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The Problem of Delayed Treatment for Mental Health Conditions


The Problem of Delayed Treatment for Mental Health Conditions

October 9, 2022

From recognizing one needs treatment to finding an in-network provider to scheduling an appointment, getting help for one’s mental health can be a time-consuming and disheartening process. One study found that since 2000, individuals with schizophrenia, mood, and anxiety disorders have taken nearly 32 months on average to receive their first treatment. 

Aside from the immediate harm of suffering from the symptoms of a mental illness, a delay in treatment is associated with a range of negative outcomes, highlighting the importance of prompt access to rapidly effective interventions. 

 

Here are some key findings: 

Rates of Treatment Response and Remission

When examining the impact of the duration of untreated illness (DUI) on mental health outcomes, much research has focused on rates of response (i.e., at least a 50 percent reduction in symptoms) and remission (i.e., a full recovery). A meta-analysis, which compiled data from several studies on the topic found some striking results. In particular, they found that:

 

  • Patients with a DUI shorter than eight weeks after their first episode of depression have a 70 percent greater probability of achieving a response
  • Patients with a DUI shorter than eight weeks after their first episode of depression have a 65 percent greater probability of achieving remission

 

Response to Antidepressants

Researchers looked specifically at the response to antidepressants and found similar results. For example, studies have found that:

 

  • Patients with obsessive-compulsive disorder who did not receive treatment within the first 24 months were 28 percent less likely to respond to SSRIs (selective-serotonin-reuptake inhibitors)
  • Subjects with major depressive disorder who did not receive a first-line antidepressant until  six months or more after their depression started were 13 percent less likely to experience remission
  • Longer DUI was associated with a lower response to antipsychotics and a higher rate of relapse in individuals with schizophrenia

  

Suicide

Mental illness can bring about feelings of hopelessness and despair which can cause patients to think about or attempt to commit suicide. Several studies have found that a longer DUI is associated with more suicidal thoughts and attempts for a range of conditions. For example, studies have found that:

 

  • Bipolar patients with a longer DUI showed a higher number of suicide attempts during a five-year follow-up
  • In patients with schizophrenia, suicidal plans or attempts were significantly higher in subjects from communities without an early detection program relative to those from early detection communities
  • Depressed patients with a longer DUI also showed an increase in the number of hospitalizations and suicide attempts

 

Cognitive Performance

Deficits in cognitive performance (e.g., in tasks involving memory, attention, verbal abilities, etc.) have become one of the core features of mood disorders and are significantly associated with DUI. A 2020 study found that:

 

  • Over half of the subjects diagnosed with major depressive or bipolar disorder showed mild cognitive impairment.
  • Those with major depressive disorder who showed cognitive impairment had a six month longer DUI on average
  • Remission was associated with improvements in memory, executive function, and attention, but not in visuospatial abilities or verbal fluency

 

Physiological Changes in the Brain

Researchers have found that as mental health conditions go untreated, they can produce a range of physiological changes in the brain. For example, one meta-analysis found that:

 

  • Long durations of untreated illness are associated with brain changes in individuals who have schizophrenia, bipolar disorder, major depressive disorder, panic disorder, and obsessive-compulsive disorder 
  • In schizophrenia, significant changes can occur within the first year
  • Some brain changes may be associated with poor treatment response

 

Associations with other Chronic Conditions

Mental illness is associated with various other chronic health conditions, such as heart disease and diabetes. Again, a longer DUI is associated with worse outcomes regarding many of these conditions. A 2022 study found that:

 

  • Subjects with depressive and bipolar disorders with DUIs longer than one and two years, respectively, were nearly 30 percent more likely to have physical comorbidities
  • Longer DUIs were significantly associated with higher BMIs, which can cause or exacerbate other physical conditions
 
Takeaways

These findings highlight two general takeaways. First, there is an obvious need to shorten the time it takes for patients to receive treatment. Given the wide range of adverse outcomes that become more prevalent as DUI increases across several mental health conditions, individuals dealing with mental illness must receive treatment as soon as possible. 

 

Second, there is a need for novel treatments. Even when patients can see a physician, first-line treatments can take several weeks to months to work. For a sizable subset of these individuals, these solutions may not be effective, even when their illness is recent. Additionally, longer DUIs are associated with physiological changes in the brain, which may be why standard treatments tend to be less effective over time. As a result, solutions working in different ways targeting different parts of the brain, like ketamine, TMS, or other emerging interventions, may prove critical for treating individuals who do not respond to first-line treatments.

 

At Heading Health, we utilize a multi-pronged approach to combat these issues. First, we offer an integrated team of specialists who work together to provide prompt care tailored to each patient’s individual needs. In most cases, we can see patients within 24-48 hours. To support this approach, we use cutting-edge treatments with rapid and sustained responses, meaning patients get in and get better quickly.

 

Talk with your doctor to determine whether these treatments are right for you, or schedule an appointment with one of our psychiatrists or therapists to advise you on 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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Interview with an Expert: Should Ketamine Be Combined with Psychotherapy?


Interview with an Expert: Should Ketamine Be Combined with Psychotherapy?

October 7, 2022

With evidence mounting in support of ketamine’s therapeutic effect on depression and other mental health conditions, clinics and physicians are increasingly prescribing it as a standalone solution. While ketamine has clear benefits on its own, experts are beginning to explore the role psychotherapy plays in enhancing or extending its effects.

 

In a recent edition of The Peter Attia Drive, Professor of Psychopharmacology and leading ketamine scholar Celia Morgan addresses this topic, among several others related to ketamine’s use in treating depression and other mental health conditions. 

 

Her take? Psychotherapy is critical to obtaining a lasting effect from ketamine. Here’s why.

 

Ketamine Increases Neural Plasticity

One of the key reasons Professor Morgan believes ketamine is most effective when combined with psychotherapy is its mechanism of action (i.e., how it changes the brain to produce its therapeutic effects).

 

When ketamine enters the brain, it attaches to N-methyl-D-aspartate (NMDA) receptors, causing a release of glutamate (a chemical messenger in the brain) and brain-derived neurotrophic factor (BDNF). The result is that neurons (tiny cells in the brain that send and receive information from each other) have an increased ability to grow, reorganize, and rewire themselves in response to new experiences, a phenomenon known as neural plasticity.

 

Among other things, neural plasticity enables us to learn and acquire new habits, including our cognitive and emotional tendencies. Professor Morgan argues that because many psychological therapies target these mental habits, they may be more effective when used after ketamine treatments. She states:

 

We know that what we’re asking people to do in psychological therapy is to think differently about things and learn new ways of thinking about old problems. [Neural plasticity] seems to me like an intuitively appealing mechanism.

 

Professor Morgan goes on to suggest that not only might therapy be beneficial but that its precise timing after a ketamine treatment may be especially critical, stating:

 

I think the idea you know for me as a psychologist is that you could time your psychological therapy when your brain is most plastic. […] We know from animal studies this might be starting four hours following the ketamine days peaking about 24 hours.

 

Ultimately, more research needs to be done to determine when ketamine causes the greatest increase in neural plasticity in humans. Professor Morgan notes that:

 

We want to be doing some work at the moment to sort of chart the time course of that in humans by looking at EEGs […] and trying to target the window of this synaptic plasticity

 

Experimental Participants Receiving Therapy Maintain Therapeutic Benefits for Longer

Ketamine’s impact on neural plasticity suggests that ketamine should enhance the effects of psychotherapy in theory, but how does this pan out in practice?

 

In a recent study on the effectiveness of ketamine in the treatment of alcohol use disorder, Professor Morgan compared the effects of ketamine used on its own and when combined with psychotherapy. They found the greatest reductions in drinking and abstinence in the group that received ketamine alongside psychological therapy. 

 

What’s particularly shocking is that 86 percent of the ketamine therapy subjects remained abstinent for six months after three ketamine infusions. Given the small number of treatments, the six-month benefit patients experienced further suggests therapy had a positive impact. As professor Morgan highlights, studies show the antidepressant effects of a single IV ketamine infusion typically last from three days to a week, though repeated administrations can extend this effect.

 

Conclusion

While more research is needed to confirm and clarify therapy’s role in enhancing and extending the effects of ketamine on depression and other mental health conditions, these early results suggest the two therapeutic solutions work synergistically to deliver an optimal outcome.

 

Talk with your doctor to determine whether this treatment is right for you or schedule an appointment with one of our 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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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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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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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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What To Expect At Your First Psychiatrist Appointment

telehealth-psychiatry-image

What To Expect At Your First Psychiatrist Appointment

January 28, 2022

telehealth-psychiatry-image

Whether it is over the phone or in person, seeking help for your mental health can be daunting if you do not know what to expect. This article will give you some useful pointers to empower you to work in collaboration with our psychiatrists on starting your journey to recovery.

 

1.  Come prepared

Before your appointment, it might be useful to take some time to think about the reason for your visit. What symptoms or struggles are impacting you the most? How and when did they start? If possible, keep a diary of your symptoms over a couple of weeks. This is helpful to monitor their frequency, intensity, identify a particular time of day, potential triggers, and things that make you feel better, etc. Sleep patterns, appetite, and weight fluctuations are equally valuable sources of information for your doctor.


It is also useful to gather some details about your childhood from your family, including your birth, your developmental milestones (at what age did you start walking, talking, etc.), your behavior as a child and how you did in school. Ask your relatives if there is a history of mental illness in your family – this may be a sensitive subject but can be relevant as you might be more susceptible to certain conditions.


If you have been referred by another healthcare provider, bring your consultation letters including previous diagnoses, treatments, and medications you have been on. Make sure to bring hospital discharge letters if you had previous admissions or inpatient treatment.

 

2.  What you are likely to talk about
If this is your first contact with a psychiatrist, the appointment is likely to take about an hour.


At first, your healthcare provider may give you the opportunity to talk freely about your presenting complaint. After that, you will be asked a series of more detailed questions on your childhood, education, family, current situation, medical history, etc. They might ask you questions on some of the more intimate aspects of your life, including relationships, sexuality, illicit drugs, or if you ever had trouble with the law. This enables your psychiatrist to make a 360° assessment of your mental health and how it affects you in your daily life. If you feel uncomfortable answering certain questions, do not hesitate to let your doctor know. Do not forget that professionals are bound by confidentiality and none of the information you disclose will be shared with your relatives or the authorities.


Depending on the reason for your visit, they might ask very detailed questions about treatments and therapies you have already tried, including over the counter and herbal or non-conventional treatments – did they help? What side effects did you suffer from? Why did you stop? This will allow your doctor to tailor his approach to give you the best chance of positive outcomes. Finally, give your psychiatrist any information that has not come up in questions, but you believe to be relevant to your circumstances – you know yourself best.

 

3.  Outcome of your consultation
For someone suffering from debilitating symptoms, getting to put a name on your illness might feel therapeutic. It enables you to give an identity to the enemy you are battling, and to connect with other individuals going through the same journey. However, it is important to understand that your provider might not be able to give you a diagnosis at the time of the first consultation. Many diagnostic criteria rely on temporality, i.e., length of time you have been suffering from symptoms, and sometimes a positive diagnosis can only be made retrospectively, many months down the line. Whilst this might be frustrating, it is paramount not to rush as being given a certain label can have long-lasting consequences in terms of treatment you will be offered or will not qualify for.


However, your psychiatrist might still be able to provide you with a working diagnosis or provisional diagnosis to allow treatment planning whilst waiting for all the diagnostic criteria to be filled.


Coming to the end of your consultation, you will make a plan in conjunction with your psychiatrist about how to go forward. You might be offered a combination of therapy, medication, and other treatments such as TMS or novel agents. Remember you are the main actor of your recovery, and the decision on what treatment modality you believe will suit your circumstances is ultimately yours, guided by the advice of your psychiatrist. They will explain in detail the modalities, side effects, and evidence behind every option, to allow you to make an informed decision. You might wish to take more time to read through patient leaflets, do your own research, or talk about it with your next of kin. Other things to discuss are the frequency of follow-ups and monitoring and making a contingency plan for you to refer to in case your mental health deteriorates, such as urgent helplines and contact numbers.

 

If you have further questions about scheduling with a psychiatrist, another mental health provider, or how to best prepare for your appointment, give us a call at 512-777-2591 and we would be happy to assist you.

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3001 Bee Caves Rd

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Austin, TX 78746

Local: 512-777-2591

Dallas Fort Worth Center

2800 East State Highway 114
Suite 350
Trophy Club, TX 76262

Local: 817-674-7983

If you need immediate medical attention dial 911. If you are in mental health crisis help is available via the crisis hotline, dial 988.