Lori Calabrese, MD

Tag: Ketamine Treatment for Treatment-Resistant Depression in Adolescents

Fuel Hope With Gratefulness All Year Round

Surprising Results Can Follow Counterintuitive Choices

Thank you.

Such sweet words.

Here in the US, we’re just ending a four-day celebration we call Thanksgiving weekend. True, the official day for Thanksgiving is the fourth Thursday of November each year — but it’s also true that most families spend the entire four day weekend continuing to celebrate, spend time together, and enjoy this holiday set aside for gratefulness.

Plus, you probably know that “the holidays,” starting with Thanksgiving and lasting through New Year’s Day, is a difficult time for some people. Yet many others actually enjoy all the festivities, sharing, eating, and laughing that goes with good times together.

Whether you’re a celebrator or an abstainer from these gatherings, there are some things we can talk about to improve these days for the grievers, and improve sensitivity for the revelers.

Thanksgiving was first conceived by the Pilgrims after their original successful harvest in the New World.

That doesn’t mean it was their first harvest, but rather the first time it was successful and there was food to eat. There’s nothing like starvation to inspire gratitude for food.

They called it their harvest festival.

George Washington made a proclamation that Thanksgiving should be celebrated in 1789, and it was sporadically celebrated. However, Thomas Jefferson chose not to celebrate the observance, so the day of gratefulness tended to be hit and miss until 1863.

In the midst of the Civil war, Abraham Lincoln declared Thanksgiving be observed as a federal holiday on the fourth Thursday of November … and that has continued to this day.

It might strike you as odd that President Lincoln started a federal holiday observation when the country was at war with itself, when families were torn apart by sons, fathers, and grandfathers marching off to to battle…

Homes and farms were burned. Families were seeing more funerals than birthdays.

Does that sound like a time to be thankful…?

Can you imagine the uproar?

“Have you heard what he’s done now??? He’s declared thankfulness as a national holiday, of all things!!”

“I’m not surprised…after all, seeing as how we do have SO MUCH to be thankful for right now… I’m so sick of this war and this administration! I’ve lost my farm! How will I feed my family?!!

…and on and on it might have gone.

Doesn’t sound all that different from what we hear today, does it?

Counterintuitive Declaration in the Middle of the Chaos

Is it possible he had a higher purpose than just creating confusion in the midst of the terrible war?

We do know that he had an abiding faith. He seemed to understand that choosing thankfulness can inspire better decisions and better outcomes. Thinking of others inspires generosity…and his nation needed generous hearts from top to bottom if it were to heal.

Some of the most liberating principles of life have been around for hundreds of years and dozens of generations. And sometimes they’re hard to grasp because they’re locked in counterintuitive thinking.

Oprah Winfrey put it this way:

“Be thankful for what you have; you’ll end up having more. If you concentrate on what you don’t have, you will never, ever have enough.” — Oprah Winfrey

And therein lies the secret. The secret of justice and unity that President Lincoln reached for, the secret of poverty vs. abundance that Oprah warned about, the benefit that we all receive when we take the time to focus on everything and everyone in our life that’s good.

The Secret of Gratefulness.

“At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” –Albert Schweitzer

Albert Schweitzer may not be a familiar name to anyone under the age of 50. But, he won a Nobel Peace Prize in 1952 for his extensive work in Africa in an area now known as Gabon, near the Republic of the Congo.

He had studied extensively in theology and medicine, and as a newlywed set out with his bride to live in this place where sickness and suffering were crushing the people. Over the course of his life he built an enormous hospital complex to treat the thousands who came to him for help.

He wasn’t perfect — and even embraced perspectives that would offend us now in our modern culture — but he gave what he had from who he was and helped make life better for thousands.

It’s no mystery why he might have felt his “light go out” from time to time. His work was demanding and unrelenting in a place where hardships abounded.

But he understood gratitude.

Do you ever feel as though your light is going out…and you need it rekindled? Me, too. In fact, most of us can say that words of encouragement spoken at the right time can help to turn us around.

Beloved 20th Century Actress Doris Day has seen it all. She knows the value in that counterintuitive assertion of gratefulness. In her own words:

“Gratitude is riches. Complaint is poverty.”

On her way to becoming a dance star, her car collided with a train. Her injuries took a serious toll that permanently ended her dancing career. But, rather than give up, she turned to singing under the training of a voice coach. She soon made movies that were wildly popular in the mid 1900’s … and her fans assumed her life was perfect.

But behind the sweetheart-girl-next-door image she presented to the public… was a victim of domestic abuse, a history of 4 marriages, the widow of the only man she loved, loss of her fortune, and complete exhaustion.

But she, too, understands gratitude in the face of adversity.

As humans we may envy what another has that we don’t. Wealth, charm, health, fame…but focusing on what we don’t have does nothing to improve our situation.

Turning a laser beam of attention on our envy of another person only fuels a raging fire of jealousy inside us. And we grow more bitter and focused inward. It isolates us and doesn’t improve anything.

On the other hand, being grateful for the gifts, the benefits, the talents we do have, empowers us to make those gift, talents, and benefits bigger, brighter, and more abundant.

Helen Keller said that she cried that she had no shoes, until she met a man who had no feet.

Helen Keller, if you’re not familiar with her, was blind, deaf, and mute… so you can see her metaphor about the lack of shoes…

“Necessity is the mother of invention,” they say. So her gratitude for having feet led her to find ways to serve mankind, and especially others who were blind, deaf, or mute… or all three.

Miss Keller knew there was no place in her life for self pity.

She came to understand gratitude at a young age.

During World War II, as able-bodied men went to war, and women and children were left behind, women who’d never considered such a thing went to work for wages. It was a time of hardship. But, rather than complain, these women put on their work shoes and headed for the factories.

Many of us had grandmothers and great grandmothers who worked in the factories to make bombs, aircraft, trucks, and other tools needed to fight the war.

Is it any wonder that gratefulness and the can-do attitude that was required to rise above those difficulties led to a song in the last year of the war that strengthened that frame of mind? :

You have to accentuate the positive,

Eliminate the negative,

And latch on to the affirmative,

But don’t mess with Mr. In-Between.

Comical? Maybe so…but you get the message.

Like we saw with the man with no shoes, there is always something to be grateful for. And gratitude has a way of propelling you above the circumstances you wish would change, so you can see the bigger picture.

Gratefulness transforms your perspective.

And when that happens, you’re no longer a victim, but rather on top of your circumstances. The circumstance may not change the way you want it to, but your improved outlook can give you power over it.

No one is without flaws, and no one’s life is perfect. But each of us can contribute to the lives of others in some way, and in the process gain the freedom to overcome our own struggles on some level.

Psychiatric disorders can render you emotionally paralyzed… trapped inside inertia, fatigue, and despair. And as you know, there are other types of paralysis. If you’ve experienced this, you may be able to relate to Jon Morrow.

Jon Morrow is a wildly successful blogger whose body is paralyzed by Spinal Muscular Dystrophy. He can move nothing except his eyes and lips. Helpless? Well, he was for awhile. But he has pushed through from a point of inertia and despair to doing what he could do…until he learned to drive traffic to his blogs and has achieved the status of the most widely read blogger in the world.

He has generated more than 200 million views of his blogs and earned $50 million as a result.

A spoiled rich kid? Not in the least. This guy was facing the end of his life because of his need for healthcare, and no money to pay for it. His story is hugely inspiring. If he can accomplish his dreams…anyone can.

And Jon understands gratefulness.

Look for his blog Unstoppable.me. It will give you a shot in the arm to choose and express gratefulness and overcome adversity.

Gratefulness is liberating, empowering, and humbling… all at the same time.

So now that the Thanksgiving 2018 holiday weekend is behind us…let’s not lose sight of the lessons we’ve learned together as we venture through the rest of the winter holiday season and into the new fledgling year 2019.

With gratefulness you can turn on the light in someone in your world, and illuminate your own heart at the same time.

Still, if you’re suffering under the weight of a psychiatric disorder that hasn’t yielded to any medicine you and your doctor have tried, there is something more you can do as you focus on gratitude in your life.

Ketamine treatment is a series of IV infusions that have demonstrated in thousands of cases an extraordinary capacity for relieving depression and anxiety in the vast majority of those who have not been helped by anything else.

From severe treatment-resistant depression, bipolar depression, and suicidal thinking, to social anxiety, PTSD, OCD, and addictions, ketamine has the remarkable ability to rebuild signaling structures and systems along with regulating a wide variety of puzzle pieces in the brain that make up the sense of wellbeing, joy, motivation, and initiative you long for.

At Innovative Psychiatry, we’re big believers in joy. Happiness. And gratitude. We offer help and we offer hope — with new treatments that can turn things around for you.

Call us. We want you to experience relief and the ability to build a rewarding life you enjoy… and to revive and renew the relationships in your life that are important to you.

With gratitude for the opportunity to share my thoughts with you this year, I want to wish you a warm and heartfelt joyous season of holidays.

To the renewal of your best self,

Lori Calabrese, M.D.

November 26, 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
ASKP Meeting Notes: The 2018 Inaugural Conference of the American Society of Ketamine Physicians
New Advances in Ketamine Treatment
2018 has been a good year. A very good year.

In this fall season of harvest and bounty which surrounds us outdoors, we find ourselves as ketamine physicians with wonderful gifts to work with: in our world of neuroscience and psychiatry, the soil is rich, the seeds have been planted, and hard work has been done – sometimes for years! – by experts who have paved the way, and brilliant emerging experts whose work and insights inspire us all.

I’m talking about the 2018 ASKP Meeting in Austin, TX.

Ya shoulda been there

It was the Inaugural Meeting of the American Society of Ketamine Physicians – hence, ASKP – and it was a conference that fueled excitement, embraced inquiry, acknowledged the need for temperance … and left all of us thirsting for more opportunities to work, study, collaborate, and publish.

I want to tell you about the meeting.

Especially if you or someone in your life suffers from a mood disorder. If you’ve been struggling for a terribly long time. If you’ve begun to think of yourself with symptoms that have become “treatment-resistant.” Sound familiar? Then dial in to learn about IV ketamine treatment advances.

What you learn may help you think outside the box you’ve found yourself in.

Hard Pruning Can Leave You Unable to Recover

As you know, it’s terrible to struggle to live your life when your confidence, your hope, your ability to think and perform, are all dulled, impaired…broken down.

Major depression, panic disorder, social anxiety, PTSD, OCD, bipolar disorder, addiction … the list goes on … all of these can make it nearly impossible to reach the goals you may have for your life.

You’ve probably seen your doctor and tried some different medicines, but if you’re not feeling better, you may be part of the large group of depressed or anxious people for whom conventional medications don’t work.

If you’ve heard of ketamine, you may know that it’s showing great promise for helping a majority of people who weren’t helped by antidepressants.

But, you may not have been able to find someone who administers ketamine treatment properly. Because until recently doctors have just been on their own offering ketamine the best way they know how.

Sometimes their methods don’t work very well.

So physicians who provide ketamine treatment are beginning to organize into groups to exchange their ideas, experiences, and discoveries, in hopes of solidifying some of the true “best practices” that provide the best outcomes for their patients.

An important organization that’s doing this is the American Society of Ketamine Physicians, or ASKP — and we just held our Inaugural Conference September 20-22, in Austin, TX.

Let me start by saying how grateful I am for the many opportunities to meet with other medical pioneers who are committed — like we are — to helping people who suffer with treatment resistant psychiatric disorders.

Conferences are a festival for the mind. Ideas spark, slides fly by, data positively crackles in the air — and so does good humor, agreeableness, collaboration, and humility. We are humbled by the pain our patients experience, and inspired by our colleagues to learn more, think critically, design carefully, proceed with integrity.

We are privileged to have ketamine in our toolbox and to be able to offer ketamine treatment to patients whose suffering has become unbearable.

ASKP is helping us do just that.

IV Ketamine Treatment Advances: Leaders

We were treated to a lineup of seminal leaders in the field. Steve Mandel, M.D., the President of ASKP and Ketamine Clinics of Los Angeles, James Murrough, M.D., of Mount Sinai and Sam Wilkinson, M.D., of Yale, Steve Levine, M.D., of Actify Neurotherapies, Carl Bonnett, M.D., of Klarisana in San Antonio who has been working with veterans for years treating depression, PTSD and pain; Rupert McShane, M.D., whom I met at KRIYA and Oxford, Raquel Bennett, Ph.D., the founder of KRIYA Institute and the KRIYA Conference, and Jason Wallach, Ph.D, of University of the Sciences, a brilliant synthetic chemist and expert on the pharmacology of ketamine and related novel NMDAR antagonists.

Dr. Mandel’s opening address caught everyone’s attention when he opened with statistics about suicide. He reported that 44,000 people die by suicide each year, and 25 times that number attempt to end their lives. There are more suicides among physicians than any other profession.

He stressed that there are so many people who need this medicine and not nearly enough doctors providing it — if for no other need than to help prevent suicide. But of course, we shouldn’t stop there.

He also pointed out that in his practice, he’s seeing more and more patients who have a delayed response, just as we see at Innovative Psychiatry.

Because of this, it’s so important that if you don’t feel better after your series of infusions, that you must not give up. You may be a late responder and we’re learning more about this all the time.

Extensive Research That Began During Residency

James Murrough, M.D., Ph.D., was next and he talked through the history of ketamine’s research for treating psychiatric disorders. He spoke of Carlos Zarate’s work in 2010 which was the first study in patients with treatment-resistant bipolar disorder.

He got involved in ketamine research as a resident in a study of 47 patients led by Sanjay Mathew, MD who, with Zarate, co-authored the book Ketamine for Treatment-Resistant Depression. It was a difficult study, and ketamine treatment was surrounded by skepticism at the time. (For some people, it still is.) But it was the largest number of patients studied clinically at that point.

Dr. Murrough did a beautiful, comprehensive review of the clinical literature on ketamine’s effectiveness. He and his team published a study in 2015 that demonstrated that ketamine’s effect is rapid and robust.

Then, studies accumulated that showed ketamine’s effect lasts longer when given in a series. (Which is why we give a series of 6 – 9 at Innovative Psychiatry.)

Groundbreaking studies…over and over and over.

Steven Levine, M.D., talked about what he’s learned through 30,000 ketamine infusions with 3000 patients over the past several years.

And he made the point that stress itself is a risk factor for relapse.

Raquel Bennett, Ph.D.

I don’t have room here to tell you enough about every presentation, but really quickly I want to tell you about Raquel Bennett’s presentation.

Raquel Bennett, Ph.D., spoke about the varied ways ketamine is used in psychotherapy and the importance of selecting patients appropriately for each type of treatment.

She also chaired a panel discussion with Eli Kolp, M.D., Robert Grant, M.D., and Jeff Becker, M.D., about their varied therapeutic approaches and their work with ketamine in psychotherapy.

Sandhya Prashad, M.D., spoke about the hallucinogenic potential of ketamine. While many physicians have been reluctant to delve into this aspect of ketamine, the dissociative symptoms patient experience are key to their improvement.

This wonderful gathering included research scientists, clinical researchers, full-practice physicians, and psychologists who explained their own discoveries for us to assimilate.

So many luminaries, so little time…

Rupert McShane, M.D.

Sam Wilkinson, M.D., explained the challenges of research and reviewed key studies. Rupert McShane, M.D, presented data on oral ketamine and abuse concerns. I first met Rupert at the KRIYA conference and he encouraged me to attend the Oxford International Conference on Ketamine for Psychiatric Disorders 2018 conference last March. He chaired the Oxford event, which was spectacular. He’s been generous with his mentorship in so many ways. Such a lovely man.

Rachel Dalthorpe, M.D., talked about hormonal factors in ketamine infusion treatment. She referred specifically to premenopausal women and proposed an ideal time during the menstrual cycle for scheduling follow up infusions. Such valuable information.

I was delighted to see so many of the luminaries there who have previously spoken at Kriya… like Jason Wallach, Jeff Becker, and Steve Levine … and from the Oxford Conference like Rupert McShane and Jenny Southgate … Such friends … and such a hall of fame!

Benjamin Keizer, Ph.D., talked about pain and the impact it has on the brain. Jennifer Southgate, Ph.D., spoke about her work with urothelium and bladder inflammation, and how ketamine can affect the bladder.

Ronald Hertz, M.D., explained his important work on the use of ketamine for treating severe and chronic pain…and CRPS. Randall Malchow, M.D., talked about his own studies treating pain. Jason Wallach, Ph.D., spoke on the pharmacodynamics of ketamine, expounding on the history of derivatives of PCP. He also discussed the difference between r-ketamine and s-ketamine. He is brilliant, engaging and makes chemistry fascinating.

Ketamine Advocacy Network Helps Physicians and Patients Alike

Finally, Dennis Hartman, who founded the Ketamine Advocacy Network, spoke about the extreme importance of patient advocacy. I was delighted to meet Kim Juroviesky. Kim hosts a Facebook group for ketamine patients, which is growing fast and helping so many.

The entire two days was chock-full of data, expert opinions and suggestions regarding clinical use of ketamine.

What an inauguration! Ketamine treatment is growing rapidly in use and in its positive effects. The more we can learn, the better able we are to effectively treat more patients with bright outcomes.

At Innovative Psychiatry, we administer ketamine and other treatments for treatment-resistant mood disorders. And we align our methods with best practices to help you achieve the most favorable outcome.

If you suffer from severe depression, social anxiety, bipolar disorder, PTSD, OCD, substance abuse disorder, and suicidal thinking, please call us.

And know that you don’t have to suffer with your symptoms. Let us help you find the life you want to live, and discover the best you, you can be.

To the reinvigorating of your best self,

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October 1, 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
IV Ketamine Can Treat Adolescent Depression

Ketamine Treatment Shows It’s Effectiveness with Treatment-Resistant Adolescent Depression

For generations, teenagers have struggled with depression, and treatment has been only moderately effective. We need to treat adolescent depression urgently. Failed grades, lost schooling due to poor attendance, interrupted social development, broken dreams…

Pressures of Achievements

A young woman who had excelled in high school, was senior class president, a drum major for the marching band, and had great SATs wanted to be an ophthalmologist and headed out of state for college.

Hard-working and self-disciplined, she held a job to help pay her expenses, got involved in campus politics, and began trying her hand at a few new freedoms. A little under age drinking led to a lot more, and the pressures of college and work eventually pushed her to consider suicide. Before long she was diagnosed with major depressive disorder and suicidal ideation.

Her doctor prescribed medications for her depression, but nothing changed. Time passed without improvement.

She had to take a leave of absence from school. Just getting out of bed and going to class had become insurmountable.

But ketamine can treat adolescent depression.

Coping Mechanisms That Isolate Teens

A young man had “wowed” his way through grade school and junior high. He’d been invited to a magnet school focused on science and technology for his high school years. After winning a pile of awards for his debate team, as well as in math and science competitions, he couldn’t continue.

The agoraphobia and social anxiety that plagued him in restaurants and barber shops finally conquered his courage. He refused to go in to get haircut ever again. It was just too crippling…too stifling. So his hair grew and grew until it reached his waist over the ensuing years. He always wore a long dark tweed coat his grandfather had given him. He felt safer inside that coat.

But he drew attention, too. When he walked into a pharmacy security personnel shadowed him until he left…assuming he carried weaponry under that coat. But he wasn’t a threat. He was suffering from major depression and phobias and coping the best he knew how.

He’d tried a variety of medicines his doctor prescribed, but he continued to get worse. It colored his outlook about everything.

Depression in Teens: About More Than Attitude

Adolescent depression is a serious illness that interrupts a young person’s normal social, mental, and academic development. It colors the way he or she sees the world, and the people in it.

In adolescents, the prefrontal cortex is not yet fully developed, due to their age. This portion of the brain makes judgments, considers consequences and outcomes, controls impulses and emotions, and helps people understand each other.

So without this development already in place, a teen is more likely to make dangerous decisions on the spur of the moment, overlook the cost of his actions, and react to people and situations without a balanced understanding of the results.

When you add depression to this mix, and the impaired outlook that goes with it, a teen with untreated depression can cost himself and others failed goals, injury, and painful consequences.

For these reasons, depressed adolescents need treatment options that work. And ketamine is a remarkable option to treat adolescent depression.

When Treatment Fails, Better Options are Paramount

As many as 40% of depressed teens are not helped by the first round of treatment, and only half respond to the second round. We’ve talked before about how failed treatment affects teens with bipolar disorder, and how each successive attempt at treatment lowers the likelihood of a therapeutic response with traditional medications.

But the same is true with major depression in teens.

Studies demonstrate that these young developing brains need protection from the ravages of severe disorders to avoid serious consequences.

Effective treatment for adolescent depression that restores the brain to healthy function is vital.

Because of the critical cost of untreated disorders, researchers have delved into the quest for novel and potent treatments that do restore a teen’s brain to normal function. That bring remission. (And remember, we consider a disorder “untreated” even when current treatment isn’t working.)

Since ketamine in small doses has been receiving such recognition for its effectiveness with children and adults in treatment of depression, anxiety, bipolar disorder, PTSD, OCD, and suicidal thinking, some researchers surmised it should be effective with teens, too.

In Search of Effective Treatment

In a study published this month in the Journal of Child and Adolescent Psychopharmacology, a research team led by Kathryn Cullen, MD set out to gather more information about the use of ketamine to treat depression in adolescents. And they made some important points upon completion of the study.

They provided 6 ketamine infusions spread over 2 weeks to 13 adolescents who suffered from treatment-resistant depression. Initially, they based dosage on the ideal body weight for the participant’s age. None of the participants responded to the first infusion, so they changed their strategy. Dosing was then based on actual body weight … and guess what?

Obese participants received doses according to their body weight and experienced a solid response with the higher dose.

This demonstrates the importance of personalizing the dose to achieve remission.

Another important point is that prior studies indicated that pediatric patients require a higher dose than adults to achieve a dissociative state, which is an important aspect of ketamine treatment.

The same seemed to hold true with these adolescents, which may indicate that adolescents respond to ketamine treatment more like children than adults.

Understanding that key point can help psychiatrists in personalizing dosing for adolescents they treat.

Cullen’s research team concluded that ketamine treatment may be a significant option for relieving treatment-resistant depression in adolescents. And that psychiatrists need more research to determine ideal dosing for this age group.

Just to make an observation … and let you in on a secret. In the world of neuroscience, researchers make exceptionally cautious statements about their findings. They may sound a bit underwhelmed. But they aren’t. When a researcher says that a treatment may be effective for a given population, it’s akin to your neighbor setting off 30 minutes of fireworks!

Here at Innovative Psychiatry we treat adolescents regularly who suffer from treatment-resistant depression, and watch them emerge from ketamine treatment with joy, restored resilience, energy to be creative, motivation to achieve, and enjoyment of their relationships.

If your teenager suffers from major depressive disorder, and traditional treatments haven’t helped, call us.

The sooner your child is treated, and his brain development is restored to its best function, the more he or she can continue to grow into the healthy and resilient adult he or she is meant to be.

To the restoration of your best self,

Lori Calabrese, MD

August 20, 2018

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