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Methods to Receive Ketamine Therapy

Ketamine: Sprays, IVs, Injections, and Lozenges.

August 15, 2023

When it comes to finally feeling better Ketamine offers promise to those who have failed to find relief from SSRIs. More options for administering this medication now exist. Here's an overview of the most common.

Ketamine is a treatment that is offering many patients faster relief for mood  and chronic stress disorders particularly treatment-resistant depression, anxiety, and PTSD. For those that have not responded well, or at all, to other treatments like SSRIs, the medication offers hope for healing that many patients once felt was impossible.

 

 

Unlike a daily pill, Ketamine is offered in sessions over the course of a series. Ketamine sessions should be offered in controlled settings and supervised by medical professionals. 

 

 

 

Intravenous (IV) Infusion: This is one of most common and studied method of ketamine administration. An infusion of ketamine is delivered directly into a patient’s bloodstream through a vein. The dosage and duration of the infusion are controlled to achieve therapeutic effects. IV ketamine treatment often involves a series of sessions over several weeks, and requires medical supervision.

 

 

Intramuscular (IM) Injection: In this method, ketamine is injected into a muscle, and dosage is tailored to the patient. Intramuscular injections are considered an alternative to IV infusions, especially when IV access is challenging.  Like IV injection the dosage is carefully controlled based on body composition, past tolerance to the medication, and other factors your psychiatrist will discuss with you in your consultation and follow-ups. 

 

 

Nasal Spray (Spravato®): Esketamine, a derivative of ketamine, has been approved by the U.S. Food and Drug Administration (FDA) as a nasal spray for treatment-resistant depression. Patients self-administer the nasal spray under the supervision of a healthcare provider. Nasal spray offers a more convenient option especially for those who do not want IVs or injections.

 

 

Sublingual or Buccal:  Ketamine can also be administered by placing a tablet or lozenge under the tongue or against the cheek. The medication is absorbed through the mucous membranes in the mouth. It’s important with this administration of Ketamine to follow the clinicians instructions for receiving the medication to ensure the best possible absorption and results.

 

 

Effectiveness of the different methods can vary based on the specific condition being treated, individual patient responses, and factors such as dosage and treatment protocol. The choice of method should be made in consultation with a qualified healthcare professional based on the patient’s individual circumstances and medical history.

 

 

At Heading clinics in Austin and in Dallas-Forth Worth the majority of patients receive ketamine through Spravato® nasal spray, or intramuscular injection.  Regardless of method all patients at Heading receive treatment with direct medical supervision.  Everyone responds to medications differently, and given the dissociative affects of Ketamine it can be safest to have clinicians who specialize in psychiatric care on hand to give guidance, answer questions, and offer support for patients going through their series.

 

If you feel you could be helped with interventional psychiatric treatments, like Ketamine Therapy, reach out.  Our clinicians in Austin and in Dallas-Fort Worth would love to support your journey to health and healing. 

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5 Ways to Improve Your Ketamine or Spravato® Experience

5 Ways to Improve Your Ketamine or Spravato® Experience

August 8, 2023

When it comes to feeling better it is understandable that people with treatment-resistant depression feel nothing will work. Spravato® - a version of Ketamine - has been giving people hope.

Ketamine and the FDA-approved version Spravato® are gaining attention for treating depression that hasn’t responded or has not responded well enough to other medications, therapies, or both.

 

Spravato® must be administered in person at an approved center or clinic under the supervision of an approved clinician. At Heading Ketamine is also administered in person.

Our team offered a few ways to improve the experience receiving Ketamine or Spravato® and get the most out of treatment.

 

5. Follow Preparation Instructions from Your Care Team

“We conduct a thorough psychiatric consultation with a patient to establish the best route of care. If Ketamine or Spravato® is determined as the best next step our our clinical staff  follow up directly with instructions to prepare. Prior planning for schedule, travel arrangements, and understanding the DOs and DONTs help a patient feel more relaxed and safe going into their series,” shared Dr. Arif Noorbaksh, based out of Heading’s Trophy Club, Texas center which is just outside of Dallas Forth Wort.  

 

4. Remember, Your Questions are Welcome!

Unlike traditionally prescribed SSRIs, which can take weeks for symptoms to subside, Ketamine or Spravato® prescribed for depression can create change very fast.  The immediate effects of the medication create an altered state, and this experience (sometimes referred to as a ‘trip’) can feel surprising and unexpected.

 

During your consultation, and on the day of your sessions feel free to ask all of the questions that are on your mind. Your care team will be more than happy to walk you through any aspects that you might be nervous about, and also help you better understand the medication itself and how it works with your body for healing. 

 

3. Explore Your Intention 

Establishing an intention for treatment can improve the experience. You may have heard of having a ‘bad trip’. While remembering or processing experiences during therapeutic sessions is part of the experience, the mindset going in can improve your perception of the experience. 

 

Feeling prepared can go a long way to influence feelings of safety and calm, which in turn allow you to be more open to the immediate experience, and continue to integrate and optimize once the acute effects of the medication have worn off (and while the neuroplastic window is still most optimal.)

 

2. Meet with a Therapist Prior to Treatment and Soon After Treatments

Intentions shouldn’t be agendas, but rather frameworks for experience.  Be gentle with yourself as you consider prompts and affirmations.  A therapist can help with this!

 

If possible it is recommended to meet with a therapist prior to your first session to prepare. Andrea Marquez, a therapist at Heading in Austin, had this to say about preparation before interventional treatments, “I like to team my patients exercises such as body scanning, breathing practices, and self-soothing techniques. This can help them get back to the present moment if they become overwhelmed or surprised during their first Ketamine or Spravavto® experience.”

 

Likely your therapist will also want to see you soon after your sessions, within a day or two, to help you process the experience and set intention for the next. Integration has long been an aspect of psychedelic therapies, and academic study of this aspect of treatment is ongoing. After you have your initial sessions under your belt you and your therapist can shift from preparation and coping skills for the immediate treatment itself into understanding and integrating the ways in which Ketamine treatment can positively influence your goals for change. 


Regarding post treatment therapy sessions, Andrea also shared, “Over time I help patients work on thought processes that they may notice when they are in an interventional treatment. Together we unpack what came up. I also ask the patient what they feel will best support them. Sometimes it is just to hold space for those thoughts, and other times they desire a move towards change.” 

 

1. Stay Consistent

Ketamine offers fast relief for many patients who are struggling. But, the long-term outcomes are most optimal with consistency throughout a whole course of treatment, along with staying involved with follow up psychiatry and psychotherapy appointments. 

 

Typically Ketamine and Spravato® series are set for a series of several sessions across 11-12 weeks with additional maintenance as needed.  Attending all of the sessions in the prescribed cadence is important to the long-term positive outcomes that can be experienced from this course of treatment.

 

Ketamine and Spravato® open a window for change. But you are the one who is making it happen. If you need help making your treatment and follow up therapy talk with your care team about scheduling. Advocating for your care is a positive and powerful step in the healing journey. Mental health professionals are happy to help patients find the best rhythm of care that empowers you to say committed to the process. 

 

Ketamine is an exciting area of research, and it has the potential to help many people who suffer from depression, anxiety, and PTSD. If you or someone you know is considering using Ketamine for mental health treatment, consider setting up a consult with Heading where you could receive ketamine or Spravato® treatment in our centers in Austin or Dallas-Forth Worth.

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Care Insights: Synergy of Ketamine and Therapy for Emotional Healing

The Synergy of Ketamine and Therapy for Emotional Healing: An Austin Therapist's Perspective

Maximal Benefits of Ketamine through Therapy with Andrea Marquez LCSW

In the heart of Austin, Texas and a few hours north in Dallas-Fort Worth patients arrive at Heading clinics to receive a groundbreaking approach to mental health and the treatment of depression, anxiety, and PTSD – Ketamine therapy. Ketamine Therapy, known for its association with psychedelic substances, has emerged as a beacon of hope for individuals battling mood disorders that have not been helped well enough, or at all, by traditionally prescribed first-line treatments. What sets this therapy apart is how its effects on the brain can directly integrate with the benefits of counseling, creating a dynamic duo that optimizes treatment for those seeking profound emotional healing.

 

Most often patients in Heading’s care receive treatments in the form of Intramuscular Ketamine or in a nasal-spray medication called Spravato®.  Patients will physically come in for Ketamine in Austin or Ketamine in Dallas to a Heading clinic. Ketamine treatment is a series of treatments over several weeks, and the safety, comfort, and expert support of in center treatments makes the choice to have in-person treatment well worth the visit. 

 

Conveniently, in between treatments patients are often paired with a therapist that sees the patient virtually. Combining virtual therapy appointments optimizes the benefits of the in-center treatment with the transformative change that can come from working with a licensed therapist who understands the healing potential of Ketamine, and the unique effects it has on the brain.  This article shares the perspective of one of Heading’s therapists who often treats patients who are also receiving Ketamine or Spravato® in the center. 

 

Meet Andrea Marquez, LCSW, a respected therapist and supervisor at Heading, who has been at the forefront of this innovative approach, combining the transformative power of Ketamine treatments with the healing potential of therapy. Andrea’s dedication to her patients’ well-being has led her to explore the untapped potential of neuroplasticity and the behavioral change that therapy can evoke in conjunction with Ketamine’s effects on the brain.

Groundbreaking Synergy: Therapy and Ketamine Unite

When asked to provide insight into the benefit of combination therapy and ketamine Andrea explained how the two healing modalities complement each other, creating a well-rounded experience for her patients. “Therapy combined with interventional treatment has been helpful in keeping patients engaged in treatment and gives them the ability to check in on their concerns and experiences,” she shared. 

 

Still, some patients are nervous about Ketamine, associating it with its illicit use and abuse as a street or party drug. Andrea understands their nerves and feels the combination of ketamine and therapy can calm these fears, and enhance safety and efficacy, “By providing a supportive environment, therapy helps destigmatize the use of Ketamine and empowers patients to make sense of their unique journey with the treatment and understand its usefulness.”

Neuroplasticity Unleashed: Ketamine Opens the Door

Andrea’s expertise in mental health and her understanding of neuroplasticity have led her to recognize the window of opportunity that Ketamine treatments offer. “Ketamine treatments place the brain in a unique state making it more receptive to change,” Andrea explained. 

 

It was an old belief that the physical structure of the brain became relatively unchangeable after a certain stage of development. Now scientists, psychiatrists, and therapists who are experts on the brain and thought processes know that this is not true. The brain is capable of change and healing. This capability for change, or neuroplasticity, is key in changing long held habits. Ketamine heightens the neuroplastic state and in this heightened state patients have the potential to break free from negative thought patterns and establish new neural connections, creating lasting positive changes in their mental landscape.

Reinforcement and Resilience: Grounding and Mindfulness Techniques

Ketamine therapy, though safe with relatively low risk of adverse side effects, can still be experienced as quite intense. While technically a dissociative anesthetic Ketamine produces a brain and body experience that is often described as psychedelic.

 

 

Prior to treatment Andrea teaches patients  grounding and mindfulness techniques they can use during sessions, providing patients with invaluable tools to navigate their emotional experiences. These techniques can be employed in Ketamine sessions and in every day life. “If I am able to meet with them before they get started, I teach them mindfulness exercises like a body scan, paced breathing, and self-soothing techniques,” Andrea explained. 

 

Feeling comfortable, safe, and well cared can make treatment a positive experience. Deep breathing, mindfulness techniques, and body scanning exercises help soothe the nervous system helping the patient’s breath rate, and heart rate remain calm, and bring awareness to areas of physical tightness or tension so that the patient can more fully relax. 

 

 

These techniques not only assist patients during their Ketamine treatments but also equip them to cope with intense emotions in their everyday lives, fostering resilience and emotional well-being.

Empowering Positive Change: Therapy and the Power of Thought Processes

As mentioned, Ketamine opens windows to review experiences and emotions in a new way, and establish new healthier connections. The benefits do not go away when the acute effects of the medication wear off. Instead, time in between Ketamine treatments offers a special period to address anything that’s come up. 


Unlike self-employed techniques like journaling or reflection, both of which can be very helpful, taking the added step to meet with trained therapists during a ketamine treatment series offers deeper benefits. Licensed therapists, especially those who have worked with patients who are going through ketamine treatment, have skills, and experience to employ a variety of techniques that can be tailored to the patient’s case, and needs in the moment. 

One of the key aspects of therapy in conjunction with Ketamine treatments is the opportunity to work on thought processes. Andrea pointed out, “[After a treatment] We look at what comes up and what connections they make. Then I have the patient tell me what will best support them, whether it is just to hold space for those thoughts and emotions or if it is something they want to change.” Through this collaborative exploration, patients gain insights into their thoughts and emotions, empowering them to embrace their emotional healing journey.


In summary, Andrea emphasized the immense potential of integrating therapy with Ketamine treatments. This well-rounded approach creates a powerful synergy, optimizing the benefits of both Ketamine’s effect on the brain and the emotional healing, mindset shifts, and behavior change that therapy facilitates.


“Integrating therapy with Ketamine treatments allows patients to experience a more comprehensive and holistic approach to healing,” Andrea concluded.

Taking the Next Step

Through her expert guidance, Andrea illuminates the untapped potential of neuroplasticity, the power of thought processes, and the significance of grounding and mindfulness techniques in this integrated treatment. As the world of mental health continues to evolve, the synergy of therapy and Ketamine promises hope and healing for those seeking relief from depression, anxiety, and PTSD.

 

If you are interested in learning more about Ketamine or Spravato® treatments to address major depression, anxiety, or PTSD email info@headinghealth.com to request a psychiatric consultation. 

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Preparing : A Guide to Your First Ketamine Treatment and Spravato® Treatment

Credit: Yang H. Ku/C&EN

Preparing for a Transformative Ketamine Therapy Experience

Preparing for a Transformative Ketamine Therapy Experience

A Guide to Your First Ketamine Treatment and Spravato® Treatment

Why Ketamine?

Ketamine therapy and its derivative, Spravato®, have emerged as promising treatments for individuals struggling with major depression and other mental health conditions. These innovative therapies offer new hope for those who have not found relief with traditional antidepressants. If you’re considering ketamine treatment, it’s essential to prepare yourself adequately for this potentially life-changing experience. 


In this blog, we will explore the key aspects of preparing for a ketamine therapy session, while incorporating insights from Dr. Arif Noorbaksh, a psychiatrist at Heading Health in Dallas, Texas, and Austin, Texas.

 

Understanding Ketamine Therapy

Ketamine therapy involves the controlled administration of ketamine, a dissociative anesthetic, to induce an altered state of consciousness, which many compare to a psychedelic experience, and interacts with the brain through the glutamate system which is different than many antidepressants which address serotonin reuptake. Spravato®, a nasal spray formulation of esketamine, a variant of ketamine, has been approved by the FDA for treatment-resistant depression specifically. 

 

Ketamine introduces windows of neuroplasticity, even after the immediate dissociative effects have worn off, empowering patients to reexamine thoughts, behaviors, and patterns that are proving detrimental to their mental health. This aspect of Ketamine therapy is one reason why very often those who are seeking Ketamine treatment are also seeing a therapist who understand their treatment and can help them integrate it into their therapy sessions, optimizing results. 

 

Dr. Noorbaksh also explains, “Ketamine and Spravato® appointments typically last a couple hours. Feeling safe, comfortable, and prepared is important for the process.” 

 

The purpose is to promote psychological exploration, facilitate emotional healing, and alleviate symptoms of depression and thus feeling safe, informed, and well cared for during your treatment not only makes the experience more pleasant but it actually aides in the effectiveness of treatment itself.  

 

Creating a Safe and Comfortable Environment

Dr. Noorbaksh emphasizes the significance of ensuring a safe, comfortable environment during ketamine therapy sessions. 

 

He advises, “Some people feel a little queasy from treatment. It’s helpful for a patient to eat earlier in the day to avoid hunger, but also not within two hours before treatment to reduce nausea.” 

 

To enhance your comfort, he suggests bringing along comfort items such as comfortable clothes, an eye mask, a favorite playlist with headphones, and even a pillow and blanket. These items can help you relax and feel at ease as you allow the medication to take effect.

 

Addressing Coffee, Alcohol, Medications and Other Substances:

Dr. Noorbaksh also highlights the importance of discussing medications and substances with your healthcare provider prior to undergoing ketamine therapy. He shares, “At Heading we have a full consultation to determine appropriate treatment. Also prior to Ketamine and Spravato® treatments we advise patients regarding alcohol and caffeine use, and other medications – including over the counter medications – to ensure safety before, during, and after treatment.” 

 

Open communication with your healthcare provider about your current medications, including over-the-counter drugs, alcohol, and caffeine, is crucial to ensure the safety and effectiveness of the treatment. It is helpful to have your medical history, medication list, known allergies, and a willingness to discuss substance use on hand when connecting with a doctor about Ketamine therapy.

 

Proper Planning for Transportation

Dr. Noorbaksh stresses the importance of arranging safe transportation to and from your ketamine therapy sessions. He advises patients to make suitable arrangements, as they will not be able to drive after treatment. 

 

“Patients should leave their own car at home, make safe travel arrangements as they cannot drive after treatment, and must get a good night’s rest before resuming normal activities, including driving, the next day,” he explains. 

 

By planning ahead, you prioritize your well-being and the safety of yourself and others.

 

Ketamine Therapy in Austin, Texas, and Dallas, Texas

If you’re considering ketamine therapy in the Austin, Texas, or Dallas, Texas areas, Heading Health offers comprehensive treatment options including Ketamine therapy, psychiatry and medication management, and psychotherapy. 

 

With the guidance of experienced professionals like you can embark on a transformative journey toward mental wellness with a care plan personalized to meet your needs.

 

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5 Tips for Managing Work Stress from Patricia Hernandez LCSW, Therapist in Austin, Texas

5 Tips to Reduce Work Stress with Patricia Hernandez, LCSW a Therapist at Heading in Austin, Texas

5 Tips to Reduce Work Stress with Patricia Hernandez, LCSW a Therapist at Heading in Austin, Texas

Working in a high-pressure job can take a toll on mental health. 

 

Truth is that 85% of Americans note their workplace as stress as significant, and 25% say that work stress is the biggest stress in their life .

 

Whether it’s on a shift, in the office, over a virtual all, or a bit of all of it, workplace culture and the demand of our jobs has significant impact on mood health, and wellbeing. Changing an entire workplace culture, the style of our boss and colleagues, or finding a dream job with broad flexibility are not things that are in the average worker’s control. Most people when they find themselves in a stressful work environment don’t have the luxury of quitting their job to find something else. 

 

But, that doesn’t mean there are things every individual can do to make their work experience better. 

 

Patricia Hernandez, LCSW, a therapist at Heading in Austin, Texas, offers practical tips to help you reduce stress at work. Implementing these tips can improve your productivity, well-being, and overall satisfaction at work.

Tip 1: Empower Yourself with a Calm Space.

“Curate calm within the chaos,” Patricia notes.

It’s essential to create a sense of calm within your workspace, especially if your job involves a lot of chaos.

 

 

Patricia suggests doing this by adding personal touches to your workspace, such as pictures of loved ones, or objects that make you feel happy. Using your favorite mug for coffee or tea can also bring a sense of comfort and calmness, setting a routine of self-care amidst an otherwise stressful routine. 

 

Take a look at your desk. The images on it may help you reduce pain. In fact a study showed that looking at images of loved ones had pain-relieving effects.  Similarly, calming images such as looking at nature, space, or beautiful art – like taking a mental vacation – can reduce tensions and anxiety. 

 

Taking small steps to create a more positive and pleasant work environment can go a long way in reducing stress.

Tip 2: Don’t Skip Your Lunch Break

Patricia suggests, “Don’t work through lunch. It may seem counter-productive, but it’s the very thing that will give you a boost for the rest of the day.”

It’s easy to fall into the trap of working through lunch, but it’s essential to take a break and allow your mind and body to rest. Use your lunch break to step away from work and recharge.

 

Working lunches may seem like a great way to maximize your output and time, but they tend to have the opposite effect. 90% of workers who take lunch breaks note that they feel more refreshed,, less stress, and ready to tackle the rest of the day with a better outlook. Workers that feel less overwhelmed tend to be more productive, and effectively manage their time. Breaks are good for employees health and good for company morale.

 

You can take a walk, read a book, or simply enjoy a quiet meal. Taking a break from work can help you come back feeling more refreshed and motivated, ultimately improving your productivity and well-being.

Tip 3: Socialize at Work

“We spend a lot of time at work. Developing relationships while working is good for our wellbeing. Find a work buddy to chat and occasionally vent, but don’t co-ruminate,” Patricia recommends.

Sometimes, it can be helpful to have someone to talk to when you’re feeling stressed at work. Find a colleague who you trust and feel comfortable venting to about work stress. However, it’s crucial to ensure that you’re not ruminating on the stress and negativity, which can make things worse. Instead, focus on small talk and building a positive work relationship that fosters a sense of belonging and community.

 

For those worried that workplace friendships might derail their day, don’t fret. Research shows otherwise. A Gallup poll found that workplace friendships increased job satisfaction, boosted overall productivity, and even lessened workplace injuries. So, circle up to the IRL or virtual water cooler and chat up a friend.

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Tip 4: Use all of your vacation time.

“Use your PTO. It’s your benefit to use, and everyone needs and deserves time away from work,” Patricia states.

Most people don’t use all their allotted PTO in a year, but it’s essential to take time off work to rest and recharge. Using your PTO can help you break away from the daily grind, relieve stress, and give you time to engage in activities that bring you joy and fulfillment. Whether it’s taking a vacation or just taking a mental health day, using your PTO can be a powerful tool for reducing work stress and improving your overall well-being.

 

But taking breaks is not limited to just lunch and PTO. It’s important to step away from the screen throughout the day. Taking short breaks throughout the workday can be incredibly beneficial for your mental health and productivity. Even if you’re pressed for time, taking five minutes to step away from your desk and clear your mind can make a significant difference in how you feel. You can take a walk around the office, stretch your body, or practice mindfulness meditation. Remember, taking a break can help you come back feeling more refreshed and focused, ultimately boosting your productivity and reducing stress.

Tip 5: Bring Mindfulness Into the Workplace

“When you’re feeling stressed at work, taking a few deep breaths can help you calm down, and refocus. Use a powerful mantra that resonates with you, and repeat it to yourself as you inhale and exhale,” Patricia coaches.

The term ‘mindfulness’ is more mainstream than ever. But without regular practice the concept can seem like nothing more than a fluffy feel-good idea, or a even a little too new-age for a serious go-getter at work.

 

However, nothing could be further from the truth. People who take the time to regulate their nervous system through breathing, meditation, and simple movement like walking have a happier time at work and less difficulty engaging in decision making, and managing their projects. Mindfulness practices may look different from person to person, but the goal is the same: to move out of a reactively highly aroused state of mind, to a more calm, focused, and present state of mind. This can help you feel more centered, grounded, and present, ultimately reducing your stress and anxiety levels, and feel more in control of your actions at work.

 

In conclusion, reducing work stress requires intentional effort and self-care. By implementing these tips from Patricia Hernandez, a therapist at Heading Heath in Austin, Texas, you can take control of your mental health and well-being at work. Remember to prioritize self-care, take breaks, and seek support when you need it. These small changes can have a significant impact on your stress levels and overall satisfaction at work.

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Brain Change with Psychedelics

The Depressed Brain may Rewire with Psychedelics

March 29, 2023

Researchers are discovering more information about why psychedelics may improve the symptoms of depression, and it's not all about the 'trip'.

Some psychedelic drugs, such as psilocybin and MDMA, how promise in treating depression and post-traumatic stress disorder. They do this by encouraging the growth of new connections between neurons in the brain. This ability of the brain to make new connections is called plasticity. However, exactly how these drugs promote plasticity has been unclear.


It’s important to develop related drugs that can promote brain plasticity without causing ‘a trip’. 

Dr. David Olson and his research team from the University of California, Davis, have developed a sensor that can tell which drugs that attach to a receptor called 5-HT2AR in neurons have hallucinogenic properties and which do not. This study aims to figure out why only some of the drugs that bind to 5-HT2AR are capable of promoting brain plasticity. Brain plasticity refers to the brain’s ability to form new connections. Improved plasticity can help treat mental health disorders like depression and post-traumatic stress disorder.


Researchers discovered that a compound’s ability to enter a neuron and bind to receptors inside the cell determines how well it can promote the growth of dendritic spines. Dendritic spines are structures that help to connect neurons in the brain. The research team also found that clusters of the 5-HT2AR receptor could be found both inside and outside the neurons. The compounds that could bind to the receptors inside the neurons caused the dendritic spines to grow. But, the compounds that only bind to the receptors on the outer surface of neurons, such as serotonin, did not have the same effect.

When they used an electrical current to allow compounds like serotonin to enter neurons, the compounds promoted dendritic spine growth. Similar results were seen in neurons engineered to make a protein that can pull serotonin into cells. Neurons that took serotonin inside formed new dendritic spines. Neurons where serotonin could only bind to exterior 5-HT2ARs did not. When they tested this phenomenon in living brains of mice engineered to make a protein that can bring serotonin into neurons, the mice formed substantially more dendritic spines than in mice without the protein. The mice also showed improvements in a behavior test thought to be relevant to depression.


These results suggest that the 5-HT2ARs inside and outside of neurons activate different cell-signaling pathways. The researchers hope that these results will help develop better drugs that can safely activate the pathways for brain plasticity while avoiding hallucinogenic effects.


Interventional psychiatric treatments like Ketamine and Spravato® are already in use for depression including at Heading Health centers in Austin and Dallas. The addition of more psychedelic treatments, and understanding of each one’s particular best use is continuing to be researched with promising results offering hope that psychiatric researchers are moving closer to understanding how psychedelics can be safely administered for the rapid treatment of long-standing stress disorders. 

The research is now focusing on decoding the biological mechanisms behind how psychedelics can affect the brain and how the effects of these psychoactive drugs can be harnessed for therapeutic benefits. 


The research team is exploring the effects of psychedelics on the body’s serotonin, glutamate and dopamine systems, as well as their impact on the hypothalamic-pituitary-adrenal axis, which plays a key role in the body’s stress response. They hope that by understanding the underlying biology of these substances, they can develop more effective treatments to help people suffering from mental illness. In addition, they are also studying the potential of psychedelics to enhance cognitive performance, creativity and even spirituality. Ultimately, the researchers hope that by better understanding the biochemistry of psychedelics, they can develop more effective treatments to help people suffering from mental illness and even improve overall well-being.

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Care Insights: Why Team Approach Is Key in Treating BPD with Dr. Darren Fred and Andrea Marquez, LCSW

Why a Team Approach is Best for those with Long-standing and Complex Conditions like Borderline Personality Disorder with Dr. Darren Fred and Andrea Marquez, LCSW

March 21, 2023

Collaboration is Key

Diagnoses carry weight. They not only impact the patient’s own view and understanding of what they’re going through diagnosis can also influence care plans and treatment. Getting the diagnosis right is crucial, and when it comes to a diagnosis of borderline personality disorder finding specialized providers who collaborate on care improves outcomes. 

 

Outside of in-patient care where a patient experiences a dedicated team consistently working together on their case, outpatient practices with a team of psychiatrists and therapists who directly work together are less common. Given the known shortage of mental healthcare providers –  and additional shortage of providers who specialize in BPD –  collaboration between providers and providers who seek to develop an expertise in the care of people with a BPD diagnosis is needed. 

In this Care Insights we spoke with Dr. Darren Fred, a psychiatrist at Heading Health who treats patients across Texas through virtual psychiatry. We also heard from Andrea Marquez, LCSW a therapist at Heading Health who offers virtual therapy also for patients in Texas. Both Dr. Fred and Andrea Marquez have experience and expertise when it comes to caring for patients with trauma, and complex including Borderline Personality Disorder. They offer their insight into the diagnosis itself, why a direct, team approach offers superior care, and how having a practice that employs both prescribers and therapists can be a game changer for patients living with difficult-to-treat disorders.

 

“Collaboration in just about any work field is ideal, and that holds true in medicine and specialties such as behavioral health – especially with long-standing or difficult to treat conditions,” said Dr. Fred. 

 

Direct communication between therapists and psychiatrists working with patients with borderline personality disorder is beneficial in overcoming barriers to treatment, and potential missteps which may impede care. Stigmatization and marginalization of patients diagnosed with personality disorders has been studied as a significant obstacle in finding care, and finding providers on both the medical and therapeutic sides of care can be difficult.

Improving Mental Health Care Through Efficient Communication

“A team approach for managing patients with a borderline personality diagnosis is ideal and has many benefits for the patients,” started Dr. Fred. 

 

“The most obvious benefit is that both treatment parties, the therapist and the prescriber, work together to be on the same page when it comes to diagnosis and treatment.”

 

 

“I completely agree with Dr. Fred’s point of view,” offered Andrea.  “If you have a patient with an inaccurate diagnosis, or if it takes too much time to get information shared between providers, it affects a patient’s therapy experience, too. Misdiagnosis and delays in care means someone who is struggling waits even longer to experience the improvement in their symptoms that they need, or achieve goals they have for quality of life.”

 

 

Not only is ensuring that an agreed upon diagnosis is accurate and made clear between providers, Darren and Andrea pointed out how a team approach benefits the patients experience handling the logistics of care, can improve the provider’s knowledge of the patient’s case, and can motivate a patient to take a more active role in treatment itself.

 

Reducing Frustration for the Patient

“When a patient has a diagnosis that should be addressed through a combination of therapy and medication they will be attending a lot of appointments – which may seem obvious – but it can be overwhelming to juggle especially for people who are already dealing with significant struggles,” said Dr. Fred.

 

“In my experience with both psychiatrists and therapists under one roof, regularly participating in provider meetings, and being able to send quick, secure messages to one another removes barriers and improves the patient outcome and experience.”

 

It’s not uncommon for a patient receiving mental health care to shuffle between several places. Often the everyday mechanisms of communications, paperwork, and scheduling that creates delays in care. Seemingly simple tasks such as patients signing release forms to be faxed to a separate medical office takes time. From there both providers have to try to align time between seeing patients to share notes. Minimizing the burden of these tasks accelerates treatment.

 

“In my private practice days, where I was a solo practitioner, it could be very difficult to get in touch with a psychiatry provider to consult on a patient – especially when it required connecting with a provider who had a lot of experience treating a patient with borderline personality disorder. I feel very fortunate that I work in a practice where a patient has a team. As a therapist, directly connecting to one of my patient’s prescribing providers is a normal part of operating.  In our practice here at Heading we message one another to collaborate on a patient’s care,” Andrea shared.

 

Spotting Common Misdiagnoses

When it comes to psychiatrists and therapists who specialize in personality disorders, collaboration can also help spot misdiagnosis and ensure appropriate treatment.

 

 

“Collaborating with other providers can also help address misdiagnosis. Patients with borderline personality disorder often have trauma histories, other diagnoses such as PTSD, and most often a mood disorder diagnosis,” explained Dr. Fred. “Unfortunately many patients will see one provider who gives them, for example, a bipolar mood disorder diagnosis. Then, another provider might tell them they do not have bipolar disorder but rather unipolar depression.  This can be frustrating and confusing for patients, especially when one provider is suggesting treatment specific for bipolar disorder, and the other is suggesting treatment specific for depression.”

 

 

Dr. Fred’s elaborated on the additional concerns that come with common misdiagnosis for borderline personality disorder noting that not only does that change the treatment protocol, but the medications prescribed may be simply ineffective, or worse, the patient may be prescribed a medication with many side effects, but never experience the intended relief due to not addressing the appropriate problem.

 

 

“Take for example a common diagnosis differential of depression or bipolar depression. From a prescriber standpoint these different diagnoses have huge ramifications,” Dr. Fred cautioned. “If a patient with borderline personality disorder is diagnosed with a co-occurring bipolar disorder, but does not actually have bipolar disorder, it can lead them down a road of being prescribed medications that may be more sedating, and have more intense side effects such as weight gain, or something more permanent like tardive dyskinesia – which is a complication from antipsychotic medications – and all the while their depressive symptoms are being undertreated, their mood is not improving, and the aren’t feeling better.”

 

 

“I completely agree with Dr. Fred’s point of view,” Andrea noted. “Bipolar Disorder is one of the most common mistakes we see on the psychotherapy side as well when it comes to borderline personality disorder and co-occurring diagnoses.  I have seen so many patients come in for therapy who are diagnosed with Bipolar Disorder and what they actually are managing is Depression, Anxiety, and/or complex PTSD and they also meet criteria for Borderline Personality Disorder.  

 

Empowering Patients Through a Team Approach

Prescriptions aren’t the only concern. Misdiagnosis also affects therapy too. Darren shared that the psychoeducation a patient has around their diagnosis influences the decisions they may, or may not, take in terms of their own care. Andrea agreed.


“Mood symptoms can be managed by medication but trauma needs a different lens,” shared Andrea.


When it comes to changing thoughts, behaviors, and ultimately feeling better patients who feel empowered to make change, and are encouraged to an active role in their care will have better outcomes.


“It’s not uncommon for a patient who has been struggling for a long time to assume they have no control of their behaviors especially if they are on medication and it’s not working as they thought it would.  Misdiagnosis delays a patient becoming empowered to make the positive changes necessary for them to live a more fulfilling life, and rely less on coping mechanisms that have painful consequences,” summarized Dr. Fred. 


With psychoeducation, appropriate diagnoses, and a team that collaborates the impact is not only the selection of more effective prescriptions and therapeutic techniques, it also inspires the patient to take an active role. To demonstrate how impactful a collaborative, specialized team can be for patients who have difficult and complex diagnosis,  Andrea went on to share this care story:


One of the most successful cases I have seen has been while working with the providers here at Heading.  A colleague of mine, a prescriber, and I were working with the same patient.  The prescriber noticed that the medications they had prescribed the patient were not working well and they looked at my notes and sent me a message to do a quick call.  


I was able to give my opinion that I did not see a cyclical pattern of symptoms but that there was a consistent set of issues causing chaos in her life that were causing acute stress symptoms that were insomnia, restlessness, intense emotions, impulsive temper outbursts and some self-medicating.  We discussed steps forward.


And a month later I was able to go back to the prescriber and share more revelations after working with the patient for another couple of weeks.  I was able to report that there might be some subclinical Bipolar Disorder symptoms there because of persistent cyclical sleep and mood changes that could not be explained because acute stress had subsided.  


We are still working with this patient and the patient has started asking us to share information they forgot to tell in an appointment or therapy session.  to tell one of us something and she would like the other to know.  Because they have a team, this patient has become more connected in their care and is taking an active role – which is wonderful!


Living with a complex mental health diagnosis, like borderline personality disorder, comes with a long list of symptoms and struggles that severely impact the quality of a person’s life and their relationships. Ensuring that the care team supporting a person’s journey is specialized, collaborative, and has easy access to clear communication not only makes the patient’s experience easier, it improves their ability to find healing. 


 People struggling with mental health disorders, and their loved ones, should feel confident in asking their doctor about how they approach care when it involves multiple providers.  Finding the right team of providers who make it a priority to maintain open communication and collaboration helps a patient achieve the best outcome possible.

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Blog depression Ketamine Provider spravato wellness women's mental health

10 Helpful Facts About Ketamine Therapy

10 Helpful Facts About Ketamine for Depression and Anxiety

March 15, 2023

When it comes to feeling better it is understandable that people with treatment-resistant depression feel nothing will work. Ketamine is an option that is changing the story and offering hope.

Ketamine is a powerful drug that has been used in medical settings for decades, but it is now gaining attention for its potential to treat depression, anxiety, and PTSD. 

 

 

Here are 10 surprising facts about the drug that you should know. 

 

  • Ketamine is used in medical settings as an anesthetic, but it is also being used in psychiatric care as a treatment for depression, anxiety, and PTSD.
  • Ketamine is a dissociative anaesthetic that has psychedelic effects. It produces a feeling of altered consciousness and can cause hallucinations.
  • Research suggests that Ketamine positively impacts neuroplasticity, which is the ability of the brain to form new connections and reorganize itself. So, while the ‘trip’ may be all the buzz, the positive impact is has on brain connections overtime that is really exciting for patients who have experienced treatment resistance.
  • Ketamine is often used in combination with psychotherapy to help treat mental health conditions, and a therapist who is trained in offering care to patients in ketamine therapy can help patients process their treatment experiences and maximize its benefits.
  • Ketamine is generally considered safe but can cause side effects such as dizziness, nausea, and confusion. Seeking treatment within a center under medical supervision may be optimal as having a medical care team present to support treatment can both enhance safety and puts some patients at ease knowing if they are anxious about the experience.
  • Spravato® is a medication that is a variation of ketamine that has been FDA approved for treatment resistant depression. It is administered as a nasal spray.
  • Ketamine is not recommended for people with certain medical and psychiatric conditions, including heart disease and high blood pressure. This is why it is important to get a thorough consultation with a psychiatrist who specializes in this treatment, and can continually meet with you to monitor care.
  • Ketamine is not recommended for recreational use. 

Ketamine is an exciting area of research, and it has the potential to help many people who suffer from depression, anxiety, and PTSD. If you or someone you know is considering using Ketamine for mental health treatment, consider setting up a consult with Heading where you could receive ketamine or Spravato® treatment in our centers in Austin or Dallas-Forth Worth.

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Categories
anxiety BIPOC Mental health Blog Provider wellness women's mental health

Myths & Realities About Anxiety

Common Myths and the Realities about Anxiety

March 2, 2023

Myth: The Signs of Anxiety Disorders are Obvious
Fact: Anxiety Disorders Have Many Easy to Miss Symptoms

While the internal experience for someone with anxiety may feel loud, uncomfortable, and shaky often to people on the outside it may be hard to tell that someone is in distress. 

 

In fact many people with anxiety disorders are hypervigilant which can, from the outside looking in, seem like they are simply very disciplined, proactive, or ‘on top of everything’.  

Myth: Anxiety is In Your Head
Fact: Anxiety Is a Very Real Physical Experience

Anxiety disorders create effects on the body due to stress, which in turn can lead to additional ailments over time.

 

These physical symptoms are numerous and varied, but common symptoms include digestive issues, trouble sleeping, lowered immunity, irregular heartbeat, headaches, trouble concentrating, feeling lightheaded, changes in eating habits, and changes in sex drive.

Myth: Medication is the Only Treatment
Fact: Many People Find that Therapy & Mindfulness Techniques Help Too

Medications will not cure anxiety they can help manage the symptoms. For many people medication is an effective tool for feeling better as it can help calm anxiety well enough for a person to address the causes and their behaviors that may be impacting anxiety. 

 

 

However evidence suggests that a combination of therapy along with medication can be more effective than a single treatment alone in treating chronic and longstanding anxiety. In therapy people struggling with anxiety will learn skills to cope with anxiety, as well as behavioral change that can help someone making choices and take actions that support a healthier life.  Some people stay on medication for a while, and others only for a select period of time. This is normal, and when it comes to long-term support therapy may be the most effective option. 

 

 

In addition to medication and therapy, lifestyle choices including improving diet, exercise, and sleep habits can also be important aspects of treating anxiety.

Myth: Anxiety Is a Real Disorder Because Everyone Gets Stressed Out
Fact: Anxiety Disorders are Different Than Having Everyday Worries

While everyone experiences anxiety at some point in life, anxiety disorders are not simply worry.

 

Generalized Anxiety Disorder is persistent, and symptoms are more intense and last for longer than common worry.  Additionally anxiety disorders can cause interruption to daily living, and create problems at work, and in relationships. Because anxiety disorders also have physical symptoms as well as psychological symptoms, and can interrupt a person’s life so significantly, those with anxiety disorders are more likely to turn towards substances and other coping mechanisms to try and manage the experience. Those with anxiety disorders are also more likely to experience other mental health issues like depression. 

 

For these and many other reasons it’s important to take anxiety seriously, and to work with professionals who understand how to treat anxiety that has become more than just a passing worry. 

Myth: Avoiding Stress and Anxious Thoughts Will Cure Me
Fact: Surpressing Thoughts and Avoiding Everday Life Stress Won't Make Anxiety Better

The realities around avoiding stressful situations and thoughts may seem counterintuitive. Contrary to popular belief trying to ignore or suppress anxious thoughts may help temporarily but often they simply come back stronger. Similarly while there may be unnecessary stressors that can be eliminated from life, stress cannot be completely avoiding. Avoidance behaviors can backfire and reinforce feelings of anxiety and overwhelm. Instead therapy can help support a person in finding ways to navigate stress with less overwhelm, and feeling more empowered. 

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Categories
anxiety BIPOC Mental health Blog depression Provider wellness women's mental health

Care Insights: Black Maternal Mental Health with Meghan Murchison

The Positive Impact of Therapy in Maternal Care with Meghan Murchison, LPC

February 24, 2023

Getting Therapists Involved in the Maternal Healthcare Conversation

In this edition of Care Insights we spoke with Meghan Murchison, a therapist with Heading Health who is based out of Houston, Texas.  Meghan’s passion for counseling started from a desire to reduce the stigma surrounding seeking therapy, especially for Black and BIPOC people. Now, Meghan says it is her journey as a mother that continues to fuel her passion to support people in finding mental wellness.  She offered insight from her own life as well as her professional expertise on the subject of maternal mental health, what she thinks is important for pregnant people to know, and how she feels therapists and doctors can do better when it comes to helping new mothers and parents thrive. 

 

“I have a passion for maternal mental health and focusing on women and the very broad spectrum of motherhood. My personal goal is to decrease the amount of deaths related to childbirth and post childbirth,” Meghan began.

Moms Need More Than Screenings

“I would like for us all to remove the stigma attached to postpartum depression, and how people have been solely categorized as having postpartum depression and not exploring other very real things like access to resources and support, PTSD after difficult pregnancies or traumatic births, OCD, anxiety, and even psychosis which can also occur during pregnancy and after childbirth,” she offered.

 

“After having a baby you go to doctor’s office and they do this little check-off list but I personally, as someone who completed the list and have clients who have completed the list,  I don’t feel that it is thorough enough. It’s a start, but we need to do more” Meghan noted.

 

“Physicians could do better in making sure that they partner with psychiatrists and partnering with therapists, and keep those referral pathways top of mind. Women should be getting help immediately, and preferably long before this 6 week checkup because finding a therapist after you’ve had a baby is probably the very last thing on your mind.” 

 

The checklist that Meghan is referring to is a screening that typically occurs while a woman or pregnant person is in the care of an OBGYN. The American College of Obstetrics and Gynocology recommends that doctors and providers screen postpartum for depression and anxiety. ACOG also recommends screenings occur before and during pregnancy to help ensure that comprehensive follow up also happens after birth as well. While screenings are common, studies have found that OBGYNs may need to do a better job ensuring referrals and resources make it to the patient. A 2020 study concluded that screening may not be enough, which echoed Meghan statement. Rather, increasing awareness and increasing resource availability seemed to be missing pieces to supporting the over 15% of postpartum people diagnosed with depression after birth. 

 

“Screenings just aren’t enough,” said Meghan.

 

When asked what therapists could be doing better, Meghan didn’t skip a beat.

 

“Expecting mothers need help and someone who listens. And it doesn’t matter if you have five kids, two kids, or it’s your first pregnancy, it is – to me – imperative that people receive therapy throughout the entire process of pregnancy, birth, and postpartum because it’s a reeling experience. Changes in your body physically and chemically. Changes in your work and social life. Changes in your relationship, and your sex life. And so many of the activities that you used to love may not be on the table any more, or at least for a while. Not to mention pregnancy can also be dangerous for some people. So it can be a scary time,” she said.

 

Advocacy and education seem to be missing pieces according to Meghan.  Very often people don’t seek out therapy until after there is a known problem, or someone in their life suggests it. While routine and regular physical checkups with a physician or midwife are involved in pregnancy healthcare, mental healthcare checkups with a licensed therapist are not considered routine. 

Improving Outcomes for Black Women

“Advocating for seeking therapy before and throughout pregnancy is something I would love to see for all moms, but I believe it is very important for Black mothers because there is still an inequity in Black maternal mortality rates,” Meghan noted when expanding on her desire for therapy to be considered more routine in prenatal care.

 

 

“Expecting moms, especially Black women, can benefit by having a therapist who helps them develop the skills necessary to advocate for their needs during pregnancy care. As a black woman, not only do I have to worry about the fact that my provider may not listen to me, or take my needs or wants into consideration because there is still a very real bias that exists in healthcare.”

 

 

Meghan discussed not only her professional experience witnessing Black women navigate difficult pregnancies, but she shared personal stories as well, “With my second child I was so afraid. I mean you’re already afraid as a mom. You’re just worrying about each day. Let me get this baby to the next day. Let me get this baby to the next week. Let me get this baby to the next month but then when you throw in  preeclampsia or gestational diabetes it raises the bar. I was so frantic because diabetes is already something that heavily affects the Black community.” 

 

 

Statistically Black women do experience more complications during pregnancy, higher maternal and infant mortality rates. While maternal mortality rate has experienced disappointing numbers in general over the last two decades, the gap for Black maternal mortality rates has increased and seems to have peaked during the pandemic.  Additionally, Black women report, on average, less satisfaction with their care, less trust in their providers, and a larger concern about bias among providers. 

 

 

“And ours is a community that already experiences a lot of disparity. For many Black women just securing a job with good benefits is a really big deal. So to be able to keep that job and keep that insurance often becomes the priority rather than really focusing on getting adequate rest and care.”

 

 

“My own pregnancy was very nerve-wracking and scary. But, luckily, I had a therapist that I’d been speaking with consistently. It made a huge difference in the way I approached my prenatal appointments, the questions I asked, and, how I spoke to my doctors. Just having someone who can help you feel more confident in every appointment can really improve the experience and the health of a pregnant person,” Meghan concluded.

Empowering The Expecting

“There is a huge opportunity for mental health providers to lean towards this community,” Meghan suggested.

 

Therapy for those experiencing pregnancy for the first time is shown to reduce rates of anxiety. Meghan proposes that it may also have a positive effect on how a person feels about the care they receive during pregnancy as well, and empower them to feel strong about the role they  play in the health of their pregnancy and new baby. 


“Therapy offers an outlet, as well, as a space of accountability,” Meghan explained.


“Going to therapy is a bit like going to see a trainer in the gym. You learn the moves, and practice them, and you have a coach guiding you on how it’s done. Then you go work out on your own. In the early stages of pregnancy, those tips and guidance are essential, because everything is new. The outlet [of therapy]  can be very cathartic and it helps a woman feel like she’s not alone because of pregnancy and learn how to use her voice.”


Therapy is often thought of as a place to share feelings, or examine events and how they influence responses. Cognitive behavioral therapy, for example, helps patients recognize when a thinking pattern may be faulty and influences a behavior or reaction that is unhelpful, and it is a widely used therapeutic modality for anxiety and depression. However, therapy is not solely CBT. 


Therapy also can involve reframing a narrative, or belief system, about oneself, as well as coaching for a pregnant person who may be feeling intimidated by doctor’s appointments. Using a therapy session as a training ground to practice establishing boundaries, practice speaking up for themselves at appointments or during labor and childbirth, and discussing plans, fears and desires can be a outlet to process difficult emotions in a safe space. Additionally many therapists employ mindfulness techniques, and can offer education and practices that support nervous system regulation which can be helpful during moments of anxiety including birth itself. 


“I can share from my own experience that I had a doctor that solely focused on  having a safe delivery – and my birth preferences were not really part of the discussion. ‘Get the baby out safely’. That’s fair, but I wanted to enjoy my experience. I told my therapist that I was a little concerned that my doctor wasn’t not listening to me. My therapist was able to give me the feedback I needed. She told me ‘ok you have to be assertive and you have to tell her ‘this is what I need. Where can we meet in the middle?’ She also suggested I get a doula and encouraged me to write down a birth plan,” Meghan shared.  


“I heavily encourage talking about that birth plan with your therapist. Birth can be scary, but also it’s beautiful, and more times than not that mom and baby are both healthy. A therapist can help you focus on the positive potential outcomes too, especially when you’re feeling very anxious. So talking to your therapist is helpful in gathering those plans and empowering you to speak your truth.”


When considering her bottom line and what she hopes for the future, Meghan was clear.


“I personally believe that all Black women should know that they have a right to control their medical experience specifically. In birthing and caring for a child we have a history of pain, and a story that needs to change. Dating all the way back to slavery black women often had no autonomy over their experience as a mother, many times their children were ripped away from them or they spent all their time caring for other people’s children without being able to dedicate the same time caring for their own. And so I want black women to know that they are powerful, that this is their experience, and their experience only,” Meghan concluded. 


“If someone makes you feel bad about speaking up for yourself, then they are not the provider for you. They are not a support person for you. You have to find another support person and not to give up on finding that person or people who will help you make your birth the best possible experience for you and baby.

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Complete our consultation form and an intake specialist will get in touch.


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