I sifted through the article and took out several points in the discussion of the article below.:
By taking the focus off “oneself” and placing it on other stimuli,
it is possible that ketamine decreases awareness of negative
experiences and consequently improves mood.
The transient dissociation experienced by depressed patients
during a ketamine infusion may have the effect of dampening
what the hyperactive self-monitoring associated with
Radiology findings may reflect ketamine’s ability to reclaim frontal control over deeper limbic structures, thus strengthening the cognitive control of emotions and decreasing depressive symptoms.
Ketamine may cause a “disconnect”
in several circuits related to affective processing, perhaps
by shifting focus of attention away from the internal
states of anxiety, depression, and somatization, and more toward
the perceptual changes (e.g., hallucinations, visual distortions,
derealization) induced by ketamine. Similarly,
during an emotion task, ketamine attenuated responses to
negative pictures, suggesting that the processing of negative
information is specifically altered in response to ketamine.57
By taking the focus off “oneself” and placing it on other stimuli,
it is possible that ketamine decreases awareness of negative
experiences and consequently improves mood
Major depressive disorder (MDD) is one of the most prevalent conditions in psychiatry. Patients who do not respond to traditional monoaminergic antidepressant treatments have an especially difficult-to-treat type of MDD termed treatment-resistant depression. Subanesthetic doses of ketamine-a glutamatergic modulator-have shown great promise for rapidly treating patients with the most severe forms of depression. As such, ketamine represents a promising probe for understanding the pathophysiology of depression and treatment response. Through neuroimaging, ketamine’s mechanism may be elucidated in humans. Here, we review 47 articles of ketamine’s effects as revealed by neuroimaging studies. Some important brain areas emerge, especially the subgenual anterior cingulate cortex.
Ketamine could offer a fast and effective treatment for people with depression, even those who have failed to respond to current therapy options. A new medical reviewpublished this month adds to the growing evidence that the drug could be used in a clinical setting.
The review, published in the Harvard Review of Psychiatry, analyzed 47 studies on ketamine as a treatment for depression. The paper outlined specific ways in which ketamine affected the brains of depression patients.
Ketamine is a drug that can relieve pain and cause feelings of relaxation. It is generally used as an anesthetic in medical setting, but it is also abused as a party drug. Recreational users typically seek a sensation described as being similar to an out-of-body experience.
Despite its popularity at parties, ketamine has been the subject of numerous clinical studies for its potential to treat depression. Data have been mounting in its favor, and now a team at Harvard Medical School has reviewed the evidence thus far.
The authors found that many patients given ketamine displayed measurable positive changes in brain activity in areas associated with the ability to process and control emotions, Business Insider reported.
Those changes include activation of the subgenual anterior cingulate cortex—connected to both emotions and cognition—as observed by neuroimaging. The activation was directly associated with improvement of depression symptoms in as little as 24 hours after patients received a single intravenous subanesthetic ketamine dose.
The drug also enhanced how the brain responded to positive emotions, a change indicated by increased connectivity in the right-hemisphere caudate. That enhancement helped relieve symptoms of depression, possibly because of this region’s connection to the brain’s reward system.
Although the review did not describe exactly how ketamine produces its antidepressant effect, the authors noted that the effect may be indirect. Past research found that ketamine affects several receptors in the brain, such as opioid receptors, adrenegic receptors and serotinin receptors. The review concluded that the side effects of ketamine’s effect on those receptors may be the root cause of its antidepressant response. However, more research is needed to confirm this.
Here is a knock off of the article from Ascend Ketamine in Houston:
There is an undeniable connection between depression and chronic pain. While depression is a clinical mental health disorder, it manifests with inexplicable psychical ailments: migraine headaches, back pain, etc. And while chronic pain is a clinically physical condition, it manifests with inexplicable mental ailments: elevated stress levels, poor quality of sleep, low self-esteem, etc. And the worst part: these mental and physical conditions perpetuate each other. Chronic pain exacerbates depressive symptoms. Depressive symptoms result in heightened levels of pain. And so on…
Breaking the Pain-Depression Cycle
Being proactive is the most important step an individual can take in an effort to break the pain-depression cycle. Acute pain can easily become chronic pain if left unaddressed. Advocate for yourself and speak to a physician if you notice any of these symptoms, even if you don’t think they are anything to be concerned about:
Depression, sadness or anxiety
Poor quality sleep or trouble falling asleep
Loss of hope
Loss of interest in enjoyable activities
Changes to your appetite
Inability to become motivated
Be mindful of—and avoid—stressful situations, as stress can result in heightened pain levels. And don’t assume that depressive symptoms will be resolved when your pain is minimized. It’s better to talk about what you’re experiencing now than it is to spend months or years suffering in the future.
Ketamine Infusions for Chronic Pain & Depression
Ketamine treatments are proven to reduce chronic pain and alleviate the symptoms of depression in up to 70% of patients. If chronic pain and depression are negatively impacting your life, ketamine infusions may be an option for you. Taking a multi-disciplinary approach to treating chronic pain, depression, and other psychiatric disorders, however, is a more high yield approach than any one therapy. Other treatment options to consider include:
Psychotherapy or counseling
Exercise, meditation, journaling, and other mind-body solutions
Medicinal or pharmacological solutions
Ketamine infusions coupled with any of the above treatments will likely yield the most promising results, minimizing chronic pain and effectively reducing depressive symptoms before they become untreatable.
CBS News Features Dr. Ashraf Hanna Discussing How IV Ketamine is Successfully Treating Lyme Disease
TAMPA, Fla., Feb. 22, 2016 /PRNewswire/ — CBS news just broadcast a featured story on Lyme disease and itsfar-reaching complications. There are over 400,000 new cases of the disease diagnosed each year, and the rate has been increasing dramatically.
Dr. Ashraf Hanna, a board certified physician and director of pain management at the Florida Spine Institute in Clearwater, FL discusses this tragic disease: “Lyme disease is a infectious disease caused by bacteria which is transmitted by ticks. The symptoms include rash, fatigue, arthritis of the joints, joint pain, muscle aches, and headaches, numbness, tingling and pain. 70-80% of patients get relief from antibiotics within a few weeks by their primary care or infectious disease physician, but 20-30% may continue with chronic pain symptoms.”
“For the remaining 20-30%, it is not a simple infection anymore; it is a complex, multi-system disease. We have to treat the different types of co-existing infections, autonomic dysfunction, hormonal deficiency, food allergies, etc. But the major contributing factor with persistence of those symptoms after antibiotic treatment is neuro-inflammation and immune-mediated reactions,” stated Dr. Hanna.
IV Ketamine appears to be the best treatment for late stage Lyme disease, after failed antibiotic treatments, and other therapies. Many Lyme patients are reporting remarkable success after treatments with IV Ketamine.
One of the Lyme Patients being treated by Dr. Hanna was Krysten Fernandez: “A few weeks after my tick bite, my symptoms began getting worse, I had extreme pain and was becoming lethargic and weak. I visited over 40 doctors, and after having being misdiagnosed and trying many failed remedies and treatments that were actually worse for my condition, I was finally diagnosed with Late Stage Lyme Disease. At this point I could not work or even walk. I used to be independent and active, was a yoga instructor and had a successful Internet business. Everyday was a struggle to do the simplest tasks.”
“After years of suffering and depression, I found Dr. Ashraf Hanna at the Florida Spine Institute and he recommended IV Ketamine for the treatment of my late stage Lyme disease. After only a few treatments, I had incredible results! My pain levels were reduced, and I felt better than I have felt in years! I am so thankful that Dr. Hanna was able to treat me with IV Ketamine. I can now walk again, have increased function in my limbs and I am getting back to a normal life and feeling great!” said Krysten.
“IV Ketamine Infusion simply blocks receptors in the brain that are responsible for releasing chemicals that cause inflammation of the nervous system that in turn can cause painful symptoms. What makes our program different is that we incorporate physical therapy so that we not only improve pain, but also improve function, and we have seen amazing results. We want patients to get their life back and live productive, fulfilling lives,” Said Dr. Hanna.
EFFECTS OF INTRAVENOUS KETAMINE IN A PATIENT WITH POST-TREATMENT LYME DISEASE SYNDROME:
Discussion and conclusion
A recent double-blind, randomized, placebo-controlled
clinical trial was conducted to evaluate the efficacy of IV
ketamine in patients with treatment-resistant depression.15
These investigators reported that IV ketamine was effective at
reducing depressive symptoms in this patient population. The
results of our case report and evidence from similar studies
and preceding case reports substantiate the antidepressant
efficacy of ketamine.4,16–18 To our knowledge, there have
been no other reports in the literature that have assessed the
effects of IV ketamine in a patient with PTLDS until now.
In this patient with whole-body chronic pain associated
with PTLDS, IV ketamine drastically reduced pain levels
(Figure 1). The patient’s depression and suicidal ideations
were also eliminated post-ketamine infusion. Although we19,20
and others21,22 have reported the efficacy of IV ketamine for
the treatment of chronic pain, this patient’s results were not
typical. In this case, the drastic reductions in pain levels (VAS
reduced from 7 to 2) were followed by an eventual return to
baseline. However, when the patient’s pain did return, shorter
booster infusions were sufficient to maintain analgesia for
months at a time. This is in contrast to, for example, our
previous documentation of a patient with fibromyalgia who
achieved complete remission for more than a year postinfusion
without additional treatment.19
The current PTLDS patient’s pain levels were adequately
controlled using IV ketamine infusions for a duration of
~1–2 months from the last infusion session. Given that the
elimination half-life of IV ketamine is only 2.5 hours,23,24
this means that the duration of analgesia produced in this
case did not require the sustained pharmacological action
of ketamine, since it would have been eliminated within
the first day following the last infusion. This observation
supports theories that chronic pain associated with PTLDS
may be neuropathic in nature25 and that ketamine’s analgesic
efficacy is centrally mediated.
“Central sensitization” has been coined to describe
numerous neuropathic pain conditions resulting from a
nociceptive insult that triggers a prolonged but reversible
increase in the excitability and synaptic efficacy of neurons
in central nociceptive pathways.26 Ketamine is thought to
de-sensitize centrally mediated pain via repeated NMDA
receptor blockade.27 However, it is likely that ketamine acts
via multiple mechanisms to produce analgesia in neuropathic
pain conditions. Neuropathic pain has been associated with
increased glial activation and subsequent release of proinflammatory
cytokines. Interestingly, ketamine produces
pharmacological effects that reduce cell excitotoxicity via
NMDA antagonism and reduce inflammation by suppressing
the hyperactivation of microglia.28 Moreover, ketamine
produces immunomodulatory actions that may also be
uniquely beneficial to conditions that may have an autoimmune
component, such as PTLDS. Thus, ketamine appears
to produce a robust polypharmacological “entourage effect”
that is highly effective in treating neuropathic pain conditions
– which are notoriously difficult to treat with more
conventional analgesic drugs.
In conclusion, the pain relief (~71% decrease) described
in this case report was achieved without the use of increasing
doses of opioid analgesics and, in fact, afforded the
patient’s fentanyl dosage to be reduced from 125 µg to 75 µg
(40% decrease) every 48 hours. Opioid-sparing therapies,
such as ketamine, should be used more frequently for the
management of chronic pain. This is especially important
given the frequency of opioid dependence and abuse, which
has reached such severity to be widely regarded as an “epidemic”.29
Future studies should be conducted to optimize
ketamine for the management of chronic pain conditions
without the use of opioids, where appropriate.
CLEARWATER, Fla., Dec. 22, 2017 /PRNewswire/ — Chronic pain, inflammation and depression are major components of many conditions such as CRPS, RSD, Fibromyalgia, treatment-resistant depression, PTSD and Chronic Lyme Disease. IV Ketamine Infusions have successfully helped thousands of patients for which conventional treatments had failed. In the past, most insurance companies did not cover Ketamine treatments limiting many patient’s access to the drug. Now, many insurance companies have recognized the significant effectiveness of Ketamine and are beginning to cover many treatments.
Dr. Ashraf Hanna, a board certified physician and director of pain management at the Florida Spine Institute in Clearwater, FL discusses this breakthrough treatment: “IV Ketamine Infusions offer hope to my patients and give them relief from their pain and suffering. We are happy to announce that many insurance companies are now covering Ketamine treatments!”
“The insurance companies can no longer ignore the overwhelming research studies by top universities and hospitals regarding the use of Ketamine for numerous difficult-to-treat medical conditions. We use IV Ketamine Infusions for chronic pain as well as treatment-resistant depression, PTSD, OCD, anxiety and many more,” stated Dr. Hanna. “The fact that insurance is now accepted has really opened up the possibility of this treatment for many patients from around the world.”
IV Ketamine has been a safe and effective FDA-approved drug for nearly 50 years. At a molecular level, Ketamine blocks the NMDA receptor. The NMDA receptor is responsible for the body’s underlying neural network (similar to a computer network) and it’s ability to process pain signals to the central nervous system. Over-activation of this receptor can result in excitotoxicity, resulting in a myriad of pain disorders. Ketamine is thought to correct this over-activation by blocking the NMDA receptor. However, the therapeutic effects of ketamine far outlast the actual drug levels in the body leading many to hypothesize that ketamine induces secondary changes that produce long-lasting therapeutic effects in a myriad of disease states.
“While not all insurance companies cover every Ketamine treatment, we hope to continue to add new Ketamine-compliant insurance companies in 2018. Our goal is to help as many patients as possible with this amazing treatment. I have provided over 8,000 Ketamine infusions and have seen so many incredible successes over the past 5 years. Some of my patients were unable to move a limb or walk and now have complete mobility and can walk unaided,” stated Dr. Hanna.
Title: source Ketamine for chronic pain: risks and benefits.
Authors: Niesters, M., Martini, C. and Dahan, A.
Journal: Journal of Clinical Pharmacology
Abstract: The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4–14 days) show long-term analgesic effects up to 3 months following infusion. The side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity. The recreational use of ketamine is increasing and comes with a variety of additional risks ranging from bladder and renal complications to persistent psychotypical behaviour and memory defects. Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain. Link to Full Text
Title: buy canadian viagra Influence of ketamine and morphine on descending pain modulation in chronic pain patients: a randomized placebo-controlled cross-over proof-of-concept study
Authors: M. Niesters, L. Aarts, E. Sarton and A. Dahan
Journal: British Journal of Anesthesia
Abstract: Background Descending inhibition of pain, part of the endogenous pain modulation system, is important for normal pain processing. Dysfunction is associated with various chronic pain states. Here, the effect of ketamine and morphine on descending inhibition is examined using the conditioned pain modulation (CPM) paradigm in chronic neuropathic pain patients.
Methods CPM responses were obtained in 10 adult neuropathic pain subjects (two men/eight women). All subjects had peripheral neuropathy as defined by abnormal quantitative sensory testing. The effects of S(+)-ketamine (0.57 mg kg–1 h–1 for 1 h) and morphine (0.065 mg kg−1 h−1 for 1 h) were tested in a randomized, placebo-controlled double-blind study. CPM was measured at baseline and 100 min after the start of treatment and was induced by immersion of the leg into a cold-water bath. The test stimulus was a 30 s static thermal stimulus to the skin of the forearm.
Results Without treatment, no CPM was detectable. Treatment with ketamine, morphine, and placebo produced CPM responses of 40.2 (10.9)%, 28.5 (7.0)%, and 22.1 (12.0)%, respectively (for all treatments, CPM effect P<0.05), with no statistical difference in the magnitude of CPM among treatments. The magnitude of CPM correlated positively with the magnitude and duration of spontaneous pain relief.
Conclusions The observed treatment effects in chronic pain patients suggest a role for CPM engagement in analgesic efficacy of ketamine, morphine, and placebo treatment. Link to Full Text
Title: follow url The Dose-Dependent Effect of S(+)-Ketamine on Cardiac Output in Healthy Volunteers and Complex Regional Pain Syndrome Type 1 Chronic Pain Patients
Authors: Olofsen, Erik MSc; Sigtermans, Marnix MD, PhD; Noppers, Ingeborg MD, PhD; Niesters, Marieke MD, Msc; Mooren, Rene MSc; Bauer, Martin MD; Aarts, Leon MD, PhD; Sarton, Elise MD, PhD; Dahan, Albert MD, PhD
Journal: Anesthesia & Analgesia
Abstract: BACKGROUND: Ketamine is used as an analgesic for treatment of acute and chronic pain. While ketamine has a stimulatory effect on the cardiovascular system, little is known about the concentration–effect relationship. We examined the effect of S(+)-ketamine on cardiac output in healthy volunteers and chronic pain patients using a pharmacokinetic–pharmacodynamic modeling approach.
METHODS: In 10 chronic pain patients (diagnosed with complex regional pain syndrome type 1 [CRPS1] with a mean age 43.2 ± 13 years, disease duration 8.4 years, range 1.1 to 21.7 years) and 12 healthy volunteers (21.3 ± 1.6 years), 7 increasing IV doses of S(+)-ketamine were given over 5 minutes at 20-minute intervals starting with 1.5 mg with 1.5-mg increments. Cardiac output (CO) was calculated from the arterial pressure curve obtained from an arterial catheter in the radial artery. Ketamine and norketamine plasma concentrations were measured. A novel pharmacokinetic–pharmacodynamic model was constructed to quantify the direct stimulatory effect of ketamine on CO and the following adaptation/inhibition.
RESULTS: Significant differences in pharmacokinetic estimates were observed between study groups with 15% and 40% larger S(+)-ketamine S(+)-norketamine concentrations in healthy volunteers compared to CRPS1 patients. S(+)-ketamine had a dose-dependent stimulatory effect on CO in patients and volunteers. After infusion an inhibitory effect on CO was observed. Pharmacodynamic model parameters did not differ between CRPS1 patients and healthy volunteers. The concentration of S(+)-ketamine causing a 1 L/min increase in CO was 243 ± 54 ng/mL with an onset/offset half-life of 1.3 ± 0.21 minutes. The inhibitory component was slow (time constant of 67.2 ± 17.0 minutes).
CONCLUSIONS: S(+)-ketamine pharmacokinetics but not pharmacodynamics differed between study populations, related to differences in disease state (CRPS1 or not) or age. The dose-dependent effect of S(+)-ketamine on CO was well described by the biphasic dynamic model. The effect of S(+)-ketamine on CO was similar between study groups with respect to its stimulatory and inhibitory components, despite group differences in age and health. Link to Full Text
Title: http://cinziamazzamakeup.com/?x=dove-acquistare-levitra-originale-20-mg-in-italia Intravenous Infusions in Chronic Pain Management
Authors: Boleslav Kosharskyy, MD, Wilson Almonte, MD, Naum Shaparin, MD, Marco Pappagallo, MD, and Howard Smith, MD
Journal: Pain Physician
Abstract: In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people’s lives but also on the economy with an estimated annual economic cost of at least $560 – 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. Link to Full Text
Title: follow link The Use of Ketamine in Neuropathic Pain
Authors: Sarah Lee O’Brien • Sanjog Pangarkar • Joshua Prager
Journal: Curr Phys Med Rehabil Rep
Abstract: Hyperactivity of N-methyl-D-aspartate (NMDA) receptors may be one of the factors in the genesis of neuropathic pain (NP). Ketamine is a dissociative anesthetic and analgesic that is the most potent NMDA receptor antagonist currently available for human use. There is a growing body of literature for three decades suggesting efficacy of subanaesthetic doses of ketamine in the treatment of NP, particularly the pain in complex regional pain syndromes. The primary limitations of ketamine use are secondary to psychotomimetic and, to a lesser extent, sympathetic activation. The purpose of this article is to review the history, pharmacology, pharmacodynamics, clinical benefits, and limitations of ketamine for treatment of NP. Methods of administration and management of adverse effects are highlighted based on the clinical experience of the authors. Link to Full Text
Title: Ketamine: a growing global health-care need
Authors: T. T. Dong, J. Mellin-Olsen and A. W. Gelb
Journal: British Journal of Anesthesia
Abstract: Ketamine was first synthesized in 1962, patented in Belgium in 1963, and approved for human use by the US Food and Drug Administration in 1970. Unlike inhalation anaesthetics, ketamine provides analgesia, preserves airway reflexes, offers haemodynamic stability, and maintains respiratory drive, which gives ketamine an excellent safety profile. It is therefore a favoured choice for trauma triage, use in man-made and natural disasters, and for many other patients with compromized haemodynamic stability. However, side-effects, such as agitation, hallucinations, and panic attacks, have limited its clinical use as an anaesthetic in affluent countries. Lately, ketamine has found new uses in clinical medicine in addition to renewed threats to its availability. Link to Full Text
Title: Ketamine-induced affective switch in a patient with treatment-resistant depression
Authors: Girish Banwari, Prutha Desai, and Prahlad Patidar
Journal: Indian Journal of Pharmacology
Abstract: There is growing evidence to support the rapid, albeit short-lived antidepressant effect of subanesthetic dose of ketamine, a noncompetitive glutamate N-methyl-D-aspartate receptor antagonist in treatment-resistant unipolar and bipolar depression. Ketamine is known to cause transient mood elevation or euphoria, psychotomimetic effects, and dissociative symptoms, but its use in unipolar or bipolar depression has not been reported to induce an affective switch amounting to persistent or prolonged hypomania/mania or manic-like syndrome. We report the case of a 52-year-old male with first episode, continuous, nonpsychotic, treatment-resistant, unipolar major depression of 10 years duration, who manifested a switch from depression to mania while being treated with subanesthetic dose of ketamine, given intramuscularly. This case suggests that polarity switch should be considered as a potential side effect while using ketamine for treatment-resistant depression. Link to Full Text
Title: Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial
Authors: James W. Murrough, , M.D., Dan V. Iosifescu, , M.D., Lee C. Chang, , M.D., Rayan K. Al Jurdi, , M.D., Charles E. Green, , Ph.D., Andrew M. Perez, , M.D., Syed Iqbal, , M.D., Sarah Pillemer, , B.A., Alexandra Foulkes, , M.S., Asim Shah, , M.D., Dennis S. Charney, , M.D., Sanjay J. Mathew, , M.D.
Journal: American Journal of Psychiatry
Abstract:Intravenous ketamine demonstrated rapid antidepressant effects in an optimized study design, improving depression severity in 64% of treatment-resistant patients 24 hours after a single dose. The double-blind trial provides evidence for the role of the N-methyl-d-aspartate glutamate receptor in depression, a receptor not currently activated by existing antidepressant drugs.
Ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, has shown rapid antidepressant effects, but small study groups and inadequate control conditions in prior studies have precluded a definitive conclusion. The authors evaluated the rapid antidepressant efficacy of ketamine in a large group of patients with treatment-resistant major depression.
This was a two-site, parallel-arm, randomized controlled trial of a single infusion of ketamine compared to an active placebo control condition, the anesthetic midazolam. Patients with treatment-resistant major depression experiencing a major depressive episode were randomly assigned under double-blind conditions to receive a single intravenous infusion of ketamine or midazolam in a 2:1 ratio (N=73). The primary outcome was change in depression severity 24 hours after drug administration, as assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS).
The ketamine group had greater improvement in the MADRS score than the midazolam group 24 hours after treatment. After adjustment for baseline scores and site, the MADRS score was lower in the ketamine group than in the midazolam group by 7.95 points (95% confidence interval [CI], 3.20 to 12.71). The likelihood of response at 24 hours was greater with ketamine than with midazolam (odds ratio, 2.18; 95% CI, 1.21 to 4.14), with response rates of 64% and 28%, respectively.
Ketamine demonstrated rapid antidepressant effects in an optimized study design, further supporting NMDA receptor modulation as a novel mechanism for accelerated improvement in severe and chronic forms of depression. More information on response durability and safety is required before implementation in clinical practice. Link to Full Text
Title: Intravenous Therapies in the Management of Neuropathic Pain: A Review on the Use of Ketamine and Lidocaine in Chronic Pain Management
Authors: Harsha Shanthanna
Journal: Neuropathic Pain
Abstract: Neuropathic Pain is a term referred to “pain arising as a direct consequence of a lesion affecting the somatosensory system”. As a first line option, oral medications are mostly used, as they are easily available, relatively safe, and do not need much resources. They include antidepressants in the form of tricyclics, newer selective reuptake inhibitors of serotonin and norepinephrine, gabapentin, pregabalin etc. Although neuropathic pain conditions do share some common clinical features, they are quite diverse when considered individually according to their etiology and pathogenesis. Hence not all patients and not all types of neuropathic pain respond to such oral therapy. In practice patients are given a form of such neuropathic pain medication along with or without an opioid, depending upon the extent of pain that the patient suffers. Opioids are potent analgesics but are not a good choice for neuropathic pain conditions. With time the clinician is left with fewer alternatives and furthermore, with the the increasing knowledge that escalation of opioid therapy will perhaps lead to hyperalgesia and tolerance, it becomes necessary to explore other options. Among the other options one can always consider to explore treatment with intravenous medication such as Ketamine, Lidocaine, and Magnesium etc. This chapter would highlight the use of ketamine and lidocaine in the form of drug profile, the pharmacological basis behind its use, strategies to use, important side effects and limitations and available evidence base, including a review of randomised controlled studies. Both are considered separately in two different parts. References for both the parts are given at the end, in separate sections. Link to Full Text
Post-Treatment Lyme Syndrome
Title: Post-Treatment Lyme Syndrome and Central Sensitization
Authors: Shweta Batheja, , M.B, B.S., Jenifer A. Nields, , M.D., Alla Landa, , Ph.D., Brian A. Fallon, , M.D., M.P.H.
Journal: Journal of Neuropsychiatry
Abstract: The authors of this clinically important article describe the process whereby chronic Lyme disease and its CNS sequelae can result in various treatment-resistant pain and anxiety disorders that are characterized by hypersensitivity to noxious and non-noxious stimuli. These may include skin reactions, fatigue, muscle weakness, extreme sensitivity to sound or smell, and, also, mood and cognitive symptoms. The article reviews several treatment approaches beyond antibiotics, including antidepressants and anti-epileptic drugs.
Central sensitization is a process that links a variety of chronic pain disorders that are characterized by hypersensitivity to noxious stimuli and pain in response to non-noxious stimuli. Among these disorders, treatments that act centrally may have greater efficacy than treatments acting peripherally. Because many individuals with post-treatment Lyme syndrome (PTLS) have a similar symptom cluster, central sensitization may be a process mediating or exacerbating their sensory processing. This article reviews central sensitization, reports new data on sensory hyperarousal in PTLS, explores the potential role of central sensitization in symptom chronicity, and suggests new directions for neurophysiologic and treatment research. Link to Full Text
Title: Review of pharmacological therapies in fibromyalgia syndrome
Authors: Winfried Häuser, Brian Walitt, Mary-Ann Fitzcharles and Claudia Sommer
Journal: Arthritis Research & Therapy
Abstract: This review addresses the current status of drug therapy for the management of fibromyalgia syndrome (FMS) and is based on interdisciplinary FMS management guidelines, meta-analyses of drug trial data, and observational studies. In the absence of a single gold-standard medication, patients are treated with a variety of drugs from different categories, often with limited evidence. Drug therapy is not mandatory for the management of FMS. Pregabalin, duloxetine, milnacipran, and amitriptyline are the current first-line prescribed agents but have had a mostly modest effect. With only a minority of patients expected to experience substantial benefit, most will discontinue therapy because of either a lack of efficacy or tolerability problems. Many drug treatments have undergone limited study and have had negative results. It is unlikely that these failed pilot trials will undergo future study. However, medications, though imperfect, will continue to be a component of treatment strategy for these patients. Both the potential for medication therapy to relieve symptoms and the potential to cause harm should be carefully considered in their administration. Link to Full Text
Title: Effects of Intravenous Ketamine Infusions in a Neuropathic Pain Patient with Lichen Sclerosus et Atrophicus
Authors: Ashraf F. Hanna, Josh S. Armstrong, Adam J. Smith
Journal: Karger Open Access
Abstract: A patient reported to the Florida Spine Institute (Clearwater, Fla., USA) with severe lichen sclerosus of the anogenital region and legs. The patient’s pain presentation was neuropathic with hypersensitivity, allodynia, swelling, and weakness. The patient had failed multiple pain management modalities including opioid therapy, anticonvulsants, and antidepressants. The patient completed a standard intravenous ketamine infusion regimen developed at the Florida Spine Institute and reported complete abolishment of her pain syndrome. For the first time, we report that ketamine infusions also dramatically improved a patient’s lichen sclerosus. That ketamine is known to have immunomodulatory properties, and given the clinical observations described in this case report,suggests that ketamine should be explored as a possible new therapeutic option for managing lichen sclerosus, especially in cases that are refractory to conventional therapies.
Title: Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews
Authors: Neil E O’Connell, Benedict M Wand, James McAuley, Louise Marston, G Lorimer Moseley
Journal: Cochrane Database of Systematic Reviews
Abstract: Complex regional pain syndrome (CRPS) is characterised by persistent pain, usually in the hands or feet, that is not proportionate inseverity to any underlying injury. It often involves a variety of other symptoms such as swelling, discolouration, stiffness, weakness and changes to the skin. This over view sought to summarise and report all of the available evidence arising from systematic reviews for all treatments for this condition regarding how well they work and any potential harm that they might cause. We identiﬁed six Cochrane reviews and 13 non-Cochrane systematic reviews that included evidence relating to a broad range of treatments, from drugs to surgical procedures, rehabilitation and alternative therapies. For most treatments there were only a small number of published trials and the quality of these trials was mixed. As such, most of the evidence for most treatments is of low or very low quality and can not be regarded as reliable.We found low quality evidence that a daily course of the drug ketamine delivered intravenously may effectively reduce pain, although it is also associated with a variety of side effects. We found low quality evidence that the bisphosphonate class of drugs, calcitonin and programmes of graded motor imagery may be effective for CRPS, and that mirror therapy may be effective in people who develop CRPS after suffering a stroke. Low quality evidence suggested that physiotherapy and occupational therapy did not lead to clinically important beneﬁts at one year follow up, and that blocking sympathetic nerves with local anaesthetic is not effective. There is moderate quality evidence that an intravenous regional blockade using the drug guanethidine is not effective and may be associated with complications.For a range of other interventions we found only very low quality evidence or no evidence at all. No conclusions should be drawn regarding the value of these interventions based on this level of evidence.Based on the existing evidence it is difﬁcult to draw ﬁrm conclusions as to which therapies should be offered to patients with CRPS.Better quality research is vital to reduce uncertainty in this area and is necessary before conﬁdent recommendations can be made. Link to Full Text
Title: Glutamate Receptor Antagonists as Fast-Acting Therapeutic Alternatives for the Treatment of Depression: Ketamine and Other Compounds
Authors: Mark J. Niciu, Ioline D. Henter, David A. Luckenbaugh, Carlos A. Zarate Jr., and Dennis S. Charney
Journal: Annu Rev Pharmacol Toxicol.
Abstract: The N-methyl-d-aspartate (NMDA) receptor antagonist ketamine has rapid and potent antidepressant effects in treatment-resistant major depressive disorder and bipolar depression. These effects are in direct contrast to the more modest effects seen after weeks of treatment with classic monoaminergic antidepressants. Numerous open-label and case studies similarly validate ketamine’s antidepressant properties. These clinical findings have been reverse-translated into preclinical models in an effort to elucidate ketamine’s antidepressant mechanism of action, and three important targets have been identified: mammalian target of rapamycin (mTOR), eukaryotic elongation factor 2 (eEF2), and glycogen synthase kinase-3 (GSK-3). Current clinical and preclinical research is focused on (a) prolonging/maintaining ketamine’s antidepressant effects, (b) developing more selective NMDA receptor antagonists free of ketamine’s adverse effects, and (c) identifying predictor, mediator/moderator, and treatment response biomarkers of ketamine’s antidepressant effects. Link to Full Text
Highlight: Ketamine: A New (and Faster) Path to Treating Depression
Left: Change in the 21-item Hamilton Depression Rating Scale (HDRS) following ketamine or placebo treatment. Right: Proportion of responders showing a 50 percent improvement on the HDRS following ketamine or placebo treatment.34
Source: Carlos Zarate, M.D., Experimental Therapeutics and Pathophysiology Branch, NIMH
The most commonly used antidepressants are largely variations on a theme; they increase the supply within synapses of a class of neurotransmitters believed to play a role in depression. While these drugs relieve depression for some, there is a weeks-long delay before they take effect, and some people with “treatment-resistant” depression do not respond at all.
The delay in effectiveness has suggested to scientists that the medication-induced changes in neurotransmitters are several steps away from processes more central to the root cause of depression. One possibility for a more proximal mechanism is glutamate, the primary excitatory, or activating, neurotransmitter in the brain. Preliminary studies suggested that inhibitors of glutamate could have antidepressant-like effects, and in a seminal clinical trial, the drug ketamine—which dampens glutamate signaling—lifted depression in as little as 2 hours in people with treatment-resistant depression.34
The discovery of rapidly acting antidepressants has transformed our expectations—we now look for treatments that will work in 6 hours rather than 6 weeks. But ketamine has some disadvantages; it has to be administered intravenously, the effects are transient, and it has side effects that require careful monitoring. However, results from clinical studies have confirmed the potential of the glutamate pathway as a target for the development of new antidepressants. Continuing research with ketamine has provided information on biomarkers that could be used to predict who will respond to treatment.35Clinical studies are also testing analogs of ketamine in an effort to develop glutamate inhibitors without ketamine’s side effects that can then be used in the clinic.36 Ketamine may also have potential for treating other mental illnesses; for example, a preliminary clinical trial reported that ketamine reduced the severity of symptoms in patients with PTSD.37 Investigation of the role of glutamate signaling in other illnesses may provide the impetus to develop novel therapies based on this pathway.
One of the imperatives of clinical research going forward will be to demonstrate whether the ability of a compound to interact with a specific brain target is related to some measurable change in brain or behavioral activity that, in turn, can be associated with relief of symptoms. In a study of ketamine’s effects in patients in the depressive phase of bipolar disorder, ketamine restored pleasure-seeking behavior independent from and ahead of its other antidepressant effects. Within 40 minutes after a single infusion of ketamine, treatment-resistant depressed bipolar disorder patients experienced a reversal of a key symptom—loss of interest in pleasurable activities—which lasted up to 14 days.38 Brain scans traced the agent’s action to boosted activity in areas at the front and deep in the right hemisphere of the brain. This approach is consistent with the NIMH’s RDoC project, which calls for the study of functions—such as the ability to seek out and experience rewards—and their related brain systems that may identify subgroups of patients with common underlying dysfunctions that cut across traditional diagnostic categories.
The ketamine story shows that in some instances, a strong and repeatable clinical outcome stemming from a hypothesis about a specific molecular target (e.g., a glutamate receptor) can open up new arenas for basic research to explain the mechanisms of treatment response; basic studies can, in turn, provide data leading to improved treatments directed at that mechanism. A continuing focus on specific mechanisms will not only provide information on the potential of test compounds as depression medications, but will also help us understand which targets in the brain are worth aiming at in the quest for new therapies.
PET scans revealed that ketamine rapidly restored bipolar depressed patients’ ability to anticipate pleasurable experiences by boosting activity in the dorsal anterior cingulate cortex (yellow) and related circuitry. Picture shows PET scan data superimposed on anatomical MRI.38
I also threw in a reprint of the article from NIH regarding strategic principle #2 to find biomarkers of mental health disorders:
Highlight: GPS for the Brain? BrainSpan Atlas Offers Clues to Mental Illnesses
The recently created BrainSpan Atlas of the Developing Human Brain incorporates gene activity or expression (left) along with anatomical reference atlases (right) and neuroimaging data (not shown) of the mid-gestational human brain. In this figure, the location and expression level of the gene TGIF1 is shown in a brain from 21 weeks postconception.
Source: Allen Institute for Brain Science
Technologies have come a long way in mapping the trajectory of mental illnesses. Early efforts provided information on anatomical changes that occur over the course of development. In a step that has been hailed as providing a “GPS for the brain,” the BrainSpan Atlas of the Developing Brain, a partnership among the Allen Institute for Brain Science, Yale University, the University of Southern California, and NIMH—has created a comprehensive 3-D brain blueprint.25 The Atlas details not only the anatomy of the brain’s underlying structures, but also exactly where and when particular genes are turned on and off during mid-pregnancy—a time during fetal brain development when slight variations can have significant long-term consequences, including heightened risk for autism or schizophrenia.26 Knowledge of the location and time when a particular gene is turned on can help us understand how genes are disrupted in mental illnesses, providing important clues to future treatment targets and early interventions. The Atlas resources are freely available to the public on the Allen Brain Atlas data portal. Already, the BrainSpan Atlas has been used to identify genetic networks relevant to autism and schizophrenia.27,28 In both of these studies, the fetal pattern of gene expression revealed relationships that could not be detected by studying gene expression in the adult brain. As most mental illnesses are neurodevelopmental, mapping where and when genes are expressed in the brain provides a fundamental atlas for charting risk.
NOVA Health Recovery <<< Ketamine infusion center in Fairfax, Virginia 22306 – ketamine for depression, pain, addiction
Call 703-844-0184 for immediate evaluation!
I am posting a Ketamine article I published in “Your Health Magazine” below. There is excellent studies demonstrating the efficacy of Ketmine in multiple disorders, especially depression, PTSD, post-partum depression, suicidality, Obsessive-compulsive disorder, and severl other mental health problems. Likewise, Ketamine is effective in numerous painful conditions, including CRPS, neuropathy, fibromyalgia, post-herpetic neuralgia, phantom-limb pain, and others. I will discuss articles on each in the ensuing months.
I have used Ketamine over the past 20 years with excellent results in multiple settings. I have always been impressed by it’s safety, especially when it comes to respiratory and cardiac situations.
More and more information is coming about Ketamine’s versatility. Even Time magazine had a recent posting regarding it’s use in depression:
Ketamine has been safely used for over 45 years, serving as an effective anesthetic agent that has also been shown to have benefits in the treatment of a wide variety of painful conditions as well as mood-related disorders. Treatment-resistant depression is an example of a life-threatening disorder that can be improved through the use of specific protocols that involve the infusion of Ketamine. Depression causes tremendous suffering in both quality of life as well as medical problems that result from the stress it produces. Many individuals have tried numerous therapies that have had little to no impact on their depression, leaving them feeling hopeless over their condition. It turns out that for properly selected individuals, Ketamine can provide acute relief within hours to days. Unlike typical antidepressants, Ketamine interacts with certain brain-derived factors that encourage nerve cells to make meaningful connections that can diminish depression within a much shorter time than a standard depression medication. It is a ‘brain reset’ of sorts, allowing underlying medications to be adjusted while your mood is rapidly elevated through genuine changes of brain circuitry.
Ketamine also provides potentially effective treatment in cases of painful conditions, such as RSD/CRPS, trigeminal neuralgia, post-herpetic neuralgia, and several other nerve conditions. Ketamine can be used in an office-based intravenous protocol and then continued in a topical treatment for those who respond well.
Although Ketamine is FDA approved for anesthetic use, it has not been sent to the FDA for approval of any other medical states. However, the evidence for Ketamine’s ability to provide relief in conditions such as PTSD, anxiety disorders, depression, suicidality, post-herpetic neuralgia, CRPS, trigeminal neuralgia, and multiple other conditions has accumulated over 45 years of use in multiple studies. Ketamine is also being evaluated for drug addictions as well as alcohol use disorder. More recently, Ketamine was featured in Time magazine (August 2017) and in JAMA (November 2017) due to the positive effects it has had in difficult-to-treat depression.
More and more clinics are offering this treatment, which creates new possibilities for improving conditions that formerly had so few options. With proper patient selection and appropriate monitoring, Ketamine can be safely and comfortably used in an office setting. With a standard slow infusion, most people do not even notice any significant side effects. If you have suffered from any of these conditions then ask your specialist if Ketamine may be a solution for you.
“Addiction is a devastating disease that affects an individual physically and psychologically. Counseling may help the psychological component but medications can be much more effective for the physical changes that result from alcohol and opioid abuse.” – Christopher Sendi MD • Link in bio #alcoholaddiction #addiction #opioidaddiction #counseling #medication #recovery#addiction#medication#recovery#counseling#opioidaddiction#alcoholaddiction
Depression afflicts 16 million Americans.
One third don’t respond to treatment
A surprising new drug may change that”
The drug in question is ketamine. Will ketamine stop suicidal thoughts better than traditional antidepressants?
When someone is suicidal seconds count!
Q. Is ketamine infusion safe for the elderly? My son’s mother-in-law (age 69) has been diagnosed with major depression. She has made two suicide attempts.
I am not sure what she is taking now, but she seems apathetic, worries about everything and interacts inappropriately with family. She is almost completely unresponsive to her grandchildren. This is a total change from her personality five years ago, when she was devoted to her family and engaged with the world.
A. Major depression takes a terrible toll on the individual, family and friends. Suicide attempts are a clear signal that your son’s mother-in-law is desperate and requires expert medical intervention.
Ketamine (Ketalar) is a fascinating drug that has been used since 1962 as a general anesthetic. Over the last several years researchers have discovered that this medication has profound antidepressant activity that kicks in within hours instead of the usual weeks of standard drugs. When someone is suicidal it is dangerous to wait weeks for an antidepressant drug to work.
“These cases demonstrate that low doses of sublingual ketamine repeated over a span of hours can induce rapid remission of suicidality in unipolar or bipolar depression.
“Chronic use of oral or sublingual ketamine has been helpful in the past 4 years for many of my patients with mild depressive symptoms.
“Sublingual ketamine may be a practical option for managing suicidality in outpatients as an adjunct to traditional antidepressants and mood stabilizers and could shorten the hospital stay of psychiatric inpatients. Sublingual ketamine is worthy of systematic study as a treatment to provide rapid relief of suicidal ideation.”
…”the evidence to date supporting the clinical use of ketamine as antisuicidal treatment is extremely preliminary, and on the basis of the article by Ionescu et al, conclusions concerning the effects of ketamine on suicidal ideation should be drawn with caution.”
“Cancer patients experience increased risk and incidence of suicide and other psychiatric disorders.
“In the past 10 years, evidence has emerged showing that sub-anesthetic doses of ketamine (0.5 mg/kg) induce fast-acting antidepressant effects on depressed patients. Antidepressant effects of ketamine were observed as soon as 40 min after infusion and typically lasted at most for 7 days, with some patients experiencing more prolonged mood improvement.
” Collectively, this study provides novel information about the rapid antidepressant effect of ketamine on acute depression and suicidal ideation in newly-diagnosed cancer patients.”
“Ketamine for Treatment of Suicidal Ideation and Reduction of Risk for Suicidal Behavior”
“Our review concludes that ketamine treatment can be seen as a double-edged sword, clinically to help provide treatment for acutely suicidal patients and experimentally to explore the neurobiological nature of suicidal ideation and suicidal behavior.”
Ketamine and Your Mother-In-Law:
There is inadequate research on ketamine infusion in older patients (Expert Opinion on Pharmacotherapy, April 2017). Since this medication may alter blood pressure and heart rate, the latest recommendations from the American Psychiatric Association call for monitoring so that immediate care may be provided if necessary (JAMA Psychiatry, April 1, 2017).
More articles from The People’s Pharmacy about whether Ketamine can stop suicidal thoughts are available at these links:
Dr. Sendi graduated from Georgetown University Medical School and trained at Pitt County Memorial Hospital, East Carolina University, Greenville, N.C. for his Board Certification in Internal Medicine. He is also ABPSUS Board Certified in Emergency Medicine and Board Certified in Obesity Medicine with the American Board of Obesity Medicine.
NOVA Health Recovery was founded to provide the optimal care to patients suffering from life-altering, preventable illnesses such as Obesity, Addiction, and Pain. We provide progressive therapies for challenging cases of depression, PTSD, neuropathy, CRPS/RSD, and other painful conditions using Ketamine infusions in a comfortable and safely monitored setting. We also use state-of-the-art interventions for addictions of multiple types, providing the tools and support to allow one to move forward in a healthy, successful manner. There is no need to suffer from treatable conditions in which progressive medication assisted therapies, behavioral support, wellness plans, and general health screening can allow you to improve your quality of life. We also use telemedicine to make it easy for you to see your physician from the comfort of your own home.
American College of Physicians, American Society of Addiction Medicine, American Society for Nutrition, The Obesity Society.
Dr. Sendi has 21 years experience in the medical field. Included experiences are Addiction and Pain Management, Obesity and weight management, lipidology, and wellness. Dr. Sendi is Board Certified in Internal Medicine, Emergency Medicine, and Obesity Medicine. His additional interests include wellness, aging, and health-risk mitigation.
Have you Tried all options for depression and pain?
At NOVA Health Recovery, we understand how painful conditions, such as CRPS, post-herpetic neuralgia, and neuropathies rob your life of comfort and quality. We also recognize the suffering that mental health problems, such as anxiety, depression, and PTSD inflict on people and destroy the ability to enjoy even their best years. Many have exhausted multiple therapies and feel hopeless about any treatment at all. NOVA Health Recovery offers Ketamine treatments to appropriate patients who suffer such conditions. In conjunction with other regimens, Ketamine infusion, offered in a monitored, comfortable setting, may provide improvement. This option may just be what you need to pick up your mood and decrease you pain while your regular medications take effect.
Want to learn more? Schedule a consultation today by calling 703-844-0184.
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