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What Does Spravato Feel Like? A Patient’s Perspective 


What's Does Spravato Feel Like? A Patient's Perspective

October 3, 2022

This post was written by a member of our team currently receiving treatment, using Spravato, in Michigan where he resides. He wanted to share his story with us in hopes that it might help patients seeking care with Heading. While he is not a patient of Heading (as Heading provides care to patients in Texas) his treatment program, environment, and experiences detailed in his share are very similar to those at Heading. We are grateful he chose to share his story with us.

 

 

 

I have suffered from anxiety and depression for most of my life. Treatment began at age 12 when I was diagnosed with generalized anxiety and obsessive-compulsive disorder (OCD). While the initial treatments helped to some degree, many symptoms remained, and the side effects of the drugs I took became intolerable. 

 

Over the next 17 years, I switched from one oral antidepressant to the next, desperately trying to find something that addressed my symptoms without causing side effects that were worse than what I was trying to treat. Eventually, my psychiatrist recommended a drug called Spravato (esketamine nasal spray), a rapid-acting drug used for treatment-resistant depression. He told me that Spravato works differently than traditional antidepressants by increasing levels of glutamate and brain-derived neurotrophic factor (BDNF). These two changes have been associated with improvements in depression and anxiety. Knowing this, I felt hopeful that I might get the benefits I was looking for without the drawbacks I was trying to avoid.

 

Though I was excited about trying out the new intervention, I grew increasingly anxious as I awaited my first treatment session. Both esketamine (the active ingredient in Spravato) and its more famous cousin, ketamine, are psychoactive, meaning they can alter one’s normal state of consciousness, affecting one’s thoughts, feelings, and perceptions. 

 

Before trying Spravato, I had very little experience with psychoactive drugs and none with anything that might be considered a psychedelic. As a result, I had no idea what to expect. To make matters worse, I felt that I wouldn’t react well to the experiences that Spravato might bring about because I suffered from severe anxiety. I went into my appointment blind to what I was about to experience. Though my fears were unwarranted, I would have benefited greatly from a clear and honest description of what was to come.  

 

My Experience with Spravato

Below I describe to the best of my ability what I typically feel during a Spravato treatment session. Though some of these experiences may generalize, it’s important to remember that everyone’s brain is unique and may react differently to Spravato.

 

Dissociation

One of the more talked about effects of Spravato is its ability to cause dissociation. Though it is described differently by different people, the effect is generally characterized as a temporary feeling of disconnection from one’s thoughts and feelings.

 

I like to describe my personal experiences with dissociation as akin to the sensation one gets when looking at their avatar through a virtual reality headset. Everything is in the location it’s supposed to be and moves when it should, but you don’t identify with your avatar. Its movements don’t feel like your movements. Its body doesn’t feel like your body.

 

The feeling of separation from my thoughts is harder to describe. The best I can say is that it feels like I am “viewing” my thoughts rather than “thinking” them. They simply pass by, unauthored by me.

 

Feeling of Relaxation

Despite having unusual sensations like the feeling of dissociation, I often experience a wave of relaxation as my concerns and worries drift away. My thoughts quiet down, and former troubles begin to feel like they don’t matter as much.

 

Feelings of Stress and Anxiety

Though Spravato can be pleasurable, it can also be unpleasant and stressful. I believe this is at least partially the result of the following two factors.

 

First, while under the effects of Spravato, my mind tends to focus on unpleasant thoughts at the core of many of my worries (more on this below). Though these thoughts are easier to entertain at the time, they can still be challenging to confront.

 

Second, aside from its psychological or psychoactive effects, Spravato causes physical sensations that tend to be more unpleasant. For example, I often get dizzy and feel like I am slowly spinning in my chair. As a result, I feel nauseous. When these sensations become too intense, the overall experience can become quite stressful. Fortunately, my doctor prescribed an antiemetic (i.e., an anti-nausea drug), so these sensations have become less frequent and more tolerable.

 

Increased Empathy

The state that Spravato puts me in makes it easier for me to put myself in other peoples’ shoes. Often, I will spend time thinking about past arguments or disagreements. While doing so, I have an easier time understanding where the other person was coming from and why their reactions and feelings were appropriate. More generally, I tend to have a stronger concern for the well-being of others.  

 

Enhanced Ability to Confront Unpleasant Thoughts

Through my Spravato experiences, I have realized that at the heart of many of my daily fears are more general worries that I have trouble recognizing or confronting. While under the effects of Spravato, my attention is almost unavoidably directed toward these fundamental concerns

 

Here’s a personal example to shed light on how this works. Among the many things I worry about, work is often at the top of the list. I worry while working on assignments, submitting them, waiting for feedback, etc. Though I had spent so much energy feeling anxious about this, I never looked at the underlying concern or belief that connected all these more specific worries. During one Spravato treatment, I realized that I had deep concerns about my intellectual abilities and that I viewed each work assignment as a potential instance where my real lack of capability would be revealed.

 

Though the fear remains, knowing it exists and is responsible for so many other specific worries has made it easier to deal with.

  

Visual Distortions

Around 10 minutes into each treatment, I start to notice some visual effects. First, my vision becomes fuzzy, and I have trouble refocusing each time I move my eyes. Over the next few minutes, this effect increases in intensity until everything looks as though it is shaking for a few seconds after I shift from looking at one spot to another.

 

Aside from becoming fuzzier and shakier, my vision tends to change in a different way. Specifically, objects appear to be slowly expanding and contracting as if they are breathing. Often, I’ll try to match my breath to the rate at which the things are “breathing.” It’s pretty relaxing.

 

When I close my eyes, I notice a further visual effect. As I keep them shut, I see faint geometric patterns. This is especially noticeable when my eyes are almost but not completely closed, which happens to me somewhat frequently when dozing off under Spravato. My guess is that my brain is doing its best to interpret the unusual visual stimuli it is getting, and the result is that I have some minor closed-eye visuals.

 

Post-Treatment Effects

Though many of the effects subside by the end of the two-hour treatment, some remain for several hours. I tend to feel tired, off-balance, and a bit groggy. These effects slowly dissipate as the day goes on but do not linger into the next day.

 

Concluding Thoughts

From enhanced empathy to feelings of dissociation, Spravato experiences can feel intense or overwhelming when you don’t know what to expect. After I learned first-hand what the experience feels like, my Spravato sessions became much more relaxing and pleasant. Hopefully, my descriptions will help other anxious patients get there more quickly.

 

Stay tuned for part two of this blog, where I describe the long-term effects of Spravato on my depression and anxiety.

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Nutritional Therapy for Mental Health


Nutritional Therapy for Mental Health

October 1, 2022

When trying to treat depression and anxiety, most people turn to psychotherapy, oral medications, or some other medical intervention.

 

While these treatments are effective and often a vital part of many individuals’ mental health toolkits, they aren’t the only ways to prevent and treat mental illness. In particular, research increasingly suggests that our diets can have a significant impact on our mental health. For example, a 2017 study found that around a third of subjects who switched to a Mediterranean-style diet no longer had symptoms of depression by the end of the trial, compared to eight percent of the participants who made no dietary changes. 

 

Nutritional therapists utilize these findings to help patients with a wide range of conditions by offering evidence-based, individualized advice on dietary and other lifestyle changes they can make to support their bodies and, in turn, their minds. 

 

Let’s look at some answers to common questions about nutritional therapy and its role in mental health. 

How Does Nutritional Therapy Impact Mental Health?

It’s common knowledge that what we eat can impact our physical health. For example, it’s well known that eating a diet high in sugar can increases one’s odds of developing diabetes and that high cholesterol, high sodium diets can increase the risk of developing heart disease.

 

But how can nutrition have an impact on mental health conditions? While the connections between diet and mental health are complex, there are, essentially, two ways in which what we eat can improve or harm our mental well-being.

 

First, the nutrients in our food get sent to the brain, altering its functioning in various ways that can impact mental health. For example, antioxidants, found in high levels in fruits and vegetables, can make their way into the brain and decrease oxidative stress, which has been implicated in several mental illnesses. Second, they can impact the health of our gut microbiomes. This collection of bacteria, viruses, fungi, and microbes performs a variety of roles, from producing some of the brain’s serotonin to regulating immune function, which can impact brain health and, ultimately, our psychological well-being.

What Conditions Can Nutritional Therapy Be Used to Treat?

From depression to schizophrenia, nutritional therapy can be used to treat a wide range of mental health conditions. This is partly because many mental disorders are caused or exacerbated by a set of common factors one can impact with their diet. As our resident expert and registered dietician, Sally Twellman notes:

 

Inflammation appears to be a common factor in mental illness, and dysfunction in the gut is often at the root of chronic inflammation. When you look at the research, regardless of the manifestation of mental illness, symptoms typically improve by decreasing inflammation and replenishing the micronutrients that one needs to thrive. And this is really across the board.

How Does Heading Health do Nutritional Therapy Differently?

Heading Health’s approach to nutritional therapy is unique in several important ways.

 

First, our nutritional therapy can be combined with in-house teletherapy or telepsychiatry. This is critical because nutritional therapy is often best used to amplify the effects of other treatments, like psychotherapy or medications, rather than as a stand-alone solution. Second, we utilize a holistic, evidence-based approach, which encompasses more than the standard dietary changes, like those involving proteins, calories, and carbs. As Sally notes when discussing her approach to nutritional therapy:

 

Often when we discuss nutrition modification, we only focus on proteins, calories, fat, and carbohydrates. That’s important. But then we often forget that the real medicine in our food comes from vitamins, minerals, and phytochemicals. If we don’t have those basic building blocks and we don’t have those correct signaling molecules, it’s difficult for our brains to function optimally.

 

Importantly, we don’t stop at dietary changes. We also include lifestyle modifications (e.g., exercise, meditation, journaling, breathwork, etc.), which are known to positively affect mental health and can enhance the effects of dietary alterations.

 

Overall, we look at the whole person and consider how they can make small but meaningful adjustments that complement other treatments they are receiving to optimize their mental health.

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FDA Approves Fast Acting Antidepressant – Auvelity


FDA Approves Fast-Acting Antidepressant: Auvelity

September 23, 2022

On August 19, the U.S. Food and Drug Administration (FDA) approved Axsome Therapeutics’ Auvelity for the treatment of major depressive disorder (MDD) in adults. This new drug has several significant benefits over traditional antidepressants, making it an exciting advancement that offers new hope for individuals struggling with depression.

Here are six key takeaways.

#1: It’s Rapid Acting

One of the main drawbacks of many oral antidepressants is that they can take a long time to work. For example, selective serotonin reuptake inhibitors (SSRIs), like Zoloft, Prozac, and Lexapro, can take four to six weeks before they even begin to take effect.

 

Given how debilitating depression and anxiety can be, rapid symptom relief is critical. Initial studies indicate that patients taking Auvelity showed improvements in depression severity scores in as little as one week.

#2: It Works Through a Novel Mechanism of Action

The standard array of antidepressants works primarily on one or more of three of the brain’s chemical messengers: serotonin, norepinephrine, and dopamine. More specifically, they increase the amount of these neurotransmitters in the space between neurons (nerve cells in the brain that receive and relay information to each other).

 

Auvelity contains two compounds, bupropion, and dextromethorphan. This treatment combination works by inhibiting N-Methyl-D-aspartate (NMDA) receptors, which increases the intracellular levels of glutamate, an excitatory neurotransmitter found throughout the central nervous system (CNS). This increase in glutamate causes the release of another chemical called brain-derived neurotrophic (BDNF) factor, which may help symptoms of depression by allowing neurons to form new connections more easily.

 

#3: It Can Be Taken Orally

Auvelity is the first FDA-approved NMDA antagonist for depression that can be taken orally as opposed to intravenously (through an IV), intramuscularly (injected into the muscle), or intranasally (sprayed into the nose). While these alternative routes of administration have their advantages, some may feel they lack the convenience of a pill that can be taken in the comfort of one’s home.

 

#4: It is Not Associated with Weight Gain or Sexual Dysfunction

Even when the standard antidepressants are effective, they can come with side effects that lead patients to discontinue them despite their therapeutic effects.

 

Likely due to its novel mechanism of action, dextromethorphan-bupropion was not found to be associated with weight gain or sexual dysfunction, two of the more commonly experienced side effects. Additionally, the clinical trials found that, unlike ketamine or Spravato (intranasal esketamine), dextromethorphan-bupropion did not cause transient psychotomimetic effects (i.e., delusions, delirium, perceived distortions of space and time, etc.). 

 

#5: It Can Be Used as a First-Line Treatment

Though there are other treatments for depression that work through novel mechanisms, such as Spravato and TMS, they are approved by the FDA for treatment-resistant depression (i.e., depression that has not responded to multiple oral antidepressants).

 

A lack of FDA approval often results in a lack of insurance coverage. This means patients who would prefer to try one of these novel treatments but have yet to undergo a series of trials with standard oral antidepressants must first wait through weeks or months of potentially unsuccessful treatments.

 

Auvelity changes this. Because it is FDA approved for major depressive disorder full stop, doctors can use it as a first-line treatment for depression before a patient has tried other antidepressants.

 

#6: It is Not the Same as Ketamine or Spravato

While ketamine, Spravato, and Auvelity are all NMDA antagonists, Auvelity is unique in ways that makes them difficult to compare. For example, Auvelity exerts its NMDA antagonism continuously but at a lower level of intensity. In contrast, ketamine and Spravato cause a flood of glutamate in a relatively short period of time. The differential effect of this on treatment outcomes is not yet known, as no studies have compared these medications directly. 

 

Talk with your doctor to determine whether this treatment is right for you, or you can schedule an appointment with one of our team of psychiatrists or therapists to advise you on this or any other potential treatments for depression, including ketamine, Spravato, and TMS. Call us at 805-204-2502 or request an appointment here.

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Study Finds Ketamine Provides Rapid Relief from Severe Suicidal Ideation​


Study Finds Ketamine Provides Rapid Relief from Severe Suicidal Ideation

September 20, 2022

Each year, around 800,000 people die from suicide, and nearly 20 times that number attempt it. 

 

Though the causes of suicide and suicide attempts are varied, it is often preceded by suicidal ideation (i.e., contemplations, wishes, and preoccupations with death and suicide). As a result, researchers have increasingly been searching for compounds that treat these thoughts and feelings. 

 

Ketamine has stood out as a promising candidate, with several studies indicating that it is highly effective against suicidal ideation. While these results are encouraging, they generally have not focused on patients experiencing more severe suicidal ideation (SI) or in the middle of a suicidal crisis. Additionally, as far as outcomes go, many studies have measured the number of “treatment responders” (i.e., individuals who experience at least a 50 percent reduction in symptom severity) as opposed to the amount who experience remission (i.e., a complete absence of suicidal ideas).  

 

To fill in these gaps, a team of researchers led by Dr. Mocrane Abbar conducted a double-blind placebo study to assess the effects of ketamine on cases of severe SI. Due to its double-blind placebo-controlled structure, half of the subjects were given an inactive ingredient not known to improve SI. Additionally, neither the subjects nor the experimenters knew whether ketamine or the placebo was given. 

Key Findings

Below are some of the key findings from this study.

 

 

The Majority of Patients Achieved Full Remission

Sixty-three percent of the severely depressed subjects achieved complete remission of their suicidal ideation after just three days and two ketamine infusions.

 

It Worked Rapidly

SI is an urgent condition warranting an immediate and swift response. As such, it’s vital that ketamine not only works for many patients but also exerts its effects quickly and robustly.

 

As the graph above shows, many patients achieved remission almost immediately. Specifically, 43.8 percent of participants suffering from severe suicidal ideation achieved remission of their symptoms only two hours after their first infusion.

 

 

The Effect was Persistent

Immediate and robust relief of SI is a significant result on its own. However, this finding may have a limited impact if SI promptly returns. Fortunately, the researchers found that the effect lasted six weeks for nearly 70 percent of the patients.

While far from permanent, the six-week reprieve many patients experienced is promising for several reasons. For one thing, given that suicidal ideation is strongly associated with suicide attempts, these subjects may be far less likely to attempt suicide within those six weeks. Second, repeated infusions may lengthen this period of relief even further. Additionally, patients who have yet to create a holistic system of support to supplement their pharmacological treatments with other forms of therapy may find they have more energy to do this while the ketamine is lifting the heavy mental burden of severe SI.

 

 

The Effect was Strongest for Those Suffering from Bipolar Disorder

The research team found that ketamine’s therapeutic effect on SI generally depended on the mental condition the patient was suffering from.  More specifically, they found that ketamine infusions had the strongest impact on SI in patients who have bipolar disorder.

 

Among individuals suffering from depression, the effect was more moderate, with 42 percent of subjects experiencing a remission of their SI.  To shed light on the result, the researchers note that “one study of treatment-resistant depression suggests that repeated doses of ketamine might be necessary for some patients to achieve remission of severe suicidal ideas.” In other words, it may be that this group would have experienced a more significant improvement in their SI symptoms had they undergone more ketamine infusions.  Future studies will need to verify whether this is true.

 

 

It Alleviated “Mental Pain”

In addition to compiling more robust, reliable evidence that ketamine is a good treatment for severe SI, the research team collected data that may shed light on why it is so effective. In particular, they measured patients’ levels of “mental pain” and looked for correlations with remission levels.

 

They found that patients’ self-reported mental or psychological pain was strongly correlated with the severity of their SI and that the ketamine infusions had the most substantial positive effect on their SI when they alleviated psychological pain. This suggests that ketamine’s impact on SI is, at least partly, the result of its ability to relieve psychological pain.

Conclusion

Research continues to verify ketamine’s therapeutic effect on SI. This study provides some of the strongest evidence to date, suggesting that ketamine can provide rapid relief in cases of suicidal crises. It also sheds light on why ketamine has this effect and indicates that the degree to which it is helpful may depend on the individual’s particular mental health condition. 

 

If you are experiencing symptoms of SI, please contact the Suicide Crisis and Prevention Lifeline at 988. 

 

If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists who can see you in as little as one day via teletherapy.  

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Telepsychiatry Vs Teletherapy. What’s the Difference?

Telepsychiatry Vs. Teletherapy. What's The Difference?

December 16, 2022

Previously carried out primarily through in-person appointments where both practitioners and patients interacted in the same physical space, psychiatry and therapy visits increasingly began to take place through digital mediums (e.g., phone calls or video chats). According to UnitedHealth Group, there were 14 million telemental health visits in 2022 alone. 

 

Therapy and psychiatry are different but collaborative disciplines.

 

Like other areas of health different providers have different functions.  While teletherapy and telepsychiatry may accidentally be used in conversation interchangeably, what they are and what they do for their patients is different. Understanding how a therapist and psychiatrist differ and understanding how they operate in telemedicine may help you chose the best service for you.

What Is Teletherapy

In online therapy, patients meet remotely with a licensed mental health professional to talk through their emotions, thoughts, and feelings, receive a diagnosis if necessary, and treat their ailment with a non-medical or behavioral approach.

Some of the more common types of therapy include:

What Is Telepsychiatry

Just like teletherapy, telepsychiatry is also conducted digitally.

However, the goals and strategies of these appointments are different. While psychiatrists may incorporate behavioral techniques, they also focus on the biological causes of behavioral health issues. Utilizing their medical training, professional experience, and the latest academic research, psychiatrists attempt to determine whether a patient would benefit from medical treatment or intervention, and prescribe the most effective one based on the patient’s needs.

Advantages of Telemental Health Care

Though telepsychiatry and teletherapy arose primarily out of necessity, mental health professionals and their clients have found several advantages associated with virtual mental health care, including:

  • Cost: While the cost of mental health services varies, virtual appointments are generally cheaper than in-person ones.
  • Accessibility: To see a telemental health provider, you don’t need to travel far or even have access to transportation of any kind. You only need access to the internet or phone service and a quiet place to talk.
  • Time: Since there is no need to drive anywhere or sit in a waiting room, telemental health services take up much less time than in-person alternatives.
  • Selection of practitioners: With in-person appointments, your choice of practitioner is limited both by what you can afford and how far you can drive. With virtual care, your menu of offerings expands beyond your physical and financial constraints, meaning you can pick a professional who better suits your needs.
  • Less perceived stigma: Some people struggle to let go of the stigma associated with mental health care and may believe others will judge them for getting help. Virtual sessions allow patients to receive care with greater anonymity.
Considerations When Seeking Telemental Health Care

As telemedicine has become more mainstream provider’s skills in offering digital care has improved. However there are a few obstacles to keep in mind when seeking telehealth providers:

  • Nonverbal communication: Fcial expressions and body language often say as much about how we are feeling as our words. Studies have found that our ability to pick up on these nonverbal cues can be compromised in virtual settings, meaning practitioners can’t use them as easily to guide or inform their treatment. Providers may overcome this by tuning in to the changes they can see on camera, and also asking additional questions. Patients may want to consider how they can continue to interpret their nonverbal responses and verbalize them if possible.
  • Privacy: Because we share personal information in therapy, we typically prefer to keep what is said private or confidential. Privacy in virtual appointments depends on the patient’s ability to find a space away from other people where they can’t be heard. When considering telemedicine consider your privacy, and also discuss any privacy concerns that may come up with your teletherapist or telepsychiatrist. They may have insight and offer suggestions.
  • Sense of connection: For some, part of the benefit of therapy comes from voicing their concerns to someone they have developed a relationship with. Without face-to-face interactions, these connections can be harder to build and sustain. If physical proximity feels like a meaningful aspect of care for you and you find it difficult to overcome with other strategies, be open with your teleprovider and ask if referring to a provider that offers in-person care may be best for you.
Embarking on Treatment

Telepsychiatry and teletherapy are critical resources in our mental health toolkits. Though they share many similarities, they utilize significantly different approaches to treatment. While therapists emphasize talk and behavioral strategies, psychiatrists prescribe medication and medical treatments.

 

Therapy and psychiatry often go hand in hand for a patient’s care, and it can be tricky to go between providers employed through different companies.

 

At Heading we have found it beneficial to provide patients access to both therapists and psychiatrist so that care is collaborative between the patient and their team of providers. With many services like medication management for traditionally prescribed oral antidepressants (i.e. Celexa, Paxil etc.), or talk therapy (i.e. cognitive behavioral therapy, dialectical behavior therapy, trauma therapies, and psychodynamic therapies etc.) these services can be offered via telehealth. However we also acknowledge that not all treatments are best done from home, and also offer transcranial magnetic stimulation (TMS), and IM Ketamine and Spravato® treatments in our Austin and Dallas Centers. Our fully remote and hybrid dynamics of care require that all providers involved in patient care stay in collaboration with one another. Our team-based approach allows for more ease in the process. 

 

It is important to feel good about both the relationship you personally have with your therapist and psychiatrist. Also consider the relationship and communication between these two key members of the mental healthcare team.

 

 

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Ketamine and Alcohol Use Disorder​


Ketamine and Alcohol Use Disorder

September 13, 2022

Alcohol Use Disorder (AUD), a condition characterized by a problematic pattern of alcohol consumption despite physical, mental, and social consequences, is among one of the most common and costly psychiatric conditions. According to National Center for Drug Abuse Statistics, the condition affects around 10 percent of Americans aged 12 and older and is responsible for three million deaths every year.

 

Because AUD remains a difficult condition to treat, researchers are actively seeking novel therapeutic solutions. Due largely to its well-documented effects on depression, many experts are investigating whether ketamine may prove helpful against AUD. As Professors Celia Morgan and Amy McAndrew note:

 

Depressive symptoms are common in individuals entering treatment for AUD, and the likelihood of alcohol relapse is elevated in patients with such symptoms.

 

Ketamine may support alcohol abstinence by temporarily alleviating depressive symptoms during the high-risk relapse period in the weeks after detoxification.

 

Early experiments have produced promising results, with several studies finding ketamine improved abstinence and lowered relapse rates. For example, one study found that 66 percent of patients with AUD who received ketamine infusions alongside psychotherapy were abstinent one year later compared to 24 percent of patients who did not receive ketamine.

 

Recent Study Suggests Therapy Makes Ketamine a More Effective Treatment For AUD

While some experts feel that ketamine can be highly impactful when delivered on its own in the absence of any therapy, others feel patients must be supervised and receive guidance from experts during and after treatment for it to be consistently effective. As Rosaline Watts, a leading scholar in the field of psychedelic research, explains when discussing one of her recent experiments, “the drug was a catalyst to the therapeutic process, not the therapeutic process itself.”

 

With the importance of therapy in mind, a team of researchers led by Morgan and McAndrew set out to directly assess the role of therapy in ketamine-based treatments with a focus on mindfulness. In their study, they reason that:

 

The subjective experiences that accompany ketamine infusions may provide a new perspective that may be helpful in psychological therapy. Ketamine induces a dose-dependent sense of dissociation and disembodiment that has been described as facilitating an “observer state” similar to that described in mindfulness, which may be helpful for allowing patients to consider thoughts and emotions from a more removed perspective.

 

 

Methods

The researchers conducted a double-blind-placebo controlled study to assess the importance of therapy in ketamine-assisted treatments for AUD. This means special precautions were taken so that neither the subjects nor the experimenters knew what treatment they received, which helps ensure the results are more objective, reliable, and free from bias.

 

Because the researchers wanted to examine the effects of both ketamine and therapy on AUD, they needed two placebos (i.e., “inactive” treatments), resulting in four possible treatment combinations.

 

  1. Ketamine infusions with psychological therapy/mindfulness-based relapse prevention
  2. Saline (drug placebo) infusions with psychological therapy/mindfulness-based relapse prevention
  3. Ketamine infusions with alcohol education (“therapy placebo” where subjects were taught general facts about addiction and alcohol use disorder)
  4. Saline infusions with alcohol education

 

Findings – Efficacy and Safety

After three treatment sessions the researchers noticed several important outcomes. They found the number of days abstinent at three and six months after treatment was higher in the groups that received ketamine either with or without therapy, corroborating findings from earlier experiments.

                                                                                               Photo Credit to Professors Morgan and McAndrew

 

The team found some promising results when it comes to whether mindfulness makes ketamine a more effective tool against AUD. In particular, they found that relative to the subjects that received saline with alcohol education (i.e., both placebos), the group that received ketamine alongside mindfulness-based relapse prevention showed the largest percentage increase in the number of days they remained abstinent. However, the latter finding was not statistically significant, meaning future studies will need to verify that the combination of ketamine infusions with mindfulness-based relapse prevention is more effective than ketamine alone.

 

Because ketamine has the potential for abuse when used in recreational settings, Morgan and McAndrew sought to assess whether this might make it a less viable option for individuals with AUD. To do so, they tracked whether subjects used ketamine during the follow-up portion of the experiment after the supervised ketamine infusions had been administered.

 

They found that around six percent of the subjects reported using ketamine on one occasion during this period. Importantly, these individuals stated they had used ketamine recreationally before the experiment. Future studies will be needed to further determine whether AUD puts one at a greater risk of using ketamine outside supervised settings.

 

Conclusion

Though the research is in its early stages, evidence suggests that ketamine, whether used alone or in conjunction with therapy, may help individuals recovering from AUD maintain sobriety.

 

As researchers continue to explore and identify new psychiatric uses for ketamine, it is becoming increasingly clear that psychological therapy is required to unlock the full benefits of this treatment. Patients and practitioners alike should bear this in mind as they consider ketamine as a therapeutic alternative.

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Panic Attack Types, Diagnoses, and Treatments​


Panic Attack Types, Diagnoses, and Treatments

September 12, 2022

A panic attack is a sudden and brief episode of intense fear and anxiety which triggers a host of unpleasant physiological and psychological symptoms, including:

 

  • Accelerated heart rate
  • Chest pain or discomfort
  • Chills or hot flashes
  • Shortness of breath
  • Derealization and/or depersonalization
  • Sweating
  • Fear of dying
  • Fear of losing control or going crazy
  • Feeling of choking
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of numbness or tingling sensations
  • Nausea or abdominal pain
  • Trembling or shaking
Types of Panic Attacks

Though all panic attacks involve a sudden surge of anxiety, they differ in significant ways that can impact diagnosis, treatment, and prognosis. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V), there are two types of panic attacks: unexcepted and expected.

 

Unexpected Panic Attacks

Some individuals experience a panic attack out of the blue without a clear cause. Seemingly out of nowhere, their anxiety will rise dramatically, despite knowing they are not in a dangerous situation.  

 

These types of panic attacks can be particularly stressful for the people who experience them, especially the first few times they happen. Not knowing why you are feeling intense fear can make the feeling of panic even worse. Once one learns they experience unexpected panic attacks, they may spend lots of time worrying about when the next one will happen since they can’t identify causes or triggers.

 

 

Expected Panic Attacks

Some panic attacks have a clear and identifiable cause. One of the more common triggers is being exposed to something you are extremely fearful of. For example, someone who has a phobia of spiders may experience a panic attack upon finding a spider in their house. Likewise, someone who fears flying may have a panic attack when thinking about an upcoming flight. 

 

Expected panic attacks can also be brought on by your environment, even when you know there is nothing dangerous about it. For example, in one case study, an individual tended to experience panic attacks while driving, traveling alone, in enclosed spaces, and in crowds, even though they had no specific fears associated with those circumstances. 

 

These panic attacks are importantly different from unexpected panic attacks because they are predictable. Since they have an identifiable source, those who experience them may have an easier time avoiding them. 

 
Panic Attacks and Mental Health Conditions

While panic attacks are intensely stressful events regardless of their type, they are not always a sign that one suffers from a mental health condition. One reason for this is that some events are simply very scary and warrant a lot of fear and anxiety. If you only experience panic attacks in these situations, you may not receive any mental health diagnosis.

 

 

Panic Attacks and Phobias

Some situations don’t warrant intense fear. For example, there is little reason to be scared when enjoying your favorite ice cream while sitting at home and watching tv. If you consistently have panic attacks in response to a situation, idea, or object that is not a direct and immediate threat, you may be diagnosed with a specific phobia disorder.

 

 

Panic Attacks and Panic Disorders

Some people experience one panic attack and never have another. However, others experience them repeatedly. If this happens to you and your panic attacks are of the unexpected variety, you may have what is known as a panic disorder.

 

Panic Attacks and Other Mental Health Conditions

Panic attacks may also occur as a symptom of several other mental health conditions, including:

 

  • Generalized Anxiety Disorder (GAD)
  • Major Depressive Disorder
  • Bipolar Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Social Anxiety Disorder
  • Post-Traumatic Stress Disorder (PTSD)
 
Treatments

Treatments for panic attacks vary depending on the type of panic attack you experience and the condition it is a symptom of.

 

 

Exposure Therapy

If you experience panic attacks resulting from phobias, you may undergo what is known as exposure therapy. For this treatment, individuals are gradually exposed to what they are afraid of until their fear response goes away or no longer interferes with their daily lives.

 

Recently, this form of therapy has been combined with virtual reality (VR). By offering immersive virtual environments, VR allows patients to get one step closer to their fears without encountering the real thing. Studies have found that this modified version of exposure therapy is a promising alternative to the standard approach.  

 

 

Medications

Exposure therapy doesn’t work for the unexpected panic attacks common in panic disorders. Physicians typically treat panic disorders with medications (e.g., selective serotonin reuptake inhibitors and benzodiazepines). Some studies have found that ketamine can resolve panic disorders, though more experiments are needed to confirm this result.  

 

If you feel you may suffer from panic attacks or have additional questions about them, please give us a call at 512-777-2591 and we would be happy to assist you.

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6 Brain Healthy Tips for Your 4th of July Celebration

6 Brain Healthy Tips for Your 4th of July Celebration

July 4, 2022

Independence Day is upon us, with hot sunshine and loved ones gathered with games to play. Between family barbecues, watermelon galore and smores over the campfire, each year in the United States we spend around $6.7 billion dollars on our midsummer feast. 

 

But amidst all this celebration is a tricky detail we’re liable to forget: what we eat! Burgers, beers, brownies, queso dip, chips, hot dogs on hot dogs – the indulgence is never ending and can lead to feeling physically and mentally slow the following days. According to an article by Harvard Health, a diet high in refined sugars has been shown in multiple studies to not only impair brain function, but also aggravate symptoms of mood disorders such as depression and anxiety.So, here are a few tips to help you keep your mind and body working their best: 

 

  1. Veggies + dips = success – Whether you enjoy hummus, ranch, or guacamole, pair it with some carrot sticks, bell pepper strips, celery sticks, cherry tomatoes, or cucumber slices and you’ll have healthy fiber-packed options to keep bellies happy and energized. Want to up your health game even further? Check out this simple recipe for a healthy, probiotic packed veggie dip!
  2. Impress with a charcuterie board – Maybe veggies and dip is a bit basic for you. Why not try a charcuterie board? Centered around cured meats and cheeses, charcuterie boards often include other interesting, savory food items like fruits, vegetables, jams, and crackers. Whole wheats and healthy fats are great brain food, while charcuterie boards help ensure your party is one people will remember! 
  3. Know how food affects you and what to avoid – Here’s a quick list of foods that are most harmful to your mental and physical health: 
    • Soda and sugary drinks full of excess sugar contribute to obesity, high blood pressure, and long-term problems with brain function 
    • Diet sodas rich in aspartame and other fake sugars are linked to cognitive and behavioral health issues 
    • Refined carbohydrates found in white bread, pastries, and other sugary desserts have high glycemic loads that spike blood pressure, increase obesity risk, and are correlated with lowered brain function over time   
    • Trans fats packed into junk foods, frosting, ready-made cakes, and pre-packaged cookies are tied to increased risk of Alzheimer’s disease and other memory issues 
    • Alcohol is widely known for next-day effects like hangovers and stomach problems, but can also affect sleep quality or leave you with general brain fog 
  1. Tell family and friends about your goals – If you are focused on eating well as you celebrate, tell your family and friends. They may want to join you, but if not, it’s important they’re aware you aim to eat healthy so they respect your boundaries and avoid tempting you with unhealthier options. 
  2. If you’re tempted to eat more, take a break – If you’re fighting the temptation to eat unhealthy food or eat more than you normally do, take some time to yourself to check in with your body. Maybe it’s a quick walk around the neighborhood or time alone in your car. 
  3. Indulge with moderation – Sometimes the day isn’t complete without holiday staples. If a 4th of July without a cheeseburger or beer feels wrong, you don’t have to hold yourself back from those things, just enjoy in moderation. Try changing your portion to something smaller so you can have your cake and eat it too – go with half a cheeseburger or just one drink.

Looking for help as you learn what foods are right for you on your path to improved mental health? Heading Health offers science-based nutritional therapy focused on high-quality, nutrient-dense foods that provide the key vitamins and minerals needed to heal your body and the brain from the inside out. Learn more about nutritional therapy and request your appointment by giving us a call at 855-204-2502.

Happy Independence Day from Heading Health!

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LGBTQIA Mental Health Struggles & How to Help

LGBTQIA Mental Health Struggles & How to Help

By Corbin Blevins

June 30, 2022

Throughout history, society has widely disregarded mental health. For those struggling with mental illnesses such as depression, anxiety, or obsessive-compulsive disorder, this has been an incredible struggle, as frequently we are told to just “suck it up”, “have a positive attitude” or “put on a happy face”. Fortunately, over the last few years, mental health (and with it mental healthcare) has become less stigmatized. It is becoming more acceptable to reach out for help and new treatments such as transcranial magnetic stimulation (TMS) and Spravato are becoming more commonplace. 

However, for many in the LGBTQIA+ community, their journey to be accepted for their truest selves is perceived as attention-seeking. Those who choose to pursue gender-affirming counseling, gay-friendly providers, or surgeries to reflect who they are can receive severe backlash and rejection from those close to them.

Because of this, suicide rates are at an all-time high among transgender youth. Gay, lesbian, bisexual, and non-binary individuals frequently report feelings of hopelessness and anxiety as they struggle to find providers, friends, and family who truly love and support them. 

So what can be done to help provide a more mentally healthy society for the LGBTQIA+ community?  Whether you identify as part of the community or not, here are three simple things you can do to support positive mental health for all.

  • Pay attention- if you see someone who seems to be struggling, ask how they are doing.
  • Truly listen- when someone opens up to you, take the time to hear what they have to say and recognize how they are feeling
  • Express love- remember that everyone deserves to feel safe to be themselves. Whether you agree with their personal decisions or not, let them know that you care about them and will continue to be there for them. 

Lastly, if you see someone who is truly struggling, don’t be afraid to help them build a better support system. If you’re worried that they might be suicidal, ask them. This can help them know you are a safe place to talk, and doesn’t increase the risk of suicidal actions. Whether they are suicidal or not, there are many phenomenal outreach programs and LGBTQIA+ friendly providers are becoming available. If you feel comfortable, offer to help them find allies in the mental health community. 

Everyone deserves to feel safe within themselves, and at Heading, our goal is to provide safe, non-judgmental, accessible mental healthcare to all. We accept most insurance and have diverse staff from all walks of life to help ensure we can provide the highest-quality care to people from all walks of life.

As an LGBTQIA+ safe space, we invite all who are searching for allies to reach out to us. We are here for you, and we love you. You deserve happiness, and we would be honored to be your partner in finding it. Whether you are searching for help for yourself or for a loved one, please give us a call at 855-204-2502.

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Celebrating Juneteenth

Celebrating Juneteenth

By Teressa Carter, MSW, LCSW

June 20, 2022

Across the United States of America, millions of Americans young and old take great pride in living here and celebrating freedom every on Independence Day. Juicy watermelon, delicious barbecue, and vibrant fireworks fill the sky across the country as we celebrate living in the aptly named “land of the free”. However, not everyone gained true freedom that day.

 

Juneteenth, which is short for “June Nineteenth” is the day when federal troops arrived in Galveston, Texas in 1865 to take control of the state and ensure that all enslaved people were freed. This event occurred two and a half years after the signing of the Emancipation Proclamation and almost 100 years after the signing of the Declaration of Independence. Texas was the last state to set all enslaved persons free, and on June 17, 2021, Juneteenth officially became a federal holiday honoring the end to slavery in the United States.

 

As you can imagine, this holiday holds great meaning to many- both in mind and in heart. Holidays and celebrations such as this hold the key to reminding us how far we have come as a nation, and that all people are deserving of love and respect. Juneteenth is not just a celebration of the end of physical enslavement, but a celebration of diversity and individuality.

So as we celebrate this Juneteenth, we invite you to take a deeper look and allow yourself the space to embrace not just who you are today, but who you have been and who you hope to be. Holidays like Juneteenth teach us resiliency, determination, healing, and the importance of recognizing the value in everyone, including ourselves. Self-love begins with recognizing our own needs, so here are a few small ways you can honor your own value during this holiday and throughout the rest of the year.

  1. Set boundaries
    Remember, nobody can take care of you as well as you can. Give yourself permission to speak up if you don’t want to cook the pot roast, feel too tired to go to the zoo, or just need some alone time.
  2. Set goals
    While hearing the term “goal setting” can feel overwhelming at times, goals can be anything: whether it’s taking a candy-making course with your mother-in-law, changing the oil on the car, or spending an hour a week reading a good book. Ask yourself, “What would make me feel more satisfied with my life right now?”, “What would bring me greater peace?”, or even something like “What would make my day feel more enjoyable?” and follow through!
  3. Talk with someone who cares
    Whether it’s a friend, family member or therapist, choosing to spend time in an environment where you can be your authentic self and feel accepted and valued is one of the greatest forms of self-care. Talk about whatever is on your mind- anything from frustrations to successes, and anything in between! If you don’t have a place where you feel accepted and loved for who you are, spend some time looking for one. Therapy is a great place to start!

This Juneteenth let’s take the opportunity to celebrate our resiliency and recognize our own value. If you are searching for a place to start your own mental or emotional healing journey, we have worked hard here at Heading to create a safe and diverse environment to allow you to honor your individual path. We’d love for you to give us a call at 855-204-2502 to learn more about the services and support we offer, or how to find a mental healthcare partner that’s right for you.

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