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At NOVA Health recovery [703-844-0184 | Fairfax, Va 22306 ] we offer our patients cutting-edge treatment options for their depression, and one of our main stars is IV (intravenous) ketamine. But why does it have to be IV? “I don’t like needles, why can’t I just take this as a pill or as that nasal spray everyone is talking about?” you may be thinking. IV is the best route for your brain to receive ketamine because of something called bioavailability. In addition, it is also more effective, more precise, and safer for you.

What is bioavailability? It is the amount of medication that your body and brain is actually able to use, which is sometimes different than the amount of medication that your body receives. When you take any medication, parts of the active ingredients in them don’t go to your bloodstream; they get digested, altered into an unusable form, metabolized and excreted into your body. This is particularly prevalent in oral and intranasal medications. In fact, receiving a medication intravenously is the only way to have 100% bioavailability. Let’s take a look at the different bioavailability percentages based on what route you receive ketamine:

Intravenous: 100%

Intramuscular: 93%
Intranasal: 25-50%
Sublingual (under the tongue): 30%
Orally (by mouth): 16-24%

When we give ketamine intravenously, we know exactly where your entire dose is going: straight to your brain. The same cannot be said for other forms of ketamine. Intranasal ketamine has to bypass several layers of tissue before it can reach your brain, and too many things can happen that could cause you to lose some or most of your dose: sneezing, dripping, running down the back of your throat, etc. The same can be said for an oral pill and an intramuscular injection; these routes are just too unpredictable, and when it comes to treating your depression, we don’t want the results to be unpredictable.

When you receive IV ketamine in our office setting, it is given slowly over one hour. By doing this, we are able to monitor you closely, and if you experience any unpleasant side effects and want to stop the infusion, we are able to do that. By contrast, a dose of ketamine via intranasal spray would be done at home with no physician or nursing supervision, so side effects cannot be immediately addressed if they arise. The same is true for intramuscular or oral dosing – after you take the pill, or receive a shot of ketamine into your muscle, there is no way to stop the absorption of the medication into your bloodstream as the full dose is administered within seconds.

IV ketamine is by far the safest and most effective approach in using ketamine to treat depression. You are in a comfortable setting with healthcare providers with you the whole time, the potential for side effects is low, and you are certain that the dose you receive is the dose that is going to your brain, maximizing the benefits of this cutting-edge treatment.

However, we do offer the other routes of administration and take – home prescriptions for Ketamine therapies for those who are in our program. Contact us today at 703-844-0184 to get started on your treatment.


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Ketamine Nasal Sprays for Depression

What is ketamine?

Ketamine Nasal Spray
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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.

Why ketamine?

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.


  1. Ketalar [package insert]. Chestnut Ridge, NY 10977: Par pharmaceutical; 2017
  2. Browne CA, Lucki I. Antidepresssant effects of ketamine: mechanisms underlying fast-acting novel antidepressants. Front Pharmacol December 2013.
  3. Lapidus K, Levitch CF, Perez AM, et al. A randomized controlled trial of intranasal ketamine in major depressive disorder. Biol Psychology 2014;76:970–976
  4. Sanacora G, Frye MA, McDonald W, et al. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry 2017;74(4):399-405.

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Ketamine for Delirium Tremens

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.

Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal

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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. [1] 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. [2] 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. [3][4]

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. [5] 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. [2] 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. [4]

Cera-Q Uses

CeragenClick here to order Ceragen with Cera-Q today.

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. [6] 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. [6] 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. [4]Cera-Q decreases blood pressure whereas caffeine increases blood pressure.

Cera-Q Benefits

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. [7]

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. [8] 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. [8]

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. [9] 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. [10]The Digit Symbol Test is a variation of number memorization used to measure brain damage, dementia, age, and depression. [11]

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. [12] 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. [13] This test measures both auditory and visual memory. [14] 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. [13]

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. [13] 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. [13] 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. [15] 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. [13] 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.


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From street drug to depression therapy

Ketamine offers a new option for people with stubborn depression that doesn’t respond to other medications.

703-844-0184 | Ketamine Treatment Center in Alexandria, Va 22306


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.


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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
  • Weight gain
  • A heavy feeling in the arms or legs
  • A drop in energy level
  • Decreased physical activity
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Increased sensitivity to social rejection
  • Avoidance of social situations

Symptoms of summer SAD are:

  • Poor appetite
  • Weight loss
  • Insomnia
  • 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
  • Light therapy and lamps for SAD
  • IV Vitamin Therapy for rapid recovery including Vitamin D injections

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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.
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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 variety of warningson 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.
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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.”

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Ketamine is emerging as a popular treatment for depression. New research suggests the drug acts like an opioid


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."
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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.”

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What Is Traction Alopecia & Can It Be Reversed

What Is Traction Alopecia & Can It Be Reversed

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.

Traction alopecia the root of the problem.

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A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents

Trichotillomania and Trichophagia

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:

  • Scalp tenderness
  • 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.
  • Itching

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)
  • Biotin or other natural hair growth supplements
  • 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.

Combined Treatment with oral finasteride and topical minoxidil in males androgenetic alopecia


What is the Success Rate of Minoxidil?

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?

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.

There currently are few large studies proving ketoconazole actually is absorbed into the scalp enough to fully achieve this goal. However, some smaller studies have shown that shampoos with 2% ketoconazole may be as effective as minoxidil regimens. Ketoconazole also has anti-inflammatory effects which can help keep the scalp healthy and free of the grease and scale that may impede hair growth.Promotive effect of topical ketoconazole, minoxidil, and minoxidil with tretinoin on hair growth in male mice.


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.


It’s good for so much more than getting you out of bed in morning. Caffeine has been scientifically proven to potentially promote hair growth in human tissue . Basically, the stimulant plays a role in counteracting the effects of testosterone, which in turn increases hair growth potential.  Role of Caffeine in the Management of Androgenetic Alopecia

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.

Saw Palmetto

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.

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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.

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.

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