Lori Calabrese, MD

Tag: mood disorders

  • Who Should Provide IV Ketamine as Treatment for Depression?

    Who Should Provide IV Ketamine as Treatment for Depression?

    Should anesthesiologists give IV ketamine as treatment for depression.If This is What You Picture When You Imagine IV Ketamine Treatment for Depression, Think AGAIN!!

    And nix that image. Because we’re going to talk about who should provide IV ketamine as treatment for depression.

    Ketamine treatment is getting more and more attention in the press as a paradigm shifter for effective treatment for psychiatric mood disorders. And more and more medical professionals are opening offices to offer ketamine treatment for depression, and for pain management. Of course, more availability of ketamine treatment means more relief for more sufferers.

    Which is a good thing … right?

    Well, yes, but it raises some serious questions.

    Ketamine Isn’t for Everyone

    Like, for instance, is ketamine treatment for everyone?  And the answer to that is “No.” Not everyone will respond to it when it’s used for psychiatric mood disorders.

    But there are clinical factors and genetic tests that doctors can use to predict more accurately whether you’re likely to respond to ketamine treatment for depression.

    And another question: Is providing ketamine treatment for depression similar to providing ketamine treatment for pain? Is this something any medical doctor can easily do?  After all, it’s just a simple medication like any other, right?

    The answer to that isn’t exactly straight forward. First of all, the question includes an assumption that any medical doctor can easily prescribe any medication … even for specialized needs.

    Legally, this is true. Ethically and practically, it’s not.

    And while he may be able to prescribe a drug legally as a medical doctor…is he deeply versed enough in the nuances of the patient’s response to the drug and the drug’s potential side effects…as well as the patient’s potential reaction to those side effects and what to do about them….? 

    Is it really the best decision for a doctor to treat a condition he/she isn’t fully knowledgable about?

    Should an internist treat your periodontal disease? 

    An internist is expected to recognize and treat pretty much anything going on with your body…after all, he’s well-versed in inflammation and infections, and knows all about antibiotics. But his wide scope prevents him from having a specialist’s focused knowledge and deep experience with specialized aspects of your body, like your gums, for instance. So, you go to a dentist, and your dentist may send you to a periodontist for your gums…if you need it…a specialist’s specialist.

    Do All Psychiatrists Treat All Psychiatric Conditions?

    Well, let’s consider the nuances of psychiatry. There is a wide range of psychiatric disorders, including behavior disorders, mood disorders, personality disorders, cognitive disorders, developmental disorders, addictive disorders, and more — including all kinds of treatment modalities and several different kinds of psychotherapies we use — and most psychiatrists are not experts at everything.

    Of course not.

    Most of us gravitate naturally to our interests, and the best of us align our work with our own best selves — we choose the age range, the population, the conditions that fascinate us and tug at our hearts…the modalities that align with the way our own brains work and the way we interact. Some of us are researchers. Some of us are in the trenches. We play to our strengths. 

    We all should.

    Now, back to IV ketamine treatment.

    Anesthesiologists Use Ketamine in Surgery

    It’s understandable that anesthesiologists would be pretty comfortable treating patients with IV ketamine Who should provide and monitor IV ketamine Treatment for depression.since they’ve been using ketamine in surgery and emergency settings throughout their career.

    They’re also at ease sitting and monitoring a patient throughout the infusion treatment, because that’s what they do.

    Some medical doctors might get a bit antsy during that whole process, but it’s just second nature to an anesthesiologist.

    And, it’s true there are certainly plenty of anesthesiologists offering IV ketamine treatment for psychiatric mood disorders. They’re highly skilled in starting IVs, familiar with ketamine, and excellent in handling emergencies in the ER and in the OR.

    An anesthesiologist’s education and training is all about life support during critical moments in surgery. And these specialists know physiology like nobody’s business.

    But…

    Who Should Provide IV Ketamine as Treatment for Depression?

    When it comes to evaluating a psychiatric patient as a candidate for off-label use of IV ketamine treatment for treatment-resistant depression or other mood or anxiety disorders, there’s a great deal to manage. The role of ketamine used as an adjunct with complex medications and psychotherapy, for instance.

    Plus, the patients’ response to the drug and how to treat therm in their specific state of mind, whatever it is,  that emerges during treatment… All within the context of their baseline psychiatric symptoms and vulnerabilities.

    Anesthesiologists just aren’t trained for that.

    The same is true of nurses, even those in advanced practice.

    It’s my belief that the use of ketamine in the treatment of psychiatric disorders is something that is best done by psychiatrists who are thoroughly familiar with IV ketamine treatment.
    And here’s why.

    Because the things that this treatment requires — assessment of the patient and of the psychiatric response (not just the physiologic response), dose adjustment, management of fear, management of expectations… this is all psychiatric expertise. In addition, the family and their overall involvement (or lack of involvement) in the patient’s suffering… It requires we curate the experience, integrate it with psychotherapy, coordinate it within the context of the patient’s medical problems and with the professionals treating them. All these things are without a doubt what WE do and what our entire specialty is about.

    We deal with suicidal patients all day long and every night and weekend–anesthesiologists don’t and, understandably, don’t want to. But many, if not most, patients who receive IV ketamine treatment are not only no strangers to suicide, but in fact are so plagued by such thoughts their lives sometimes hang in the balance. Even to survive till the end of the infusion.

    Those tormenting thoughts just seem to creep in even when you’re not looking for them, and bring a presence to the ketamine room that stuns everyone involved.  That is, until  ketamine stops the suicidal thinking independently… and even if the depression doesn’t stop immediately… but lifts more slowly. A well-informed psychiatrist needs to be present to walk each patient through every scenario, especially when the outcome is a surprise.

    So, again, who should provide IV ketamine as treatment for depression? Definitely, not just anybody. Preferably a psychiatrist deeply experienced and educated in the nuances of ketamine treatment in psychiatric patients.

    Just as internists are not specialists in all areas of illness, not all psychiatrists are versed in the use of ketamine for psychiatric mood disorders.

    So What Kind of Psychiatrist Steps Out to Offer IV Ketamine Treatment?

    The ones who are really comfortable with medicine, and adjusting, adapting, and combining it for therapeutic outcomes. The ones who also have a strong identity as a physician first, and who are already experts in psychopharmacology.

    These psychiatrists are accustomed to a model of consultation and collaboration. And they like to work collaboratively with other psychiatrists, therapists, PCP’s, and families.

    This is no place for lone riders.

    These are the ones who know what it’s like when you’re the most suicidal of the suicidal, and who will stand with you and not be afraid. Those who understand that something transformative happens during an infusion. And that the specific experience of the infusion itself matters if there’s to be healing.

    We are grateful to the anesthesiologists who brought ketamine out of the OR and into the office.  

    But the psychiatric care of our most fragile, desperate, and ill patients — with multiple tangled psychiatric disorders, complex histories of polypharmacy and treatment failures, excruciating trauma, and concurrent medical problems — demands the finest life-saving that we have to offer, by psychiatrists. Nothing less.

    We continue forward to learn all we can from our patients and the dedicated neuroscientists who Who should provide Iv ketamine as treatment for depression in someone like this man?continue to explore the actions of this remarkable drug. As they explore, we continue to see our treatment-resistant patients enjoy extraordinary responses in 80% of cases.

    If you’ve suffered from treatment-resistant mood disorders and have tried multiple treatments without success, we get it. Innovative Psychiatry is a practice that specializes in helping people who have not found help before. People who have been to other psychiatrists and were failed by traditional treatments. People who are running low on hope.

    Innovative Psychiatry is into hope renewal. Through groundbreaking use of medications and treatments, we’re helping people like you live again. Enjoy life again. Please call us to schedule an appointment. We’ll evaluate whether you’re a likely candidate. There really is hope.

    To the release of your very best self,

    Lori Calabrese, M.D.

    Lori Calabrese, MD offers innovative psychiatric treatment like IV Ketamine

  • Your Microbiome: How It Affects Your Mood

    Your Microbiome: How It Affects Your Mood

    Young woman buying fresh vegetables to support her microbiome and moodWhat Is Your Microbiome and Why Does It Matter?

    In the last five years, researchers have learned more and more about the the organisms in our own intestinal tract, our microbiome. Let’s talk about the connection between those organisms and their affect on our physical and mental health, for better or for worse.

    The types of specific organisms that flourish there have a strong influence on the function of the brain and nerve pathways — and, therefore, on your mood and peace of mind.

    What does Depression have to do with your belly?

    Anyone who suffers from depression may know there’s an inherited tendency for that to occur. If either of your parents also struggled with depression, the chances are stronger that you might, too. But beyond your own personal DNA, there’s another huge area of DNA that may influence the moods you experience far more.

    Deep within your intestines is a community of microscopic bacteria which are both helpful and harmful. This community of trillions of mutually beneficial microbial cells make up the bacteria of your gut. We call it your personal microbiota. Each of these cells contains genes, and the combination of the genes in all of them is your own personal microbiome.

    If the genes in your microbiome influence low stress and a positive outlook, the effect on your mood is likely to be positive. But if the genes in your microbe-flourishing gut are  favorable to high stress and melancholy, the impact on your outlook is likely to push you into a rut of stressed living.

    For the most part, this microbiome is friendly and beneficial to your digestion. It makes use of far more nutrients from your food than would be possible without it. However, in recent times, scientists discovered that this same community of bacterial organisms are to blame for inflammatory and autoimmune diseases like atherosclerosis, asthma, and autism.

    You can change your life

    Learning to understand the microbiome and even influence its effect is potentially a superbly rewarding endeavor.

    So we have to ask: if this teeming ecosystem of bacteria in our intestines can accomplish good productive health-promoting feats, or trigger destructive diseases that can cripple us for life, is there a way to affect this microbiome so it does good and not evil?

    To better understand the answers to this and other questions, we need to understand how the natural flora in the gut exchanges information and products with the brain.

    The vagus nerve can bring the strongest guy to the ground

    And it turns out there’s a nerve that connects the two, called the vagus nerve.

    Have you ever seen someone faint at the sight of blood? This fainting reaction happens when the vagus nerve tells that person’s brain to suddenly dilate blood vessels in the body, which results in fainting… and they go out like a light.

    It’s the reason that you might see a picture of something gory, and feel a sick feeling in your stomach right before your brain declares “lights out” and you fall to the floor. It’s the vagus nerve that sends those signals.

    So with that in mind, what does the vagus nerve communicate to the brain, and what determines that choice?

    Think of it this way:

    When friendly, health-promoting bacteria ( probiotics) dominate the environment in your gut, those bacteria tell the brain that the environment is favorable for an upbeat mood. Then the sullen melancholy feelings mysteriously melt away. Nutrients and protein are sent to the brain to nourish that upbeat mood, and your glum outlook subsides.This lady is relaxed and upbeat because of favorable microbiome in gut.

    But the opposite is true if the dominating bacteria promote depression, stress, and anxiety.

    The gut is the largest organ in the immune system? Really??

    The gastrointestinal system is the largest organ in the immune system. This flourishing ecosystem of bacteria can have a positive or negative effect on other aspects of your well-being. So it’s important to your daily welfare to understand how this happens. Then you can take action to promote the best possible environment in your gut for your best well-being and mental function.

    Certain bacterial families weaken your immune system, decrease your confidence and emotional stamina, and promote a chronic long-term condition of high stress.

    Others reduce stress and promote wellbeing and resilience.

    Studies have shown that the more extreme stress is in your life, the community of symbiotic organisms in your gut will create a favorable environment for chronic stress, and unfavorable for mental relaxation.

    Stress or Relaxation

    Just as “birds of a feather flock together” so it is with these organisms. If you allow stress to go unchecked, the bacterial environment in your gut will shift. And it will come to match that ecosystem of stress and illness. Over time, you’ll find you feel locked-in and stuck in that stressful lifestyle and the outlook that goes with it.

    But, it’s also possible to actually change the environment in your gut. It can be made to support low stress, an upbeat outlook, and energy to enjoy life. And you can do it through the foods you eat, the things you do for pleasure, the amount of sleep you get, and more.

    For instance, studies have discovered that when lab animals were given probiotics, their high anxiety behaviors were calmed and their immune response was normalized, as well as their apparent relaxation.

    Psycho-biotics

    If probiotics do that much for lab animals, how much more will they do for you?

    Certain bacteria in specific families are considered “psycho-biotic” organisms because, like the probiotics just mentioned, they have an antidepressant effect on the brain.

    Further, through systems involving these gut microbes, nutrients are processed and passed through the blood-brain barrier. That improves the relaxation of processes that take place in the neurons. (The nerves that carry information signals to and from the brain.)

    The point here is that these probiotic systems are even equipped with a transport to make sure the right nutrients reach the brain and produce the hoped-for results.

    This is all great news for those of us who feel we drew the short straw concerning mood disorders in our family tree. It turns out that by investing in the mountain of genetics in our gut microbiome, we have the power to turn our genetic destiny on its proverbial ear.

    Watch for my blog next week.  Learn more about good microbiota to nurture. See a list of actions you can take, foods you can eat, and factors you can include in your daily life. All of this will ensure your probiotic heroes are flourishing in your gut promoting your best, most productive, and well-adjusted self.

    To the flourishing of your best self,

    Lori Calabrese, MD

    Icalabrese-0195_g_crop-webf you’ve suffered from depression, anxiety, or other mental health obstacles and have not had relief, Dr. Lori Calabrese, MD offers innovative psychiatric solutions. Contact us here for an in-depth evaluation. We’ll learn which solutions could work for you best and transform your life as you know it. We’re here to help you find your very best self.

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