Lori Calabrese, MD

Tag: Ketamine Treatment for PTSD

Biological Psychiatry Stamps Out Stigma and Old Wives’ Tales
When Your Loved One Needs Treatment –

The Stigma of Old Wives’ Tales Can Cause Crisis… or Tragedy…

A mother’s heart is broken when she finds her 19 year old son dead in his car…apparently from carbon monoxide poisoning. She knew he’d struggled for years, saying things like he wished he was dead…or about how he wanted to jump off a bridge.

She’d wanted to help him, wanted to relieve his sadness, but didn’t want to take him to a psychiatrist because of the stigma… she didn’t want him labeled.

Believing he’d grow out of it… she didn’t want him hampered in life by a psychiatric diagnosis. She had the best intentions…

Meanwhile, she signed him up for riding lessons at a nearby stable, tried to get him interested in basketball. Helped him participate in Boy Scouts.

All because she thought a new interest would captivate him and help him overcome his sadness, poor self-image, and low energy. He seemed to have no initiative, motivation, or courage to fight it off.

So she kept trying… unwittingly missing the fact that these very symptoms were the reason why he needed help… and lacked interest in much of anything…

Stigma About Psychiatric Illness Can Blind You to a Loved One’s Need

A middle-aged man watches his wife of 23 years from the corner of his eye. What’s happened to her? he thinks to himself.

She’d always been a highly-motivated, creative person who took pride in herself and her contributions to their family and the community. But now she seemed to have lost interest in her appearance and her family.

She was taking a lot of naps and had gotten behind on the laundry. In fact, he’d been running the washer and dryer in the evenings to just catch up, make things easier. Last week he started cooking meals because they’d gotten sick of carry-out.

What happened…? Had she gotten lazy…? Or was it something else…?

He tried to talk to her…to learn if something had happened to her friendships or if she needed more supplies for her hobbies… but she showed no interest in that subject.

The truth is, he was growing more and more concerned.

After mentioning this to a trusted friend at work, his friend suggested an appointment with a good psychiatrist might shed some light. He was shocked.

A psychiatrist???

“My wife may be bored…or maybe she has the flu. But she doesn’t need a psychiatrist…! That’s for nut cases!!”

His friend shrugged. “I went to one a couple years ago, and to tell you the truth, it really helped.”

Pshhhhhh. Psychiatrist. Ridiculous.

Or is it?

Neuroscience Research is Shining a Light in Darkness

Most of us realize that psychiatric disorders carry with them a stigma that’s sometimes associated with terms like, “nut jobs,” “looney tunes,” and “crazies.”

However. Not only do neuroscience and psychiatry know there’s a mountain of information about the brain and how it works that we don’t know yet, but society in general knows even less.

We’ve talked in past articles about the exciting things that are being discovered in neuroscience research, like G proteins on lipid rafts that must be slid off to play their role in signaling between parts of the brain.

And neuronal bursts in the lateral habenula that seem to accompany depression, and how ketamine can dampen those bursts, and by doing so, relieve depression.

We’ve talked about how siblings of someone with bipolar disorder are 10 times more likely to also develop the same disorder. But…we don’t know exactly why. Just pieces of it.

Biological Psychiatry Stamps Out Stigma by Helping Us Learn to See the Cause of Suffering

So, in terms of actively exploring and learning and developing treatment, you might say the brain is the last real frontier in the human body. Since psychiatric disorders still carry lots of stigma in society, it’s important to learn all we can about what actually causes them, and what can be done to relieve them.

It’s only been a few decades since “bad parenting” was considered the root of so many disorders, not to mention blame on the sufferer who was considered “weak.” It’s pretty commonly known now that these were fallacies.

An interview published last week in Psychiatric Times by two psychiatry residents with Carol Tamminga, MD, shed more light on the quest to get to the basis of the biology of these conditions.

Dr. Tamminga specializes in biological psychiatry and its effort to find neurobiologic reasons for disease through brain imaging, genetics, and circuits. With her team, she searches for biologic confirmation of DSM diagnoses like schizophrenia, bipolar disorder, and schizoaffective disorder.

But her research from that perspective didn’t really make the connections she thought it would. They had expected to find biomarkers for each diagnosis, but they weren’t there. So the team started over.

They had about 1000 participants with psychosis symptoms across 5 states, and 500 people who had none of these symptoms.

They tossed out the diagnoses and looked only at brain imaging, EEG brainwave analysis, eye tracking analysis, and cognition. And without information about diagnoses or signs and symptoms to influence their findings, they found these patients each fell into one of 3 clusters, based on these findings.

Here’s a rundown of the 3 groups:
- First – Biotype One: People who have low cognition, very low hyporeactive EEG, and the highest amount of gray matter of all the groups.
- Next – Biotype Two: Modestly low cognition, very high hyper-reactive EEG
- Finally – Biotype Three: The most interesting of all — “barely abnormal at all,” but just as severe psychosis as the other groups.
So they scratched their heads to try to understand why this group didn’t have the biologic features of the first two, although their psychosis was still very severe. And they discovered the common denominator was cannabis use during adolescence.

… What?

Stigma Is Born in Old Wives’ Tales

Obviously, there is lots to talk about and learn from their findings, but for this conversation let’s focus on the point that stigma is born in wives’ tales…it’s not based on fact. And many people — more than we realize — still believe the archaic views that were passed down to them from older family members about psychiatric illnesses.

So you can see where those wives’ tales came from, right…? They came from a time when neuroscience was as baffled by the brain’s behavior and disorders as anyone else … so there were theories …theories that are now being disproved because we have the technology to learn what’s really going on … piece by piece.

Since false theories have fueled so much of the stigma, and connected it to diagnoses, maybe it’s a good thing for research to pave the way to do without the diagnostic labels… eventually… and instead to replace them with biotypes. You think? And then, perhaps, treatment could be according to biotype … ?

Biological Psychiatry Stamps Out Stigma and Old Wives’ Tales

Let’s hope we can see a fresher perspective now…in ours. Because the whole purpose in knowing what’s causing the disorder — which is usually a combination of biologic conditions in the brain, environmental influences that can alter the expression of DNA (we call those “epigenetic factors”) and learned behavior that makes it worse — is to find out how to treat it. To bring relief.

And there lies the reason for both the fields of psychiatry and psychology.

At least, there are all sorts of new questions to answer.

At Innovative Psychiatry in South Windsor, CT, we seek answers every day for our patients who suffer from various psychiatric symptoms. We use the latest research to find solutions that will help you rediscover the best you can be.

And among those solutions, the most powerful and widespread that’s been discovered is ketamine treatment.

If you’ve suffered from severe depression that other treatments haven’t budged, as well as bipolar disorder, OCD, PTSD, social anxiety, panic disorder, or suicidal thinking, call us.

We provide ketamine treatment in the most therapeutic way that’s currently been found through neuroscientific research. And we stay closely connected to current research as it happens to be sure we’re providing every opportunity for you to make the best possible recovery.

Our goal is not to put a bandaid on your pain, but to help you achieve remission.

It’s true that not every patient we treat achieves remission. And we’re still learning from researchers as well as our own patients’ experiences to help more patients.

We see more remission with ketamine treatment than has ever been seen with any other psychiatric treatment. But for reasons we don’t yet understand, ketamine doesn’t seem to be for everyone.

But odds are it will help you feel better and function better than you have in a very long time.

If your psychiatrist doesn’t offer ketamine treatment, call us. We love working with your healthcare team to help you achieve the very best results for you.

Give yourself the opportunity to be the best you you’ve ever been.

To the rediscovery of your best self,

Lori Calabrese, M.D.
September 3, 2018
Learning Emotional Regulation Skills Can Prevent Relapse
Emotional Regulation in Mood Disorders

Can be Improved !!

Ketamine Treatment and Psychotherapy

“Cassie..?”

“Yes, Mom?”

“Sam called … says he can’t come over because he has to go to the mall with his mom …”

“WHAAAAATT??? That CREEP!!”

The freshly opened Coke can in Cassie’s hand flew at the door like a bullet and exploded into a hole just above the door facing … carbonation spewing everywhere.

“Cassie…. it was his mother’s decision…” But before her mom got the words out, Cassie had crashed through the front door and was gone.

Ever reacted to disappointment the way Cassie did? Know anyone who has?

Adapting or Stressing Out?

There’s a whole cascade of adaptations or maladaptations that occur in a moment of disappointment or frustration … or hurt. The things that go through your mind, the decisions you make in the split second after the moment and beyond, determine how an event will affect your life.

If you choose healthy ways to look at the event, and to respond, your mood will reflect that you have the skills to adapt, and roll with the punches. Learning emotional regulation skills can make the difference.

When you choose maladaptive thoughts that are self-destructive and create more conflict, you lay another brick in the foundation within yourself for an eventual diagnosis of depression.

In many psychiatric disorders, impaired emotional regulation (or emotional dysregulation) is a common characteristic. For most of us, it’s not that hard to see that some people with certain disorders — like, say, bipolar disorder — may have a hard time regulating and controlling their emotions.

There are other disorders where this may happen, too. Like PTSD, panic disorder, and depression.

A child affected by a disorder like depression or bipolar disorder often has difficulty developing his emotion-managing skills. Add to that certain conditions that also interfere, like alexithymia, for instance … and it’s all that much harder.

Emotion Regulation and Alexithymia

Alexithymia is a term coined in 1972 by Peter Sifneos, introducing to psychiatry the condition of a person who can’t identify or describe their emotions. Since emotion is felt physically … if you can’t feel it… it must be awfully hard to articulate.

In your case, maybe you don’t feel emotions or find it hard to put them in words … or maybe you do feel them.

If so, your condition can be just as difficult for you as it is for someone who experiences alexithymia, because both can put you in awkward, even embarrassing, situations.

Society Maintains Certain Expectations of Us All

Emotion self-regulation is the ability to respond to whatever is going on at the moment in a way that’s socially “tolerable” … but also flexible to fit the circumstances. For instance, so you can either react spontaneously or … if the situation requires it … delay your response til a more appropriate time and manner.

The ability to self-regulate your emotions is a complex stack of dominoes. A thousand different things stimulate in you a potential response or reaction…every single day.

If you don’t develop the ability to manage your reactions — in other words, if you don’t find out how to respond to a given situation in an appropriate way — your inappropriate reactions can isolate you from jobs, relationships, and fulfillment. People may see you as someone who doesn’t fit in.

The Behavior Police

Society imposes pressure on everyone to adapt to behaviors it considers in line with a civilized community. And people can be cruel as they police the boundaries to ensure everyone “behaves.”

If you’re able to develop an intuitive understanding of those boundaries as you grow through childhood, and if you can implement the “acceptable” behaviors in various situations, it will help you in every situation as you grow through adulthood.

However, as we mentioned before, some people are unable to do this adapting. And you may find yourself reacting forcefully and loudly in situations where you feel strong emotion.

Learning Emotional Regulation Skills Can Be Difficult

On the one hand, this difficulty regulating and adapting emotions to the situation is important, but what can you do if you just can’t? Furthermore, what happens if you never learn how…? Or never get better enough to learn…?

So here’s the thing.

It’s tough to learn how to redirect and adapt your responses to situations you’ve found upsetting in the past…especially when you’re in the heat of it. So treating the disorder and minimizing the pressure you feel to react is a solid first step.

It’s Easier to Learn Emotional Regulation Skills Without Symptoms

With medications that drastically reduce symptoms, you’re in a better position to actually use therapy that can help you develop skills to respond differently to circumstances that you’ve reacted to in the past.

Therapy that helps you learn to problem solve rather than erupt, and handle circumstances instead of brooding or avoiding those situations altogether can be far more effective if your emotions aren’t in overdrive.

Because, according to studies, when you can’t modulate your emotions, it does seem to set you up for relapse of your disorder. To stay healthy, you need to learn to think healthy. This underpins that infrastructure within you to sustain mental and emotional health.

Poor Emotional Regulation Leads to Relapse

Researchers in Norway published a meta-analysis of studies on emotional modulation in May of this year in Frontiers in Psychology. The report analyzed 72 studies involving 3371 participants with major depression or those in remission from depression, and 5094 healthy controls.

Huge numbers.

They studied the way the participants managed their emotions through difficult and stressful experiences.

Then, they found that when they compared the way the healthy people (who’d never been depressed) responded the way those with major depression and those in remission responded, the healthy people had constructive, self-loving ways of responding and those with depression had more self-destructive ways of responding.

These researchers also found that the more “maladaptive” a person’s response to difficulty or conflict, the more likely that person will become depressed.

Conversely, the more healthy and constructive a person is in adapting to stressful situations, the less likely he will be depressed.

So poor ability to respond to difficulty and conflict correlates to likelihood of depression. And learning emotional regulation skills can prevent depression relapse.

And there’s more…

3 Factors Influence Emotion Regulation in Depression Remission

They found there are factors that influence how well someone with depression in remission can regulate his or her emotions:
- Age when the illness began
- Anxiety disorder that accompanies the depression
- How long the disorder has been in remission
Clearly more study is needed. We need to understand healthy adaptive means of emotion regulation. And we need to learn how to help depressed patients even when their disorder is in remission. We want to help them develop healthier responses. And by doing that, prevent relapse.

How many times do people stop psychotherapy — or stop their meds — as soon as they feel better? How many times have you?

Also, they urged more study of alexithymia in patients with remission so that they can understand how it impacts their ability to learn healthier responses.

How Ketamine Treatment Can Help

And keep in mind, if you’ve been treated for these disorders and you have not achieved remission, you may be a candidate for ketamine treatment. No other treatment has been as effective in as many treatment-resistant cases.

As we said before, it’s not easy to unlearn old habits and learn new ones in the way you think about and respond to painful or frustrating situations. If you’re in pain yourself, and the structures in your brain are broken and worn down from the stress of a mood disorder, this is especially true.

Remission can empower you to build a healthier inner thought life that sustains remission when you do achieve it.

At Innovative Psychiatry, we see people achieve remission through ketamine treatment every week. We’d love to work with you to help you build a healthier, more rewarding life.

Give yourself the chance to be well.

If you’ve suffered with a mood disorder and other medicines and treatments haven’t helped much or at all, call us at 860.648.9755. Let us help you achieve remission and a more meaningful life.

To the development of your best self,

Lori Calabrese, MD
August 6, 2018
Dance of the Genes: Activity Patterns that Link Some Mental Health Disorders… and Not Others

May is Mental Health Awareness Month!

That means we have the privilege to talk about the realities of mental and emotional well-being, and the psychiatric disorders that threaten it.

Even 20 years ago, our society was still so steeped in the stigma that people with depression and other psychiatric disorders were often overwhelmed with burdens of shame and ostracized at school, work, and even within families. We haven’t completely defeated the stigma, but let’s take a moment to appreciate how far we’ve come.

Mental Health Awareness Through Media

It was an exciting moment when we first saw the public service announcement showing Glenn Close talking about her sister’s disorder and her love for her 8 years ago. Score ONE Against Stigma.

Glenn Close, the actress, whose sister has bipolar disorder and whose nephew has schizoaffective disorder, began speaking out with her family in 2010.

She and her sister founded BringChange2Mind that year, and have broadcast public service announcements and interviews about life with psychiatric disorders.

Her sister, Jessie Close, writes blogs for the BringChange2Mind website. Jessie responds to those who write or call about their own difficulties or of those who love them.

And Glenn Close’s family is not the only one who has spoken out. A host of celebrities have stepped up to expose their own personal struggles with depression, bipolar disorder, substance abuse disorder, and more. People like Mariah Carey, Catherine Zeta-Jones, Carrie Fisher, Ted Turner, and lots more have told their their stores and spoken openly about their struggles.

Thank goodness.

Neuroscience Breakthroughs Stamp Out Stigma

One of the most important ways we strike a blow to the stigma of psychiatric disorders is to talk openly about these illnesses, just as we do about illnesses of the heart, lungs, liver, and kidneys.

The more we make psychiatric disorders part of casual conversation, educating as we go, the further back we push the stigma associated with this suffering.

We also spread the word about everything neuroscience discovers related to the causes and treatments for mental health disorders.

And by the way, genetic links have been found for pretty much every major psychiatric disorder. Even 15-20 years ago there was enormous speculation among certain aspects of society about whether psychiatric disorders were even real…

But now, we have functional MRIs, genetic links and maps, and the pathophysiology of these disorders. Suffering patients are pushed into corners far less than they used to be, with demands to “prove” they’re ill.

But it’s not over.

Dance of the Genes

We need to keep learning, and keep shouting out the truths about psychiatric illness for the sake of those who suffer and need help. Always to drive away uninformed judgment, and stigma.

So let’s talk about some things that have been uncovered regarding the solid foundation of psychiatric illness. And the breakthroughs in treatment that are emerging. The treatments that can not just relieve, but conquer, these terrible illnesses. Let’s talk about the dance of the genes: activity patterns that link some mental health disorders and not others.

Researchers discovered certain arrangements of gene activity associated with specific psychiatric disorders in a recent study. Illnesses like depression, autism, alcohol use disorder, bipolar disorder, and schizophrenia show up as the result of these genes expressing themselves, according to the study published in Science in February 2018.

These researchers studied postmortem brain tissue from 700 identified patients with those disorders, and compared them with matched controls and with controls with a non-psychiatric inflammatory disorder. They were looking for patterns of genetic similarities and differences in the cerebral cortex — across large brain regions.

They found similar levels of certain molecules among people who suffered from autism, bipolar disorder, and schizophrenia.

As they studied further, they found out that there are links between bipolar disorder and depression, which doesn’t seem that surprising. BUT … also between depression and autism. And between bipolar disorder and schizophrenia — and autism and schizophrenia.

Researchers have known that since 2013. But most of the rest of us haven’t.

What’s really news is that certain psychiatric disorders are more similar biologically than we’d ever thought if we’re just looking at the diagnoses themselves–the names we use. If we just dig deeper…

Astrocytes Activate to Signal Specific Conditions

There are star-shaped cells in the brain and spinal cord called astrocytes that provide support for those cells that make up the blood-brain barrier, among lots of other things. They supply nutrients for nerve tissue, and help with repair in the brain and spinal cord after serious injury.

So the genetic patterns or systems these researchers found actually affect how the brain cells communicate with each other.

Because the astrocytes activate with certain conditions. And many of the same astrocytes activate in conditions we wouldn’t have expected to be linked to each other.

These researchers see potential for identifying those patterns that genes express in astrocyte activation for each condition, which can eventually help us identify the underlying biologic vulnerabilities for these conditions.

As complicated as this sounds, this is a stigma buster! It’s not only “proof” for these disorders, as if anyone has anything to prove. But, it paves the road to improving the diagnosis of psychiatric disorders in the future — faster and with better accuracy, so treatment can be the RIGHT treatment for better outcomes.

Reach Out to Those Around You

While these possibilities are brewing, reach out with compassion to those in your world, in your circle, who clearly suffer. You see it in their “inappropriate behavior,” their inability to perform, and their despair.

Take a breath. Give them a moment of kindness. Of patience. Recognize that they didn’t ask for these limitations. But they carry them every day without relief.

Give to mental health research. Support organizations that offer respite and treatment.

Psychiatric illness isn’t elusive or ethereal. It can be identified in genes, in functional brain scans, in genetic patterns that write their own recipes for health and wellbeing… or disabling illness.

Environmental, biological, psychological, and genetic factors come together and spark most, if not all, psychiatric conditions. There is pretty much always a combination of factors behind each illness.

The fact remains that countless people suffer without help. They reach out on Facebook, on Twitter, and especially on Quora. So many people who have taken the medicines and aren’t any better.

Thankfully, there are also those who are better. Those fortunate ones who get better with antidepressants, anxiolytics, and mood stabilizers. But far too many don’t improve…and feel more desperate every day.

For you, we want you to know you’re not alone in this struggle. As you can see, neuroscientists press forward, as well as psychiatrists and neurologists, working to help people like you get better.

Studying to find improved treatments. And hope.

Innovative Psychiatry Specializes in Tough to Treat Illnesses

At Innovative Psychiatry, we’ve been specializing in helping those who couldn’t find effective treatment before for many years. We love a challenge. And we offer a variety of novel and advanced treatment options to help you get truly better.

Ketamine treatment is the most dramatically effective treatment we’ve seen in our lifetime. It doesn’t help everyone, but it does help most. Furthermore, its extraordinary antidepressant effects help our patients improve with such vigorous speed and depth that their lives begin anew.

Ketamine treatment relieves mental health disorders.

If you’ve been suffering from a psychiatric disorder that hasn’t improved from other treatments, call us. The right medicines given with the necessary expertise can change a life forever.

To the emerging of your very best self,

Lori Calabrese, M.D.

May 7, 2018

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