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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 Ways Spravato® is Different Than SSRIs

5 Ways Spravato® is Different Than Most Depression Medications

5 Ways Spravato® is Different Than SSRIs

Spravato® is a version of ketamine administered as a nasal spray. It is used to treat a type of depression called treatment-resistant depression. Treatment-resistant depression is a type of depression that is not improved by other medications. Spravato® is different from SSRIs, which are commonly prescribed for depression, in a few ways:

 

1. How it works:

Spravato® affects a different part of the brain called the glutamate system, and blocks certain receptors to help improve depression symptoms. Whereas SSRIs work by inhibiting the reuptake of serotonin changing the levels of this chemical in the brain.

 

The glutamate system and the SSRI system are different in terms of their role in the brain and how they affect depression. In simpler terms the glutamate system and the SSRI system are like two different teams in the brain that work in separate ways to help with depression. 

 

Glutamate plays a role in regulating mood. Glutamate is the most abundant neurotransmitter in the brain and is involved in various brain functions, including mood regulation, cognition, and learning. It acts as an excitatory neurotransmitter, meaning it helps facilitate the communication between nerve cells.On the other hand, the SSRI system focuses on a different brain chemical called serotonin. Serotonin is a neurotransmitter that also plays a role in regulating mood. SSRIs, which stands for selective serotonin reuptake inhibitors, work by increasing the levels of serotonin in the brain. By preventing the reuptake of serotonin, SSRIs help to keep more of it available in the brain, which can improve mood and relieve depression symptoms.

 

Both systems have different ways of addressing depression, and medications like Spravato and SSRIs target these systems to help people with depression feel better.

 

2. How you take it:

Spravato® comes as a nasal spray that you use in your nose making the absorption very quick. SSRIs usually come as pills that you swallow.

 

The nasal spray does of Spravato® are administered after you’re seen by clinic or center staff, and a psychiatrist. From there the effect of the medication will start to set in, and the psychiatrist and medical staff will monitory and support the patient during the appointment which typically lasts 2 hours. Those taking Spravato® should have a ride home after their appointment, and have a restful sleep before driving.

 

3. When it’s used:

Spravato is used when other medicines, like SSRIs, haven’t worked for depression. SSRIs are often the first choice for treating depression.

 

Diagnosing treatment-resistant depression involves a full evaluation. Initially, depression is diagnosed based on symptoms and criteria, and some people find successful reduction of symptoms with medication, therapy, or both.  However for some, these first-line treatments don’t work. For those individuals, a psychiatrist will assess treatment history, including the types of medications, other interventions, and side effect. From there they may recommend a different type of treatment, like ketamine or Spravato®. 

 

4. How quickly it works:

Spravato® has rapid benefit with some patients experiencing improvement within hours or days. SSRIs usually require several weeks of continuous use for symptom relief.

 

The method of taking Spravato®, as a nasal spray, is one reason why patients’ feel effects rapidly. However, quicker symptom relief is also related to the way in which Spravato® connects with the brain. Researchers are also studying the ways in which Spravato® improves neuroplasticity, or the brain’s ability to change, which can accelerate the relief the symptoms of depression especially when offered in combination with therapy. 

 

5. Where it’s taken:

Spravato® is given in a clinic or center with mental health care experts on hand for you. In contrast, SSRIs can be taken at home  as a daily pill. 

 

Many patients find the presence of their mental health professionals very comforting. Since Spravato® is a version of ketamine some people may be hesitant to participate in treatment out concern about the psychedelic-like effects of the medication. However, the dosage and care of each patient is closely monitored by psychiatrists, nurses, and medical assistants who are familiar with Spravato® treatment enhancing both safety and efficacy. 

 

It’s important to know that Spravato has risks and side effects, so it should only be used with a doctor’s guidance. If you have questions about depression treatments, it’s best to talk to a doctor who can give you personalized advice based on your situation.

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Ketamine and Depression: Science 101

How & Why Ketamine is a Breakthrough Treatment

Long standing stress from stress and anxiety takes a toll on brain function and connections. Ketamine can help restore those connections in a different way than traditional SSRIs.

Ketamine for Treating Depression and PTSD: Science 101

Depression and stress disorders are common. In this article, we will look at the research on using ketamine to treat depression and PTSD, including how it works, how well it works, and any potential side effects.


These mental health conditions can make it hard for people to enjoy their lives, and cope with stress. There are many different ways to treat depression and PTSD, including therapy, medication, and lifestyle changes. But, for some, depression and anxiety become chronic, long-standing, and resistant to traditional treatment.

 

Ketamine has become a promising treatment option for these conditions. Ketamine is a medication that was first used as an anaesthetic, and is now known widely for its use in alleviating the symptoms of hard to treat depression and stress disorders.  When standard treatments like therapy-only, SSRIs-only, or a combination of therapy and SSRIS do not work, other psychiatric interventions, like Ketamine treatment, offer new hope.  


What is ketamine?

 

For many ketamine is a familiar word, but not always for it’s medicinal use. While ketamine has reputation for being a club drug, and like other medications, has been abused in uncontrolled settings, for medical purposes and with the correct dosage and administration it is a safe and highly effective treatment. Ketamine has been used for decades as an anaesthetic. In human medicine Ketamine has historically been used as a means of sedation and for pain management. In fact Ketamine is on the WHO’s list of essential medications for pain management and anesthesia.  


While in an active phase of treatment, Ketamine makes people feel detached or dissociated from their surroundings and themselves.  However, the impact of ketamine on the brain is now believed to last after the immediate effects have worn off, and the benefits in a psychiatric setting can build overtime and with continued treatment.

 

How does ketamine work for depression and PTSD?

As is the case with many medications research is always deepening the understanding scientists and doctors have on the how & why psychological change occurs with Ketamine treatment.  What is known is that  ketamine does help with depression and PTSD especially when other treatments have failed to bring about lasting relie, and the way it works in the brain is different than how traditionally prescribed SSRIs work.

 

Ketamine targets the glutamate system in the brain, which plays an important role in healthy brain functioning. Glutamate is a highly abundant neurotransmitter, responsible for facilitating signals between nerve cells. Through the target of the glutamate system scientists theorize that Ketamine works by blocking a protein called the NMDA receptor in nerve cells and activating another protein called the AMPA receptor, which helps with forming and saving memories. This interaction between the NMDA and AMPA receptors may lead to the quick and sustained improvement in mood and behavior seen with ketamine treatment. Ketamine may also increase the production of BDNF, a protein that helps nerve cells grow and survive, and change the activity of neurotransmitters like serotonin, norepinephrine, and dopamine, which are involved in mood regulation.

 

Interestingly, the pain relief and mood improvement can last even after the drug has left the body. This might be because ketamine changes how the brain’s cells talk to each other, which can help the brain form new connections that last longer than the drug’s effects. Often this concept of being able to change and create new connections is called neuroplasticity. 

 

Evidence for using ketamine for depression and PTSD

 

There is a lot of evidence showing that ketamine can be used to treat depression and PTSD. Many studies have shown that ketamine can quickly and effectively reduce symptoms of depression and PTSD.

 

One study published in the American Journal of Psychiatry found that a single IV infusion of ketamine improved mood and suicidal thoughts in patients with treatment-resistant depression. Another study published in the Journal of Clinical Psychiatry found that a series of six IV ketamine infusions reduced symptoms of PTSD in military veterans.

 

Several studies that look at many studies together, called meta-analyses, have also shown that ketamine is a safe and effective treatment for depression and PTSD. A meta-analysis published in the Journal of Affective Disorders found that ketamine was more effective than a dummy treatment at reducing symptoms of depression, with a large effect size and a quick onset of action. A systematic review published in the Journal of Clinical Psychiatry similarly found that ketamine was effective at reducing symptoms of PTSD, with a moderate to large effect size.

 

What are the potential side effects of ketamine?

 

Like any medication, ketamine can cause side effects. The most common side effects of ketamine are dizziness, drowsiness, nausea, and vomiting.  Ketamine will also impair your ability to drive or operate machinery which is why Heading requires patients have transportation to and from treatment. Other potential side effects include hallucinations, changes in blood pressure, and respiratory problems, which is why Heading recommends treatment be in-person and under the direct supervision of medical professionals. It is important to talk to a healthcare provider about the risks and benefits of ketamine treatment before starting treatment.

More research

There are a number of studies that discuss the use of ketamine for the treatment of depression.  Here are a few examples of scientific resources that may be of interest.

 

Zarate, C. A., Jr., Singh, J. B., Carlson, P. J., Brutsche, N. E., Ameli, R., Luckenbaugh, D. A., … Charney, D. S. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856–864. https://doi.org/10.1001/archpsyc.63.8.856

  • This study found that a single intravenous (IV) infusion of ketamine was associated with a rapid and significant improvement in mood and suicidal thoughts in patients with treatment-resistant depression.

Feder, A., Parides, M. K., Murrough, J. W., Perez, A. M., Morgan, J. E., Saxena, S., … Charney, D. S. (2014). Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 71(6), 681–688. https://doi.org/10.1001/jamapsychiatry.2014.30

  • This study found that a series of six IV ketamine infusions was associated with a significant reduction in symptoms of PTSD in military veterans.

Caddy, C., Giaroli, G., White, T. P., & Tracy, D. K. (2019). Ketamine as a treatment for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 245, 959–973. https://doi.org/10.1016/j.jad.2019.03.053

  • This meta-analysis concluded that ketamine is a safe and effective treatment for depression, with a large effect size and a rapid onset of action.

Bremner, J. D., Vythilingam, M., Vermetten, E., Adil, J., Khan, S., Nazeer, A., … Krystal, J. H. (2008). Pilot study of repeat-dose intravenous ketamine in treatment-resistant posttraumatic stress disorder. Biological Psychiatry, 63(3), 339–341. https://doi.org/10.1016/j.biopsych.2007.05.028

  • This study found that a series of IV ketamine infusions was associated with a significant reduction in symptoms of PTSD in a small group of patients
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The Irreplaceable Benefits of In-Center Ketamine Treatments

Is it Better to Receive Ketamine in a Center or at Home?

January 9, 2023

Unlike with most antidepressants, patients considering ketamine have to consider different methods of receiving the medication as well as the location for treatment: at home or in a clinic under the supervision of a medical professional. 


While at-home treatments have the advantage of convenience and accessibility, there are aspects of the in-clinic process that cannot be duplicated at home. Some experts even argue an in-clinic treatment is essential for safety and efficacy.  From the added sense of security to access to a well-oiled integrated care team, every part of the in-clinic experience is thoughtfully designed to optimize therapeutic outcomes.


By exploring the benefits of in-clinic treatments below, you’ll be well-suited to make an educated decision on which option is right for you.

Access to Different Ways of Taking Ketamine

Ketamine is available in several forms or routes of administration, including oral tablets, nasal sprays, and IV infusions. While oral tablets are commonly prescribed for at-home use, others must be administered at a clinic. At Heading, we offer Spravato® (intranasal esketamine) and intramuscular (IM) ketamine. In both instances, you need a medical provider’s support and supervision.


“Each method of receiving ketamine treatment has its benefits and drawbacks, many of which are unique to individual patients,” shares Dr. Tyson Lippe, an Austin-Texas-based psychiatrist here at Heading Health. “However, patients taking Spravato®, which is FDA-approved to treat treatment-resistant depression, will need to come into the clinic – it’s a requirement.” 


Dr. Arif Noorbaksh highlights that cost is a key reason in favor of having access to all the ketamine forms and routes of administration.

Spravato®, which is delivered intranasally, is FDA-approved to treat treatment-resistant depression. And for the vast majority of these patients that we see at Heading, this also means that insurance will play a part in covering the expense. 


While our team at Heading has worked hard to ensure we can also provide coverage for IM ketamine, we are unique in this respect. At other clinics, Spravato® may be a patient’s best bet for getting their treatment covered.

Optimal Set and Setting for Mental Health Improvement

With any intervention that has the potential to produce psychoactive effects, the set and setting (i.e., the patient’s mindset and treatment environment) are vital. Most immediately, how you feel going into the treatment can impact how you feel during it. If you go in confident and calm, you’ll be more likely to have a pleasant experience.


Aside from being valuable in its own right, positive ketamine experiences can result in other good outcomes. For example, studies have found that pleasant ketamine experiences are associated with better treatment outcomes, while scary ones can undermine ketamine’s antidepressant effects. Knowing that a care team is steps away can help ease nerves about treatment, and may put patients at ease knowing help is available should they experience any adverse side effects.


While everyone has their own unique preferences regarding set and setting, an environment that supports feelings of safety and security is essential. Ketamine treatment centers are well-equipped to provide this. 


With physicians and therapists on-site, patients can feel confident that a competent professional is there to help. As Dr. Noorbaskh shares:

Patients receiving ketamine in a clinic or medical center receive an entire team of people who are supporting the best possible outcomes. Safety is, of course, paramount. Patients also take comfort in knowing that they have a medical team who can immediately make them more comfortable and answer any questions or concerns they may have in real-time. And these are also the same people you will see time and time again. Developing therapeutic relationships requires trust, and building trust over time with your care team enhances the experience. 


Being in the hands of a team of professionals isn’t the only way clinics can support a positive mindset. Clinics often take great care to design the treatment rooms so they are conducive to feelings of calmness and relaxation. For example, they may include soft ambient and natural lighting, cozy chairs, fresh greenery, and ample space to help you settle in and focus on your journey.

Improved Patient-Provider Relationship

At-home ketamine therapies are sometimes paired with telehealth tools to help guide patients through their treatments. However, while telehealth increases access and flexibility, there are situations where in-person treatments offer irreplaceable benefits, especially for individuals experiencing loneliness and isolation. 


As Dr. Tyson Lippe shares:

I see patients through telehealth, and I also see patients in person. Telehealth certainly increases accessibility, which is incredibly valuable. That said, loneliness and isolation are significant mental health concerns. Anytime we are able to connect directly with people who truly care about our health and well-being, there is a benefit. Offering care in a more hybrid fashion with telepsychiatry and in-clinic treatment administration opens up accessibility while also maintaining great care.

Behavioral Activation

Aside from helping patients combat loneliness and isolation, in-person treatment centers can lead to better outcomes simply by providing patients with a regularly scheduled outing and a chance to interact with friendly staff. In fact, in one evidence-backed form of psychotherapy called behavioral activation, practitioners help patients engage in pleasurable activities that get them moving and socializing to alleviate symptoms of their depression. 


By offering patients a reason to go out, enjoy the company of physicians they’ve grown close to, and undergo a relaxing treatment on a consistent basis, ketamine clinics are able to supplement the therapeutic effects of ketamine itself with the benefits of behavioral activation. 

Comprehensive, Integrated Care

Ketamine often works best when combined with other interventions. For example, Janssen Pharmaceuticals, the maker of Spravato®, recommends combining the treatment with an oral antidepressant. Similarly, researchers have found that psychotherapy can extend the therapeutic effects of ketamine. 



Dr. Noorbaksh highlights how, for a holistic approach to work seamlessly, providers from different disciplines and areas of expertise must develop close working relationships that facilitate the delivery of comprehensive, integrated care:

An important aspect of medicine is developing relationships with other healthcare professionals. At Heading, our approach is hybrid with telehealth for psychiatry and therapy services and in-person visits for interventional treatments like TMS and ketamine. When it comes to combining services, I don’t have to go far to help my patients find great therapists. I’m able to directly communicate with my patients’ therapists, nurses, and care coordinators. Direct communication means there’s less time that my patients and I are waiting for treatment notes to be reviewed or changes in care to take place.

Accountability

Though ketamine can alleviate symptoms far more rapidly and with less frequent maintenance than other interventions, repeated visits are often necessary to sustain the full benefits of the treatment. However, the mental health conditions that ketamine can be used to treat can make it more difficult for patients to stay on schedule.


When asked how in-person treatment centers are well-equipped to address this issue, Dr. Noorbaksh emphasized the value of the interpersonal connections and support patients receive from their care team:

The human interaction and support patients receive from the clinical team during treatment are tremendously valuable. Psychiatric care nurses, medical assistants, and the psychiatrist providing care all get to know their patients and facilitate touch points that simply can’t be replicated in the same way remotely.


In other words, providers at in-person treatment centers can draw on their close connections with and deep understanding of their patients to help mitigate any motivational barriers to receiving treatment. 


Aside from interpersonal connections, clinics are well-equipped to take over the logistical obstacles that might otherwise make scheduling and receiving treatment overwhelming for individuals suffering from anxiety and depression. Dr. Lippe shares that:

Mental health conditions like anxiety and depression can make it hard to keep engaging in activities that are beneficial to health and well-being. But having a clinical team that schedules appointments, offers reminders, and conducts follow-up visits helps keep patients on track. This is vital as we know that staying on track with treatment and in therapy can lead to faster and more durable outcomes. 

Finding the Best Option for You

Ketamine is a powerful psychiatric intervention that can alleviate symptoms of the most severe cases of depression. Specialized clinics designed to optimize each part of the treatment process are likely the best place to undergo ketamine therapy and maximize its therapeutic potential. Some of the most important benefits treatment centers are better suited to provide include:

  • The ability to choose the most effective and affordable type of ketamine and route of administration
  • A tailored environment carefully crafted to support feelings of confidence, safety, and security
  • Close patient-provider relationships that use the power of social connection to build on ketamine’s effects
  • Behavioral activation through consistent appointments, which provide individuals with depression with a regularly scheduled relaxing outing and the opportunity to socialize
  • Comprehensive, integrated care supported by efficient communication among healthcare professionals
  • Added accountability due to interpersonal connections with staff and a competent team ready to take care of all the logistics of planning appointments.
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How Ketamine Works Quickly When Other Treatments Have Failed

How Ketamine Works Quickly When Other Treatments Have Failed

December 7, 2022

Ketamine (and its cousin, Spravato®) are novel antidepressants that have been gaining recognition for their ability to provide rapid relief from the most severe forms of depression, including treatment-resistant depression (TRD) and depression with suicidal ideation. In addition to their quick effects, ketamine-based therapies can work even after several other treatments have failed to produce an adequate response. All of this raises the question, how does ketamine work, and what is it doing differently?

 

Researchers are continually increasing their understanding of how Ketamine works differently for depression and anxiety, and they have identified several promising mechanisms of action.

 

Here are six effects of ketamine that experts believe might explain why it can have such a rapid and significant impact on depression even when other treatments have failed.

#1: It Increases Glutamate and BDNF

Most antidepressants work on a set of chemical messengers in the brain called monoamines, which include serotonin, norepinephrine, and dopamine. Though effective, these medications can take over a month to start working, and some find they don’t provide adequate relief no matter how long they take them.

 

Dr. Steve Levine explains that targeting the glutamate system is markedly different than the way that traditional SSRIs work.

 

 

Ketamine-based therapies differ from these interventions by impacting glutamate, an excitatory neurotransmitter that research has continued to suggest plays a critical role in depression. When ketamine enters the brain, it binds to the N-methyl-D-aspartate receptor (NMDA) receptors, ultimately causing a surge of glutamate.

Credit: Yang H. Ku/C&EN

The rise in glutamate brings about other important changes. In particular, it leads to an increase in brain-derived neurotrophic factor (BDNF), which supports the survival of existing neurons and encourages the growth of new ones (more on this below).

#2: It Helps Neurons Grow and Connect

In order to adjust our thoughts and feelings to the world around us, our brains must be malleable and adaptable.

 

Ultimately, this means that our neurons (i.e., tiny nerve cells in the brain that send and receive information) must be able to grow, form, and modify connections with other neurons, in a phenomenon known as neuroplasticity. 

 

 Research has repeatedly found that neuroplasticity is impaired in depressed individuals. These processes are often deficient in parts of the brain that are important for mood regulation, including the prefrontal cortex, amygdala, and hippocampus.

 

Ketamine has clear links with neuroplasticity. For example, ketamine studies on rats with depression-like symptoms have found that symptom relief was associated with increases in neuroplasticity. Importantly, this happens rapidly. One study found that a single dose of ketamine began to reverse deficiencies in neuroplasticity within 12 hours.

#3: It Might Reduce Inflammation 

Inflammation is heavily associated with depression, with some estimates suggesting that approximately one-third of depressed patients have elevated inflammatory markers.

 

Some research findings indicate that, in addition to all of its other mechanisms, ketamine may improve depression by reducing inflammation.

 

Animal studies have found that ketamine may have anti-inflammatory effects. Some human studies have found similar results, but the findings have not been inconsistent.

#4: It Can Improve Sleep 

Consistently poor sleep is harmful to mental health. Researchers have found that ketamine might improve sleep in several ways and that these changes are associated with better therapeutic outcomes. For example, ketamine appears to improve slow-wave sleep, decrease early night awakenings, and strengthen circadian rhythms, sometimes after a single treatment. 

 

As is often the case, it is hard to determine which way the causal arrow goes. It could be that those who experience a robust antidepressant response sleep better because they are less depressed, or it could be that those who sleep better end up feeling better. Future studies will need to verify the connection between ketamine, sleep, and depression.

#5: It Can Make People More Optimistic

Optimism has an obvious connection with depression. The more you can focus on the positives or be confident that good things are coming your way, the better you’ll feel. These optimistic tendencies and outlooks can be more challenging for individuals suffering from depression.

 

A recent study explored whether one of the ways ketamine reduces the symptoms of depression is by increasing optimism. The research team found that within four hours of a ketamine infusion, individuals with TRD were more optimistic when judging the likelihood of experiencing adverse events in the future. Importantly, this optimistic reorientation was correlated with lower depression scores one week after treatment, suggesting that ketamine’s effect on optimistic beliefs may help explain ketamine’s rapid impact on depression.

 

#6: It Creates Profound Altered States of Consciousness

Ketamine is well-known for its psychoactive effects (i.e., changes in mood, feeling, thoughts, and perception). For example, when given at the doses used for depression, ketamine can cause dissociative states, where one feels disconnected from their body and thoughts

Given that ketamine consistently produces altered states of consciousness which begin to occur around 15 minutes after administration, it’s natural to wonder whether they play an active role in rapidly alleviating symptoms of depression. 

 

Because ketamine is a dissociative anesthetic, most research in this area has focused on whether ketamine’s dissociative effects may be connected with therapeutic outcomes. Findings have been inconsistent. While some studies have found that dissociative experiences are associated with better responses, others have not.

 

Ketamine can occasionally produce psychotomimetic effects (i.e., delusions, delirium, perceived distortions of space and time, etc.) and mystical experiences. A recent meta-analysis (i.e., a review of many studies) found that neither effect appears to be strongly associated with improvements in depression.

 

It is important to note that this area of research is still in its infancy, and few studies have been conducted with the explicit goal of assessing the antidepressant effects of the altered states of consciousness produced by ketamine. Much more research will need to be done before we can draw any confident conclusions. 

 

Key Takeaways

Ketamine-based therapies are rapid-acting interventions that work in unique ways to produce their therapeutic effects. Though there is much left to discover, experts have identified several mechanisms which might explain why ketamine can offer rapid relief from depression when other treatments have failed. In particular, ketamine-based therapies may work by:

 

  • Impacting different chemicals in the brain, like glutamate and BDNF
  • Helping neurons grow and form new connections in a process known as neuroplasticity
  • Reducing inflammation
  • Improving sleep
  • Increasing Optimism
  • Causing profound subjective experiences through its psychoactive effects
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Patient Perspective: What Spravato® Did for My Anxiety and Depression.


Patient Perspective: What Spravato Did (and Didn't Do) for My Anxiety and Depression

December 1, 2022

This post was written by a member of our team who currently resides in Michigan and receives treatment there. In the interest of transparency, he is not a patient of Heading as Heading serves people in Texas. However, his treatment program and the experiences detailed are similar to those of patients at Heading. We are grateful that he wanted to share his story with us.

 

 

Over the past few months, I have been undergoing Spravato (intranasal esketamine) therapy to address my anxiety and depression. To help others considering or currently incorporating Spravato into their treatment plans, I have been documenting aspects of my experience. After the first few sessions, I described in great detail what the treatments feel like for me so that others can prepare themselves for Spravato’s psychoactive effects. 

 

In this post, I discuss Spravato’s effect on my mental health, including the benefits and residual issues, to provide a clear picture of what it did and didn’t do for me. 

Psychological Benefits

Less Fear and Anxiety

Though I deal with both depression and anxiety, the latter is my primary condition and may very well be responsible for the former. I’ve experienced heightened and unwarranted levels of stress and worry for as long as I can remember and have been diagnosed with several anxiety disorders, from generalized anxiety disorder (GAD) to obsessive-compulsive disorder (OCD), to several phobias.

 

These conditions are driven, at least partly, by intense feelings of anxiety and fear. One of the more noticeable effects of Spravato has been that the subjective sensation of anxiety has diminished dramatically. I am far less prone to feel the icy cold tension that ripples through my body when I encounter a situation I perceive as dangerous or threatening in some way.

 

This therapeutic effect of Spravato had a positive downstream impact on other symptoms. For example, phobias are much more manageable as the fear I would typically feel when thinking about or encountering what I’m afraid of is less intense. Though I have not been able to try it yet, I think this change would enhance exposure therapy and allow me to chip away at my fears even further.

 

Increased Empathy

In my previous post, I noted that during my Spravato sessions, I felt more empathetic and compassionate. For example, I often found myself thinking through past debates or arguments and having an easier time seeing things from the other side’s perspective. This effect tends to persist even after the psychoactive effects of Spravato have worn off. I find that I am generally kinder and more agreeable.

 

Resilience/Optimism

As part of my anxiety and depression, I have struggled to bounce back from obstacles and setbacks. 

 

Since starting my Spravato treatments, I have noticed that I am much less likely to get knocked down by an unexpected obstacle. Though I may experience shorter-term stress, it’s generally less intense and tends not to drag me down the way it used to. I’m also much better at actually solving the problems I encounter. Whereas before, I may have viewed a challenge as insurmountable, I’m now much more inclined to feel I have the resources and capacities to think my way through it. 

More generally, I have felt more optimistic. I evaluate situations more favorably and view positive outcomes as more likely to occur. Recent research suggests this may be one of the main ways Spravato® works. Specifically, one experiment found that individuals with treatment-resistant depression (TRD) who received ketamine treatments showed an increase in optimism about their personal lives as soon as four hours after their first ketamine dose and that this was correlated with improvements in depression.

 

Openness to New Experiences

I’ve always struggled to get myself to try new things. I like consistency and predictability, and new experiences get in the way of maintaining my desired level of stability.

 

Spravato® has started to weaken this disposition. A notable example of this involves my diet. I’ve been a picky eater my whole life and have always found it difficult to expand my palette. Opportunities to try new foods used to fill me with anxiety. Whenever I overcame this wall of fear, my mind reacted negatively to the novel tastes and sensations. Since starting my Spravato® treatments, my ability to eat and enjoy new foods has seen a noticeable improvement. For example, I tried fish for the first time in my life, which I had all but written off entirely.

 

I still like to stick with what’s familiar, but by and large, I am significantly less thrown off by change and novelty and have a much easier time opening up to new experiences.

Remaining Issues

Rumination

My depressive and anxious tendencies contain both cognitive and affective components. There are feelings of depression and anxiety, but there are also negative thought patterns associated with them. 

 

While the feeling of anxiety has diminished, some cognitive components have stuck around. In particular, my tendency to ruminate remains and continues to interfere with my ability to get things done. When there is something I’m worried about, I still get stuck in negative thought loops about it. While it’s somewhat easier to pull my mind away from the potentially bad outcomes, my negative thoughts remain magnetic, pulling my mind toward them even when I know it would be best to think about something else. 

 

Anhedonia/Lack of Pleasure

One of the hallmarks of depression is the inability to experience pleasure or find joy in activities, also known as anhedonia. Over the past few years, I’ve begun to experience this symptom, albeit to a limited degree. 

 

I was surprised that Spravato® didn’t address this component of my depression, as several studies have found that ketamine is highly effective at treating anhedonia. To understand why it didn’t work in my case, I searched for more detailed research on the topic and came across an interesting finding. Specifically, I discovered that some studies have found evidence that taking benzodiazepines (e.g., Ativan, Xanax, Valium, etc.) while undergoing ketamine therapy appears to decrease the chances that you’ll experience an improvement in your ability to experience pleasure. For example, one study found that none of the participants who found relief from this symptom were taking benzodiazepines.  

 

Because I have been taking Ativan for years before and throughout my Spravato® treatments, this might explain why my anhedonia remains.

 

Takeaway

Spravato® has improved my mental health in several significant ways. I’m less anxious and more empathetic, resilient, and open to new experiences. As I mentioned it also hasn’t completely eliminated all of my symptoms as I still tend to ruminate and am working to regain pleasure and joy from my usual activities. Does the fact that I’m not entirely cured mean Spravato® isn’t a good tool for me? I don’t think so. 

 

I’ve experienced improvement. I am far better off than before and more able to tackle what’s left with therapy or other medications. 

 

Residual symptoms may lead some to question whether it was worth it has more to do with how Spravato®’s efficacy is represented than anything else. Often, it’s depicted as a magical cure-all. While this may be the case for some people, it likely won’t be for many others. There’s always more work to do. But that doesn’t mean Spravato® isn’t a valuable option. 

 

In my case, it will continue to play an important role in my journey to mental wellness.

 

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Can Ketamine Treat PTSD?

health.hardvard.edu


Can Ketamine Treat PTSD?

November 3, 2022
health.hardvard.edu

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition caused by exposure to a terrifying or traumatic event. Individuals with PTSD may experience flashbacks, nightmares, severe anxiety, and uncontrollable or intrusive thoughts about the event. About eight percent of the population will experience PTSD over the course of their life. This condition is significantly more common among combat veterans, with nearly a quarter developing it during their lifetimes.

 

The standard treatment involves some form of psychotherapy, oral anti-depressants, or some combination. Many psychotherapies (e.g., exposure therapy, cognitive behavioral therapy, cognitive processing therapy, etc.) require patients to confront aspects of the traumatic event or how they think about it. While these therapies can be effective, they can also be stressful, causing many to stop treatment early.

 

The FDA has approved two medications, sertraline, and paroxetine, for the treatment of PTSD. These medications have several drawbacks. They take four to six weeks to start working. They also come with many side effects that lead many to stop taking them. Even when patients stick with the medications, only around 30 percent achieve remission. While other medicines have been used, the evidence for their efficacy remains questionable. As a result, there is a desperate need for faster, more effective, and more tolerable treatments for PTSD.

Why Test Ketamine for PTSD?

Over the past few years, ketamine has been explored as a potential solution. Researchers have turned to this medication for several reasons. One reason has to do with how ketamine acts in the brain. Ketamine is an N-methyl-D-aspartate receptor (NMDA) receptor antagonist. This means that it increases the amount of glutamate (a chemical messenger in the brain) and brain-derived neurotrophic factor (BDNF), which helps neurons grow and form new connections.

Credit: Yang H. Ku/C&EN

Early animal studies indicate that glutamate and BDNF play important roles in PTSD. One study found low levels of glutamate in mice exhibiting PTSD-like behavior after exposure to stress. Other experiments have found that several brain regions associated with fear and mood regulation had shrunk in mice after similar stress tests, suggesting BDNF might help rebuild these atrophied areas.

 

Ketamine is also well-established as a rapid-acting antidepressant. Since depression is a prominent symptom of PTSD, it should help with this part of the condition.

The Studies

Initial Experiments

With all this in mind, researchers turned theory into practice and began testing ketamine as a treatment for PTSD in human participants. In a 2013 study, an army veteran who was given a single infusion of ketamine experienced rapid and robust relief of his PTSD symptoms that lasted 15 days. 

 

Following this finding, another group of researchers conducted a randomized controlled trial (RCT), meaning they gave one group ketamine and another a placebo. They found that PTSD levels were significantly lower in the ketamine group 24 hours after the infusion, and the effects persisted for around seven days.  

 

Experimenters, hoping to extend the amount of time before symptoms returned, tried giving subjects repeated infusions of ketamine. In one study, patients received six infusions over two weeks. Eighty percent of patients achieved remission for 41 days on average. 

 

Ketamine With Psychotherapy

While 41 days is a significant amount of time, more sustained relief would be ideal. Instead of using more ketamine treatments, some researchers have explored whether the effect could be extended when combined with psychotherapy. 

 

One of the commonly cited reasons for doing this is that PTSD is associated with deficits in what is known as  “memory reconsolidation,” which occurs when a recalled memory is changed or altered in some way. Normal memories decay or degrade over time. Some theorists believe that for patients with PTSD, their trauma memories remain as clear and vivid as the day they were formed. Many therapies target this process of reconsolidation. 

 

Ketamine is associated with neurogenesis. Recent studies have found that neurogenesis is important in reconsolidation. As a result, researchers have tested whether therapy might extend the effects of ketamine. One study which combined ketamine with prolonged exposure therapy found that after 90 days, the ketamine group had lower PTSD symptoms when compared to the group that received a placebo. 

Prevention Vs. Treatment

Aside from comparing ketamine with and without therapy, researchers have tested its effects on PTSD when administered at different stages in the PTSD process. A recent meta-analysis compiled all the research on combat veterans and found some surprising results. Most notably, they found that when given during the early stages of PTSD (1-3 months after the traumatic event), ketamine exacerbated their symptoms. However, when administered beyond this stage, ketamine was consistently helpful. Exactly why the timeline is so important is unclear. 

Conclusion

Ketamine appears to be a powerful treatment for PTSD. With that said, there are some caveats. When administered on its own, the effects are short-lasting. Repeated infusions can extend the benefits, but only to around 41 days. Psychotherapy may prolong the therapeutic results further, but more research will need to be done to confirm this. Lastly, the treatment may not work for all PTSD patients, especially those who experienced their trauma more recently.

 

 

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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Upcoming Events and Content in Honor of Veteran’s Days


Upcoming Events and Content in Honor of Veteran's Day

October 28, 2022

During the week of Veterans Day, Heading Health will be hosting events and publishing articles to honor our military veterans. We will be taking a close look at the mental health issues veterans face, highlighting providers who specialize in treating veterans and gathering insights from their experience, as well as discussing the therapeutic potential of psychedelics as treatments for service-induced mental health conditions.

 

Check out the details of these events and others in the Austin area below.

 

Heading Health Speaker Series: What Now? How Veterans Can Overcome Post-Deployment Hurdles to Happiness

Teressa Carter – LCSW

In the Heading Health Speaker Series events, we highlight perspectives from our team of mental health professionals to learn from their unique backgrounds, experiences, and viewpoints.

Femi Olukaya – LPC

 

In our Veteran’s Day edition, nutritional therapist Sally Twellman will interview Femi Olukaya, a therapist and military veteran, and Teressa Carter, a social worker with experience serving and treating active duty service members. They will explore the difficulties veterans face when integrating back into civilian and family life, the problems this can cause, and what we can do to soften the landing and ease their transitions back home. 

 

This event will be recorded and available to stream on YouTube. Stay tuned for more details.

 

Articles

Provider’s Perspective: Why Veterans Struggle to Seek Mental Health Care and What to Do About It

Despite the prevalence of mental health issues among veterans, many struggle to seek out help. In this article, Teressa Carter, will take a deep dive into this problem, offer suggestions for veterans and active military members unsure of whether or how to seek care, and provide advice for clinicians to help them perform patient outreach and build rapport with military clients. 

 

Ketamine for PTSD

Estimates suggest that 10-20 percent of veterans have post-traumatic stress disorder (PTSD), characterized by flashbacks, nightmares, and severe anxiety caused by exposure to a terrifying event. Recent research shows that ketamine may help veterans recover from this debilitating illness. This post will summarize the research, highlight key findings, and explore what this means for future treatments for PTSD.

 

Other Events in the Austin Area

The Rebirth: A Veterans Day Celebration Exploring Psychedelic Medicine

This three-part event will highlight the healing power of psychedelics for veterans. Specifically, it will include:

 

  1. A showing of the documentary film From Shock to Awe, which covers the lives of U.S. military combat veterans and highlights the transformational impact psychedelics have had on their mental health
  2. An expert panel which will discuss the importance of psychedelics and the urgent need to increase accessibility to these alternative treatments.
  3. A chance to hang out, listen to music, and catch up with friends at famed music club, Antonne’s

 

This event will take place on Friday, November 11, from 3:00 PM – 11:00 PM CST.

 

Get your tickets here.

 

 

The Mission Within: Psychedelics & Healing the Wounds of War

Founded by Dr. Martin Polanco, The Mission Within offers psychedelics such as ibogaine, 5-MeO-DMT, and psilocybin to treat veterans with traumatic brain injury (mTBI), PTSD, depression, and addiction as a result of experiences during military service.

 

In this panel, you’ll hear from veterans who participated in The Mission Within and how psychedelics helped them overcome service-related trauma and heal their relationships with loved ones.

 

This event will take place on November 3, from 6:45 PM – 8:30 PM CST.

 

RSVP here.

 

 

 

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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Treatment-Resistant Depression


Treatment-Resistant Depression

October 24, 2022

When treating depression, physicians often prescribe a first-line anti-depressant (e.g., Zoloft, Prozac, and Lexapro). While these treatments work for many, a significant portion find that their symptoms remain even after trying several antidepressants. Known as treatment-resistant depression (TRD), this condition affects around 30 percent of adults with major depressive disorder (MDD).

 

Despite its prevalence, many are unaware of treatment-resistant depression, how to determine if they might have it, or what to do about it. 

 

Explore answers to these questions and more below.

When is Depression Treatment Resistant?

Treatment-resistant depression is generally defined as a lack of response to a few adequate trials of antidepressants. However, this leaves several questions open, including:

 

  • What counts as a lack of response?
  • What is an adequate trial?
  • How many antidepressants must a patient have tried?

 

It’s important to note that there are no universal answers to these questions. Instead of settling them, try answering the following questions:

 

  • Have your treatments failed to make you feel good?
  • Do you still not feel like your old self?
  • Have the side effects been difficult to manage?

 

Answering yes to any of these questions means you’re not getting the help you need, and it’s time to talk to your physician, who can decide the next best course of action. 

Risk Factors for Treatment-Resistant Depression

Though researchers are still uncovering all traits that can increase the chances of having or developing TRD, we know several factors are associated with the condition. In particular, depression is more likely to be treatment-resistant:

 

  • If it began at an early age
  • The longer one has had depression
  • The more frequent or longer lasting one’s depressive episodes are
  • When there are ongoing stressors
  • If one has other physical or mental health conditions

What to Do About Treatment-Resistant Depression

Treatment-resistant depression is treatable. Below are steps you and your physician can take to alleviate your depressive symptoms that haven’t responded to the first few treatments.

 

  • Confirm your diagnosis: Depression that co-occurs with or is caused by other mental health conditions may require a different treatment protocol. As a result, your physician should confirm your diagnosis if your depression isn’t improving in response to treatment.
  • Add on talk therapy: Medications often work best when combined with some form of talk therapy. If you find your depression hasn’t responded adequately to your antidepressants, adding on therapy can give them a boost and help alleviate symptoms.  
  • Change your medications: Just because a few medicines haven’t worked doesn’t mean none will. Newer anti-depressants (e.g., Spravato and Auvelity) that act on different neurotransmitters than first-line treatments can provide relief even when the standard solutions haven’t worked.
  • Try a non-medication-based intervention: While oral antidepressants are the most common medical treatment for depression, other options exist. For example, transcranial magnetic stimulation (TMS) is a non-invasive procedure where magnetic pulses are used to modulate activity in parts of the brain associated with mood regulation and is FDA approved for treatment-resistant depression.

How We Treat TRD at Heading Health

At Heading, we offer a comprehensive set of solutions to tackle TRD from every angle and provide rapid and sustained relief. We work hard to ensure that cost is not a barrier to accessing the interventions you need. We work with most insurance plans, from United Healthcare to Medicare to Blue Cross Blue Shield, and can provide coverage for all of our services, including ketamine, Spravato, and TMS, for most patients with TRD. Click here for a complete list of participating providers and to schedule a consultation to see whether our solutions are right for you.  

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