that ketamine’s effect on pain is complex, and an opioid receptor antagonist prevents ketamine from relieving pain. We know that opioids have an antidepressant effect, and Dr. Williams wondered if ketamine’s antidepressant effect depended on the opioid system.

    There were 12 subjects in all who completed the study; 7 had dramatic relief of symptoms. Even more interesting, 6 of the 7 achieved remission. 

    Now, the design of the study included crossing over between 2 groups of subjects. So, to accomplish this, one half received a placebo an hour earlier, then ketamine. The other half received naltrexone an hour beforehand, then ketamine. As you may know, naltrexone blocks opioid receptors, so if ketamine relies on the opioid system, in part, then naltrexone should prevent ketamine from reducing depression symptoms.

    After the ketamine infusion, they allowed the subjects to become depressed again. They became deeply enough depressed to reach the 20% mark on their evaluation tool. Then they were given another infusion of ketamine. If they received placebo with the first infusion, this time they were given naltrexone. If they received naltrexone with the first infusion, this time they were given placebo.

    Opioid Receptor Antagonist Blocks Ketamine’s Effects

    Those who received naltrexone experienced no benefit from the ketamine infusion, whether they received it prior to the first ketamine infusion or the second one. 

    The same is true of suicidal thinking as measured on the tool. Those who received naltrexone experienced no reduction in suicidal thoughts.

    Interesting, right? But, keep in mind, this was a very small study, and much, much more work needs to be done looking at these issues. This is too preliminary, and these numbers are too small, to make sweeping generalizations. Certainly, closer to home, at Yale, patients treated with naltrexone have responded to IV ketamine. So much to learn!

    Disrupt – Include – Engage – Innovate…

    Ketamine Infusions Stop Suicidal Ideation in Outpatients and Avert ER Visits and Hospitalizations

    Finally, my own story. I had the opportunity to present my own data.

    I’m very interested in how IV ketamine can rapidly reverse suicidal thinking in patients with depression. Passionate about it, actually. Taking a long, hard look at my own experience with more 235 adults and adolescents with treatment resistant depression, I presented data which showed that serial, titrated ketamine infusions stopped suicidal thinking in the majority, and prevented ER visits and psychiatric hospitalization.

    We have dozens of case reports, small studies, beautifully written case series, and elegant placebo-controlled trials of ketamine treating depressive episodes — and very fine studies teasing out the effects of ketamine on suicidal thoughts in small numbers of patients.

    APA 2019 poster presentation: Disrupt. Include. Engage. Innovate.

    What’s been missing — for us all — are extensive results from real-world psychiatric treatment with ketamine in large numbers of patients like the ones we see every day–people who are complex, and have more than just one thing going on (like anxiety, OCD, trauma, and histories of substance misuse in addition to their depression or bipolar disorder). People who are medically ill, or in chronic pain. Those who have made numerous trips to the ER for suicidal ideation. So many who have been hospitalized, made suicide attempts, have been failed by ECT, or failed by TMS.

    People like you. Or like people you know.

    When I think about what ketamine can do best, and who it needs to work for first, it’s the patients I see — people like this: Depressed. Sick and tired of it. Sick and tired of treatment not working. With thoughts it would be a relief to not wake up, or with frank thoughts of suicide.

    There were No Suicide Deaths, Suicide Attempts, ER Visits or Hospitalizations in my High Risk Group Treated with IV Ketamine Infusions

    This is the first report from a real-world psychiatry office practice in the community using IV ketamine to treat suicidal thinking in hundreds of adult and adolescent patients with treatment resistant depression.

    The response from attendees to the data was enthusiastic. But we were even more excited with the breadth of new research presented during that same 2 hour poster session. Information that touched on ketamine, suicidality, and treatment resistant depression. It’s extraordinary to see so much energy and thought put into examining these connections. Here are some examples of the new research posters that surrounded me:

    This hand reaches desperately to survive to show how someone suicidal feels.
    • Effect of Ketamine and Esketamine in Suicidal Ideation: Relationship to Depression
    • Patient-Reported Outcomes in Major Depressive Disorder with Suicidal Ideation: A Real-World Data Analysis using Patientslikeme Platform
    • Care Setting Type and Readmission/Subsequent ED Visit Risk Among Patients with Major Depressive Disorder and Suicide Ideation or Suicide Attempt
    • Do the Impact of Risk Factors or Protective Factors for Suicidality
      Change in Response to Effective Treatment? A Case Study
    • Esketamine’s Antisuicidality Effects on Treatment-Resistant Depression: A Role for the Subcutaneous Route
    • The Relationship between the Big Five Personality Traits and the Suicide Crisis Syndrome in an Outpatient Population
    • Resilience Moderates the Relationship between Suicidal Narrative and Suicidal Behaviors
    • Effects of Ketamine and Esketamine on the Levels of Brain-Derived Neurotrophic Factor in Patients with Treatment Resistant Depression
    • Development of a Real-World Ketamine Database Registry: Centers of Psychiatric Excellent (COPE)
    • Managing Esketamine Treatment Frequency Toward Successful Outcomes: Analysis of Phase 3 Data
    • Esketamine’s Antisuicidality Effects on Treatment Resistant Depression: A Role for the Subcutaneous Route

    And the beat goes on.

    Disrupt – Include – Engage -Innovate !!

    So, in fact, we enjoyed a wealth of disruptive information shared through hundreds of studies, new technologies, and new paradigms. We engaged with the information and with each other, included diverse groups who attended and the patients they advocate for and treat. We’re moving forward to innovate in our mindset, our approach, our science, and our treatments.

    Because after all, it’s for you that we attend these conferences. No doctor practices in a vacuum, but our best and most healing practices are born from collaboration within the psychiatric and neuroscience community.

    Ketamine Treatment at Innovative Psychiatry

    So here at home, we focus our energies on you.  Do you have thoughts about suicide that treatment has not been able to stop? Do you suffer from symptoms of depression that recur or persist no matter what you do?

    If so, please call us.

    Young woman is happy with depression lifted by ketamine treatment.

    Let’s determine if you’re a candidate for IV ketamine treatment.

    While it isn’t the right treatment for everyone, (because nothing is) it is remarkably helpful to most. And we’re learning all the time more ways it can help more people.

    We live, study, collaborate, work, and share our findings to help you find the rewarding and fulfilling life you’ve longed for. Together, we can Disrupt -Include – Engage – Innovate …and help transform your life. Give yourself the opportunity to feel well and to enjoy the things in life that mean the most to you. We’re here to help.

    Ketamine KRIYA Conference 2018
  • The Oddities, Charm, and Suffering of Bipolar Disorder

    The Oddities, Charm, and Suffering of Bipolar Disorder

    Suffering of bipolar disorder can include indiscretions in dating and dancing.

    “Though I am often in the depth of misery, there is still calmness, pure harmony, and music inside me.”  —Vincent Van Gogh

    May is Mental Health Awareness Month, and I’ve been thinking about how to disrupt the stigma of “mental illness.” It’s a term I don’t like – but it’s still used throughout the world, unfortunately. To me, “mental illness” is an archaic and stigma-ridden phrase. Because it can isolate people who experience these illnesses in their own dark corner of misery, and surrounds their condition with mystery and skepticism. Yet cardiovascular, pulmonary, or liver disease are all discussed in the light of day and with credibility. There should be no difference. So, let’s talk about the ins and outs of one “brain” illness: the oddities, charm, and suffering of bipolar disorder.

    My patients encounter stigma every day. Family members and friends who are furious with them, and just worn out by it all. Critical. Disgusted. Steeped in stigma.

    And many of my patients are steeped in shame. It’s for them — and their families — that I’m writing today… and for you.

    So let’s talk about what a person can be like who endures the suffering of bipolar disorder. Because the symptoms of a disorder like this one can seem to be intertwined with the person’s personality … for better or for worse. 

    In fact, neuroscience researchers have discovered a genetic connection that influences the personality development of a person with bipolar disorder. We’ll be talking more about the scientific side of bipolar disorder in a future post.

    Emma was diagnosed with bipolar I when she was 15.  She’d stolen her parents’ credit card, and had charged $4700 in a weekend taking friends to nice restaurants, shopping for clothes, and attending concerts. She felt like a million bucks…and tried to spend a million, too.

    Her parents got alarmed, and she got admitted to a mental health crisis unit where she could be evaluated for 72 hours. It was here that she received her diagnosis of bipolar I disorder. The doctors there started medications to help stabilize her mood, and discharged her within a week.

    Shock and awe. Not enough time to see how the medications really worked, or to wade through her questions and fears about this new diagnosis. This wasn’t how it was supposed to go.

    She left confused, a bit shell-shocked, and with no small amount of anxiety as to what life would be like now. The shame she felt gripped her. How could she face anyone? She believed she’d never be able to show her face again anywhere… and the new pills she was taking made her feel weird.

    Bipolar disorder patients seek risky behavior, like this rave party.

    Emma’s next few years were tumultuous, as the medicines didn’t help her stabilize, but even seemed to make her more unstable. Add to that the hormonal changes of adolescence and their affect on symptoms, and the instability…better said, the roller coaster… of her emotions was almost impossible to endure.

    Everywhere she looked, she saw disapproval. Despite regular and frequent visits with her psychiatrist, she felt miserable and her symptoms seemed to get worse and worse.

    Emma and her parents participated in therapy, to become educated about this illness. They also learned how to support structure in her life, as well as methods of helping her decompress when the need arose. 

    Oddities, Charm, Suffering of Bipolar Disorder… So Many Facets

    But her ability to participate with them in counseling got sporadic as her symptoms worsened. During depression she couldn’t get out of bed, and anxiety made leaving the house seem insurmountable.

    But there were also transient periods when she felt a bit more like herself. Her sense of humor had always been spectacular, and often kept her family in stitches. Those light-hearted fun times reminded them of the history they shared, and endeared her to them all the more.

    But…her bedroom floor. Trashed! It was the place clothes and food wrappers went to die. And personal hygiene? …Let’s just say that was a work in progress. She didn’t bother to shower unless she was badgered. But she was feeling better, and creating magnificent, enchanting poetry, so no one wanted to argue with her about hygiene. They had all learned to choose their battles.

    Still, there were also the times when she came home drunk or high.  She told her parents she was sorry, but they feared for her…and wondered what to do.

    She craved the calm, a break from the suffering of bipolar disorder.

    The irony was that when her friends were high, they acted crazy. However, at the same time, when she was high it made her mind feel clear and grounded. She didn’t crave the substance, she craved the clarity. But her parents knew the dangers of addiction.

    She was an odd bird, and she knew it. She figured she’d always feel like the odd one out.

    But, for real, she had to give her parents credit. She could see they were really trying to understand. But it wasn’t a walk in the park.

    At times she felt anxious and angry, and couldn’t tell why. But her parents would react in ways that seemed to her more like an attack. So she responded in kind.

    So Complicated!!

     Through therapy they learned that “pulling rank” and trying to force her to comply only served to escalate her reactions and agitate her when she was manic. They learned to listen patiently when she verbally shot words like bullets in a long tirade. They learned this was a symptom.

    And they learned it was important to treat her with respect, in spite of her outbursts. After all, she wasn’t a spoiled child, she was ill. And… they learned that during times of peace, her talents, empathy, and growing wisdom had a richness they’d never seen in anyone before.

    They had to admit this was new territory, and they couldn’t fall back on their old parenting patterns without making matters worse.

    She was still their Emma, but there were times they didn’t recognize her. The counselor helped them see that all of these behaviors together were part of “their daughter with bipolar disorder.” Good times, bad times, times she amazed, and times she broke hearts.
    Happy young woman having fun in better times.

    Though Emma came home from the crisis center filled with shame, through counseling and the love and acceptance of her parents, along with time, she found she was slowly healing. She and her parents learned together that the mood swings – which were sometimes violent – were not a sign of her contempt for them, but rather a shift in her brain cell function that was involuntary.

    So her parents learned to show her they were standing with her when she found herself in mixed states, exploding with manic energy, rage, and heartbreak.

    Emma had made a friend at the crisis center, and was saddened for her and the awful scenes she described with her parents. Her friend felt so alone and hopeless because her parents viewed her behaviors as threats to their authority, rather than symptoms, and tried to shame her into compliance. Before long, her friend ran away from home.

    Emma knew she was really lucky to have parents who tried so hard to support her and stand with her in this illness.

    At times, she felt upbeat, pleasant, and enjoyed time with her parents, as well as a friend. In those same times, Emma often waxed poetic, writing pages of melodious rhyme, describing her magical wonder of the world as she saw it. Her words carried wisdom far beyond her years, and her creativity resulted in thoughtful and meaningful gifts for those she cared about.

    But as the wonder bubbled up…the bubbles came faster and faster until she felt as though she was all bubbles, like helium…and she was floating, exhilarated, and able to do anything.

    The Suffering of Bipolar Disorder Can Appear To Be Something Else

    People with bipolar disorder seek risky behaviors like climbing this water tower to paint graffiti on it.

    She’d climb a water tower and paint graffiti at the top, or she’d have sex with three different guys in the same night, or shoplift something from Macy’s.  Why?  Because she could do anything. (or at least she thought she could.)

    Was she rebellious? Not intentionally. But she was manic at those times, and her perceptions were distorted, as well as her judgment. And impulsive. Oh my…intensely impulsive. Could that be fixed by her parents’ discipline? Ummm…not likely. Impulsivity and distorted perceptions are symptoms of bipolar disorder.

    Unfortunately, there were times the police brought her home, or the store security officer called her parents, or… once…she found out she was pregnant.

    Sadly, she miscarried 6 weeks later. It was all so terribly painful. The grief so suffocating. She really wanted that baby. It didn’t matter that she struggled to care for just herself…she wanted that baby more than she wanted air.

    The grief continues to this day. On bad days, the pain of it rises up fresh and in waves. It’s almost more than she can bear. And the pain never lessens, or heals, but is always fresh and suffocating…because of the disorder in her brain. And the pain she feels when the waves return often push her into another mixed state episode.

    But eventually, with sleep, healthy meals, and medication, she begins to recover each time.

    Then, just about the time she feels a little stable, here come the bubbles again. And she forgets to go home by curfew because of the adventure she’s on. Then the crash… and eventually, the recovery.

    The Suffering of Bipolar Disorder Untreated Leads to Worsening Symptoms

    Sad woman with suicidal thoughts because of suffering of bipolar disorder.

    Years later…?  Emma was 22, and the periods of depression became too frightening. The pressure within her gave way to visions of her death. The pain, then the end. The determination to end the pain rose higher and stronger. The risk of an impulsive act that would remove her hope permanently led her parents to deeply research the options that might be available to help her. 

    They learned about IV ketamine treatment and how it can end suicidal thinking in a few hours. They discussed it with her psychiatrist and made arrangements to see a psychiatrist who offered this treatment and would consult with Emma’s doctor to coordinate her care. 

    All three of them made the trip together, planning to stay for a couple weeks and make it a sort of vacation. They hoped the break and new scenery would do her good. And they believed that saving their daughter was the best investment they could make.

    They’d read of people who had experienced help from bipolar depression with IV ketamine treatment, but their greatest concern was to help her continue to live. 

    They’d also read that people with bipolar disorder have an average life span of 25 years less than those who don’t have this illness. They could see the risk and felt they had to take measures to protect her.

    After the couple of infusions, she didn’t appear to be so deeply and dangerously depressed. Her mom mentioned the suicidal thoughts, asking if there was any change.

    Emma blinked. Oh yeah. As a matter of fact, she realized she hadn’t had any thoughts like that in 2 days. With all that was going on…she forgot that was why she was here. Her parents exchanged a hopeful glance.

    With another infusion, her mom noticed she was picking up after herself. And she got in the shower and shampooed her hair…then blew it dry!  Now this was a moment both parents noticed…but tried to not make an issue of it.

    By the end of the series of treatments,  Emma’s mom saw a light in her eyes that had been gone for months. And Emma suggested a shopping trip and lunch, which never happened when she was depressed.

    Once they arrived back home, Emma was upbeat, and disappeared into her room to organize it and clean. This was no small chore, mind you. She asked her dad to carry out the 3 huge trash bags of trash she picked up from the floor. He jumped at the chance.

    This young woman is happy since ketamine lifted her depression.
    Emma, herself, was surprised about her own motivation and initiative. And she found she enjoyed the sun filtering through the trees…the ducks paddling around the pond at the park, and the aroma of someone’s barbecue cooking outside.

    There was no question about it. She was feeling better. In fact, she felt better every week. She slept better at night, and had more energy for living during the day. A few weeks later, she realized she had a song playing in her head. So she hummed along. Her mom flashed a grin at her. It was so good to see her feeling so much better.

    Emma has had some rough days and weekends since her IV ketamine treatment. Times when she felt exhilarated and knew she might make a bad decision. But she’d learned to call her doctor, report the subtle symptoms, go in and do what she needed to do to avoid sliding into hypomania.

    Overall, her life improved dramatically after ketamine. Every month she sent a note to her ketamine doctor to let her know how she was doing. She missed fewer appointments with her local psychiatrist and her therapist. And somehow she seemed better able to manage herself now.

    While Emma still has challenges, her life is happier and easier to manage. She’s more productive and was able to go to college and actually do the work. What traditional medications couldn’t do for her, IV ketamine treatment could.

    At Innovative Psychiatry, we see patients who suffer from bipolar disorder often. Patients who experience significant improvement through IV ketamine treatment. If the suffering of bipolar disorder, especially bipolar depression, begins to return at some point, we’ll quickly arrange an appointment so you can receive a new infusion to refresh your well being. 

    If you suffer from bipolar disorder or another mood disorder, and you’ve not been helped by the medicines your doctor prescribes up till now, please call us.  We will schedule a consult to determine if you’re a candidate for IV ketamine treatment. And if you are, you can begin your treatments right away.

    Be the best version of yourself with ketamine treatment for the suffering of bipolar disorder.

    We’ll help you connect with the version of the best you that has become hidden, and help you feel and function better, so you can enjoy a rewarding and fulfilling life.

    We’re here to disrupt stigma.

    And innovate— not just with fresh new effective treatments like ketamine, but innovate with understanding. 

    We don’t just infuse ketamine—we infuse compassion, and we infuse hope.  We live for that.

    With respect and appreciation for the beauty of your best self,

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine
    This image has an empty alt attribute; its file name is Angled-dark-blue-Lori-Calabrese-MD.png

    Lori Calabrese, MD

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