Monthly Archives: October 2021

ketamine infusion therapy

What Is Ketamine Infusion Therapy?

Ketamine, also known on the street as “Special K,” has been abused in the past as a recreational drug due to its hallucinogenic and tranquilizing effects. However, today it is receiving a lot of positive attention due to it being used “off-label” to treat treatment-resistant depression. (When a drug is “off-label” it’s being used to treat a condition in a way that doesn’t have FDA approval.)

Ketamine infusion therapy involves the administration of a single infusion or a series of ketamine injections. This may help with the management of psychiatric disorders such as:

How Does Ketamine Work To Fight Depression?

The way ketamine works are not completely clear yet because it exerts an antidepressant effect in a new way. It might be able to help people manage their depression successfully when other treatments haven’t worked. It is likely that ketamine targets the NMDA receptors in the brain and binds to them. 

By doing this, it sets off a chain of reactions that leads to the release of molecules that help neurons (brain cells) communicate with each other along new pathways. This process is known as synaptogenesis and likely affects the individuals:

  • Mood
  • Thought patterns
  • Cognition (the process of thinking and understanding)

Ketamine may also influence depression in other ways. It may reduce signals involved in inflammation which has been connected to mood disorders. Similarly, it may also facilitate communication in certain areas of the brain. It is very likely that ketamine works in several ways at the same time and is still being studied.

Why Is Ketamine So Significant For Treating Depression?

The significance of ketamine as a treatment for depression is that it can: 

  • rapidly reduce suicidality (life-threatening thoughts and behaviors), 
  • relieve other serious symptoms of depression, and 
  • can be effective in treating depression combined with anxiety.

Other treatments for depression and suicidal thoughts typically take weeks or even months to take effect. Also, some people need to try several different approaches and medications to find relief. This is the case for talk therapies, antidepressant medications, TMS (transcranial magnetic stimulation), and ECT (electroconvulsive therapy). ECT is currently the most effective treatment for major depression that doesn’t respond to other therapies.

Two Types Of Ketamine

There are two main types of ketamine. They are both used to treat major depression that hasn’t responded to two or more treatments (treatment-resistant depression). They are:

  1. Racemic ketamine: usually given as an infusion, or IV, into the bloodstream. Approved by the FDA decades ago as an anesthetic, it is used off-label for depression.
  2. Esketamine: approved by the FDA, it is given as a nasal spray.

The two forms interact differently with the receptors in the brain. The way the drug is given and the type will determine the drug’s effectiveness and side effects. So far, most research has been on ketamine infusions.

Ketamine Infusion Side Effects

All drugs have side effects. However, when someone is suicidal or severely depressed, possible benefits may outweigh possible side effects. Given by infusion, ketamine may cause:

  • High blood pressure
  • Nausea and vomiting
  • Disturbances in perception (colors, textures, and noises that seem excessively stimulating, blurry vision, time seems to speed up or slow down)
  • Dissociation (out-of-body experience)

Generally speaking, any changes in perception or dissociation are most evident during the first ketamine injection and end very soon afterward. The nasal spray form may cause the same side effects, but the timing and intensity of those effects are different.

Main Drawbacks

Some medical professionals are advising caution until the long-term effects are studied more thoroughly. These are some of the major drawbacks to ketamine therapy:

  • The beneficial effects of the drug wear off after 7 to 10 days so patients need to get infusions on a regular basis. 
  • Some studies have shown that it can be toxic to brain cells.
  • It may cause bladder damage at higher doses.
  • It could cause psychotic-like symptoms during treatment.

Still, it should be noted, ketamine can help some people with depression and is especially beneficial for patients who require immediate improvement and have failed with conventional FDA-approved treatments. Research is ongoing on ketamine’s long-term safety and the best doses.

Help For Veterans

Ketamine may provide relief from the post-traumatic stress disorder (PTSD) that many veterans endure. PTSD is a mental health problem that many people develop after experiencing a trauma, such as combat. According to Aimee Cabo Nikolov, BSN who runs the Ketamine Medical Clinic in Miami (a division of the Neurosciences Medical Clinic), ketamine may be the most important discovery in half a century. About 35% of their clinic are military veterans who need treatment for PTSD and ketamine is giving them hope that other kinds of treatment didn’t provide.

Pain Management

Besides being included in the treatment of psychiatric disorders such as MDD and PTSD, it is also being used for post-operative and chronic pain management. Intravenous (IV) ketamine infusion therapy has developed as a treatment for several conditions.

What Is Ketamine And Where Did It Come From?

Ketamine started being used in Belgium in the 1960s as anesthesia for animals. It was approved by the FDA as an anesthetic for people in 1970. Thereafter, it was used in treating injured soldiers in Vietnam because, unlike other anesthetics, ketamine doesn’t slow breathing or heart rate. This means that patients don’t need a ventilator to receive it.

Today ketamine is gaining ground as a treatment for major depression which is the leading cause of disability worldwide. Recent estimates in the U.S. show 16 million adults had an episode of major depression in a year. In addition, suicide rates rose significantly between 1999 and 2016 increasing by over 30% in 25 states. Due to its rapid action, ketamine could play a part in preventing suicide.

Do You Have Any Mental Health Questions?

If you are experiencing issues with or have concerns about your mental health don’t wait to get help. Located in Newport Beach, CA, the Lido Wellness Center is available to help you manage and understand your mental and emotional health problems. We offer multiple levels of care so you can receive the treatment that is truly right for you. Contact us today. If you think you have a problem, you need to talk about it.

References:

www.health.harvard.edu/blog/ketamine-for-major-

www.ivketamine.com/iv-ketamine/

www.psycom.net/ketamine-depression

www.psychiatry.uams.edu/clinical-care/in

 

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Success at Lido – From Our Founding Vision to Clinical Reality, and Everything in Between

As the Executive Director and Co-Founder of Lido Wellness Center (LWC), I often get asked how my own mental health doesn’t take a dive as I am, daily, surrounded by the struggles of our clients, and consistently hearing about all they’ve encountered and endured. Interestingly, however, I view my space within the mental health community in a completely different light. I don’t feel drained by the work I do. In fact, I have always felt deeply moved, challenged, and honored to bear witness to our clients’ biggest discoveries and personal changes. Their courage and resilience through incredible difficulty inspires me daily, and makes me so certain that this work chose me – it called me – and I can’t imagine doing anything else with my life. This is the inspiration that formulated LWC’s founding vision, and urged us continually onward and upward in the treatment world.

I can also humbly credit LWC’s growth and success to its clinical treatment approach and offerings. As we always affirm and strongly project in our program design, LWC’s official mission is to be the last treatment episode our clients will need before they finally embark on a fulfilling life of better health and enhanced wellness. This clinical approach is specifically designed to restore meaning, purpose, and connection to our clients’ lives. To this end, our clinical providers consciously examine clients – focusing on their behaviors, current beliefs, and their present symptoms – while simultaneously conducting a deep exploration into the past elements and experiences that contributed to the development of that specific symptom presentation. We do all of this with an utmost emphasis on emotional safety, keeping our clients’ needs at the forefront.

While we prioritize emotional safety, we also openly acknowledge that the healing journey is not always comfortable – in fact it’s largely uncomfortable. Healing from old patterns and maladaptive behaviors is difficult. Despite this difficulty and discomfort, and in the face of any challenge, the LWC team is unfaltering in the execution of their expertise and unwavering in their compassionate support.

Our clinical programming, in support and furtherance of our vision, is so valuable in practice. When a client is going through a painful experience, it’s vital that their mental health providers can support and hold that pain, while assisting that individual in discovering ways in which they, too, can hold and manage their own pain while nevertheless making room for new, positive emotions. LWC’s philosophical and practical mental health approach introduces clients to the skills and interventions necessary for healthy emotional and behavioral processing.

In the wake of trauma, our bodies adapt to survive, but simultaneously place us in a constant, and exhausting, state of vigilance. But, through LWC’s human-centric treatment approach, our courageous clients dive into self-discovery, shake up ineffective practices that no longer serve them, and establish and re-establish connections, skills, and beliefs that help them, not just survive, but thrive.

For anyone reading this who is thinking about seeking treatment at LWC, yet may remain unsure, I want you to know that healing is possible! LWC patients are some of the most inspiring and fearless individuals I’ve ever been graced to work with, and their commitment to treatment is extraordinary. You, too, are capable of doing difficult things and achieving a healthier and happier life! Treatment is hard work, this is certainly true, but I know this for certain—it is much harder to live a life out of alignment, absent wellness, and lacking purpose and meaning.

by Lesley Tate-Gould, PsyD, SEP
Co-Founder & Executive Director

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What is EMDR?

Eye Movement Desensitization and Reprocessing is a therapeutic approach utilized to help individuals move past traumatic events. 

Whether the trauma is a little “t” or big “T” event, traumatic occurrences have the potential to reorganize the nervous system into a constant state of hyperarousal (panic attacks) or hypoarousal (numbed out, disassociated). 

 

Most of the time, the mind-body-brain routinely manages new information and experiences without issue. However, when something out of the ordinary occurs, and the event is too overwhelming, such as a car accident or being subjected to chronic adverse experiences like childhood abuse/neglect, our adaptive information processing system (AIP) can become overloaded. These types of events can result in disturbing experiences remaining frozen in the brain or remaining “unprocessed.” 

 

The nervous system becomes hypervigilant, on edge, and overly sensitive to external stimuli. Sight, sound, taste, touch, and smell become powerful triggers that warn the nervous system of danger. Even in the most benign environments, the body can feel unsafe and out of control. The mind will also create a story about the events, often a negative belief (I am responsible, unlovable, unworthy, unsafe). Individuals with unprocessed trauma can appear detached, numbed-out, zoned-out, or struggle with panic attacks, nightmares, flashbacks, intrusive memories/thoughts/images, and become irritable or easily agitated. 

These symptoms of PTSD are frightening and can become debilitating to an individual if untreated. Without the proper treatment and coping skills, a person will implement any strategy for some relief often turning to alcohol, drugs, over-exercising, over-eating, and isolating behaviors to name a few. These strategies often create more issues and even more traumatization. 

How EMDR can help

EMDR posits that the brain has a natural adaptive information processing system (AIP) that under normal circumstances works seamlessly. However, when overwhelming experiences occur, the information from the trauma (images, sounds, feeling states, emotions, and cognition) is not allowed to process or integrate from the Limbic system (home of the fear response) to the prefrontal cortex (home of higher thinking/executive functioning). The eye movements or bilateral stimulation (audio or tactile can be used) assist the brain in reprocessing and integrating the memory. Full integration of the memory from the Limbic system to the prefrontal cortex moves the memory from implicit memory to explicit memory storage. The integration of the memory allows the individual to begin feeling less overwhelmed by external stimuli (sound, smell, taste, touch, sight) and internal stimuli (memories, thoughts, emotions, feeling states) that trigger the fear response (fight or flight). 

A typical session of EMDR lasts between 60-90 minutes with the individual fully awake and in control of the process. The clinician collaborates with the individual to identify target memories, level of disturbance, and validity of negative core beliefs. Bilateral stimulation (eye movements, audio or tactile) are implemented for 20-30 seconds. Once the bilateral stimulation has ended, the client reports any images, emotions, body sensations, and cognitions. The memory is considered integrated and reprocessed when the client reports a SUD (subjective unit of disturbance) of  0-1/10, a VOC (validity of cognition) of 7/7 for positive belief, and a clear body scan (no activation in the body). 

Although the memories are not forgotten, the experience of remembering no longer has the power to create PTSD symptoms. The flashbacks, intrusive images, hypervigilance, disassociation, and negative core beliefs begin to subside. More importantly, the individual can engage in life once again without fear of suffering from a PTSD symptom.

In addition to PTSD, EMDR has been successful in treating the following:

Anxiety, depression, stress, phobias, sleep problems, complicated grief, addictions, pain relief, phantom limb pain, self-esteem, and performance anxiety. 

Further information on the phases of EMDR can be found on www.emdr.org and www.emdr-europe.org  and in the book “Getting Past Your Past” by Francine Shapiro. 

by Janie Montiel, AMFT

Primary Therapist

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