Lori Calabrese, MD

Tag: Ketamine Treatment for PTSD

Persistence: The Road to Resilience Helps You Try, Try Again

With perseverance, you can build the life you want to live.

You’ve probably seen the photo of an old stone lighthouse in the storm, with overwhelming waves crashing against it and around it. It looks like it will surely be knocked down…but it’s not. Those waves go on year in and year out, decades upon decades, but it stands strong. It stands to give light to ships in the storm. Steadfast, it shines its light, no matter what.

This is persistence. Holding steadfast to the hope for better days, believing in the peace that will follow the storm, no matter how great the pressure… it endures.

Storms are a part of every life, and the risk of collapse is real. If there was no fear, no risk, the endurance would be unremarkable.

However, because the risk is real, there is great reward when you see the calm that follows the storm. And each storm that you survive prepares you to be stronger to withstand the next one.

Holding Steady in Chronic Illness and Abuse

Marti withstood storms. Life-threatening illness that came in waves and threatened to destroy her. An abusive partner who shifted from violent to repentant and back again, bringing her within an inch of her life. Repeatedly.

But each time, she nursed her wounds, and determined to try again.

Marty had contemplated or attempted suicide quite a few times in the 25 years she’d been depressed. Through those times Marty’s depression worsened and she wanted to die, but she kept holding on for a day when life might get better.

After her ketamine treatment, she discovered that she still had some of the perseverance she’d developed through those years of constant crisis. And, she learned about the importance of practicing endurance, self-control, letting go, and honesty with herself.

As the ketamine treatment continued to improve her outlook long after the infusions were over, she thought often about how to work on her “infrastructure” that she’d heard so much about.

How to increase her own determination to stand steady when some symptom returned, by knowing it would pass again like they’d come to do.

Or to keep putting one foot in front of the other when she lost her job and wanted to give up. …Or when she had 2 twelve-day hospitalizations the same month and she couldn’t see a time when she would be well.

Persistence – The Road to Resilience – May Be Enhanced by Ketamine

While she was undergoing ketamine treatment, she arranged with her therapist to have a session 24 hours after each infusion. It was clear she needed therapy to heal from the scars of that abusive relationship.

And she’d understood that there was something special about the 24 mark after the infusion that really helped the therapy to be more effective.

Marti found the neuroplasticity ketamine treatment had initiated allowed her to see through her faulty thinking in that relationship, so she could heal, and move forward in her life.

It encouraged her when she realized that each time she held steady through a period of emotionally swinging out of control, she felt stronger to do that the next time.

After awhile, she also worked at being kind to others in the wake of her symptoms subsiding post- infusion. The more times she stopped herself from over reacting toward someone, the easier it was the next time.

Each of these steps helped her peace to grow. She felt more serene, more confident in her ability to function in life. And in her healthier state, she found someone new who brought out the best in her, and supported her healing and restoration.

She’s now in full remission and kindness has again become the backdrop of her nature, though her assertive personality is still fully hers. She couldn’t have gained this ground without ketamine, but once she had its help, she made great strides that paid off in the reward of a fulfilling life.

Holding Steady Between Bipolar Episodes

Bernie withstood storms. Like Marty, he came close to succumbing to them. The frequent storms of bipolar depression made survival appear like an ugly life sentence, with no escape.

But, then his parents heard about ketamine treatment. They gave him articles to read …and the more he learned, the more he wanted it.

After the treatment, he felt relieved… but there were still symptoms some of the time. When symptoms did come up, he knew he needed to keep putting one foot in front of the other, and keep moving forward, because he could finally see hope.

He found that the reduced symptoms and his better frame of mind in between was making his life more “endurable” when the symptoms did rise up.

Persistence is believing in good days ahead when a storm is pounding down on you and your ship is breaking apart beneath your feet.

Persistence knows that no matter how overwhelming this moment…or this decade…seems to be, there will be a better day – a happier ending.

When you’re persistent, your mind is focused on the positive outcome of the crushing circumstances you’re enduring, and you know that you don’t want obstacles like complaining or an attitude of defeat to prevent you from reaching that reward. So you look at the promise you see of what lies ahead, rather than focusing on or magnifying the circumstances you’re in.

And like Marty, each time you hold onto that promise and plod forward with determination, you gain more strength to do it again in an even worse storm. You get stronger.

The seeming foreverness of each bout with illness that never seemed to stop for years, and the seeming inevitability that the abuse would finally end her life, only bowed and gave way to her hope as she worked with the ketamine treatment to change her outlook.

And hope, as well as the ability to be resilient during storms, finally took root and stayed.

So persistence is a component of strength you can develop, nurture, and establish within yourself. Like a well-dug foundation it will hold you on course during the most threatening times of life.

Persistence is akin to perseverance.

Keep on keeping on…no matter how shrill the wind whistles. And no matter how long you pull your cap down over your head and bow into the freezing rain, you will endure. Because that persevering will hold firm in your mind the view on the other side of what’s going on, and it gives you the durability to emerge from the whole horror unscathed.

A bit wiser, a bit stronger, yes. But with a new confidence that drives away fear.

In time, you can arm yourself with that new confidence and the hard-earned wisdom that reminds you what it takes to survive, and build the future you find in the pot o’ gold on the other side.

One step at a time. With determination, and a new instinctive sense that it’s persistence that will keep you on the scene so you can enjoy the rewards that await you.

Because it’s persistence that helps you try again and again and again. Perseverance tells you to get back up after falling down, brush yourself off, figure out why you fell, and incorporate that new knowledge into your next try.

Stubborn Persistence is Required for Marriage to Survive

Do you notice older couples who are white haired, and take evening walks holding hands with their dog on a leash? Ever wonder how they stayed in love that long?

It wasn’t magic.

There is no 40-, 50-, 60-year marriage or more that lasted that long without persistence. No one knows how to make a marriage work on the wedding day.

Some may have a little more insight than others about getting along, or putting someone else’s interests ahead of their own.

In this generation of self-assertion and self-absorption, that’s all but a lost art. Still, it wasn’t an accident that two people with stooped posture and white hair feel like holding hands and enjoying each other’s company after so many decades of living together.

To enjoy their autumn years, they had to learn early about getting back up and trying again. They’ve most likely had times when they couldn’t stand each other and didn’t want to stay together even another day. But one of them, one time or another, probably stepped up with persistence and determined to build a bridge, forgive the other one, and ask for forgiveness, too.

Without that? They wouldn’t have made it to their next anniversary. And you can ask them…but I’d guess with confidence that they both have done that many times…and more times than they can count… they’ve each taken turns at playing that role, until they managed to get really good at it.

Over time they learned that persistence, road to resilience, has kept their marriage strong.

…And, eventually realized they were glad they were still together…to watch their children graduate from high school; to give away their daughters in marriage; and to welcome and play with their grandchildren and great grandchildren.

You’re Human, After All

Everyone falls down in their endeavors. But the persistent ones brush off and get back up and try again…and again… As many times as it takes as long as they live.

That kind of persistence leads to success, and resilience, and countless rewards.

Does a three-year-old play the violin like a maestro the first time he picks it up?

No.

He makes mistakes and gets frustrated. He wants to throw it away and forget it. But his mom, whose name is Persistence, sees that he picks it back up and tries again. And practices. Again and again… and over the years, the 3-year-old eventually lands 1st chair in high school… and later gets to decide if he’d like to accept that invitation to play in the Philadelphia Philharmonic.

What do you want to bet he’s now become so good at persistence, he knows how to apply it in countless areas of his life? As with the hare and the tortoise: slow and steady – consistently – wins the race.

Persistence.

Honestly? Without perseverance and persistence there’s not much you can accomplish in life. Because everyone falls down. Everyone gets discouraged at some point. Everyone fails at something. Abandoning the vision strikes the death blow to that endeavor.

However, with persistence there’s nothing you cannot do. The more you use it, the stronger it gets. Until persisting is part of who you are, and a tool you put to use in every project. And persistence gives way to resilience.

The character of a psychiatric disorder – the actual activity of it in the brain – wears down resilience, and flattens out persistence. If you’ve suffered from depression, social anxiety, PTSD, bipolar depression, or addiction, or suicidal thinking, you probably can’t imagine the resilience and persistence required to stand up after you’ve been down so long.

But that’s where ketamine comes in. Since at least a third of all people afflicted with these disorders experience no relief from prescribed medications, something more novel and advanced is required to bring relief. Ketamine treatment is the first treatment that has made an extraordinary difference for these patients.

And it’s such an advantage that another benefit of ketamine is its neuroplasticity that makes it easier for you to make changes in your mind that allow you adapt to your circumstances, reduce your stress, apply persistence, and build resilience.

If you’re even considering treatment with IV ketamine, or have recently received it, you know you have persistence and a good measure of grit.

You know what it’s been like…how you’ve been able to withstand the disappointment of one treatment after another — or one effort after another — not working. You already have some persistence working for you.

Ketamine delivers a one – two punch. First restoring connections in the signaling systems in the brain, and then providing neuroplasticity to help you make the changes in your outlook you want to put in place.

Because if you’ve been depressed, and now you feel better after ketamine treatment, you want to keep feeling better, right?

You want to do the work that will help you maintain a remission frame of mind. So you can continue growing, and press on with developing the life you want to live. The best way to do that is to remove the stressors in your life.

We do the work, too. We’re up at night, reading, refining, persisting in trying to identify the best treatment options that can get you back to your best self. We offer treatment when your symptoms persist, when your doctors have done all they can, when you’ve just gotten tired.

We’re here to help you win your battles… and in that process, persistence is priceless.

Call us if we can help.

To the persistence of your best self,

Lori Calabrese, M.D.

February 4, 2019
Fix Your Inner Life: Embrace the Truth About Yourself

Be sure it’s your real self you’re showing. Because it is your real self that needs to be loved. Daphne Rose Kingma

It’s the most healing thing you can accomplish as you work through the changes in your thinking, your responses, your outlook and attitude about people and your world after ketamine treatment. As you build an infrastructure of peace and generosity…fix your inner life and learn to embrace the truth about yourself.

Self-doubt, self-defensiveness, and pretense eat away at your self-respect and love of yourself…and can lead to depression. But you want to reduce the stress in your life to help your wellbeing thrive.

How do you reduce the stress? By facing the truth that eats at you or that you hide from yourself.

What sort of truth..? Well, that you’re human, for starters. That you’re not always perfect in your responses to life’s stressors. And that there are plenty of things you can learn to make your life work better for you.

Things like humility, admitting your shortcomings, and asking for forgiveness, to name a few. To accept yourself as a learner in this life and not to expect yourself to know everything out of the gate.

Using Pride as a Shield of Protection

Pride drives many of us to present ourselves as infallible, until we realize that pride also shackles us from the fulfillment of intimacy in relationships.

Replacing pride with love can be scary. It can make you feel exposed and vulnerable until you get used to it. But doing so can transform your life and drive loneliness away.

Something we do as humans is to construct personas that we tell ourselves others will find more likable or respectable than who we really are. But a persona that you construct is always stilted. Unnatural.

Have you ever been around someone who’s utterly at home in his own skin? Isn’t he or she absolutely enjoyable and relaxing to be around? The reason they’re enjoyable and relaxing to be around is because they’ve found a certain degree of peace with who they are.

They accept themselves as they are so there’s no need for pretense. When someone is trying to prove themselves, it can make you uncomfortable. But when you sense they have nothing to prove, you subconsciously feel like you can relax.

At the same time, you get the sense that their mental health is pretty good.

It’s the exception to meet someone like that, rather than the rule. Most of us aren’t free of pretense, until we learn what we need to learn so we can be who we are.

This shouldn’t be so hard. You know?

But we live in a world that feels dangerous and makes us think we have to protect ourselves. So we do. We build walls around ourselves. Thick, impenetrable armor to keep ourselves safe.

And we guard that armor, those walls, to stay safe. Then, if anything threatens to expose us under the armor, we get anxious and defend it. Don’t we?

So, after all that work, we’re reluctant to knock down those walls. We don’t feel safe without the armor.

And that’s why we have to learn to see what the walls and the armor are costing us. We have to see that they’re interrupting our social development and our opportunities for close, fulfilling relationships.

They also require that we remain vigilant, prepared to defend any attack on our security in the armor. So we can’t relax. We can’t let our guard down.

Fix Your Inner Life

You have to change the way you think. The way you respond to things.

You may need to get really honest with yourself. You may find you have to learn how to embrace the truth, and learn to accept yourself as human, fallible, and forgivable. When you do that, you may also feel more lovable.

And when you feel lovable…and LOVED… you’ll tend to find it much easier to generously love others.

Ok. I know it’s certainly easier said than done. It’s an uncomfortable process to look head-on at things in yourself you haven’t before. But, it leads to a very comfortable, confident, joyful way of living.

Ketamine Treatment Can Help You Achieve Remission

This isn’t news. We’ve known this for years.

But, if you’ve had ketamine treatment, and feel much, much better, you sure want to stay better, right?

Well, one important aspect of staying better is to unravel the conflict you carry inside you that you may not even realize is there.

But…it IS there. And it interferes with the peace within you. So what can you do?

Embrace the truth about yourself.

Just like letting go of what you NEED to let go of, when you embrace truth about yourself it helps you relax with who you really are.

Accepting your shortcomings, and dropping that guard that says you’re flawless, admirable, or beyond reproach, helps you embrace the truth that you’re a real living fallible human worthy of giving and receiving love.

And there’s another plus: doing so will increase your self respect.

Sound pretty far out? What if you don’t know what you have inner conflict about? Or how to tell if your guard is up?

What if you’ve been presenting yourself the way you think people expect you to for so long you don’t remember what it was like to be yourself?

Scrutinizing Your Inner Self

Start with looking closely at that experience or event that scratches at your conscious memories. What are you telling yourself about it? What about it might be seen differently?

Pay attention to your inner voice…do you find yourself defending yourself over what happened? What could you be “hiding” from yourself?

It might be related to some sort of blame you place on another person… or something you’re hiding from yourself. Look deeper. Could you have caused the situation, even though you didn’t intend to? Is it possible you share responsibility for what happened?

And what happens when you look at the other person’s role with a heart of forgiveness and understanding? Can you see how the outcome might not have been his/her intent?

Then. Just say it. “It’s my responsibility that so-and-so happened. ” Or…share the responsibility… ” I share in the responsibility that so-and-so happened. I didn’t intend for it to go down the way it did. He/she probably didn’t intend it either. I’m human, and I was wrong. I handled the situation badly. I’m truly sorry, and I’ll really try to not do it again.” Then move on with the resolve to make good decisions and to treat others well going forward.

I Was Wrong

It’s very difficult sometimes to reach this point. But giving up the fight and accepting that you’re fallible can be so liberating. You THOUGHT it could destroy you, hence the long arduous combat in your mind.

But when you really see that you were wrong…you can accept that it happened. And the fight inside you…the defensive arguments in your head…begin to disappear and become quiet.

And that quiet is a deposit of peace into your inner self. Enjoy the reward of harmony you feel.

Then take what you’ve learned and apply it to the next situation that comes to mind…because another situation will. You’re human and fallible. And so is everyone you know.

Going forward, you may find you’re a little less judgmental, a bit less inhibited…and more and more relaxed. In that relaxed and peaceful state, it’s much easier to feel better.

With these things at work within you, you can accept yourself as human, and realize that through forgiveness of yourself you are more able to love and receive love. And that brings joy.

Remember, this discussion is NOT to say that if your remission fades away, it’s your fault.

IT’S NOT.

But since stress remodels and prunes the signaling circuitry in the brain, which can lead to depression and other disorders, it stands to reason that the more you can remove stress from your life, the better the environment is for remission to thrive.

At Innovative Psychiatry, we want to be a part of your recovery as you use your ketamine treatment to help you bring change in your thinking, your outlook on life, and your attitudes.

Everyone needs these changes, but not all understand how to make them.

If you’re not in the habit, but have experienced joy from ketamine treatment, changes like we’ve talked about can help you continue to enjoy that joy, increasing love…and freedom from emotional pain.

January 28, 2019
Want to Help Ketamine Remission Last? First Strengthen Your Personal Infrastructure

In past posts, we’ve talked about remission by ketamine, the 50-year-old anesthesia medicine that stepped up to the plate in the last ten years or so… to bridge the gap in the treatment of an array of psychiatric disorders.

And once you’ve achieved remission, you want to help ketamine remission last. You don’t want to return to your same old ways of reacting. Or to the same old stress and risk losing the ground you’ve gained.

So let’s continue. We’ve talked about the growing body of evidence that demonstrates the extraordinary antidepressant effects of this medicine in numerous psychiatric disorders. Illnesses like severe treatment-resistant depression and bipolar depression. as well as its unparalleled impact on PTSD to arrest symptoms and restore peace to the traumatized individual.

In our own practice, Innovative Psychiatry, we’ve seen ketamine treatment make a dramatic difference with social anxiety, that cruel disorder that creates obstacles between you and financial success, self respect, meaningful relationships, and general fulfillment in life.

So that after ketamine treatment, you can effectively interview for the job you want. You can initiate and develop loving relationships. In fact, you can basically BE who you are and at your best. While you contribute to your team at work and your family and community, as well. So you want to help ketamine remission last.

But it doesn’t stop there. We’ve also seen ketamine treatment relieve OCD symptoms, providing the neuroplasticity for needed changes through therapy.

And then there’s alcohol use disorder as well as crack and other addictions, which ketamine (as demonstrated through the work of Dakwar and others) helps you conquer by weakening or erasing cravings.

We’ve seen similar positive results in our own practice, though there have not yet been enough studies to validate this benefit across the board… yet.

Then, possibly the most amazing of all is suicidal thinking…no matter what the cause that led to it… can be eradicated, often within an hour, and usually in less than four. We’ve seen extensive positive outcomes of this life-saving benefit in our office.

Your Personal Infrastructure Seems to Play Some Role in Making or Breaking Your Remission

Sometimes people achieve remission with ketamine treatment only to lose it after a few months as the stressors of life wear away at the repair work the treatment accomplished, and the remission is lost… or seems to be.

Interestingly, because stress is such an important cause of the pruning of brain cell connections (synapses) it appears that sometimes when patients receive ketamine treatment while under severe stress, it seems to not work for them.

Then, sometimes it happens that the patient finally begins to enjoy ketamine’s benefits after the stress is significantly reduced. This is something we’ve observed multiple times but lack the extensive research to back up… yet.

So it’s important that we distinguish those benefits we see every week at Innovative Psychiatry from those that have already been validated by peer-reviewed research.

It takes time for research to catch up with the widespread use of ketamine treatment. And it requires multiplied studies upon more studies to establish the reliability of any benefit.

So let’s be clear that the benefits of ketamine treatment we’ve seen at Innovative Psychiatry have already been reported in research studies. But, not with the overwhelming stacked-up body of evidence that stands behind ketamine for depression. Not enough to proclaim them from the housetops without an explanation.

Even so, it’s important that you know these things are happening, and we’re playing a waiting game for the research to catch up and explain what we’re seeing in practice.

Meanwhile, while we wait, we want to let you know that we’re discussing what we’ve found works for our patients. And although we make the disclaimer that this is not individualized medical advice for you personally, we want to share the best of what we’re reading and actually doing. In the name of transparency. And in the name of hope.

Now to recap…we were talking about how stress seems to undermine the benefits of ketamine…or at least it appears to. And there’s more to stress than meets the eye. Right?

Sometimes the stress is inside our heads…like things aren’t going the way we wish they would, or something we hoped would last doesn’t, or maybe people aren’t doing what we think they should.

Or we like the job but hate the commute and arrive at work ready to rip someone’s head off…or we hate the job and every day is miserable.

…or we have friends who drive us crazy, use and abuse us, but we keep spending time with them.

And that’s where “infrastructure’ comes in. You want to help ketamine remission last. And the rebuilding of your environment, your decision-making, your thinking patterns, and your responses to the challenging moments in life, is part of your personal infrastructure. All of that tries to return you to your former state before treatment…or can establish you in your new peaceful life of joy and productivity.

It’s impossible to cover all those elements in one post, but we’ll attempt to show ways you can tackle certain elements that make up your inner and outer environment over time… here and in some posts to come.

A Full Overhaul Of Your Life, Step by Step, Can Be the BEST Medicine

And a good place to start is by taking a look at learning to let go. It’s completely normal and natural to assume that any depression or anxiety you have is the result of the behavior of others. That you just got worn down from it all.

And there may be some truth in that.

But in exploring the causes, it may surprise you to learn that their behavior may not actually be the cause, as much as your reaction to their behavior that is.

Now understand this. We’re not implying here in any sense that your lack of response to ketamine, or the loss of remission, is in any way your fault, or even within your control.

But it’s important to understand that the best prescription for maintaining stability with remission includes maintaining health in those things in your life and environment that you can control.

Things like your respect for yourself and for other people. Your persistence in pursuing peace in your life and relationships. The development of a kindness-centered approach to yourself and those in the world around you.

…And the evaluation of your life and simplification of the burdens and demands it presents. Ensuring you have the power to enjoy life’s simplest pleasures…which may include letting go of things that pull you down or hold you back.

These are things that can help ketamine remission last.

So let’s talk about a fundamental skill that can change your life…for the better.

Letting Go

When we talk about letting go, it’s not reserved to only one thing…such as letting go of a relationship. Since relationships can be so important in our lives, and the ending of them can be so painful, letting go of relationships that have died is high on the list.

But there are other issues in our lives that may present themselves as we consider letting go to reduce stress.

Such as letting go of being right in our discussions at work with our boss or co-workers, and in our discussions at home with those we love most, such as our spouse and kids.

And what about letting go of fighting to get our way, when obstacles are thrown in our path? This may be akin to letting go of being right, but it has a personality all its own.

Possessions Can Shift from Useful Tools to… Jailer

How about letting go of your pride in your possessions…? For instance, let’s imagine a teenager sets his icy soft drink can on your dining room table…allowing condensation to mar its flawless finish?

What goes through your mind when you see it? Rage that a kid with no manners has caused your beloved heirloom table some damage…? Fear that your spouse will hit the ceiling? Compassion for a young man who didn’t know better… so you pick up the can and set it on a coaster for him?

It’s ok to enjoy having nice things, but when the “thing” is higher on your priority list than the development and well-being of a person…well that “thing” is controlling you.

Which do you value more: A 19th century mahogany table with a flawless finish that was handed down through your family over a hundred years….? Or a tall and lanky boy who needs a haircut and a clean t-shirt ?

If you’re honest with yourself, it really might be the table. But if that’s the case, maybe it will help you see the kinds of things you can work on, possibly with a therapist, to improve the infrastructure in your head.

Because anger causes stress. And anger toward that kid is stress you don’t need. Compassion on the other hand doesn’t, and actually supports your remission frame of mind.

Remember…you’re learning to nurture peace… in your head. And to do it means developing a response of gratitude, humility, and kindness.

What If You Lost It All?

On the other hand, picture your belongings lost in a fire. No one’s fault, really. But it cost you every material thing you own. How do you feel about that? Sad? Sure… all those memories and photos…but the house and belongings?

This is a loss you’ll never fully recover from materially, but does it reach the core of who you are?

Now. Picture the phone call that makes the world STOP. Your spouse, your three children, and your only grandchild have been in a terrible car accident. No one survived.

What do you feel? What does the furniture or sports car mean to you now?

My point here is that we have a way of putting people and things on a priority list… and that list can get all mixed up. But this scenario helps to show how those things we think are important lose their glow instantly when those at the core of our hearts are lost.

And that being the case, putting ourselves through unnecessary stress to preserve things that pale in comparison to those we love… well, it’s a waste of valuable moments and energy when we think about what really matters to us.

And therein lies the secret. Rather than wasting our lives by hurting people to preserve things, we find our life is best spent preserving the moments with those we love the most.

And the things…the houses, cars, antiques, reputation, recognition…none of these things can compete with the people we love the most.

The Greedy Monkey

You’ve heard the story of the monkey who is shown a jar of cookies. A jar that has a small mouth. He sticks his hand in and grabs a cookie…but can’t pull his hand out unless he lets go of the cookie. The opening just won’t accommodate anything larger than his open hand.

Because he won’t let the cookie go, he panics. Swinging the jar around in the air in a temper because it won’t give him the cookie, he finally smacks himself on the head with the jar and it hurts so much, he immediately lets go of the cookie to hold his head.

Sound familiar… at all? Is there anything in your life that’s pleasurable to you that you don’t want to let go? And if circumstances prevent you from having it or keeping it…does it make you mad?

If you have any marred tables or unyielding jars in your life, take a moment and breathe… Think about what trying to protect and preserve that “thing” costs you. Are your feelings on your cuff? Do do you snap at people when its security is threatened? Do you feel panic at the idea of it being removed from your life…?

The Surprise Benefits of Letting Go

The unexpected surprise you can discover by disengaging from “it” is that the angst of control that you’re powerless to perfect is replaced by a growing peace and relief. And when you have succeeded in reaching that point, that same peace and relief is a signal that you’ve now added a brick to the foundation in your personal infrastructure.

That thing, whether it’s your marriage, your shiny sports car, your child who’s supposed to fulfill your dreams….your house, the money you make in your job that prevents you from spending time with those who yearn for your attention…no matter what it is, has been holding you back and isn’t deserving of what it takes from you.

Picture serenity in your life. Peace. What has been removed from the picture when you think of it?

An alcoholic wife, an abusive screaming boyfriend, a job that you bring home and work on till you go to bed…? Maybe it’s more house than you can afford, so you’re driven to work three jobs to pay the bills. If it is, that house controls you.

Life is short. We get the most out of it when we can cherish every moment. In your daydreams, when you wish for reprieve…what do you erase from your life in your mind’s eye to make room for hope? Peace? Love? Enjoyment?

Commit to Finding Ways to Let It Go

First of all, in your mind and heart.

This is one facet of the infrastructure in your life that you may need to confront and adjust to make room for remission.

It will be easier to explore these things after you’ve had ketamine treatments because of the neuroplasticity that results. The ability to think in new ways. To change, and make productive decisions for your life.

So…to get there… you may want to consider ketamine treatment for severe and suffocating depression, your wracking and immobilizing bipolar depression, PTSD that injects traumatic reactions into your days…and your nights.

OCD that stands in the way of your achievements, and that social anxiety that has plagued and isolated you since you were a child. And for suicidal thinking that threatens to snuff your life before you even have a chance to recover.

Wanna Help Ketamine Remission Last? You Can If You Strengthen Your Infrastructure

Strengthening your infrastructure involves ferreting out burdens you can lift off yourself, like excess belongings, excess weight, whatever it is that requires your service and obligation…and prevents you from freely enjoying opportunities with those relationships that matter.

Let it go. Help Ketamine Remission Last

By giving your brain…your inner self…the most optimal environment for healing and growing possible.

It means simplifying the grandness of your life… For you, it might mean living beneath your means so you can travel, write, or volunteer. Or shedding those friendships that demand your time but don’t contribute. It’s shedding the less meaningful to free up time and space for what’s ultimately important.

For this person it may mean letting go of the bitterness he carries toward his ex-spouse for leaving him. For another, it may mean selling the house to travel the country in an RV and stop and paint when the view is spectacular.

And for someone else, it can mean retiring from the corporate job to teach underprivileged children, or to cook meals in a soup kitchen for the homeless.

For you? Maybe it’s saying no to all those obligations that crowd your life so you have time to spend with those who adore you.

Basically, it’s about pulling weeds in your life to help ketamine remission last, and to preserve your joy. To put the life ketamine helps you find to the very best use.

You know what your strengths are…if you take time to think about it. Those special gifts you have ached to get out.

No one can tell you what it is for you. But that’s the fun of exploring your own infrastructure to find your path for cherishing the moments of life, and enjoying your new found joy. It’s a painful process that gives birth to fulfillment. And along that path, you’ll find joy.

Even though we don’t see everyone achieve remission with ketamine treatment, we do get to see that most do. And more and more physicians are learning better and better methods for administering ketamine for the best possible outcomes.

The result is that more physicians are reporting higher numbers and better outcomes. The field of ketamine for psychiatric disorders is growing as physicians and researchers collaborate and learn from each other.

Meanwhile, researchers and physicians alike continue to discover more with hopes of bringing relief and remission to those who aren’t experiencing it now.

If you suffer from symptoms that no medicine has helped, call us.

We’re here to help you experience life the way you’ve longed to live it.

To the liberating of your best self,

Lori Calabrese, M.D.

January 21, 2019
Can You Overdo Probiotics? What Will it Hurt? What Can Happen?

What’s too much? Too little? Or maybe it’s the wrong strain? How do you get it right..?

You know the saying, “If a little does a little bit of good… then a lot must do a whole lot of good…” But when it comes to probiotics, too much of a good thing can be a bad thing.

We’ve talked before about the microbiome, the ginormous collection of microbes that live in your gut.

Some of those bacteria, fungi, viruses, and other microbes maintain a thriving ecosystem of sorts that assists your body in many of its functions. And they also provide a powerful immune system to protect you from infections, cancer, and viruses from the common cold to HIV.

There are — at any given moment – -10 microbes to every single cell in the human body. So we’re vastly outnumbered from the start.

But thankfully, the majority of those microbes help us function and protect us from invaders. The rest of them are always on the attack and being destroyed or eaten by the “good” bacteria.

Until something happens that jars that system out of balance. For example:

An infection treated by antibiotics, where the good bacteria are wiped out along with the bad.

Stomach upset that results in vomiting or diarrhea, where massive evacuation of the intestine leaves behind a weakened balance of beneficial and destructive microbes.

An injury that drives you to take a heavy load of ibuprofen, and your stomach lining becomes irritated, causing pain and bleeding.

In each of these examples, ingesting probiotics can help to restore balance in your gut, and relieve symptoms.

But, there are so many probiotic products! How do you know what to take and what to avoid? How do you know you won’t cause more harm than good?

The fact is, it’s hard to know. And unless you conduct some deep research on the subject, but rather grab a bottle off the grocery store shelf, you may not know now or ever.

Since you hear all around you how probiotics make you healthy, it’s natural that so many people want to overload their systems with “good bacteria” without respecting the balance within the microbiome that keeps everything working. But, can you overdo probiotics?

Balance is The Secret to Nature’s Success

For instance, when you think about the jungle, it may be tempting to remove everything you consider unpleasant so you can enjoy an exotic hike when you’re on vacation.

So let’s say we had a way of removing all the mosquitos, spiders, and other pesky insects, as well as lions, and snakes, and gila monsters. That does make it sound like strolling through the jungle would be so much safer for us…

But.

We know, don’t we, that there is a balance in the eco system, and every creature is somewhere on the food chain? So if we removed insects… then birds and reptiles and anteaters might starve. And that would starve the larger predators and soon… well, the whole system would likely collapse.

We know we can’t do that. Balance is the key all through nature, and it’s when our body systems are balanced that we experience well-being.

Microbes in our body must be balanced too.

The same is true with the microbes in your gut. We must respect and support the balance there.

So when you get sick you may need to build up the good microbes a bit. But if you try to flood your system with good microbes that overwhelm the balance with the destructive ones, other systems can be thrown out of balance, too.

As we’ve stressed before, your microbiome is your gut-brain axis. So what goes on in your microbiome shows up in your emotions and vice versa.

There are even specific bacteria that contribute to a happier outlook, reduce anxiety, and increase wellbeing. Some of the most helpful are Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus brevis, Bifidobacterium lactis (B. animalis), and Bifidobacterium longum.

Fermented foods, like kombucha, kimchi, kefir, plain yogurt and sauerkraut introduce live bacterial cultures. They’re probiotic foods–they introduce varied bacterial strains that are so important to your health.

But sometimes, if you can’t or don’t eat these, you might choose to buy a probiotic capsule. (Yep … we’ve all been guilty.) Sometimes it’s easier, faster, or you just need or want the extra assurance of varied bacterial cultures.

If you choose a probiotic, it should include the specific bacterial strains above that help prop up and stabilize your outlook.

And your dosing should be in moderation. Researchers state that a good probiotic should have up to 10 billion colony forming units (CFU) that you take daily, and that it should have at least 5 different strains per bottle. The more variety the better.

The reason you take a probiotic is to strengthen your beneficial bacteria so they’re not overwhelmed by the destructive ones, right?

At the same time, you don’t want to overwhelm your system with those beneficial bacteria. There are so many questions we don’t yet have answers for… like can you overdo probiotics?

Or… what happens if the yin-yang balance of tension between the two is removed? Do some of the beneficial bacteria switch sides? Do they become destructive… mimicking symptoms they have always before helped to eradicate?

In which case… maybe too much of a good thing is a bad thing?

Here is a better, more effective approach.

Balance of Power in Your Microbiome is the Ticket

But here’s where balance comes in. If your probiotic provides a great deal more than 10 billion CFU per day, you need to get your doctor’s advice. There are some products that provide 40 billion…and others even 400 billion CFUs.

And while these may be helpful in someone who has been seriously ill and may need a strong probiotic for a few days, it’s not that hard to introduce too much probiotic into your system.

Overdoing It By Over Dosing Probiotics

When this happens, side effects can emerge. It may be as simple as stomach upset and diarrhea, which can be terribly unpleasant. Or as complex as mimicking severe psychiatric symptoms like depression or anxiety or panic attacks.

We need to learn from each other, and from research, and take caution when we hear of bad experiences others have had from accidentally mismanaging their probiotics.

While research has not caught up with the widespread use of probiotics yet — we don’t have hard and fast guidelines about exactly what, how strong, how much, how often and for what, exactly — we’re learning more all the time. And there are cases of those who took a misstep and paid the price.

Here’s one example…something that could happen to anyone:

Carolyn is a 64-year-old woman in excellent health who’s always been robust and energetic.

She’s cared for pets and farm animals all her life and loves working with and riding horses. There’s nothing she’s afraid of… nothing she won’t try. In a word, she’s resilient.

Years earlier, Carolyn had suffered a knee injury that occasionally flared up. She had been taking large doses of ibuprofen that eventually irritated her stomach and led to bloating, shortness of breath, cramping, and bloody diarrhea.

She was frustrated with the misery and prolonged diarrhea, so she sought the advice of her nutritionist. He suggested a potent probiotic that provided 400 billion CFUs a day until the bottle was empty. So she followed his advice and took the whole bottle. At that point she was feeling wonderful… physically and emotionally.

She was wrapped in a sense of burgeoning wellbeing and decided if a little did a little bit of good… Her nutritionist suggested if she was to continue taking the probiotics, she should cut her dose in half.

She went to the store to buy another bottle and continued to take the original dosage without reducing them. What could it hurt?

Four days later, she awoke in the middle of the night feeling anxious. Her heart was racing, her left arm numb, and she was lightheaded. Eventually, she was able to go back to sleep, but the feelings of anxiety kept recurring.

Three more days passed. She was laying in her bed at night when gripping fear overwhelmed her. Her thoughts were racing out of control, she was lightheaded…she thought of dying, of losing her mind, felt detached and terrified.

Eventually, the terrible fear subsided, the racing thoughts slowed down, and she realized she was going to be ok.

But she was shaken.

Carolyn had never experienced anything like this before in her life. She’d always been resilient and solid…both feet firmly planted… through even the most severe crises in her life. What had happened to her?

Even though the symptoms had passed again, they recurred often and unpredictably the next few days. She researched frantically to find answers for what was happening to her.

The only thing that was different in her life was the probiotics, which had quickly healed her stomach problems. Could it have caused these new symptoms?

Then she found an article in Mental Health Daily about the side effects and adverse reactions to probiotics that people have reported. And there she found her answer.

That if you take more than 20 billion CFUs (she was taking 400 billion CFUs) per day, you can get side effects. And anxiety is listed as one of them. Who knew? She stopped the probiotics immediately. And hoped it would help.

To the Emergency Department…A Heart Attack?

Then, the next day, she woke from a sound sleep and believed she was having a heart attack. With her heart beating out of her chest, thoughts of dying in her bed overwhelmed her. She drove herself to the ED to get help. (Maybe not the best decision, but Carolyn was an independent sort.)

She told the emergency department personnel that the only thing in her life that had changed was that she was taking probiotics. The nurse sloughed it off and said, “Probiotics never hurt anyone.”

Her EKG was clear, so they gave her a medicine to calm her and sent her home.

Happily, three days after she stopped taking the probiotic supplement, the anxiety dissipated, and she felt like herself again.

She wanted to throw a party to celebrate!

Professional Nutritionist Baffled

The fact that the ED nurse had no idea probiotics could do this comforted Carolyn. She felt embarrassed to have unwittingly taken too much probiotics for too long…but apparently even some medical professionals weren’t aware there could be side effects with probiotics.

Later, she told her nutritionist what happened, and he asked her why she didn’t stop when he told her to???

She sheepishly explained.

Then he said, “In my 25 years in nutrition, I’ve never heard of side effects with probiotics!”

Carolyn told him, “Well, it sure happened to me!”

She’s been doing great ever since the whole incident and is elated to be herself again. But she learned a hard lesson. “Harmless” probiotics deserve respect for their power and impact on the human system.

From now on, she’ll ALWAYS follow directions when it comes to over-the-counter remedies. And especially probiotics!

The good news is that if probiotics can cause this much change in someone who’s healthy, they can also make a significant difference in anyone who’s not.

Along with improving health in your stomach and intestines, as well as reducing inflammation and infection throughout your body, they can also relieve symptoms of depression and anxiety.

But be aware, they’re not to be taken lightly. Experts say that since each individual is unique, there is no one-size-fits-all for probiotic supplementation.

Remember: In general terms, up to 10 billion CFUs daily. Start gently. Watch for out-of-the-ordinary symptoms. A specific strain may not be right for you, or a specific combination. Take several days or a couple weeks to test the effects of partial doses, raising the dose a little each day as long as you have no negative symptoms. Include your doctor in the process.

This story isn’t to scare you away from using a preparation that can help you become stronger and more resilient. But rather to alert you to possible risks if you use probiotics without supervision or awareness of potential side effects.

One more piece to the puzzle of health and wellbeing.

And speaking of wellbeing, how is yours?

When Nothing Else Helps, What Then?

The use of things like probiotics to strengthen your microbiome, and bioavailable curcumin to improve your health, your mood, and your wellbeing, eating a healthy diet that includes fermented dishes like kimchee, sauerkraut, and yogurt, along with frequent exercise and a good night’s sleep, can all help you to achieve wellbeing in your life and reduce stress.

But some of us are genetically predisposed to certain conditions, or find that life stressors spark symptoms or depression, anxiety, PTSD, OCD, addiction, and even suicide.

Maybe you’ve taken the medicines your doctor prescribes but don’t feel they work because you’re still not better. Maybe the wait, or the weight gain, or other side effects are all not worth it any more.

If that sounds like you, you may be a candidate for the kind of forward-thinking, innovative ketamine treatment that we offer.

Since the beginning of this century it’s been intensively studied for treatment-resistant depression, bipolar depression, suicidal thoughts, and now for other psychiatric disorders. In the last few years its use has become more and more widespread, and studies have proliferated to learn more.

For those of us in psychiatry who are treating our sickest patients with it, it’s the most extraordinary medicine we’ve seen in 50 years. In fact, in our lifetime.

Interestingly, it seems to have the most robust effects on those whose disorder is the most severe.

If that sounds like you, we may be able to help you get better.

As we say so often, ketamine isn’t for everyone… But nothing else available works so rapidly and so well for so many struggling with hopelessness.

So, if you’ve endured symptoms of a severe mood disorder way too long, call us.

We want to help you start your new year on better footing, with the power to enjoy your life and relationships, and contribute to the lives of others.

Here at Innovative Psychiatry, we see people who’ve been depressed for years walk out with joy, hope, and the energy to engage in the things that are important to them.

Give yourself the chance to really live.

To the emergence of your best self,

Lori Calabrese, M.D.

January 14, 2019
Treatment of Psychiatric Disorders: 2019 Year of Promise

Compounds and methods for treating severe psychiatric disorders are getting better and better…

Charlie sank into a chair in utter discouragement, as she realized she had awakened again, after hoping as she went to sleep that this would be her last night. Her last time to breathe. Night after night she prayed to die in her sleep. Morning after morning she woke up again. Ugh.

She felt betrayed by whatever cruel powers that be…that there seemed to be no compassion for her misery…and no escape.

She dragged herself to the bathroom and turned on the shower. Instantly, she saw an image of herself hanging by a rope from the shower head.

And she screamed.

Then climbed into the bathtub and stood sobbing under the shower.

Finally, she shampooed her hair, soaped up her body, rinsed, and turned off the water.

There was nothing to do but go to work…AGAIN…and try to function…AGAIN… and hopefully not get fired, because of her poor performance. Tears filled her eyes…

Suicidal Thoughts Can Be Deadly

Charlie is one of millions in the US who want to die as a result of depression. Approximately a million people commit suicide each year, and many times that amount try but survive. And many times more than those get struggle with suicidal thoughts that keep coming back.

Because relatively few tell anyone they’re thinking about or even considering suicide, it’s been impossible thus far to estimate the number.

They don’t want to die, they just don’t want to live with this kind of misery any more. Maybe you know someone like this… or you’ve felt like this yourself.

You are the ones we want to reach, to help, and to treat so you can rebuild fulfilling and rewarding lives again.

Ketamine Treatment Continues to be Misrepresented

With all its talents — with all its extraordinary mechanisms of actions — IV ketamine treatment may need a good PR firm!

When have you seen a safe, rapid, extraordinarily effective, life-saving treatment misrepresented, misunderstood, lambasted, and gossiped about more than ketamine? (Think about that for a minute.)

I saw a comment in STAT magazine the other day that took the cake.

There were lots of great comments, some more informed than others. But you do sort of expect that in a national publication. And… there was a lengthy comment–difficult to decipher–claiming ketamine was inherently dangerous.

It was clear the individual didn’t know about the research and data. All the information that’s poured out around the globe about ketamine and related compounds for psychiatric disorders over the last 10-15 years.

The commenter seemed to only be acquainted with its dangerous and highly abusable street form, Special K. And with the extremely high doses used on the streets… repeatedly over and over and often… he or she had seen the damage that abuse of ketamine can do.

As a psychiatrist, I hate to see it represented that way, but I cherish free speech, and freedom of expression. I also cherish scientific advancement and use it — every day — to relieve suffering.

Ketamine should definitely be administered under a psychiatrist’s close supervision, not self-dosed.

Then … there are the articles by young residents and clinicians, aspiring academics, and others. Those who have little true experience with the medicine or the treatment. But they’ve jumped in to write reviews of the literature or opinion pieces about it.

The best way to learn about ketamine treatment for psychiatric disorders is to hear directly from experts who actually use it — with many, many patients — every day in their offices or research units to treat psychiatric conditions. In this case, from the neuroscience researchers and psychiatrists who have worked with it a long time.

Because the truth is, the majority of physicians have read snippets about it here and there. They’re just now getting up to speed. And some have distorted ideas about it.

An article in VeryWell Mind by Naveed Saleh, M.D., May 2018, made some erroneous statements about ketamine treatment for suicidal thinking.

First, he claimed that ketamine is best absorbed through the intramuscular (IM) route, which is just simply false.

Ketamine is 100% bioavailable only when it’s given by the intravenous (IV) route. In IV form it’s delivered straight to the brain tissues that so desperately need its benefits. IM and IN (nasal spray), lozenges, troches, and oral liquids are all less bioavailable.

In addition, there are other problems with IM injections of ketamine that we’ve discussed and that are described in that Time Magazine article we talked about.

He also made claimed that if ketamine is to be widely-used, it most likely will be as an adjunct to other medications. Another misunderstanding of his research. Because the evidence says…

Ketamine Treatment Acts Independently of Other Medications

While that may or may not be true, my vote is that it won’t need to be. Evidence shows it doesn’t depend on other medicines for its mechanism of action. It’s not dependent on other medications to create a “partial response” that it augments. It acts independently on its own merits.

In fact, the most robust research is in patients where medication has FAILED — patients who have TRD, or treatment-resistant depression.

The left half of the ketamine molecule, known as esketamine, is nearing completion in its FDA trials and IS being tested as an adjunct to other medicines, not as a primary or stand-alone treatment. It’s being packaged as an intranasal spray, and has had some serious setbacks while seeking FDA approval.

It’s exciting to see what new glimpses researchers will find as they continue to study ketamine and other related compounds for treatment of suicidal thoughts, depression, bipolar depression, PTSD, OCD, social anxiety, and addictions. Maybe it will be a new action not yet identified, or maybe additional applications or conditions that could be responsive to this extraordinary treatment.

But the majority of patients who receive IV ketamine treatment report that other antidepressants or anxiolytics have failed, and, even if they walk in on antidepressants and mood stabilizers, they attribute their response and remission to ketamine treatment.

Ketamine Treatment of Psychiatric Disorders…

At Innovative Psychiatry, we see the majority of patients with severe treatment-resistant depression, bipolar depression, and suicidal thoughts. respond and achieve remission. They are real-life, real-world people just like you or people you know. Often, they don’t have just one thing or just one disorder — because psychiatric symptoms and disorders are complex and tend to run hand-in-hand.

We call that complex psychiatric cormorbidity.

Don’t let the term scare you.

It just means that when we see patients with treatment-resistant depression — as in unipolar depression and bipolar depression — they often also have other things, too, like social anxiety, PTSD, OCD, and addictions.

They’re often hopeless. Often suicidal.

It’s one of the reasons we’re so interested in following the research in using ketamine to treat suicidal thoughts and these other psychiatric conditions — and one of the reasons I write about them so often and devote space to them here.

Suicidal thinking can disappear within a few hours with IV ketamine treatment. Think about what that would be like for you … or someone you love.

If you’d like to consider ketamine treatment, give us a call. We can talk it through.

The Microbiome Has Been Underestimated

The microbiome is the collection of genes included in the trillions of bacteria, fungi, and viruses that populate the gut along nerve pathways connecting your brain to the rest of your body. These microorganisms provide our immune system and all work together to help our minds and bodies function properly and in partnership.

Another area psychiatry is advancing quickly forward is in its understanding of the importance of the microbiome and its effect on psychiatric illness.

When the balance between good organisms is outweighed by “bad” organisms, we become sick in some way. This may be an upset stomach, a systemic virus, or a disorder like depression, to name a few. Restoring the balance of these systems in our gut can help restore our health.

In fact, physicians have come to understand that sometimes the extensive use of antibiotics may destroy so much bacteria that the good bacteria that fights disease becomes depleted.

The more we learn, the more we can refine this essential part of our bodies to support our emotional well-being, as well as fight inflammation throughout our bodies.

But, we’re also learning it’s possible to overdo good organisms, too. And other disease symptoms can begin if there are far too many of them. It’s a balanced eco-system we’re looking for… We’ll be talking more about that soon.

Plans Unfolding for the 2019 Year Ahead

And we’re brimming at Innovative Psychiatry. (How’s that for 2019?) With new initiatives, new efforts, and exciting plans.

We’re expanding our hours and our availability, and preparing to publish our outcomes peer-reviewed journals in the hope of adding to the growing body of evidence of ketamine treatment’s remarkable benefits for treating an array of psychiatric disorders. (I’ll keep you posted as that develops.)

We hope to present our outcomes at more national and international conferences this year.

On top of that, we’re adding some opportunities to help us get more help to more of our patients to finance the cost of their treatment, and help fight for insurance companies to reimburse patients for the cost of their treatment.

Ketamine Treatment: Getting Better, Giving Back

Another opportunity in the wings is a program we’re developing — the first in the country– that would allow us to help patients Get Better and Give Back to their communities with special volunteer opportunities.

This program can help patients who would not have access to treatment any other way.

As we get all our irons in the fire scheduled and the details sorted out, we’ll update you so you’ll know what to watch for. G

2019 promises to be a year of hope, and a year of gratitude and goodwill, as we see more people feeling better... and getting well… after years of struggling without solutions.

We want to see progress made toward insurance companies covering ketamine infusions for psychiatric disorders. The medical billing code for ketamine infusions exist but it is usually rejected when it is linked to a psychiatric diagnosis. We continue to fight stigma and stigmatizing terms.

Hope is on the horizon. It’s going to be a good year.

If you battle depressive symptoms, or suicidal thoughts like Charlie, that haven’t gotten better, despite various medicines you’ve tried, please get in touch with us if you’re interested in ketamine treatment.

It consists of several doses of IV ketamine, usually about 6, and sometimes a few more, over 2-3 weeks. Ketamine isn’t appropriate for all patients — and doesn’t work as well for some as it does for most of our patients — so it’s not for everyone.

But we see such high percentages of response, we can say that most likely the chances are it will be a great help to you.

Most of our patients find after a full series of infusions, they can do things they’ve procrastinated about for years, enjoy things they used to enjoy, take advantage of energy to work, create, and socialize they had found impossible, in many cases for years. And build relationships and careers that are rewarding and satisfying.

We look forward to talking with you, and helping you find your smile again.

To the best YOU you can be in 2019,

Lori Calabrese, M.D.

January 7, 2019
2018 Innovative Psychiatry: Ketamine Developments

What a year it’s been!!

As this busy year creeps toward its end, it’s fun to look back on all we’ve accomplished in our hard work to help find more effective treatment for those who suffer with symptoms that don’t respond to traditional treatment.

Since the early beginnings in my work as a psychiatrist, I’ve been devoted to staying on the leading edge, and to finding solutions for those whose symptoms persist despite their best efforts.

As I’ve added innovative and advanced treatments to my practice to extend our effectiveness. And I’ve discovered that IV ketamine treatment in a series of infusions given closely together, is the most exciting, effective treatment for depression that just won’t lift.

So, we’ve invested time, money, and staff to help us learn more about this treatment for those who need it, and about what it can do.

Interventions and Adjustments

At the beginning of the year, we explored a variety of schedules and extended hours. We’ve continued to adjust them all year. It’s always a moving target as we try to offer an opportunity for everyone to be seen and treated.

Since I began providing ketamine treatment 3 years ago, we’ve been compiling data to learn more about the outcomes with our own patients here, as well as with those who come to us from outside Innovative Psychiatry.

And we’ve consistently been amazed at what we see. But more about that in a bit.

Then, in March, I had the opportunity to attend the International Conference on Ketamine and Related Compounds for Psychiatric Disorders 2018, in Oxford, England.

This conference was the first gathering globally of neuroscience researchers, psychiatrists, and psychopharmacologists specializing in ketamine research for psychiatric use.

This momentous academic gathering explored the rapidly emerging data on the history, development, and use of ketamine, and related compounds in psychiatric treatment — in basic neuroscience, neuroimaging, and clinical studies. How does it work? Why does it work? How can we know? What does neuroimaging tell us about ketamine and the default mode network (DMN)? What’s in the pipeline with esketamine and related compounds? These are some of the questions research has been answering about ketamine. We’re gaining confidence in it as a viable and extremely useful treatment, as opposed to just an experimental treatment that would soon dissipate (as naysayers claimed).

I presented some of my data on treatment of suicidal thinking, and what ketamine can do to erase it in a poster session.

Next, came the first annual American Society of Ketamine Physicians (ASKP) Conference in September, where I saw a number of the same professionals I’d seen in Oxford…again meeting to share insights and experiences with the use of ketamine treatment in psychiatry and in pain management.

Again, we talked about the broad applications of ketamine.  And the openness among us sharing information and insights helped to broaden the horizon for all present regarding what ketamine can do to relieve suffering in our patients.

Suffering that, for far too many, had remained unrelieved before ketamine.

Friendships were building at both of these conferences as we learned from each other, asked questions, and exchanged information. I took notes as fast as I could type. The information was compelling, exciting, and clinically useful.

Then, in November, along came KRIYA Conference 2018. Many of the same medical professionals gathered along with a host of others, and something magical happened.

These celebrated and deeply experienced experts in the field of ketamine treatment for psychiatric disorders left any pretense (they might have justifiably possessed) at the door.

Deep connection happened. And a light bulb turned on.

We took notes voraciously, exchanged ideas generously, talked intensively, asked questions of each other, and utilized every second we were together.

We gathered for coffee before the speakers began. Chatted on the steps. Talked on the way in and out, and everywhere in between. And lingered even after we were ushered from the building at the end of the day … then met at restaurants and continued far into the night.

I presented from the podium this time, and appreciated the enthusiastic response my data received. But I have to say, when it comes to the feats of ketamine, it’s hard to not be excited.

In fact, Raquel Bennett Ph.D., the founder of KRIYA, declared in her opening remarks that we’re witnessing, and are also players in, the birth of a new field: ketamine for psychiatric disorders. And that this time will go down in history as a renaissance of psychiatric treatment.

As the year has progressed, those of us in this new field are collaborating and continually refining and improving our methods of treatment as we probe more deeply into the potential of this extraordinary treatment.

The Birth of a New Field

If you or someone you love suffers from depression that has not responded to treatment, this collection of researchers and doctors understands, and we’re all working tirelessly to find answers for you.

You really aren’t alone.

We’re also watching research for more evidence about new areas of ketamine research to show us more ways to apply it.

At the same time, ketamine’s actions inspire more research into why it’s so effective, and pharmaceutical companies are developing new and related medications with the advances in this frontier.

Ketamine treatment consistently shows a strong response rate for treatment-resistant depression and bipolar depression; plus there is exciting emerging data for those with disorders like OCD, social anxiety, and substance use disorders that haven’t responded to other medications.

2018 Innovative Psychiatry ketamine developments include research opportunities.

We continue to collaborate and follow research to find ways to increase those numbers. To make a rewarding life available to more people.

I’ve been busy behind the scenes reviewing new research for upcoming new treatments– like esketamine, rapastinel infusions, and brexanolone infusions for post-partum depression and the exciting work done by the scientists at Neuro-Rx.

Our Experiences at Innovative Psychiatry with You Provides Useful Aid to Other Patients in Other Practices

My experiences with my patients in the last few years inspired me to respond to a Request of Information from the NIH/NIMH on the use of ketamine for suicidal patients — hopefully to help shape future research directions. And … to write an article that we plan to publish in a scientific journal. More information about this should be coming in the weeks ahead.

As a result of all these new connections, I’ve had the opportunity to collaborate on an international level.

Over the summer, we began exploring how to serve as a potential study site so we could offer patients the opportunity to participate in clinical research trials with new medications — more on that to come.

This would give people an opportunity to get treatment with a new agent long before it’s available to the general public.

Exciting, isn’t it?

As you know, we’re all about educating our patients.

In addition to our Ketamine Blog, we offer The Ketamine Library for our patients. (Who does that? I can tell you, from my trips around the country and into Europe … no one we know.)

Extraordinary efforts at education. It’s one of the things we’re known for.

2018 Innovative Psychiatry

And we’ve also added Instagram to reach more of our readers. We’re getting the word out about new breakthroughs in treatment.

And have you noticed the facelift to our website menu bar?

You’ll notice a new menu along the top emphasizing our Ketamine Blog. (It should really be called the Ketamine and So Many Other New Things Blog –but that didn’t fit very well!) Seriously, we’ve been busy writing all year.

If you haven’t explored the blog much, jump in — we write about everything from science to heartache, from fear to gratitude, from children to aging gracefully, from friendships to loneliness, from narcissism (STILL such a hot topic!) to ketamine wannabees.

And… we also offer advice, recommendations, and insights on the topics that are hard to find anywhere else — from how to screen a ketamine clinic to why your doctor might not yet be offering ketamine treatment. Check it out!

We write about stories, successes and failures.

I look forward to telling you more about all that and about other new initiatives we have planned, coming up in the new year ahead.

This has been such an exciting year in the advancement of better and more effective treatment for our patients. The ground is rumbling with new breakthroughs for 2019.

Enjoy your holiday season as it unfolds, and remember to take a moment to show kindness to those around you. It’s one of the most important things we can do for each another.

Ketamine Inspires Hope

Lots of inspiring news here. The purpose in all we do is to help you get better. And with the hundreds of medicines at our disposal, only about 2/3 of people psychiatrists treat with all those medicines actually improve.

Ask your psychiatrist to help you get better. But if you’ve tried a couple of medications…or even if you’ve tried 30!…and you don’t feel better, ketamine may really help you.

Ketamine treatment is amazing. It can smash depression, relieve social anxiety, dismantle PTSD, break addiction, and erase suicidal thinking within a couple hours. That’s why we’re celebrating the 2018 Innovative Psychiatry ketamine developments that are saving and restoring lives.

Ketamine treatment seems to demonstrate its greatest power with those who are the most ill, who’ve had the least amount of hope.

If this sounds like you, or someone you love, call us.

We are most thrilled by the opportunity to help you get better, really truly better, and to feel well and able to build the life of meaning you’ve always wished for.

To find the motivation and initiative to pursue, and invest in, those things that are important to you. To build relationships that have the depth and longevity to add strength to your life. Basically, to have the energy to live well, rather than endure.

Give yourself your best hope. Call for an appointment to see if ketamine treatment is right for you.

To the release and restoration of your best self,

Lori Calabrese, M.D.

December 18, 2018
BDNF and Microbiome: Your Paved Path to a Fulfilling Life

Strengthen your microbiome, build up your BDNF: Live Better and Enrich Your Relationships

Feel sluggish…like your brain is falling down on the job? “Why did I come into the kitchen?” “Where are my keys?” “I’m so overwhelmed…!” Wishing you had more physical and mental energy… and feel kind of foggy..?

It’s not surprising if you do. It can happen to anyone, but there are things you can do about it.

BDNF Grows Brain Cell Connections

We’ve talked before about BDNF (brain-derived-neurotrophic-factor) and how it works like a rich compost causing brain cells to branch prolifically creating a dense network of connections to move signals around and through the brain.

We talked about how the abundance of signals help you think more clearly and understand with more depth. In turn, you have more neuroplasticity to change your perspective and your outlook to improve your enjoyment of life and the meaning you draw from it.

Did you know there are things you can actually do to increase your BDNF, and in so doing, improve your sleep, your memory, cognition, and outlook?

We’ve talked about the impact stress can have. How it prunes away signaling structures in the brain, wearing down and destroying synapses, and leaves you with a sparse number of connections between brain cells that slows down thinking, creativity, problem-solving, and hope.

Brain Cell Connections Empower Life Connections

Dr. Hannah Critchlow is a Cambridge neuroscientist whose work shows us how we form our own subjective views of the world. She weighed in on the effect of stress on your function as a leader in the workplace which also applies to your role in important relationships in your life, and basically your own well-being, as well.

In a NYT article by David Donaldson April 4, 2018, she made the point that stress “seeps into the brain, and basically starts to damage the dendritic spines — the connections in the brain — so you get a much less connected brain and it becomes much more difficult to think flexibly and creatively.”

She points out that research has shown that working out at the gym or going for a jog can help reduce the effects of stress on the body, and mental and physical activity can reduce the effects of stress on the brain’s functioning.

And…since BDNF is such a huge boost for building synapses — those connections between brain cells — and improves resistance against stress – doing things that increase BDNF is the ticket.

Dr Critchlow says that some people have high levels of BDNF naturally. This certainly helps them with productivity when they’re under stress. But for those who don’t, regular exercise can actually boost their own BDNF levels.

But there’s more.

BDNF and Microbiome: There’s More To It than Exercise

She emphasizes that beyond exercise, engaging in meaningful socialization and getting a full night’s sleep also boost BDNF. Things like going to new places, exploring new environments, exchanging new ideas — both listening and expressing — also give more synapses a jump start.

But here’s the rub. It’s tough to discipline yourself to regular exercise, go to new places, stretch your boundaries, and have stimulating conversations when you’re depressed and lack the energy to do anything. Even if you’re just feeling a bit blue.

So Dr. Critchlow recommends developing an attitude of positivity, to keep those synapses growing.

Her own hack is to maintain a gratitude journal…and she writes down 3 things at the end of every day she’s grateful for. Doing that helps her keep her mind focused to help herself think with more positivity as well as think about how she might pay it forward and help others have more positive days ahead.

It’s also helpful to listen to your own emotions, and use them to try to pick up on key alerts within you… and try to make sense of them. It’s not always easy, but it helps to learn to let them inform our decisions, rather than pulling us down into a dark pit.

Sometimes the alert is about something or someone in our environment, and other times it’s about our own “slightly flawed view of reality.” Either way, it gives us something to work on or make new decisions about how to live better and help others, too.

What Makes BDNF Increase?

So…since you and I want to live better lives, and enjoy richer relationships by deeply engaging in stimulating conversations… and reaching out to show interest in others, how can we increase our BDNF to help us have the energy to want to?

Harvard neuropsychiatrist John Ratey is the author of, Spark, The Revolutionary New Science of Exercise and the Brain. He stresses the importance of exercise for release of BDNF. From his point of view, exercise is more for the brain than the body. (Think about this and how important this might to you!) He says that it turns the power switch in the brain to ON.

But, if exercise isn’t the only way to cultivate the release of BDNF, what else can you do?

Well, one suggestion is to reduce your intake of sugar. Because it so happens that high glucose decreases BDNF release, the neuroplasticity fuel in your brain that helps you learn and change, and stimulates the very ability to learn itself.

Most of us are either trying to lose weight or avoid gaining it. (So we already have a guilt trip in place about our waist size.)

Try this instead of self-reproach:

Reach for a clearer mind, success in your work, and fulfillment in your relationships…. Make your diet decisions in light of your desire to enjoy your friends, your spouse, and your children. And to find work meaningful, to work more effectively with your coworkers, and to enjoy the success that goes with better team building.

No guilt here. Just rewards.

Give Your Pancreas a Break!

Another method is to use short periods of fasting now and again. You can work it into your schedule daily like some do, or just plan it for once a week. For example, if you stop eating at 8pm, then go to bed and sleep from 10pm-6am and put off breakfast til 8am, you’ve given yourself a 12-hour fast and hardly notice it.

A 12-16 hour reprieve like this gives your pancreas some off-duty time and boosts BDNF.

This can increase the resistance to dysfunction and degeneration of those brain cells we talk about so often. The healthier and more resilient your brain cells are, the more resilient you are.

There have been a number of studies focused on what happens to BDNF following intense exercise. One example involved a 3 minute sprint, followed by 2 minutes of rest, then another 3 minute sprint.

Participants enjoyed a 20% increase in their learning ability immediately afterwards.

You can, too.

Rich Socialization = Higher BDNF

Did you know that children who grow up in a highly stimulating and engaging social environment display less anxiety and higher levels of BDNF? In addition, they develop better social behavior in adulthood as a result.

You can probably think of someone this describes.

Children involved in team sports with social activities that occur around their team are an example that comes to mind. The exercise, the sense of accomplishment, and the great times with their friends increases their BDNF — and their synapses — and their sense of well-being.

But, this need for rich social interactions — and their benefits! — applies to all of us, even the introverts. Rich socialization is about the quality, more than the quantity, of your relationships. And as long as there is quality engagement with people you enjoy stimulating your emotions and your mental performance, BDNF increases.

The Benefit of Supplements

Supplements can boost BDNF, too, and including them in your diet or supplement regimen can play an important role in your sense of well-being, emotional balance, and bright outlook.

Krill oil, for instance, increases the omega-3 levels in your body, and one of the omega-3 fatty acids can help increase BDNF.

Resveratrol is found in dark grapes and red wine. It can also help increase BDNF, as can components found in green tea.

And, curcumin can increase BDNF, so it’s not surprising that it’s being studied for its antidepressant as well as anti-inflammatory benefits. We’re learning that it may help prevent cognitive decline as you age.

BDNF and the Microbiome

Add to those nutrients a regular dose of broad-spectrum multi-strain probiotics to strengthen your microbiome and your gut-brain axis, and you have the set-up to greatly improve your brain’s ability to produce and release BDNF, your sense of wellbeing, and your fulfillment in important relationships.

When diet is not enough…

But what if you do all these things — really do them –and still don’t feel well? In that case, you may need treatment to gain enough function so you can improve your outlook.

And if you’ve suffered with depressive symptoms for months or years and no doctor has been able to help you feel better, you may need a different type of treatment than pills.

Some people need something novel…more advanced than pills.

Consider ketamine.

Ketamine treatment is a series of IV infusions that can turbo boost your BDNF to stimulate dense branching and new connections between the neurons in your brain. Its actions are so rapid, so robust, that you can begin to feel improvement within a couple of hours.

At Innovative Psychiatry, we’re witness to the transformation people experience with this extraordinary and effective medicine. Daily.

If you suffer with little to no improvement and need a real solution that can help you enjoy a rewarding life and fulfilling relationships, call us.

We can help you find the you that seems lost and forgotten. The you that has ached for a chance to live … and love.

Reach out and give yourself the chance to enjoy. To love. And to be productive.

We’re in your corner. And we want to help you live the life you long for.

To the igniting of your very best self,

Lori Calabrese, M.D.

December 11, 2018
Ketamine KRIYA Conference 2018

KRIYA!!

The most phenomenal ketamine conference to date!

Last weekend I attended and presented at the ketamine KRIYA Conference 2018 in San Francisco. This conference emerged as the most dynamic gathering of front-line ketamine practitioners I’ve ever experienced.

And what an event!

The ketamine KRIYA Conference 2018 was extraordinarily different than any other research or clinical conference I’ve attended. It’s clear that the realm of ketamine treatment for psychiatric disorders is growing wider and deeper.

There was a true spirit of inquiry, extraordinarily open collaboration, and presentations of risks, failures, and triumphs. Sheer transparency. Openly exposed vulnerabilities. A clear admission of the limitations of what we know. The latest information about clinical uses of ketamine in psychiatry.

The insider news.

What happened when Raquel put all of it — and all of us — together?

Palpable energy instantly exploded!

During the presentations — which were riveting. As we met for coffee. Chatted on the beautiful conference grounds, sprawled out over the steps, snugged down into comfy couches, talked over creative and inventive lunches, inhaled coffee (for some of us, all throughout the day!) — there was the sense that we needed to learn from each other as fast as we could. So … we shared Ubers and Lyfts and dinner tabs.

We came from all over the country … and from as far away as Russia.

We’re serious about this.

And what a weekend! We learned so much from each speaker and each other. We talked about our data, our practices, our experiences, what we’ve learned. What we still don’t know.

Soooo many different backgrounds, so many different approaches providing patient care, so much desire to reduce suffering in our patients.

Founded by Raquel Bennett, Ph.D., KRIYA is the Ketamine Research Institute and it is devoted to understanding the use of therapeutic ketamine in psychiatry and psychotherapy.

I must give a shout out to Raquel Bennett.

In such a few short years, she single-handedly founded, organized and grew KRIYA, an organization devoted to helping people heal and live fuller lives through safe, legal, and effective ketamine treatment. She is originator of the first international ketamine conference — KRIYA’s first conference, in 2015 — on the therapeutic use of ketamine.

Raquel has earned our respect, appreciation, and applause for the enormously hard work of bringing together experts who work with therapeutic ketamine in very different ways, using different routes, for different therapeutic purposes, in all aspects of psychiatry and psychotherapy, as well as in chronic pain and hospice.

Ketamine is a visionary medicine.

But Raquel Bennett, Ph.D, is a visionary.

Fantastic speakers, wonderful food, and gorgeous (read: non-hotel) settings gave all of us opportunities to pick the brain of someone nearby. We shared, we ate, we discussed, we listened. And at the end, we kept talking until they put away the chairs, and turned out the lights … until we each left for the airport. And then checked in and kept going.

Meet me in Terminal 2. I’m at Starbucks. Find us in the International Terminal. We’re sitting in the food court.

Until one by one, each had to break away to catch a plane.

… You haven’t seen anything til you’ve seen the excitement that comes from connection.

Many thanks to Raquel and her incredibly talented, organized and generous team for making this all possible.

Raquel Bennet, Psy.D.

Though our backgrounds are different, and our methods varied, it was clear that we share the same passion: to help reduce suffering from psychiatric symptoms and physical pain.

Next, let me say, I can’t possibly share it all with you here — there were 30 different speakers over 2 days, fascinating and varied discussion panels, and a lively sharing of experiences and ideas that kept us on our toes till the wee hours.

This conference was thrilling.

Thrilling.

I attended KRIYA last year. But there has been so much growth, so much more research, so many new frontiers since then … that this gathering really can’t compare.

These 30 speakers ran the full gamut of experience with using therapeutic ketamine in psychiatry — different practice settings, different studies, varied doses, varied routes of administration, varied preparation. Varied goals.

This was no room for small or closed minds.

We ALL learned and grew during those two days.

Raquel Bennett opened to set the stage for this smorgasbord of ideas.

She said, “We are witnessing the birth of a new field.” She spoke about how ketamine was developed for anesthesiology and has served that field well. But the therapeutic use of ketamine has birthed a new field of ketamine in psychiatry.

And she emphasized that the two are as different as apples and toast.

One way they’re different is in the goals of treatment. For anesthesiologists, ketamine has been used for managing consciousness or sedation and addressing physical pain. In psychiatry, the goal of treatment is all about treating psychiatric symptoms and managing psychiatric distress.

The second difference is in training and areas of expertise, diagnostic skills, and managing emergencies, and she described the differences between anesthesiologists and psychiatrists. Anesthesiologists are best at managing surgical emergencies, interventional pain procedures and life support. But psychiatrists are experts in diagnosing psychiatric conditions and managing psychiatrist emergencies.

The third difference is in the type of patient who presents for treatment. In psychiatry, our patients need a lot of contact, a high degree of emotional safety, and a great deal of emotional support and reassurance. Things we’re deeply attuned to by our psychiatric training.

She also talked about the differences in routes of administration as well as the dose used for each type of patient to reach the individual goals of sedation vs. relief of psychiatric symptoms.

Add to that the amount of preparation required in each field. An anesthesiologist can walk into the surgical area, say hello to his patient, and tell him to count backwards from 12.

However, psychiatrists and psychologists offering ketamine treatment invest in substantial and detailed preparation of the patient before beginning ketamine treatment — to prepare for the treatment itself, the treatment experience, and how to metabolize or make sense of the treatment experience.

And the preparation involves not only a thorough history of symptoms, treatment course, previous medication and treatment failures, but also a thorough developmental and social history.

Our education and training centers on entering into an ongoing therapeutic relationship with our patients and the critical understanding and provision of a safe, therapeutic frame to do the deep work we do.

These two fields are two different animals.

Dr. Bennet encouraged everyone to learn from everyone else, in effect, to “cross pollinate” these fields and help each other to improve in clinical practice.

Then she described the use of ketamine in psychotherapy as a “lubricant” for psychotherapeutic work.

Several of the speakers described this method in their practices. This is called ketamine-assisted psychotherapy, or ketamine-facilitated psychotherapy.

And she went a step further, to describe the use of therapeutic ketamine in psychotherapy as a tool for deep spiritual exploration. This is where the goal of treatment is not symptom relief per se, but personal growth, self-knowledge, or transcendent exploration.

All in all, she encouraged matching the treatment to the individual patient, recognizing our responsibility to learn more about varied strategies and to share our findings within our field.

Speakers were diverse and fascinating. If you’ve been keeping up with progress in the field of psychiatric ketamine treatment, some of these names are sure to jump out at you:

Will Van Derveer, M.D., Wesley Rylan, M.D., Scott Shannon, M.D., Michael Stanger, M.D., Jeffrey Becker, M.D., Jason Wallach, Ph.D., Dan Engle, M.D., Lori Calabrese, M.D., John Krystal, M.D., Phil Wolfson, M.D., Jeff Guss, M.D., Elias Dakwar, M.D., George Greer, M.D., Evgeny Krupitsky, M.D., Patrick Sullivan, D.O., and Jennifer Winegarden, D.O.

And we had some lively and fascinating panelists, including Gary Bravo, M.D., Alison McInnes, M.D., Steven Levine, M.D., Steve Best, M.D., Veronica Gold, M.F.T., Greg Wells, Ph.D., Bob Grant, M.D., Genesee Herzberg, Psy.D., Jessica Katzman, Psy.D., Jennifer Dore, M.D., Julie Megler, P.N.P., Steven Levine, M.D., Steve Best, M.D., Sandhya Prashad, M.D., Steve Mandel, M.D., and me.

Oh yes, I mentioned I also presented my own data, and am excited to tell you more about that…

But… that will have to wait for another day … Without question, our fledgling new psychiatric field has turned a corner.

Ketamine KRIYA Conference 2018.

We’ll never forget this one. We can only hope they keep getting better…if that’s possible.

As exciting as this wealth of information may be, if you’re suffering from depression, bipolar depression, PTSD, OCD, social anxiety, substance use disorders…and even suicidal thinking, don’t wait. Call us.

Thankfully, if your symptoms are mild, there are a host of antidepressants and other medicines and treatments that can hopefully help you.

Ketamine is at its best for those who are severely suffering.

If you’re deeply affected by severe symptoms of depression and anxiety, we can help. Call and arrange an appointment.

Ketamine isn’t for everyone. Of course not. It doesn’t help everyone. But even among those who aren’t helped initially… sometimes there are those who get a delayed response and in a few months reach remission quite by surprise.

And even though we can’t promise everyone they’ll reach remission, the truth is that a very large percentage do.

As we’ve said before, ketamine is the most rapid and effective treatment for depression that we’ve seen in our lifetime … and really … ever.

We’re constantly learning ways to help more people benefit and get better. And chances are…you’ll experience the most remarkable transformation you could have imagined.

Our Results

At Innovative Psychiatry, we see people with these symptoms and disorders get better every week with ketamine treatment. Our results are extraordinary, and our remission rate is very high. Call for an appointment and let’s talk.

Ketamine works in some different areas of the brain in different ways than traditional medicines you might have tried that didn’t work for you. Your life really can improve dramatically.

Find out what this remarkable treatment can do for you.

November 12, 2018
PTSD Can Make You Sick. Can Ketamine Stop That Before It Does?

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

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

Bang! A sudden loud noise breaks the stillness.

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

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

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

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

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

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

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

He groans and hits the floor.

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

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

PTSD Can Make You Sick

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

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

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

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

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

Terrible diseases.

See the diseases and conditions piling up?

But there’s still more.

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

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

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

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

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

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

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

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

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

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

How the Brain and The Body Interact

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

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

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

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

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

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

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

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

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

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

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

Ketamine for severe depression.

Ketamine for PTSD.

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

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

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

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

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

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

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

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

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

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

We sure understand.

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

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

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

To the restoration of your best self,

Lori Calabrese, MD

October 29, 2018
Why Ketamine Over Esketamine? It Works and It’s Available NOW
Treatment for Psychiatric Mood Disorders Has Been Quietly Waiting To Do Its Magic for 50 Years

He was 48, in the midst of a booming career, and like some others who demonstrate that special kind of genius, he had periods when depression came over him unexpectedly…and made it extremely difficult to function.

Because of his star-level performance most of the time, his boss gave him some room during these times to find “whatever he needed to find” to get back on his feet. It was humiliating…and he felt powerless to change it. He wished he could disappear into a hole and never come out.

After a lifetime of trying to physically and mentally brute his way through the days, training himself to function anyway no matter what…using muscle memory...he was growing weary of the battle.

Prolonged Years Fighting a Mood Disorder – Demoralizing

These long bouts made him feel foolish and stupid…like he couldn’t find two thoughts to rub together, and anyone who knew him could certainly see the pain and vulnerability in his face.

His productivity and accomplishments tanked during these times, and co-workers made insensitive and cruel remarks.

“They’re jealous, honey,” his wife tried to soothe him. “Because they can’t keep up with you most of the time. You’ll be yourself again…just hang on.”

Finally, in desperation, he decided to pick up the card his sister had given him six months ago for a psychiatrist she really liked, and make a call. He didn’t know what he’d say…but at least he was calling.

…You Have to Take the First Step

Mary answered the phone. She had a soft voice, and she didn’t sound rushed. And at the end of her greeting, she asked him, “How may I help you?” It blew his mind. He didn’t know.

So he hesitated. He hadn’t called a doctor’s office in years.

“Uh. I’m wondering if I could have an appointment. I’m in bad shape. A couple times a year I get like this. Depressed, I think, but it makes me feel dumb, and weak.

“May I ask your name?”

“James.”

“Thank you, James. I think you’d really give yourself a chance to feel better if you met with the doctor as soon as possible. She has a number of advanced forms of treatment for depression that might make a real difference for you.”

“Well, I ran out of hope a long time ago.”

“Not today you didn’t–you called!”

When James arrived at the office, it was his Hail Mary last ditch effort. He sat down in the waiting room and spotted beautiful binders with The Ketamine Library on the front.

They were filled with articles and studies about ketamine treatment. It seemed the more he browsed, the more the articles answered any question he could think of…Something new for depression. hmmm. As he began to read the articles, he was astonished at the reports people gave and how much better they felt…

The articles also referred to esketamine, something about mirror images … and said it wasn’t yet available. He wondered why it was advertised when it wasn’t yet available. And he wondered how the two were related… so he kept reading…until his name was called. He stood up and walked into the office, hoping beyond hope that this time would be different…

Why Ketamine Over Esketamine (Still Testing for FDA Approval)

As esketamine nears completion of its FDA trials, and crawls closer to the coveted approval status, people all over the US who suffer from mood disorders are clamoring for more information.

Why Ketamine Over Esketamine?

The answer is rather logical.

Recently, I was asked some questions about the behavior of s-ketamine and r-ketamine, the two enantiomer Siamese twins that you get when you divide the ketamine molecule. S- stands for left, and it’s the left half of the ketamine molecule that has been named esketamine.

Someone said he had been excited about esketamine, but as he understands more about it, his enthusiasm is waning. So he asked:
- - What is an AMPA receptor?
- - Is it a part of the NMDA receptor, or a separate thing itself?
- And is it possible that there could be a synergistic effect of ketamine (Dextro + Levo) combined — meaning is it necessary to have both halves of the ketamine molecule to get the full benefits when ketamine is used for depression and other psychiatric disorders?
Why Ketamine Over Esketamine? Because It Works…and It’s Available NOW

This was my response:

“Thanks! Wow–these are great questions!

“There are 3 kinds of glutamate receptors: NMDA receptors, AMPA receptors, and kainate receptors. (Each kind has variants.) So AMPA receptors are just one of the 3 kinds of glutamate receptor and they’re different from NMDA receptors. They exist independently of NMDA receptors but they can be on the same cells next to NMDA receptors–and they often are.

“Even though there is so much interest in glutamate receptors, it’s the AMPA receptors that are really responsible for the majority of FAST excitatory transmission in the brain.

“And it’s the changes in AMPA receptors that are really at the core of synaptic plasticity.

The Nitty-Gritty On NMDA vs. AMPA Receptors – Clearing the Fog

“And long-term synaptic plasticity can last from minutes to a lifetime–a brilliant phrase that’s well known in neuroscience. Hold that thought.

“Here’s where it gets so exciting: a molecule (let’s think medicine) can bind to an NMDA receptor or to an AMPA receptor.. or to either or to both. Sometimes, a molecule can bind to an NMDA receptor and when it does, the NMDA receptor tells the neuron to make more AMPA receptors and bring them up to the surface quickly –

“Then, the numbers can increase rapidly, dramatically, and can stay high. This helps create quick responsiveness, flexibility, growth and change….and it can be for the long-term.

“Ketamine binds to NMDA receptors. And for a long time, people thought this was why it helped with depression. But then a lot of other drugs that bind to the same place failed when tested in depression and function as antidepressants.

“Hmmm…

The More We Learn, The Better It Gets

“What we now know is that ketamine directly binds to AMPA receptors and directly increases their numbers and the phosphorylation of those receptors (i.e., the activation of them) — wow! If AMPA is a major player in plasticity (and it is!) and AMPA production, activation, and movement in neuronal members increases long-term synaptic plasticity (and it does!), it may help you understand why we are all so incredibly excited about using sub-anesthetic doses of ketamine for depression: because it not only directly activates NMDA receptors (which can up the number and the location of AMPA receptors on the same cells), and because it also directly activates AMPA.

“More action, more firing, more growth… more opportunity for flexibility of thought, more opportunity for the kinds of changes that people with depression want to see in their lives.

“We see this every day in my office.

“Finally, it’s possible that there is a synergistic effect when both the r- and s- forms (the dextro- and levo- forms) of the ketamine molecule are present — which is what we use in our IV ketamine infusions. I need to explore this more, and we need more research into which form of ketamine — the r-, the s- or the racemic compound — best activates AMPA.

“Calling all neuroscientists!”

Another Question: Why Aren’t All Doctors Seeing Equal Results?

Truth be told, this is only a smattering of questions we’re all asking about ketamine, about esketamine, and about what might be the best treatment for the majority of patients who suffer with symptoms of major depressive disorder, panic disorder, social anxiety, bipolar disorder, PTSD, OCD, and substance use disorder…not to mention suicidal thinking.

Because there are a variety of ways doctors are administering ketamine, and because research is going on in laboratories and hospitals around the world to better understand what ketamine does, how it works, and what its limitations are, there are mixed reports coming from all directions.

Outstanding Outcomes Emerging in Private Practice

My intent in telling you what I see is to inform you to make the best decisions for your health. And at Innovative Psychiatry, we’re seeing the majority of our patients with treatment-resistant disorders enter remission daily, weekly, and all the time in between.

Now it’s true that there are some patients who don’t seem to be helped by ketamine, and we don’t yet know why. But. We’ve found that even some who weren’t helped initially…and went home disappointed…later responded to the treatment and entered remission within a few months. We can’t explain that….

It does matter how this medicine is administered, and we adhere to the best research, the best recommendations, and the best psychiatry we can offer — and we see outstanding… really extraordinary… results with IV ketamine treatment. We know that all doctors, and all clinics, aren’t getting the best results. But those of us who are … well, we know at least part of the reason why.

The only thing that motivates us here at Innovative Psychiatry — and always has — is finding solutions that help our patients get better. So they can live and enjoy their lives, their work, and their families.

If you’ve tried at least two traditional antidepressant treatments with no relief, ketamine treatment may be the solution. It has been for over 80% of our treatment-resistant patients up till now. No other medicine for mood disorders has come close.

If you haven’t been helped by other treatments, call us.

This is National Suicide Prevention month, and we’re here to tell you that ketamine treatment can stop suicidal thinking in just a few hours. Often less. So that when those obsessive thoughts of death and dying stop, you can use the freedom that gives you to really dive into treatment and therapy that can help you save and rebuild your life.

Find out how much better you can feel.

To the reinvigorating of your best self,

Lori Calabrese, M.D.
September 17, 2018

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