Ketamine is a drug currently approved by the FDA for use as a general anesthetic during minor surgical procedures such as biopsies. It is widely known as a recreational drug because of its ability to induce cognitive-dissociative, hallucinogenic, and euphoric states in humans. Recently, it has been implicated in research as a potential therapeutic agent in depression especially in patients who have failed previous standard therapies.
Standard pharmacologic therapies for depression take several weeks of treatment before patients experience relief. Ketamine is different in that it has been shown to reduce depression symptoms and suicidal ideation in as little as forty minutes. This is considered a potentially lifesaving breakthrough in the treatment of depression because ketamine can rapidly reduce symptoms especially in emergency situations.
How does it work?
The most common medications used in depression affect serotonin in the brain. Ketamine works by a different mechanism. It has been shown to block the glutamate receptors in the brain resulting in its famous hallucinogenic effects. Ketamine has been shown to act on several other receptors, but it is theorized that at low doses, blocking glutamate receptors in the brain may be the reason for its anti-depressive effects.
Who should (and shouldn’t) take ketamine?
Ketamine has not been approved by the FDA for treatment of depression. Although, because of new studies, psychiatrists have been prescribing ketamine “off-label” for patients who did not respond to selective serotonin reuptake inhibitors (SSRIs) such has Celexa (citalopram), Zoloft (sertraline), or Prozac (fluoxetine) for immediate treatment of symptoms.
Ketamine has been shown to transiently yet significantly increase blood pressure following administration. Patients with high blood pressure should use caution when using ketamine. Ketamine has also been shown to be associated with increases in psychosis or dissociative properties.
Ketamine nasal sprays offer a quick and convenient way to administer ketamine for patients who need immediate relief, although they are currently not available commercially, so you will not find them at your local community pharmacy. Compounding pharmacies have the proper experience, equipment, and personnel to safely compound and customize this medication for you.
This study suggests that ketamine can safely be used to avoid intubation and may decrease length of intensive care unit stay.
Severe alcohol withdrawal, or delirium tremens (DT), is a life-threatening condition that can require massive doses of benzodiazepines or barbiturates (GABA agonists), which can require intubation and prolonged intensive care unit (ICU) care. These authors studied a retrospective sample of adult patients admitted to a single ICU with DT to determine whether adjunctive therapy with ketamine improved outcomes.
They compared outcomes in 29 patients who received symptom-triggered therapy with GABA agonists with outcomes in 34 patients who were treated after initiation of a guideline that added an intravenous ketamine infusion (0.15–0.3 mg/kg/hour) to GABA agonist therapy. Using multivariable modeling that accounted for initial ethanol level and the total amount of GABA agonist required for treatment, patients who received ketamine had significantly lower rates of intubation (29% vs. 76% for patients who did not receive ketamine) and shorter ICU stay (5.7 days vs. 11.2 for patients who did not receive ketamine). There were no reported adverse events.
Cera-Q – The Anti-Aging Supplement From a Silkworm
Getting old sucks. From the physical standpoint, our metabolism slows down, muscle gain and fat loss become more difficult, and joints stiffen. From the cognition standpoint, our forgetfulness increases, it becomes more difficult to learn new tasks, and our brain physically shrinks in volume.
In the early 2000s, a group of researchers from South Korea began exploring all-natural compounds that could fight brain aging and discovered one of the most unlikely heroes – the silkworm. Specifically, the cocoon of the species Bombyx mori.
As we age, harmful protein called beta-amyloid plaque builds up in the brain. This plaque degrades neuron membrane receptors, blocks cell-to-cell signaling, and increase whole-body inflammation.  Researchers currently believe the buildup of beta-amyloid plaques is the primary cause of Alzheimer’s, the most common neurodegenerative disease on the planet.
Cera-Q is a protein hydrolysate extracted from fibroin, the major protein in silkworm cocoons.  Traditional Korean medicine has prescribed silkworm fibroin for centuries to improve health and longevity. This protein’s high glycine and alanine content (~75% of the total amino acid composition), paired with a unique molecular structure, offers the unique advantage of binding to and preventing the buildup of amyloid plaque in the human brain. 
In addition to fighting against beta-amyloid plaque buildup, Cera-Q can also increase glucose uptake to the brain which provides energy and support during both simple and complex cognitive tasks.  Multiple studies on humans, animals, and cells verify Cera-Q potency and efficacy as an anti-aging compound for the brain.
The process for isolating Cera-Q is somewhat complex. Researchers place the silkworm cocoon in a mixture containing water and proprietary enzymes to isolate the fibroin protein found into a combination of short chains of amino acids called peptides.  After isolating the protein in hydrolysate form, the mixture is dried to eliminate the water so that only the protein remains.
The result is Cera-Q powder. Cera-Q is a water-soluble tan to yellowish-tan powder with greater than 65% protein and less than 10% moisture by weight, a semi-sweet taste like the amino acid L-glycine, and a shelf life of up to two years. 
To fight aging and cognitive decline the manufacturers of Cera-Q recommend a dosage of 200mg to 400mg per day divided across two to three servings.  One study found minor benefit with a dosage as low as 10mg per day but most research uses a daily 200mg to 400mg dosage. The dosage varies slightly based on the desired application of Cera-Q, characteristics of the end user, and other ingredients that may be included in a supplement containing Cera-Q.
Higher doses offer a greater benefit when consumed for a short period but also carry a higher cost. A lower dose is more cost-efficient and beneficial when consumed chronically for a longer period but may not offer the immediate benefits seen with higher doses.
You can purchase Cera-Q Silk Protein Hydrolysate as a single ingredient supplement or as a part of a multi-ingredient blend in gummy chews, beverage, shot, powder, tablet, and capsule forms.  There is a form of Cera-Q for your regardless of how you prefer to take your supplements.
Cera-Q also works synergistically with caffeine when consumed together in a one to one ratio. 200 to 400mg of each compound can improve brain circulation, deliver more glucose to the brain, release more fatty acids, and create a blood pressure neutral environment. Cera-Q decreases blood pressure whereas caffeine increases blood pressure.
Studies on animals and human cells confirm silk protein hydrolysate’s ability to fight against harmful beta-amyloid plaques that build up in the brain as we age. Cera-Q also reduces the amount of dead tissue resulting after ischemia, an event in which a vital organ (usually the heart) or body part receives an inadequate blood supply.
Researchers injected beta-amyloid protein in the hippocampal region of rat brains and then provided 5 to 10mg per kilogram of bodyweight oral doses of Cera-Q to rats for two continuous weeks. The beta-amyloid protein reduced acetylcholine levels in the brain by 45%. Just 5 to 10mg of Cera-Q per kilogram of bodyweight restored acetylcholine levels to between 78 and 80% of the levels found in the control population. 
Low levels of acetylcholine significantly impair learning, memory, and cognitive function. A study on human cells found that administering Cera-Q two hours prior to administering beta-amyloid protein normalized cell appearance and prevented 85% of cell death compared to the control group.  Beta-amyloid protein buildup in the brain paired with high rates of cell death expedites the aging process and neurodegeneration.
Cera-Q exhibits antioxidant properties through its ability to protect against reactive oxygen species. High levels of reactive oxygen species in the body hamper our immune system and increase inflammation. Reactive oxygen species levels were 65% lower in cells receiving Cera-Q after receiving beta-amyloid proteins and just 15% higher than the control cells receiving no beta-amyloid proteins. 
As we age we also experience an increased likelihood of insufficient blood supply to vital organs. Researchers blocked the middle carotid artery of rats and then provided them with a 10mg per kilogram dose of Cera-Q daily or placebo for seven days.
Rats receiving Cera-Q had a smaller area of dead tissue around the area damaged insufficient blood supply, experienced a smaller loss of neurons, and improved memory compared to the control group.  Silk protein hydrolysates in the form of Cera-Q may become a staple compound in fighting against heart attacks and Alzheimer’s.
A sharp mind and lucid memory is critical for fighting the aging process. The studies on Cera-Q consumption in humans found that it benefits the memory and learning capabilities of children, adults, and seniors.
In 2004, 53 healthy Korean females and 13 healthy Korean males with an average age of 42 consumed either 0mg, 200mg, or 400mg of Cera-Q daily for three weeks. These individuals then completed Digit Symbol Test portion the Korean-Wechsler Adult Intelligence Scale. The Digit Symbol Test is a variation of number memorization used to measure brain damage, dementia, age, and depression. 
Individuals consuming placebo did not show improvement over baseline but those consuming 200mg and 400mg of Cera-Q increased their scores by 11.3% and 22.2%, respectively.  These results are staggering after just three weeks of supplementation.
A larger study of 99 healthy Korean adults asked individuals to consume 0mg placebo, 200mg, or 400mg of Cera-Q daily for three weeks and perform the Rey-Kim Memory Test.  This test measures both auditory and visual memory.  The placebo group experienced no improvements but both Cera-Q groups experienced significant improvements in memory maintenance as measured by word recall in a dose dependent manner. 
This means that the 400mg group had superior improvements in word recall compared to the 200mg group. The 200mg and 400mg groups also improved memory recall efficiency by 90% and 60%, respectively, compared to their intra-group baseline.  The baseline memory recall efficiency was higher for those in the 400mg group compared to the 200mg group.
This 99-person study also examined everyone’s memory quotient (MQ) and found the pre-study average to be 105.  Memory quotient assesses memory for content, location, and sequence as measured by questions related to short-term recall and recognition of both meaningful and abstract material.  A low memory quotient indicates diminished or impaired memory and logic.
At the end of the study researchers found that those in the placebo group increased their memory quotient by 3% but those in the 200mg and 400mg Cera-Q groups increased their memory quotient by a staggering 12% and 21%, respectively.  Keeping a sharp memory is critical for fighting the aging process and silk protein hydrolysate may be one of the most potent substance to help you do so.
1) “Alzheimer’s Brain Plaques.” Alzheimer’s Association, 2016, Accessed Dec. 2016.
2) “Cera-Q: FAQS.” Cera-Q, 2016, Accessed Dec. 2016.
3) “Cera-Q – Function. Focus. Freedom.” Novel Ingredients, July 2016, Accessed Dec. 2016.
4) Cera-Q Silk Protein Hydrolysate Brain Effects & Human Clinical Studies White Paper. Novel Ingredients, 2016. Accessed Dec. 2016.
5) “Cera-Q: How It Works.” Cera-Q, 2016, Accessed Dec. 2016.
6) “Cera-Q: Products and Applications.” Cera-Q, Accessed Dec. 2016.
7) Kim DK, Kang YK, Lee MY, Lee KG, Yeo JH, Lee WB, Kim YS, Kim SS. Neuroprotection and enhancement of learning and memory by BF-7. J Health Sci 2005; 51(3):317-324.
8) Chae HS, Kang YK, Shin YK, Lee HJ, Yu JI, Lee KG, Yeo JH, Kim YS, Sohn DS, Kim KY, Lee WB, Lee SH, Kim SS. The role of BF-7 on neuroprotection and enhancement of cognitive function. Kor J Physiol Pharmacol 2004 Aug; 8:173-179.
9) Lee JY, Lee SH, Sung JJ, Kim ET, Cho HJ, Kim KH, Kang YK, Kim SS, Kwon OS, Lee WB. [The effect of BF-7 on the ischemia-induced learning and memory deficits]. Kor J Anat 2005; 38(2):181-188. Korean
10) Lee et al.,[BF-7 improved memory function and protected neurons from oxidative stress]. Kor J Phys Anthropol 2004c; 17(4):313-320. Korean
11) “Digit/Symbol Coding Test.” Cognitive Atlas, National Institute of Mental Health, 2016, Accessed Dec. 2016.
12) Lee et al.,[BF-7 improved memory function and protected neurons from oxidative stress]. Kor J Phys Anthropol 2004c; 17(4):313-320. Korean
13) Kim et al., Neuroprotection and enhancement of learning and memory by BF-7. J Health Sci 2005; 51(3):317-324.
14) Na, Kyoung-Sae et al. “Mediating Effects of Cognitive Effort and Depression on Intelligence, Memory, and Executive Functions in Individuals with Mild Traumatic Brain Injury.” Psychiatry Investigation 11.2 (2014): 112-118. PMC. Web. Dec. 2016.
15) “Universal Nonverbal Intelligence Test (UNIT).” Eastern Washington University, 2016, Accessed Dec. 2016.
Ketamine offers a new option for people with stubborn depression that doesn’t respond to other medications.
Many people know of ketamine as a hallucinogenic and addictive street drug, which, when abused, can put people in medical peril. But today, doctors are increasingly looking to ketamine as a potentially lifesaving treatment for people with severe, treatment-resistant depression, who may be at high risk for suicide.
“Ketamine has been shown to be effective in people who have not responded to antidepressant treatment,” says Dr. Cristina Cusin, an assistant professor of psychiatry at Harvard Medical School. The fast-acting treatment has shown promise — sometimes improving depressive symptoms within hours of the first intravenous treatment.
While ketamine can offer hope to some, it’s not for everyone. The use of ketamine to treat depression is still controversial in some circles. “Some prescribers would never consider the use of a controlled substance for this purpose, because of the potential for abuse,” says Dr. Cusin. “But as with opiates, a drug is not good or bad, per se.” Still, ketamine does need to be carefully matched to the right patient for the right use to avoid harm, and treatment should be closely monitored over time.
A variety of uses
The use of ketamine in medicine isn’t new. It’s routinely used in hospitals both for anesthesia and for pain relief.
Currently, the use of ketamine for depression is “off label.” This means that although ketamine is approved by the FDA for some medical purposes, it’s not approved specifically to treat depression. However, that may soon change. Under its “fast track” drug approval process, the FDA is reviewing the results of clinical trials of esketamine, a ketamine-based nasal spray, to treat depression, says Dr. Cusin.
For now, people who undergo ketamine treatment for depression typically receive the drug at specialized clinics, either intravenously or as a nasal spray. Effects from the nasal spray last for a single day or a few days, while the intravenous treatment may last for a few weeks to a month. In both instances the dose is significantly lower than would be used for anesthesia or when used illicitly.
How ketamine works
Studies have shown that ketamine is effective in treating people whose depression has not responded to other interventions, says Dr. Cusin. Such treatment-resistant depression is estimated to affect from 10% to 30% of people diagnosed with the condition.
Experts believe that ketamine works through a unique mechanism, directly modulating the activity of a brain chemical called glutamate. Glutamate is believed to play a role in stimulating the growth of new brain connections that may help alleviate depressive symptoms.
People who have taken ketamine to treat their depression experience varying success, depending on their personal history—how long they’ve been depressed, how severe their symptoms are, and how many drugs they’ve tried without seeing improvement, says Dr. Cusin.
For people with less severe depression, ketamine may be effective in as many as 60% of those who try it. Among those with more persistent and significant disease, a smaller number, 30% to 40%, may experience relief, says Dr. Cusin. “The expectation should not be that it will magically cure depression in everybody,” she says. “Ketamine is not a perfect fix. It’s like any other medication.” In other words, it works for some people, and it won’t work for others.
To be effective, treatment with ketamine must typically continue indefinitely and involve careful monitoring. Clinicians who prescribe ketamine for depression should screen patients carefully to ensure the drug is appropriate for the individual, says Dr. Cusin. “Not everybody who wishes to try ketamine will be a good candidate,” she says.
Among those who should not use ketamine are people with
a history of substance abuse
a history of psychosis
elevated blood pressure
an uncontrolled medical condition.
Who can benefit?
Because ketamine is a newer treatment, there are still a lot of questions surrounding its use, says Dr. Cusin. For instance:
Which people respond best to treatment?
How much should be given, and how often?
What are the long-term effects of treatment?
Because the medication is being used off label for depression, there are no clearly defined safety recommendations either for home use or for its use in specialized clinics, she says. This means that it’s up to individual providers to guide the patient in making informed decisions about treatment. Choosing a qualified provider is essential. JAMA Psychiatrypublished a statement in 2017 outlining best practices for doctors to follow in ketamine treatment, such as performing a comprehensive assessment, obtaining informed consent, and documenting the severity of depression before starting the medication. These guidelines are aimed at increasing the safe use of ketamine for depression, and providers can use them to help ensure that the treatment is a good match for your condition.
As with any other medical intervention, anyone considering ketamine should also consider the drawbacks of treatment along with the potential benefits. Ketamine’s drawbacks include these:
Cost. It’s expensive and not covered by insurance. “The cost ranges from $400 to $1,200 per dose for the intravenous drug, and you may need as many as 12 to 18 doses a year,” says Dr. Cusin.
Unknowns. Ketamine hasn’t been used to treat depression for long enough for doctors to know whether there are any harmful long-term consequences of taking the medication. More time and study are needed to truly understand how it affects people over the long term.
Treatment failure. Many people with treatment-resistant depression view ketamine treatment as their last option, so if this therapy fails to improve their depression, they can be emotionally devastated. Realistic expectations and follow-up support are essential.
Even if ketamine does produce results, it’s still important to understand what it can and can’t do. “-Ketamine isn’t going to eliminate all frustrations and stress from your life. While it may lift some symptoms of depression, the life stressors will still be there,” says Dr. Cusin. You’ll still need support to help you manage them.
Side effects. While ketamine is viewed as safe in a controlled setting, it can frequently increase blood pressure or produce psychotic-like behavior, which may result in delusions or hallucinations. Serious adverse events are rare because the drug is used at such low doses, says Dr. Cusin.
However, provided you are an appropriate candidate for the treatment and your doctor monitors you closely, you could find that it improves your mood. “Ketamine could make a huge difference in the quality and duration of life and can be very effective for people who are thinking about suicide,” says Dr. Cusin.
Seasonal Affective Disorder and Ketamine Infusions as a rapid treatment
Do you find yourself getting depressed and sad in the fall and wintertime despite your best efforts? Seasonal affective disorder is common and can disrupt your lifestyle and happiness. Consider Ketamine infusions as an option for immediate relief with follow through intranasal ketamine. We can provide these solutions for people suffering from this disorder. A series of 2- 6 infusions can manage the majority of patients with rapid recover, almost within a few days.
Seasonal Affective Disorder, or SAD, is a type of recurrent major depressive disorder in which episodes of depression occur during the same season each year. This condition is sometimes called the “winter blues.”
Seasonal affective disorder (also called SAD) is form of depression in which people experience depressive episodes during specific times of the year. The most common seasonal pattern is for depressive episodes to being in the fall or winter and diminish in the spring. A less common type of SAD, known as summer depression, usually begins in the late spring or early summer. SAD may be related to changes in the amount of daylight a person receives.
SAD is not considered as a separate disorder, but rather is a type of depression that has a recurring seasonal pattern. To be diagnosed with SAD, an individual must meet criteria for major depression coinciding with specific seasons for at least two years. The individual must experience seasonal depressions much more frequently than any non-seasonal depressions.
Seasonal affective disorder is estimated to affect 10 million Americans. Another 10 percent to 20 percent may have mild SAD. SAD is four times more common in women than in men. The age of onset is estimated to be between the age of 18 and 30. Some people experience symptoms severe enough to affect quality of life, and 6 percent require hospitalization. Many people with SAD report at least one close relative with a psychiatric disorder, most frequently a severe depressive disorder (55 percent) or alcohol abuse (34 percent).
Not everyone with SAD has the same symptoms, but symptoms commonly associated with the “winter blues” include the following:
Feelings of hopelessness and sadness
Thoughts of suicide
Hypersomnia or a tendency to oversleep
A change in appetite, especially a craving for sweet or starchy foods
A heavy feeling in the arms or legs
A drop in energy level
Decreased physical activity
Increased sensitivity to social rejection
Avoidance of social situations
Symptoms of summer SAD are:
Agitation and anxiety
Either type of SAD may also include some of the symptoms that are present in major depression, such as feelings of guilt, a loss of interest or pleasure in activities previously enjoyed, ongoing feelings of hopelessness or helplessness, or physical problems such as headaches and stomach aches.
Symptoms of SAD tend to reoccur at about the same time every year. To be diagnosed with SAD, the changes in mood should not be a direct result of obvious seasonal stressors (like being regularly unemployed during the winter). Usually, this form of depression is mild or moderate. However, some people experience severe symptoms that leave them unable to function in their daily lives.
Seasonal affective disorder can be misdiagnosed as hypothyroidyism, hypoglycemia, or a viral infection such as mononucleosis.
The cause for SAD is unknown. One theory is that it is related to the amount of melatonin in the body, a hormone secreted by the pineal gland. Darkness increases the body’s production of melatonin, which regulates sleep. As the winter days get shorter and darker, melatonin production in the body increases and people tend to feel sleepier and more lethargic.
Another theory is that people with SAD may have trouble regulating their levels of serotonin, which is a major neurotransmitter involved in mood. Finally, research has suggested that people with SAD also may produce less Vitamin D, which is believed to play a role in serotonin activity. Vitamin D insufficiency may be associated with clinically significant depression symptoms.
There are several known risk factors that increase an individuals chance of developing SAD. For example, SAD is more frequent in people who live far north or south of the equator. Additionally, people with a family history of other types of depression are more likely to develop SAD than people who do not have this family history.
Treatment approaches to alleviate the symptoms of SAD typically include combinations of antidepressant medication, light therapy, Vitamin D, and counseling.
Because winter depression may be caused by a reaction to a lack of sunlight, broad-band light therapy is frequently used as a treatment option. This therapy requires a light box or a light visor worn on the head like a cap. The individual either sits in front of the light box or wears light visor for a certain length of time each day. Generally, light therapy takes between 30 and 60 minutes each day throughout the fall and winter. The amount of time required varies with each individual. When light therapy is sufficient to reduce symptoms and to increase energy level, the individual continues to use it until enough daylight is available, typically in the springtime. Stopping light therapy too soon can result in a return of symptoms.
When used properly, light therapy seems to have few side effects. The side effects that do arise include eyestrain, headache, fatigue, irritability, and inability to sleep (when light therapy is used too late in the day). People with manic depressive disorders, skin that is sensitive to light, or medical conditions that make their eyes vulnerable to light damage may not be good candidates for light therapy.
When light therapy does not improve symptoms within a few days, then medication and behavioral therapies such as CBT should be introduced. In some cases, light therapy can be used in combination with one or all of these therapies.
Monitor your mood and energy level
Take advantage of available sunlight
Plan pleasurable activities for the winter season
Plan physical activities
Approach the winter season with a positive attitude
When symptoms develop seek help sooner rather than later
The woman had used oxycodone for almost a decade but told her doctors she had been sober for two years. She never touched narcotics during her pregnancy, she said, and had completed rehab.
But her newborn son was in withdrawal: jittery, screaming and requiring an infusion of morphine to stay alive. The infant craved drugs, but why?
Amid an opioid epidemic, the boy’s doctors didn’t blame heroin, fentanyl or other illicit substances. Instead, they said, the infant had grown dependent on a controversial herbal supplement: kratom.
‘A false sense of safety’
According to a case report published Wednesday in the journal Pediatrics, both the unnamed woman and her infant passed urine drug screens that looked specifically for oxycodone and other opioids. But those tests didn’t look for kratom, a legal drug that has opioid-like effects at high doses.
The plant, which is native to Southeast Asia, is typically used to treat pain and curb opioid cravings. Acting on the same brain receptors as morphine and similar drugs, it is hailed by someas a solution to the opioid epidemic but derided by the US Food and Drug Administration as a potentially dangerous psychoactive drug.
The mother denied using any substances during her pregnancy — legal or otherwise — but her husband told doctors that she drank kratom tea daily to treat her withdrawal symptoms and help with sleep.
“I fear that women making genuine commitments to overcome their dependency may develop a false sense of safety by using a substance that is advertised as a non-opioid alternative,” said Dr. Whitney Eldridge, a neonatologist for BayCare Health System in Florida who was lead author on the case report.
The mother might have been well-intentioned, but because tests showed no other drugs in her or the infant, her doctors said kratom probably caused her son’s condition, known clinically as neonatal abstinence syndrome. On his eighth day of life, after he had been weaned off opioids and observed without any medications, the boy was discharged to his parents.
It’s rare, but FDA Commissioner Dr. Scott Gottlieb said in a statement that “this case is not unique.” He said the FDA “is aware of four other cases involving neonates exposed to kratom while in utero who experienced neonatal opioid withdrawal syndrome after term delivery.”
Gottlieb, whose agency has issued a varietyofwarningson kratom, called the new report “a tragic case of harm” and said it “further illustrates the concerns the FDA has identified about kratom, including the potential for abuse and addiction.”
And though Eldridge hopes more research will help lawmakers better regulate kratom, she believes that physicians today “need to counsel women who are pregnant about the risk of kratom such as they would any other legal substance that can have ill effects on their newborn.”
Experts urge caution, cast doubt
Some experts are hesitant to draw any conclusions from the report. They note that although maternal kratom use could theoretically cause neonatal abstinence syndrome, the case did not explicitly link kratom to the infant’s withdrawal symptoms.
“I’m not surprised that this is possible,” said Dr. Andrew Kruegel, an associate research scientist at Columbia University, “because kratom certainly has opioid effects and can induce tolerance in users, especially at higher doses.”
But Kruegel, who has studied the plant for seven years, noted that doctors weren’t able to test the purported kratom itself. “The main limitation is that we don’t know anything about the dosage that the mother was taking,” he said. “Without that information, you can’t really extrapolate too much.”
And the mother might not have been taking kratom at all, said Dr. Edward W. Boyer, an associate professor at Harvard Medical School and a physician in the Department of Emergency Medicine at Brigham and Women’s Hospital.
“It’s the husband who reported the kratom use,” he said. “The wife who actually ingested the product, who thought it was kratom, and the authors of the case report itself, none of those people actually verified that she was ingesting kratom.”
Kratom’s rocky past and uncertain future
Despite the FDA’s warnings, kratom is easy to buy and is sometimes sold as a tea in cafés. The nonprofit American Kratom Association estimates that 3 million to 5 million Americans use the substance, and the group says it’s open to warning labels on kratom products.
“We believe that, as in many supplements, there should be a warning that pregnant women shouldn’t take this,” Dave Herman, the association’s chairman, said. “That’s not because we think it’s detrimental. It’s because it’s a safety measure.”
Kratom acts on opioid receptors, which the FDA says is evidence of its potential for abuse. The agency points to 44 deaths associated with kratom, but Kruegel said that “if you look at those 44 deaths, the vast majority of them involve other substances, including other strong opioids.”
Boyer said kratom may have other risks, such as seizures, but he noted that it might be safer than most opioids because “there does not seem to be respiratory depression when kratom is used alone.”
Respiratory depression — slow and ineffective breathing — is what makes opioid overdoses so deadly. That’s why Boyer believes well-regulated kratom could one day be used in the fight against opioid addiction, steering users away from more dangerous drugs.
“If you do the right thing and do the rigorous studies, then there is no reason why [kratom] shouldn’t be a prescription pharmaceutical that serves as a bridge to formal drug treatment, particularly for individuals who can’t get into therapy,” Boyer said.
Challenges to developing kratom-based drugs
The American Kratom Association says there’s little incentive for pharmaceutical companies to study kratom as a potential prescription drug, especially because they can’t patent the raw plant.
“If I’m a drug company, I think that it costs somewhere, depending on who you speak to, between $1.2 and $1.8 billion to bring a new drug to market,” Herman said. “Who would spend that kind of money when some other guy can just get on a boat, ride down a river and grab it off a tree?”
Because kratom is considered a dietary supplement, manufacturers don’t need FDA approval to sell it as long as their products don’t claim to cure or treat specific conditions or symptoms.
But some companies have done just that, drawing the FDA’s ire for saying their products could “relieve opioid withdrawal” or “treat a myriad of ailments.” The association says those cases are anomalies.
“The reality is, our belief is, this is America,” Herman said. “And if a product is useful for your health and well-being, you should have the right to take it, as long as it doesn’t harm you. And we haven’t seen any evidence of that harm.”
The FDA, however, continues to warn against kratom, even suggesting that it could worsen the opioid epidemic.
“Kratom has never been studied in humans,” Gottlieb said in the statement. “What consumers and health care providers need to understand is that there are no proven medical uses for kratom. Instead, as the FDA has warned, kratom can cause serious harm and is contributing to the opioid crisis.”
Ketamine is emerging as a popular treatment for depression. New research suggests the drug acts like an opioid
Ketamine is emerging as a way to treat depression, but it appears to act like an opioid, Stanford researchers found.
Clinics are cropping up around the country where people receive ketamine infusions.
A handful of pharmaceutical companies, including Johnson & Johnson and Allergan, are using ketamine as inspiration for new prescription drugs to treat depression.
This is a vial of the animal tranquilizing drug ketamine hydrochloride, better known in the drug culture as “Special K.”
Ketamine is emerging as a way to treat depression, but it appears to act like an opioid — and it may carry similar risks, Stanford researchers found.
Clinics are cropping up around the country where people receive ketamine infusions. A handful of pharmaceutical companies are using ketamine as inspiration for new prescription drugs to treat depression. Yet the new research questions whether scientists know enough about chronic ketamine use to introduce it broadly.
The drug blocks NMDA receptors, which scientists think may treat depressive symptoms. Researchers wanted to test whether it was possible to elicit this reaction without activating the brain’s opioid receptors.
To block an opioid response, they gave participants naltrexone then infused them with ketamine. To compare that response with the normal response, they also gave participants a placebo before giving them the treatment.
Naltrexone so successfully blocked the anti-depressant effects of ketamine that researchers cancelled the study after the first interval because they felt it wasn’t ethical to continue it, said Dr. Nolan Williams, one of the study’s authors and a clinical assistant professor of psychiatry and behavioral sciences at Stanford University.
When patients took naltrexone, the opioid blocker, their symptoms did not improve, suggesting ketamine must first activate opioid receptors in order to treat depression, according to the study, published Wednesday in the American Journal of Psychiatry.
That’s not to say ketamine cannot be used occasionally, but it does raise questions about using it repeatedly over time, said Dr. Alan F. Schatzberg, co-author of the study and Stanford’s Kenneth T. Norris, Jr., professor of psychiatry and behavioral sciences. He likens it to opioid painkillers being an appropriate pain treatment when used once in the emergency room but posing problems, such as the risk of dependence, when used chronically.
“More studies need to be done to fully understand ketamine before it’s widely rolled out for long-term chronic use,” Schatzberg said.
Researchers planned on studying 30 adults but stopped enrolling patients once they decided combining ketamine and naltrexone was not only ineffective but also “noxious” for many participants. They tested a total of 12 people with both naltrexone and the placebo.
Of those 12, seven who received naltrexone experienced nausea after the ketamine infusion, compared to three in the placebo group. Two participants in each group also experienced vomiting.
Participants who received the placebo and ketamine treatment reported reduced depression symptoms. But those same participants did not see a decrease in depression symptoms after receiving ketamine and opioid-blocker naltrexone.
“We essentially blocked the mechanism for producing the anti-depressant effect, which were opioids,” said Williams.
The findings may have implications for clinics offering ketamine infusions and drug manufacturers trying to commercialize ketamine-like drugs.
Ketamine is meant to be used as an anesthetic. Since ketamine is currently not indicated to treat depression, insurance typically doesn’t cover the cost of infusions, so people tend to pay out of their own pocket. One session can run more than $500.
Meanwhile, drug giant Johnson & Johnson plans to seek approval from the Food and Drug Administration for its nasal spray esketamine this year after reporting positive results from a Phase 3 trial. Allergan plans to file its drug Rapastinel, which targets the NMDA receptors like ketamine, within the next two years. VistaGen Therapeutics is working on a similar drug.
In a statement, J&J said while the study reviewed ketamine and not esketamine, the findings “are difficult to interpret because of the study’s design.”
When most of us think of the typical person suffering from severe balding, our mind usually imagines a greying, old man losing their hair thanks to genetics and age. Medically known as androgenetic alopecia, this may be the most common form of balding, affecting 80 million people in the U.S., but it’s far from the only way we lose our hair.
Traction alopecia occurs when hair has been pulled too tightly against the scalp. It’s also one of the few forms of hair loss attributed to mechanical causes, and not genetics, hormones, or other disease processes. Traction alopecia is commonly reported in women of African descent, though it has nothing to do with ethnicity or hair type. Instead, it’s the specific hair styles and techniques popular in these communities that ultimately cause traction alopecia. However, just because it’s more common in women, doesn’t mean that it doesn’t occur in men. With the recent surge in popularity of the “Man bun”, you may be putting your locks at risk.
As frustrating as any form of hair loss may be, the bright side of traction alopecia is that sufferers don’t have to fight against genetics. If caught early, traction alopecia is an easy form of hair loss to treat and prevent by simply changing your hairstyle.
What is Traction Alopecia?
Traction alopecia is essentially hair loss caused by hair regularly and aggressively pulling at the hair. As the hair follicles/bulbs/scalp is increasingly irritated, sufferers will feel stinging, pain, and tenderness. Small red bumps (folliculitis) may also appear. If these initial symptoms are ignored, permanent hair loss can occur. Early on, traction alopecia can be reversed. However, if trauma continues and irritation persists, scarring of the damaged hair follicle can occur. Once scarred, the hair stops growing entirely and cannot be reversed without invasive medical intervention.
What Causes Traction Alopecia?
Traction alopecia is almost always caused by hair styles that pull hair too tight against the fragile skin of the scalp. Though often associated with braids, weaves, and dreadlocks, traction alopecia also occurs with ponytails, buns, pigtails, extremely long hair, extensions, etc. Helmets and turbans are also known culprits.
What Are Symptoms of Traction Alopecia?
Telltale signs that you may have traction alopecia include:
Red bumps on or near the scalp
Broken hairs near the hairline
Thinning or patchy areas of missing hair near the hairline
Relief in scalp when tight bun released.
If you notice these symptoms as soon as they appear, the damage can be reversed. However, waiting longer increases the chance of developing more severe, or even permanent hair loss.
Once scarring, or scarring alopecia occurs, treatment becomes significantly more difficult. Medical intervention by a dermatologist or hair restoration expert (703-844-0184) is strongly recommended as soon as symptoms occur.
How Can I Treat Traction Alopecia?
When caught early enough, traction alopecia can be completely treated and reversed without a doctor. If no scarring has occurred and there is no significant pain or swelling, simply letting your hair down and avoiding any hairstyles that causes scalp tension should resolve the issue.
However, be patient. The hair and scalp will need time to regrow. It can take several months, or even a full year to see progress. During this time, don’t be tempted to wear your hair tight at any time and be as gentle as possible to your hair and scalp.
If your traction alopecia has advanced to the point of significant balding, pain, swelling, or scarring—or you don’t see any new growth after a year of wearing your hair loose—it’s definitely time to see a dermatologist or hair restoration specialist (703-844-0184 | Neograft Hair transplantation | Dr. Sendi)
First, your specialist will likely test your hair to ensure the cause of your hair loss is in fact traction alopecia. This may include a biopsy of your scalp; a minor outpatient procedure where a small sample of your scalp is submitted to the lab for microscopic examination.
Then once officially diagnosed, typical treatments include:
Topical hair growth creams like minoxidil (Rogaine)
Oral or topical medications to reduce inflammation to the scalp
If scarring has occurred, no pills or creams will bring your hair back. The only way to reverse permanent hair loss is through a hair transplant procedure. Though this is an invasive surgery, it does have a high success rate for bringing your hair back to its former glory.
How Can I Prevent Traction Alopecia?
Traction alopecia is extremely preventable. Prevention doesn’t have to mean forever giving up the hairstyles that you love—though you might have to take regular breaks. Use proper hair styling techniques and strategies to minimize damage. Above all, avoid constantly pulling your hair too tightly into any style.
Maintaining your hair should never hurt. If you notice regular pain, stinging, or tension along your hairline, it’s time to try a different style. Braids or dreads, are better when they’re thick. Thin braids and dreads tend to pull more at the scalp. If you love the man bun but it’s giving you tension headaches, let it down and set your locks free.
Also, choose high-quality hair care products and minimize the use of chemicals. If you’re good to your hair and scalp, your hair and scalp will be good to you in return.
Minoxidil: Your Questions, Answered
Minoxidil is an FDA-approved drug for the treatment of androgenetic alopecia (hair loss). Prior to it being approved by the FDA for hair loss treatment, it was used as an oral pill to treat patients with high blood pressure. A common side effect of oral minoxidil is “hirsuitism” or increase hair growth on the body, face and scalp. In addition to increased (unwanted) body hair, in pill form, minoxidil has other side effects that made it impractical as an oral hair loss treatment.
In the 1980’s, the scientists at the UpJohn Corporation invented a topical formulation of minoxidil in a 2% and 5% strength, called Rogaine. When applied to the scalp it harnessed the benefit of hair growth in areas of balding while avoided the unwanted side effects that came with the pill form.
Who Should Use Minoxidil?
Minoxidil topical solution can be used by adults over 18 years old who are experiencing gradually thinning hair. People who have vertex/crown hair loss tend to respond best to the treatment, but it is effective throughout the scalp.
There are 2% and 5% formulations of the drug available for both men and women which both come in liquid solution or foam. There are also over-the-counter versions of both formulas except for the 5% strength for women, which is still under patent as it was not released until much later than the original 2%. There is really no difference between the men’s, women’s or the over-the-counter versions except the price or color of the boxes. We recommend all patients use the 5% strength and decide if they prefer the foam or solution.
How Does Minoxidil Work?
Minoxidil topical solution is intended for external use only. It is to be applied to a dry scalp per the instructions from your doctor. Once applied, it should be left on your head until it dries by itself – do not use a hairdryer in an attempt to speed up the process.
Science does not currently understand exactly how minoxidil works. It is known that unlike Propecia, minoxidil does not affect the levels of DHT. Some scientists believe that minoxidil works in part by having a vasodilatory effect upon the blood vessels. The dilation could allow for improved oxygen, blood, and nutrient flows to the hair follicles. What we do know is that it is activated in the scalp by an enzyme called sulfotransferase which is found in hair follicles. When activated it shortens the telogen (shedding) phase and prolongs the anagen (growth) phase therefore causing the miniaturized hair follicles to grow longer and stronger.
How Soon Before Results Start Showing?
Many people start seeing benefits after 4 months of using minoxidil. However, the full benefit usually isn’t realized until 12-14 months after starting treatment.
Minoxidil must be used on a continual basis in order to maintain hair growth. If you stop using minoxidil, you might experience “catch-up hair loss” in which you will start to lose hair at an accelerated rate until they catch-up with the level of hair loss that you would have had, had you never used minoxidil in the first place.
Who Shouldn’t use Minoxidil?
It was originally created to help people with high blood pressure. Therefore, if you suffer from low blood pressure, you should avoid using minoxidil unless directed by your doctor. Pregnant women and people with heart problems should also avoid using the drug.
People who have experienced hypersensitivity with the other components of minoxidil should avoid using it as well. Speak with your doctor if you have any questions regarding the drug or the ingredients.
Minoxidil will not regrow hair in areas of scarring hair loss. If you have experienced trauma or deep burns in your scalp, you should let your doctor know. People who have hair loss from hair grooming methods as cornrows or tight ponytails should also consult with their doctor because minoxidil may not be helpful.
Are there Any Side Effects of Minoxidil?
Topical minoxidil is considered safe for long-term usage to treat androgenetic alopecia. However, if you start to notice any side effects such as burning, redness, itching, or irritation, you should inform your doctor and discontinue its use.
Unwanted hair growth can occur in areas adjacent to where it is being applied. It’s also suggested that you wash your hands completely after touching the medication. If topical minoxidil comes into contact with other areas of skin on your body, unwanted hair growth can occur.
Many people use minoxidil or finasteride before they undergo a hair transplant to help improve the native hair. Recent studies have shown that using a combination of both works best in treating male androgenetic alopecia. Your doctor may suggest that you take minoxidil at the same time you take finasteride.
Researchers conducted a 1-year study of 984 men who had male-pattern hair loss and were using minoxidil 5%. At the end of the study they found that the hair loss areas in the scalp had become smaller in 62% of the study participants. Hair loss remained unchanged in 35.1% of the participants and grew larger in 2.9% of them.
Each person reacts differently to minoxidil and results will vary from person to person. Normal hair usually only grows ¼ – ½” per month so it will take at least 4 months before you start to notice hair regrowth.
Do Shampoos Help With Hair Loss?
Androgenic alopecia, most commonly known as male pattern hair loss, is an extremely common issue for many men as they age. In fact, approximately half of all men over the age of 50 are afflicted. Though many happily embrace a hairless future, others choose to fight it in hopes of gaining back the confidence connected to their locks.
Thanks to scientific breakthroughs and innovations, there are a multitude of options when it comes to improving hair growth. Surgical procedures are incredibly successful but invasive and often reserved for when previous methods have failed. Several medications also boast great results, but many also don’t want to rely on daily pills, and their possible side effects.
Instead, most men prefer to start with simple, noninvasive solutions—most notably, shampoos. With so many products on the market, some companies will try to take advantage of those desperately seeking their old head of hair.
So, how can you be sure you’re not wasting money on snake oil? You can spend $3-$100 on a bottle of shampoo, but it is worth it? First, let’s look at how shampoos developed to minimize hair loss and increase hair growth actually work.
How Do Hair Growth Shampoos Work?
Though there are various ways that people lose hair, our own hormones and genetics are almost always to blame. Typically, this is due to the effects of testosterone and dihydrotestosterone (DHT). Hair loss shampoos will use various ingredients intended to suppress these hormones. Ingredients include:
Widely regarded as the most important ingredient to look for in shampoos made to treat hair loss, ketoconazole is actually an antifungal solution which also has anti-androgenic properties that may prevent hair growth. Similar to finasteride, ketoconazole can prevent the action of testosterone or DHT on the hair.
An all-natural nutrient essential for creating healthy hair, biotin, also known as Vitamin B7, Vitamin H, or Coenzyme R helps strengthen hair. Essentially, it’s a co-enzyme that helps synthesize the fatty acids and amino acids needed to produce keratin, which is what hair is mostly made of.
Though results have not been scientifically proven, a quick Google search shows that anecdotally, many believe biotin has helped them thicken and strengthen their hair, especially when taken orally. Less is known about biotin’s benefit when used topically in a shampoo.
It is indisputable that biotin is required for hair synthesis and is incredibly safe to use. From a marketing standpoint, it also makes for a great ingredient to add to hair loss shampoos. It might help—and it certainly won’t hurt—your hair.
Don’t think drinking coffee will help though. For results, data suggests you’ll have to apply caffeine topically so it can be absorbed into the scalp and directly to the hair follicles themselves, making shampoos a great way to get it on your head.
Though official research has yet to confirm its effectiveness, saw palmetto has been used for centuries to treat hair loss and many believe they’ve had positive, all-natural hair growth results. Saw palmetto may work because it blocks the 5-alpha-reductase, one of the enzymes that converts your testosterone into DHT.
Like biotin, there has been little verified scientific proof of its effectiveness. Also like biotin, it won’t hurt or hinder hair growth. Especially if you’re seeking a drug-free solution, it may be worth a try.
How Do I Choose the Right Shampoo?
First off, always visit a doctor or hair growth specialist before starting any treatment. An expert will be able to pinpoint exactly why you are losing your hair. This can be an essential step in developing a comprehensive plan in battling your baldness. Don’t wait until it’s too late for noninvasive methods to be effective.
Also, don’t expect a simple bottle of shampoo to work miracles. Shampoos are most helpful for keeping your hair clean and your scalp healthy. In addition, shampoo removes debris that could increase irritation or inflammation that may impede hair growth. However, they do little to change the actual biology of your hair growth.
Once you’ve decided to try hair growth shampoos, always do these three things:
1. Check the Ingredients
You’ll always want to ensure you know what ingredients are included in the shampoo. When it comes to over-the-counter shampoos, the ingredients listed above have the most potential benefit based on current data. Others may be helpful as well, like niacin and argan oil, or tea tree oil, but have even less scientific backing or testimonials.
2. Look at Reviews
If a product doesn’t have at least a year of consistently high unbiased reviews by many users, skip it. The product pages should also always link to scientifically backed studies proving thorough research and effectiveness. Like the saying says—if it’s too good to be true, it probably is.
3. Give it Time
Remember—hair growth is slow. Even the best products take several months to show results. Don’t become frustrated and toss the bottle after a few weeks. Try to give it at least 4 months before deciding the product isn’t right for you.
Minoxidil and Prescription Hair Growth Shampoos
Minoxidil is widely regarded as the most effective topical FDA-approved drug to fight hair loss. Commonly used under the well-known brand Rogaine, this topical solution is used in several brands of hair loss shampoos, creams, serums and foams in both over-the-counter and prescription strengths.
Unlike the ingredients above, minoxidil has a higher likelihood of side effects including scalp irritation and increased body hair in places other than your scalp. If other treatments haven’t proven successful however, this is a great option with high success rates for both men and women suffering from hair loss. Users should expect approximately 4-6 months for results, with full results taking about a year.
Hair Loss Benefits of Finasteride
Approximately 85% of individuals who routinely use Finasteride see a stabilization of their hair loss or dramatic slowing of the loss.
Over 65% of patients who use this medication see an actual increase in hair numbers. While we typically see a greater response on the crown, it also helps the mid-portion of the scalp and to a lesser degree the frontal region.
The vast majority of patients will see an increase in hair weight. This means more volume of hair even if the actual numbers do not increase.
Side effects are rare and there are no reported medication interactions between Finasteride and other prescription medications. You should always consult with your primary physician before starting a new medication.
About Finasteride and Dutasteride
This category of drugs is known as 5-alpha reductase inhibitors. These medications prevent testosterone from being converted to DHT (dihyrdotestosterone) in the prostate, hair follicles and oil glands. DHT is the active form of testosterone that causes hairloss. The two medications available are Finasteride (Propecia and Proscar) and Dutasteride (Avodart). Neither drug blocks testosterone activity throughout your body as a whole, only in the specific areas that contain these enzymes. Proscar & Avodart are FDA approved to treat benign prostatic hypertrophy (BPH or enlarged prostate). Only Finasteride 1mg is FDA approved to treat hair loss. Dutasteride can be used to treat hair loss, but this is off label.
The vast majority of men (and some women) can benefit from these medications without adverse side effects.
Women who are pregnant or potentially could become pregnant CAN NOT take these medications, as they interfere with the developing baby’s hormones.
You CAN NOT donate blood while taking these medications, because a pregnant woman might be the one who receives your blood.
Tell your doctor you are taking one of these medications as they can lower your PSA score. Your PSA is used to monitor for possible prostate cancer development.
Although there is no proven risk the fetus, men may choose to stop this medication if you and your partner plan to conceive a child.
Finasteride and Dutasteride Side Effects
Decreased sex drive and difficulty in achieving an erection has been reported in ~2% of men using these medications compared to placebo groups. In all major studies the side effects went away upon discontinuing the use of the medication. There have been rare reports of men who claim to continue to have problems after they stopped the medication. In most of these reports, the men continued taking the medication for several years in spite of their symptoms. A class action law-suit is ongoing claiming “Post Finasteride Syndrome.” The true validity of this syndrome is still under debate and research.
Breasts or testicular tenderness can be seen but is rare (<1%) and goes away upon stopping the medication.
Allergic reactions are possible but in over 20 years of prescribing these medications I have not seen a person have an allergic reaction to any of these medications.
Depression – While not reported as a side effect in any of the major studies, there have been rare reports of depression in the literature and on the internet. The validity of these reports remains unclear.
Decreased sperm counts – While not a reported problem during FDA trials, there have been rare cases reported in the literature and a positive link between use and decreased sperm count. In trials evaluating this side effect, upon discontinuation sperm counts returned to normal within 3 months.
Breast cancer is very rare in men in general and no association between using these medications and breast cancer has been shown. However, if you experience any lumps, bumps, pain or nipple discharge you should report it to your physician.
Prostate cancer is the 2nd most common form of cancer in men in the United States and over 15% will be diagnosed with it during their lifetime. Prostate cancers are graded on a Gleason Score scale from 1 to 10. The vast majority of prostate cancers are low to mid grade types with Gleason Scores of 6 or less. In two large clinical trials of these medications there was a 15-25% reduction in the incidence of prostate cancer. However, if you developed prostate cancer there was a small increased risk that your cancer would be a higher grade Gleason Score 8-10. For those taking 5mg of Finasteride the risk was 1.8% vs. 1.1% on placebo and for those taking Dutasteride the risk was 1.5% vs. 1.0% on placebo. The data regarding the link between these medications and possible increased/decreased risk of prostate cancer remains controversial and under intense review.
Brain fog is a term that’s commonly used to describe cloudy mental thinking, difficulty with focus or concentration or sometimes difficulty with memory, or the ability to memorize new information.
Some of the key drivers of brain fog include:
How often do you see a patient who is complaining of cloudy mental thinking, difficulty with focus or concentration or sometimes difficulty with memory, or the ability to memorize new information?
In just 28 days, both healthy adult women and adolescent males showed significant improvements in attentional focus and motor speed when taking citicoline or one (1) Cerenx per day.
Cerenx works on attentional focus by increasing dopamine, increasing dopamine receptors, and protecting dopamine related neurons. Further evidence has shown that citicoline improves attention in a variety of patient populations including individuals with neurocognitive degeneration after a stroke, and elderly participants.
Cerenx works on attentional focus by increasing dopamine, increasing dopamine receptors, and protecting dopamine related neurons. Further evidence has shown that citicoline improves attention in a variety of patient populations including individuals with neurocognitive degeneration after a stroke, and elderly participants.
The Effect of Citicoline Supplementation on Motor Speed and Attention in Adolescent Males
Objective: This study assessed the effects of citicoline, a nutraceutical, on attention, psychomotor function, and impulsivity in healthy adolescent males. Method: Seventy-five healthy adolescent males were randomly assigned to either the citicoline group (n = 51 with 250 or 500 mg citicoline) or placebo (n = 24). Participants completed the Ruff 2&7 Selective Attention Test, Finger Tap Test, and the Computerized Performance Test, Second Edition (CPT-II) at baseline and after 28 days of supplementation. Results: Individuals receiving citicoline exhibited improved attention (p = 0.02) and increased psychomotor speed (p = 0.03) compared with those receiving placebo. Higher weight-adjusted dose significantly predicted increased accuracy on an attention task (p = 0.01), improved signal detectability on a computerized attention task (p = 0.03), and decreased impulsivity (p = 0.01). Discussion: Adolescent males receiving 28 days of Cognizin® citicoline showed improved attention and psychomotor speed and reduced impulsivity compared to adolescent males who received placebo.
Now that the days are getting shorter, the air is getting cooler, Virginians have had the first glimpse of cold for the season, some of us begin to feel the winter blues. These feelings of low energy and sleepiness may actually be Seasonal Affective Disorder, or SAD.
SAD is a form of depression related to the changing seasons. It usually starts in the late fall, especially in our northern climes. The decreasing hours of sunlight, along with the cold and snow, cause our bodies to retreat into the warmth and coziness of our homes. We tend to crave carbohydrates, eat comfort foods, and socially withdraw as we sleep more, and move less; much like we are hibernating!
Those most at risk for SAD are people already suffering from major depression or bipolar disorder. Risk factors include being female, family history, young age, and the further you live from the equator, the higher your risk. However, there are ways to decrease your risk, and increase your mood.
What can you do to improve your mood? Soak up the sun! When the weather allows, go for a walk on those bright, crisp sunny days. If the temperature or the ice and snow don’t allow you to venture outside, open the curtains and let the sun shine in. Exercise and eating healthy are both options to make you feel better. Vitamins, especially vitamin D, the sunshine vitamin can help with mood. Be social, visit with friends. A phone call, visit, or even a vacation to visit your “snowbird” friends will keep you socially involved.
So, if these options aren’t working or you just need something more to improve your mood, your healthcare provider may recommend seeking help from a psychotherapist. They may offer medications, light box therapy, or talk therapy.
Ketamine therapy is an option to help make it through dark times when nothing else seems to work. Contact 703-844-0184 for a consultation.
Seasonal Affective Disorder
Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.
Signs and Symptoms
Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions.
Symptoms of Major Depression
Feeling depressed most of the day, nearly every day
Feeling hopeless or worthless
Having low energy
Losing interest in activities you once enjoyed
Having problems with sleep
Experiencing changes in your appetite or weight
Feeling sluggish or agitated
Having difficulty concentrating
Having frequent thoughts of death or suicide.
Symptoms of the Winter Pattern of SAD include:
Having low energy
Craving for carbohydrates
Social withdrawal (feel like “hibernating”)
Symptoms of the less frequently occurring summer seasonal affective disorder include:
Poor appetite with associated weight loss
Episodes of violent behavior
Attributes that may increase your risk of SAD include:
Being female. SAD is diagnosed four times more often in women than men.
Family history. People with a family history of other types of depression are more likely to develop SAD than people who do not have a family history of depression.
Having depression or bipolar disorder. The symptoms of depression may worsen with the seasons if you have one of these conditions (but SAD is diagnosed only if seasonal depressions are the most common).
Younger Age. Younger adults have a higher risk of SAD than older adults. SAD has been reported even in children and teens.
The causes of SAD are unknown, but research has found some biological clues:
People with SAD may have trouble regulating one of the key neurotransmitters involved in mood, serotonin. One study found that people with SAD have 5 percent more serotonin transporter protein in winter months than summer months. Higher serotonin transporter protein leaves less serotonin available at the synapse because the function of the transporter is to recycle neurotransmitter back into the pre-synaptic neuron.
People with SAD may overproduce the hormone melatonin.Darkness increases production of melatonin, which regulates sleep. As winter days become shorter, melatonin production increases, leaving people with SAD to feel sleepier and more lethargic, often with delayed circadian rhythms.
People with SAD also may produce less Vitamin D. Vitamin D is believed to play a role in serotonin activity. Vitamin D insufficiency may be associated with clinically significant depression symptoms.
Treatments and Therapies
There are four major types of treatment for SAD:
These may be used alone or in combination.
Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat SAD. The FDA has also approved the use of bupropion, another type of antidepressant, for treating SAD.
Light therapy has been a mainstay of treatment for SAD since the 1980s. The idea behind light therapy is to replace the diminished sunshine of the fall and winter months using daily exposure to bright, artificial light. Symptoms of SAD may be relieved by sitting in front of a light box first thing in the morning, on a daily basis from the early fall until spring. Most typically, light boxes filter out the ultraviolet rays and require 20-60 minutes of exposure to 10,000 lux of cool-white fluorescent light, an amount that is about 20 times greater than ordinary indoor lighting.
Cognitive behavioral therapy (CBT) is type of psychotherapy that is effective for SAD. Traditional cognitive behavioral therapy has been adapted for use with SAD (CBT-SAD). CBT-SAD relies on basic techniques of CBT such as identifying negative thoughts and replacing them with more positive thoughts along with a technique called behavioral activation. Behavioral activation seeks to help the person identify activities that are engaging and pleasurable, whether indoors or outdoors, to improve coping with winter.
At present, vitamin D supplementation by itself is not regarded as an effective SAD treatment. The reason behind its use is that low blood levels of vitamin D were found in people with SAD. The low levels are usually due to insufficient dietary intake or insufficient exposure to sunshine. However, the evidence for its use has been mixed. While some studies suggest vitamin D supplementation may be as effective as light therapy, others found vitamin D had no effect.
Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness.
Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with depression.
There are several forms of depressive disorders.
Major depression,—severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.
Persistent depressive disorder—depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.
Some forms of depression are slightly different, or they may develop under unique circumstances. They include:
Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
Postpartum depression, which is much more serious than the “baby blues” that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
Bipolar depression, also called manic-depressive illness, is not as common as major depression or persistent depressive disorder. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression).
Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors.
Depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behavior appear different. But these images do not reveal why the depression has occurred. They also cannot be used to diagnose depression.
Some types of depression tend to run in families. However, depression can occur in people without family histories of depression too. Scientists are studying certain genes that may make some people more prone to depression. Some genetics research indicates that risk for depression results from the influence of several genes acting together with environmental or other factors. In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger.
Signs & Symptoms
“It was really hard to get out of bed in the morning. I just wanted to hide under the covers and not talk to anyone. I didn’t feel much like eating and I lost a lot of weight. Nothing seemed fun anymore. I was tired all the time, and I wasn’t sleeping well at night. But I knew I had to keep going because I’ve got kids and a job. It just felt so impossible, like nothing was going to change or get better.”
People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness.
Signs and symptoms include:
Persistent sad, anxious, or “empty” feelings
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details, and making decisions
Insomnia, early-morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.
Who Is At Risk?
Major depressive disorder is one of the most common mental disorders in the United States. Each year about 6.7% of U.S adults experience major depressive disorder. Women are 70 % more likely than men to experience depression during their lifetime. Non-Hispanic blacks are 40% less likely than non-Hispanic whites to experience depression during their lifetime. The average age of onset is 32 years old. Additionally, 3.3% of 13 to 18 year olds have experienced a seriously debilitating depressive disorder.
“I started missing days from work, and a friend noticed that something wasn’t right. She talked to me about the time she had been really depressed and had gotten help from her doctor.”
Depression, even the most severe cases, can be effectively treated. The earlier that treatment can begin, the more effective it is.
The first step to getting appropriate treatment is to visit a doctor or mental health specialist. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation.
The doctor may refer you to a mental health professional, who should discuss with you any family history of depression or other mental disorder, and get a complete history of your symptoms. You should discuss when your symptoms started, how long they have lasted, how severe they are, and whether they have occurred before and if so, how they were treated. The mental health professional may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide.
Other illnesses may come on before depression, cause it, or be a consequence of it. But depression and other illnesses interact differently in different people. In any case, co-occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder, often accompany depression. PTSD can occur after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat. People experiencing PTSD are especially prone to having co-existing depression.
Alcohol and other substance abuse or dependence may also co-exist with depression. Research shows that mood disorders and substance abuse commonly occur together.
Depression also may occur with other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson’s disease. People who have depression along with another medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co-existing depression. Treating the depression can also help improve the outcome of treating the co-occurring illness.
Once diagnosed, a person with depression can be treated in several ways. The most common treatments are medication and psychotherapy.
Antidepressants primarily work on brain chemicals called neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work. The latest information on medications for treating depression is available on the U.S. Food and Drug Administration (FDA) website .
Popular newer antidepressants
Some of the newest and most popular antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are some of the most commonly prescribed SSRIs for depression. Most are available in generic versions. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta).
SSRIs and SNRIs tend to have fewer side effects than older antidepressants, but they sometimes produce headaches, nausea, jitters, or insomnia when people first start to take them. These symptoms tend to fade with time. Some people also experience sexual problems with SSRIs or SNRIs, which may be helped by adjusting the dosage or switching to another medication.
One popular antidepressant that works on dopamine is bupropion (Wellbutrin). Bupropion tends to have similar side effects as SSRIs and SNRIs, but it is less likely to cause sexual side effects. However, it can increase a person’s risk for seizures.
Tricyclics are older antidepressants. Tricyclics are powerful, but they are not used as much today because their potential side effects are more serious. They may affect the heart in people with heart conditions. They sometimes cause dizziness, especially in older adults. They also may cause drowsiness, dry mouth, and weight gain. These side effects can usually be corrected by changing the dosage or switching to another medication. However, tricyclics may be especially dangerous if taken in overdose. Tricyclics include imipramine and nortriptyline.
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. They can be especially effective in cases of “atypical” depression, such as when a person experiences increased appetite and the need for more sleep rather than decreased appetite and sleep. They also may help with anxious feelings or panic and other specific symptoms.
However, people who take MAOIs must avoid certain foods and beverages (including cheese and red wine) that contain a substance called tyramine. Certain medications, including some types of birth control pills, prescription pain relievers, cold and allergy medications, and herbal supplements, also should be avoided while taking an MAOI. These substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help reduce these risks. If you are taking an MAOI, your doctor should give you a complete list of foods, medicines, and substances to avoid.
MAOIs can also react with SSRIs to produce a serious condition called “serotonin syndrome,” which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions. MAOIs should not be taken with SSRIs.
How should I take medication?
All antidepressants must be taken for at least 4 to 6 weeks before they have a full effect. You should continue to take the medication, even if you are feeling better, to prevent the depression from returning.
Medication should be stopped only under a doctor’s supervision. Some medications need to be gradually stopped to give the body time to adjust. Although antidepressants are not habit-forming or addictive, suddenly ending an antidepressant can cause withdrawal symptoms or lead to a relapse of the depression. Some individuals, such as those with chronic or recurrent depression, may need to stay on the medication indefinitely.
In addition, if one medication does not work, you should consider trying another. NIMH-funded research has shown that people who did not get well after taking a first medication increased their chances of beating the depression after they switched to a different medication or added another medication to their existing one.
Sometimes stimulants, anti-anxiety medications, or other medications are used together with an antidepressant, especially if a person has a co-existing illness. However, neither anti-anxiety medications nor stimulants are effective against depression when taken alone, and both should be taken only under a doctor’s close supervision.
Report any unusual side effects to a doctor immediately.
IV Ketamine Therapy
One of the most exciting new treatment options for depression is with a long known drug, ketamine. Ketamine has been used historically as an anesthetic. Recently, it has emerged as an effective treatment option for severe depression (citations below). The mechanism of action for ketamine’s antidepressant effects is not fully understood and hotly debated. However, studies of the neurobiology of depressed patients have revealed possible abnormalities that may have a causal link to depression such as increased inflammatory cytokines, decreased BDNF, and reduced hippocampal volume. Interestingly, there is much overlap in the neurobiology of depression and known consequences of ketamine treatment. Ketamine has been found to reduce neuroinflammation, increase BDNF production and hippocampal volume. Thus, it is highly likely that ketamine possesses a robust pharmacological profile that works collectively to correct abnormalities common to severe depression. Although only FDA-approved as an anesthetic, ketamine is used off-label by many physicians in cases of severe, treatment-resistant depression.
Depression is more common among women than among men. Biological, life cycle, hormonal, and psychosocial factors that women experience may be linked to women’s higher depression rate. Researchers have shown that hormones directly affect the brain chemistry that controls emotions and mood. For example, women are especially vulnerable to developing postpartum depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming.
Some women may also have a severe form of premenstrual syndrome (PMS) called premenstrual dysphoric disorder (PMDD). PMDD is associated with the hormonal changes that typically occur around ovulation and before menstruation begins.
During the transition into menopause, some women experience an increased risk for depression. In addition, osteoporosis—bone thinning or loss—may be associated with depression. Scientists are exploring all of these potential connections and how the cyclical rise and fall of estrogen and other hormones may affect a woman’s brain chemistry.
Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It is still unclear, though, why some women faced with enormous challenges develop depression, while others with similar challenges do not.
How do men experience depression?
Men often experience depression differently than women. While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping.
Men may be more likely than women to turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, irritable, angry, and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends, or behave recklessly. And although more women attempt suicide, many more men die by suicide in the United States.
How do older adults experience depression?
Depression is not a normal part of aging. Studies show that most seniors feel satisfied with their lives, despite having more illnesses or physical problems. However, when older adults do have depression, it may be overlooked because seniors may show different, less obvious symptoms. They may be less likely to experience or admit to feelings of sadness or grief.
Sometimes it can be difficult to distinguish grief from major depression. Grief after loss of a loved one is a normal reaction to the loss and generally does not require professional mental health treatment. However, grief that is complicated and lasts for a very long time following a loss may require treatment. Researchers continue to study the relationship between complicated grief and major depression.
Older adults also may have more medical conditions such as heart disease, stroke, or cancer, which may cause depressive symptoms. Or they may be taking medications with side effects that contribute to depression. Some older adults may experience what doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the body’s organs, including the brain. Those with vascular depression may have, or be at risk for, co-existing heart disease or stroke.
Although many people assume that the highest rates of suicide are among young people, older white males age 85 and older actually have the highest suicide rate in the United States. Many have a depressive illness that their doctors are not aware of, even though many of these suicide victims visit their doctors within 1 month of their deaths.
Most older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both. Research has shown that medication alone and combination treatment are both effective in reducing depression in older adults. Psychotherapy alone also can be effective in helping older adults stay free of depression, especially among those with minor depression. Psychotherapy is particularly useful for those who are unable or unwilling to take antidepressant medication.
How do children and teens experience depression?
Children who develop depression often continue to have episodes as they enter adulthood. Children who have depression also are more likely to have other more severe illnesses in adulthood.
A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depression. By age 15, however, girls are twice as likely as boys to have had a major depressive episode.
Depression during the teen years comes at a time of great personal change—when boys and girls are forming an identity apart from their parents, grappling with gender issues and emerging sexuality, and making independent decisions for the first time in their lives. Depression in adolescence frequently co-occurs with other disorders such as anxiety, eating disorders, or substance abuse. It can also lead to increased risk for suicide.
An NIMH-funded clinical trial of 439 adolescents with major depression found that a combination of medication and psychotherapy was the most effective treatment option. Other NIMH-funded researchers are developing and testing ways to prevent suicide in children and adolescents.
Childhood depression often persists, recurs, and continues into adulthood, especially if left untreated.
How can I help a loved one who is depressed?
If you know someone who is depressed, it affects you too. The most important thing you can do is help your friend or relative get a diagnosis and treatment. You may need to make an appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment, or to seek different treatment if no improvement occurs after 6 to 8 weeks.
To help your friend or relative
Offer emotional support, understanding, patience, and encouragement.
Talk to him or her, and listen carefully.
Never dismiss feelings, but point out realities and offer hope.
Never ignore comments about suicide, and report them to your loved one’s therapist or doctor.
Invite your loved one out for walks, outings and other activities. Keep trying if he or she declines, but don’t push him or her to take on too much too soon.
Provide assistance in getting to the doctor’s appointments.
Remind your loved one that with time and treatment, the depression will lift.
How can I help myself if I am depressed?
If you have depression, you may feel exhausted, helpless, and hopeless. It may be extremely difficult to take any action to help yourself. But as you begin to recognize your depression and begin treatment, you will start to feel better.
To Help Yourself
Do not wait too long to get evaluated or treated. There is research showing the longer one waits, the greater the impairment can be down the road. Try to see a professional as soon as possible.
Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed.
Set realistic goals for yourself.
Break up large tasks into small ones, set some priorities and do what you can as you can.
Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of” your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
Remember that positive thinking will replace negative thoughts as your depression responds to treatment.
Researchers from the University of Minnesota and The Mayo Clinic found that ketamine caused an average decrease of 42% on the Children’s Depression Rating Scale(CDRS)—the most widely used rating scale in research trials for assessing the severity of depression and change in depressive symptoms among adolescents. The study recruited adolescents, 12-18 years of age, with treatment-resistant depression (TRD; failure to respond to two previous antidepressant trials). The teens were administered intravenous ketamine (0.5 mg/kg) by infusion six times over two weeks.
The study reported that the average decrease in CDRS-R was 42.5% (p = 0.0004). Five (38%) adolescents met criteria for clinical response (defined as >50% reduction in CDRS-R). Three responders showed sustained remission at 6-week follow-up; relapse occurred within 2 weeks for the other two responders. The ketamine infusions were generally well tolerated; dissociative symptoms and hemodynamic symptoms were transient. Interestingly, higher dose was a significant predictor of treatment response.
“Adolescence is a key time period for emergence of depression and represents an opportune and critical developmental window for intervention to prevent negative outcomes,” the authors wrote in the study.
“Unfortunately, about 40% of adolescents do not respond to their first intervention and only half of non-responders respond to the second treatment,” they said. “Because standard interventions require prolonged periods (e.g., weeks to months) to assess efficacy, serial treatment failures allow illness progression, which in turn worsens the outcome. Hence, novel treatment strategies to address treatment-resistant depression in adolescents are urgently needed.”
The authors concluded that their results demonstrate the potential role for ketamine in treating adolescents with TRD. Additionally, evidence suggested a dose–response relationship; future studies are needed to optimize dose
Yale study found no safety issues with long-term ketamine treatment
Researchers at Yale published a new study titled “Acute and Longer-Term Outcomes Using Ketamine as a Clinical Treatment at the Yale Psychiatric Hospital” in Clinical Psychiatry. In late 2014, Yale began providing ketamine as an off-label therapy on a case-by-case basis for patients who could not participate in research protocols. The authors observed 54 patients that received IV ketamine infusion for the treatment of severe and treatment-resistant mood disorders such as depression.
“Ketamine is being used as an off-label treatment for depression by an increasing number of providers, yet there is very little long-term data on patients who have received ketamine for more than just a few weeks,” Samuel T. Wilkinson, MD,from the department of psychiatry, Yale School of Medicine and Yale Psychiatric Hospital, told Healio Psychiatry.
The Yale researchers studied the acute and longer-term outcomes in this patient population. Importantly, a subset of patients (n=14) received ketamine on a long-term basis, ranging from 12 to 45 total treatments, over a course of 14 to 126 weeks. The researchers found no evidence of cognitive decline, increased proclivity to delusions, or emergence of symptoms consistent with cystitis in this subset of long-term ketamine patients. They also reported that the infusions were generally well-tolerated.
Although this study population was relatively small, limiting the conclusions that can be drawn, this is still an important first step in establishing the long-term safety of ketamine for the treatment of a myriad of diseases that it’s being used to treat
CNN featured a segment on the use of ketamine for treating suicidal ideation–a novel, off-label use for ketamine that is currently being explored in human clinical trials. The segment featured Dr. Sanjay Gupta sharing the story of Alan Ferguson. Mr. Ferguson discussed his experience with suicidal ideation, stating that he had planned his own suicide prior to a psychiatrist suggesting the off-label use of ketamine. Fortunately, ketamine worked for him as it has for many others, completely eliminating all thoughts of suicide and depression.
While ketamine is a long-known, FDA-approved anesthetic, new uses for this old drug have recently been discovered. The new indication that is probably the farthest along is for the treatment of depression. It’s even undergoing phase III clinical trials for the treatment of depression, which are expected to be completed next year. In depression, ketamine’s mechanism of action is still being explored. Scientists know that ketamine antagonizes the NMDA receptor, which causes a number of downstream cascades that may be relevant to it’s antidepressant effects. Ketamine also increases important neuronal growth factors that can create new synaptic connections.
While there are numerous anti-depressants that are already FDA-approved, they don’t always work and–even when they do–it takes weeks to see the effect. This is what’s special about ketamine. The anti-depressant effects of ketamine are instantaneous. In the case of Alan Ferguson, his depression went from severe to mild after the first infusion, and was gone after the second. In cases of depression that involve suicidality, this rapid improvement can be the difference between life and death. Even though ketamine is not yet approved for the treatment of depression or suicidal ideation, there is an abundance of data showing that it works and it’s already being used off-label in the clinic.
Australian researchers completed the world’s first randomized control trial (RCT), assessing the efficacy and safety of ketamine as a treatment for depression in elderly patients.
In this double-blind, controlled, multiple-crossover study with a 6-month follow-up, 16 participants (≥60 years) with treatment-resistant depression who relapsed after remission or did not remit in the RCT were administered an open-label phase. Up to five subcutaneous doses of ketamine (0.1, 0.2, 0.3, 0.4, and 0.5 mg/kg) were administered in separate sessions (≥1 week apart), with one active control (midazolam) randomly inserted. Twelve ketamine treatments were given in the open-label phase. Mood, hemodynamic, and psychotomimetic outcomes were assessed by blinded raters. Remitters in each phase were followed for 6 months.
The results, published in the latest American Journal of Geriatric Psychiatry, provide preliminary evidence that ketamine is effective as an antidepressant – when delivered in repeated intravenous doses.
“What we noticed was that ketamine worked incredibly quickly and incredibly effectively,” Professor Colleen Loo, who led the pilot program told ABC News. “By incredibly effective, we mean going rapidly from severely depressed to being completely well in one day.”
“Some people think, ‘oh maybe it was just a drug induced temporary high’ — and it wasn’t,” she said. “You had the woozy effects in the first hour or so, but the antidepressant effects kicked in later.”
None of the participants experienced problematic side effects, according to the research team who administered the drug through a small injection under the skin.
“Our results indicate a dose-titration method may be particularly useful for older patients, as the best dose was selected for each individual person to maximize ketamine’s benefits while minimizing its adverse side effects,” she said.
The authors noted that further study is needed, however, to understand the risks of ketamine use and possible side effects, such as its impact on liver function in the elderly.
PTSD Treatment – Ketamine is a novel treatment for several psychiatric disorders including: Major Depressive Disorder, Bipolar Depression, Postpartum Depression, Obsessive-Compulsive Disorder (OCD), and Posttraumatic Stress Disorder or PTSD. It was originally FDA approved for anesthesia but is now frequently used off-label due to its positive effects on the various disorders listed above. PTSD is an devastating disorder that has become more and more common but medical treatments overall are still lacking.
What is PTSD?
PTSD is a disorder that develops after a traumatic experience. Such trauma sometimes involves combat, car accidents, natural disasters or sexual assaults. Up to 80% of individuals in their life will experience at least one traumatic event but, fortunately, most people do not go on to develop PTSD. The lifetime prevalence of developing PTSD is about 10% and women are twice as likely as men to develop PTSD. Those who do go on to develop PTSD typically will have one or more of the following symptoms:
• traumatic nightmares
• flashbacks taking them back to the event
• distress after exposure to traumatic reminders or stimuli
• avoidance of certain thoughts and situations
• negative thoughts and mood including shame, despair and depression.
A constellation of these symptoms must persist for at least a month for a diagnosis of PTSD to be made.
Most PTSD Treatment are ineffective for some patients and their all generally slow acting—meaning that the patient must wait weeks to have a meaningful impact on the patient’s wellness. Ketamine has now been shown to be effective at managing PTSD in several clinical studies. Moreover, physicians are beginning to present case reports where ketamine has helped their patients. One of the largest benefits of using Ketamine off label for the treatment of depression is that it is generally very fast-acting. Patients typically report feeling better after the first infusion or two. Sometimes, they report feeling 100% better after 5 days of IV ketamine therapy.
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