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July 13, 2021

Ketamine Treatment for Depression

Ketamine – that’s an anesthesia, isn’t it? Correct.

But did you know that in sub-anesthetic doses it is also a promising treatment option for pain and depression?

Let’s start at the beginning.

What is Ketamine and how does it work?

Ketamine is a medication primarily used for anesthesia. It is an antagonist of the NMDA receptors in the brain which are responsible for the anesthetic, analgesic and psychotomimetic effects. Although it’s not entirely clear how ketamine works in the treatment of depression, here’s what the scientists think. The binding of the NMDA receptors increase the neurotransmitter glutamate. This then activates the AMPA receptor.  Together, the blockade of NMDA receptors and activation of AMPA receptors leads to the release of other molecules that allow neurons to communicate better. This process is called synaptogenesis and synaptic potentiation, and is the process that is thought to affect mood, thought patterns and cognition.

What is Ketamine being used for in psychiatry?

Ketamine is being used for the management of treatment-resistant depression, bipolar disorder, obsessive compulsive disorder, and post-traumatic stress disorder.

How is Ketamine administered?

At this time, Ketamine is available in multiple formulations, although the intranasal (esketamine) and intravenous routes have the most compelling evidence for the treatment of depression. Whether intranasal or intravenous, repeated dosing is necessary to maintain a therapeutic benefit.

If you’re wondering which is better, there are no current head-to-head studies comparing the two.

Can Ketamine be used alone?

Multiple studies have demonstrated compelling evidence of Ketamine’s effect in treatment-resistant depression. Intranasal esketamine is typically co-administered with an antidepressive medication. Intravenous Ketamine can be administered as monotherapy or adjunctively with a psychotropic regimen.

How is Ketamine tolerated?

Overall, Ketamine is well-tolerated. It has a rapid onset (within 1-2 days) and has been shown to have a rapid reduction in suicidal ideation and depressive symptoms.

The most common side-effect noted with Ketamine administration is dissociation. Individuals describe it as a perceptual disturbance or “abnormal sensation”, but studies have shown no deficits in cognitive function with Ketamine use. For the most part, any changes in perception or dissociation are most noticeable during the first infusion and improve quickly afterward.

Other side effects include high blood pressure, nausea and vomiting.

At this time, the long-term effects of Ketamine are unknown.

In Conclusion…

Ketamine and esketamine represent novel treatment avenues for treatment-resistant depression and other psychiatric disorders. Although the long-term effects are still unknown, multiple studies have demonstrated the efficacy of sub-anesthetic doses of Ketamine in the treatment of psychiatric disorders.

Still have questions? Visit the Ketamine section of our website for more information.

If you are battling treatment-resistant depression and want to know if Ketamine is a treatment option for you, call (913) 381-8555 and make an appointment.

 

References:

McIntyre RS, et al. Synthesizing the evidence of ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation. Am J Psychiatry 2021;178:383-399.

Moda-Sava RN, et al. Sustained rescue of prefrontal circuit dysfunction by antidepressant-induced spine formation. Science 2019;Vol 364, Issue 6436

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September 8, 2020 0

Keep Your (Social) Distance. Tips to Combat Re-Entry Anxiety After Lockdown.

We hope that everyone had a wonderful (and safe!) Labor Day Weekend. As some aspects of everyday life are getting back to normal, or at least the “new normal”, we’d like to discuss social anxiety, specifically in today’s unique circumstances.

You have an upcoming BBQ  you’ve been invited to, or a rescheduled wedding, or you just want to venture out to the grocery store to get a few items for dinner. You want to believe that leaving home is safe again, but as you grab your mask and head out the door, you’re still feeling nervous. Is this normal? The short answer, yes.

Even if you didn’t suffer from overwhelming social anxiety prior to COVID, we’re all experiencing some degree of it now. As we try to cope with the uneasy feelings that come with the country reopening after lockdown, we’d like to discuss a few strategies that may help.

1 – Accept that having some degree of anxiety is normal.

Our current circumstances are unlike anything we’ve ever lived through before. There is no better time than now to practice self-compassion and tolerance.

2 – Think about setting boundaries for socializing. Follow the rules that make sense and that are recommended by reputable sources.

As different parts of the country continue to open at their own speed, it’s ok to also take time to gauge what your own comfort level is with re-socializing. It’s important to have a social support system and communication during these times is going to be key.

It’s counterproductive to go out and run errands or socialize with friends if this is going to send your anxiety through the roof. Consider setting boundaries right now, and let these be known to your family and/or friends ahead of time. It’s also ok for these boundaries to evolve and change. This is a process for everyone.

3 – Practice mindfulness.

Be mindful of how you consume the news. Engage in healthy routines of exercise and reducing/eliminating alcohol and drug use which can worsen your mental health and physical well-being.

Maintain a routine, stay in touch with our community, and try to find small moments of love and joy each day.

4 – Try to manage your emotional response to uncertainty.

Accept that there is no certainty right now, and practicing self-compassion and compassion for those around us is critical at this time. Know that your feelings and anxieties are valid. Even if it seems that no one else is scared or as scared about re-entering the world following lockdown, its ok to have uncertainties and doubts. If you are feeling overwhelmed, try pausing and practicing relaxed breathing or meditation. Try to name the emotion causing such an overwhelming feeling. This can help you recover your sense of control.

5 – If you need more support, do not hesitate to reach out.

If you are having difficulty coping, know that there are resources to help.

We are always here and willing to help at AwakeningsKC. Feel free to call to make an appointment for a consultation in person or by TeleHealth.

For AwakeningsKC Contact information, click here.

Crisis Text Line: Text CRISIS to 741741 for free, confidential crisis counseling.

National Suicide Prevention Lifeline: 1-800-273-8255

As we try to get a sense of what is “safe” and begin socializing again, we must understand that every outing comes with a real amount of risk. It forces the question: How much risk are we willing to tolerate? And it’s something that we must ask ourselves.

The CDC has a dedicated page with helpful tips when considering different social scenarios (such as outdoor versus indoor gatherings), and how to keep yourself and your family as protected as possible. You can visit that page here.

Again, there is no better time than now to practice compassion toward ourselves and others. Things will continue to change and evolve, and although there is a lot of uncertainty regarding the future, we should approach each day, one step at a time, and not hesitate to seek help when needed.

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July 22, 2020 0

Impact on Mental Health of Healthcare Workers during COVID-19

Healthcare workers (HCW’s), including doctors, nurses, nursing assistants, and more, have been on the frontline of the COVID-19 pandemic since it’s onset. You can imagine that this has had a significant impact on their mental health, but to what extent?

Several studies have recently been published describing the increased levels of anxiety, depression, and post-traumatic stress of those directly facing the COVID-19 pandemic. In both China and Italy, around 1300 frontline workers in each country were surveyed. The results were similar in both groups. Increased anxiety was reported by 25-44%, 25-50% reported depression, 10-30% reported insomnia, and 50-70% reported post-traumatic stress symptoms and distress. Younger age and female sex were associated with higher levels of stress in both studies. This could be a confounding factor in both studies, as more nurses, and mostly female nurses, were surveyed, however, it could also be related to the fact that nurses spend more time in direct contact with their patients. Overall, it’s not surprising that the mental health of HCWs has been affected by working on the frontlines of the pandemic.

Following the 2003 SARS outbreak, studies demonstrated an adverse psychological effect among healthcare workers as well. It is clear that pandemics like SARS and COVID-19 can create stress among all populations, but healthcare workers also are tasked with managing this stress while continuing to care for their patients, the increased risk of infecting themselves, and potentially their loved ones. If you or someone you know is experiencing increased anxiety, stress, and/or depression related to the pandemic, do not hesitate to reach out. The CDC has a specific page related to coping with mental health issues during this time, as well as numerous resources listed that you can access here.

References:

  1. Lai J, Ma S, Wang Y. Factors associated with mental health outcomes among health care workers exposed to Coronavirus disease 2019. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229
  2. Rossi R, Socci V, Pacitti F, et al. Mental health outcomes among frontline and second-line health care workers during the Coronavirus disease 2019 (COVID-19) pandemic in Italy. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766378
  3. Pappa S, Vasiliki N, Katsaounou P, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206431/#__ffn_sectitle

 

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July 5, 2020 0

Ketamine for the Treatment of Alcohol Addiction

Alcohol use disorder (AUD), or alcoholism, affects more than 14 million individuals over the age of 18 in the United States alone.1 AUD is described as a chronic brain disease that is characterized by compulsive drinking, loss of control over the consumption of alcohol, and experiencing negative emotions when not using alcohol.2

The treatment of AUD typically starts with detox. For individuals with a physiological dependence to alcohol, the abrupt cessation of drinking could result in serious complications, such as alcohol withdrawal seizures. A supervised medical detox, whether inpatient or outpatient, is always recommended.3

So I’ve completed detox, what’s next? 

Treatment programs, like Awakenings KC, will employ various modalities to assist in continued abstinence from alcohol. These include, but are not limited to, behavioral therapy, family therapy, and/or the treatment of co-occurring disorders.

An additional treatment for alcohol addiction offered by Dr. Davila at Awakenings KC is ketamine infusion therapy.

What is ketamine?

Ketamine is an anesthetic medication that acts on the central nervous system through antagonism of the N-Methyl-D-Aspartate (NMDA) receptor.4-6 Ketamine is different than other anesthetics in that it has a good safety profile and lacks the major drawback of respiratory depression.5

Over the past decade, it has been increasingly used in the treatment of depression and addiction. How does it work? Well, scientists are not 100% sure, but several mechanisms have been proposed and substantiated with research. Several animal and human models have demonstrated that ketamine can rewrite maladaptive reward memories, enhance neuroplasticity and neurogenesis, and enhance psychological therapy efficacy.4-6

Ketamine in the treatment of addiction.

Ketamine has shown promising results in the treatment of addiction.4-6 Studies have shown that ketamine infusion can promote abstinence from alcohol and reduce cravings. In recently detoxified alcoholics, abstinence rates increased from 24% to 66% in the ketamine group.7

Although ketamine itself has been utilized as a drug of abuse, in sub-anesthetic doses, it is not “rewarding”. In multiple studies, there were no patients that went on to abuse ketamine following their infusion treatments.6

In summary…

Ketamine has been shown to increase synaptogenesis and neuroplasticity.6 What does this mean? It helps restructure and reorganize the brain at a cellular level, helping to reverse the changes that are associated with depression and addiction.

Ketamine is safe, effective, and shows promising results in the treatment of depression and addiction.

If you’re interested in more information about ketamine infusions, check out the Awakenings KC website here or call for a consultation – (913) 381-8555.

 

References:

  1. Alcohol facts and statistics – NIH
  2. Alcohol abuse and addiction – NIH
  3. Alcoholism treatment: what is alcohol abuse and how to treat alcoholism – American Addiction Centers
  4. Das RK, Grace G, Walsh K, et al. Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories. Nature communications. 2019;10:5187.
  5. Ezquerra-Romano I, Lawn W, Krupitsky E, et al. Ketamine for the treatment of addiction: evidence and potential mechanisms. Neuropharmacology. 2018;142:72-82.
  6. McAndrew A, Lawn W, Stevens T, et al. A proof-of-concept investigation into ketamine as a pharmacological treatment for alcohol dependence: study protocol for a randomized controlled trial. Trials. 2017;18:159.
  7. Krupitsky EM, Burakov AM, Romanova TN, et al. Attenuation of ketamine effects by nimodipine pretreatment in recovering ethanol dependent men: psychopharmacologic implications of the interaction of NMDA and L-type calcium channel antagonists. Neuropsychopharmacology. 2001;6:936-47.

 

 

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April 13, 2020 0

Coping with stress and anxiety during the COVID-19 pandemic

As the first few months of the New Year progressed, we watched in shock and fear as the coronavirus pandemic swept China, Italy, and other countries across the globe. Over the last couple months, we have come face-to-face with this same invisible, life-threatening enemy in our own backyard. City, state, and national government officials have implemented social distancing and lock-down regulations, and for each of us, it is safe to say that life has changed in a dramatic fashion.

COVID-19 has caused widespread anxiety throughout the United States, even becoming a compounded issue for those with pre-existing mental health diagnoses. Adding to the fear of the disease itself, we have been forced to distance ourselves from those around us, isolate at home, and only seek medical care if emergent. The silver lining can be found in applications such as FaceTime, Skype, and Zoom, which allow us to continue to connect with colleagues, friends, and loved ones. Physicians are also turning to Telemedicine to ensure that communication with patients is still available in a manner that decreases unnecessary exposure to the medical setting, but is also HIPAA-safe. Despite these unprecedented times that we find ourselves in, it is beneficial to know that we have still have the ability to connect, albeit virtually, with others.

We are currently a few weeks into the pandemic here in the Midwest, and the largest anxiety-provoking question remains, how long will life continue this way? There is a great fear in the unknown that currently surrounds us all. So what are we to do to help us manage the stress, anxiety, depression, and overwhelming feelings? We’ll discuss a few tips and practices that can help you cope with our current circumstances.

  1. First and foremost, take care of yourself so that you can take care of your family and community.
    • Begin each day with gratitude. Each morning think of something, no matter how small, that you are grateful for. This practice can also be done with your kids! The current situation that we’re living in is heavy, but thinking of things that make us thankful can help start the day with a more positive outlook.
    • Exercise, stretch, meditate.
    • Eat regular, well-balanced meals.
    • Avoid drugs and alcohol.
  2. Practice a routine.
    • Create daily goals for yourself, your kids, and your family. Most individuals, including children, are used to their day being organized and structured, so it can help to continue this while at home.
  3. Take breaks from the 24/7 media coverage.
    • Hearing about the pandemic constantly can be upsetting. Try to limit your exposure and select specific news outlets that you find to be the most useful. It is good to be informed, but shouldn’t be overwhelming.
    • Obtain accurate information and know the facts about the disease. Try not to fall victim to over-sensationalized headlines and news reports. It’s easier said than done, but obtaining evidence-based, accurate information can help reduce stress surrounding the pandemic. Knowing the facts about the disease can help keep you, your family and your community safe.
  4. Connect with others.
    • Physical distancing does not mean that we cannot still reach out to those we love, whether it be by text, telephone or video call. Stay in touch with friends, family members and colleagues. Everyone is feeling anxious to some degree, and it is ok to discuss these anxieties.
  5. Last, but certainly not least, if stress is getting in the way of your daily activities for multiple days in a row, or you are having thoughts of hurting yourself or hurting others, immediately call a healthcare provider or proceed to your nearest emergency room.
    • Most doctor’s offices are providing telemedicine services and/or seeing patients that need urgent help. Don’t hesitate to reach out.
    • Awakenings KC is still open and offering Telemedicine visits, as well as in-office TMS and Ketamine infusions. Please call the office if you would like more information.

Resources:

Through this difficult time, it is of utmost importance to stay connected. Reach out to friends and/or loved ones that you know might be having a hard time. Offer the above resources if you think that they will help. If you have any additional tips or tricks on how you’re coping with the increased stress and anxiety, please share with us in the comments. We would love to hear from you. We wish everyone the best, and remember, we will get through this.

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May 8, 2017 0

6 Facts on How TMS Can Treat Your Depression

Transcranial Magnetic Stimulation (TMS) is a treatment for Major Depressive Disorder (commonly known as depression) that is gaining recognition for its success rate. We provide free consultations to see if TMS is right for you. In our office, we have had over 200 patients go through the TMS treatment since 2013. Of those who did it, 66% achieved full remission from depression and 90% had a positive response to the TMS treatment. Here are 6 facts on how TMS can treat your depression.

Works Cited

  1. Ranna Parekh, M. M. (2017, January). What is Depression? Retrieved from psychiatry.org: https://www.psychiatry.org/patients-families/depression/what-is-depression
  2. Ph.D., E. S. (2014, August 7). Are Antidepressants Effective? Retrieved from psychologytoday.com: https://www.psychologytoday.com/blog/how-everyone-became-depressed/201408/are-antidepressants-effective
  3. What causes depression? (2017, April 11). Retrieved from Health.harvard.edu: http://www.health.harvard.edu/mind-and-mood/what-causes-depression
  4. Staff, M. C. (2015, December 03). mayoclinic.com. Retrieved from Transcranial Magnetic Stimulation: http://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/details/risks/cmc-20163840
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