Tell me a little bit about yourself and how you got into this field of medicine.
Well, I am a practicing emergency room physician — been doing that for about the last 10 years — and through there, I’ve done a lot of work treating people in the emergency room with problems with depression, anxiety, alcoholism, and I see the need for some more advanced therapy.
So several years ago, I started hearing about some of these newer treatments, and seeing the need for them just sort of fit the picture that I went down that route. And one of the things that we do is a ketamine infusion therapy to treat some of these issues.
Ketamine is a drug that’s normally used in sedation for anesthesia during surgery — and a lot of physicians have been using it for depression. Tell me exactly what this is and how it helps.
It probably used to be more controversial than it is now. It’s started to become, I think, more mainstream now that more people are learning about it and seeing how effective it can be. Ketamine is a medication that’s been around for 50 years. It’s on the World Health Organization List of Essential Medicines because it’s cheap and it’s available in third world countries to be used in a number of different ways. But here in the United States, it’s most frequently used for anesthesia in the operating room. It’s been FDA approved for anesthesia for a long time.
It’s also frequently used in the emergency room, and that’s where I got my comfort level with working with ketamine. We use it off label in the emergency room for a number of other different modalities, specifically what we call procedural sedation, usually for children.
So if your kid breaks their arm and needs to have sedation so that the orthopedic doctors can fix it and set the bone. It’s a medication that you give to make them unaware of what’s happening, but you give it an a really high dose. What we do in the office is what’s called low dose ketamine infusion. So the same dose that you would give to a child over the course of a minute, you would give that same amount on a weight basis to an adult over the course of an hour. So it’s really a much safer way to give the medications.
So it kind of takes out some of that mystery that people have that they’re not really going to be awake during the procedure. It’s a very relaxed procedure that we do right in the office where the person is awake and interacting.
Part of me imagined sleeping on a bed, completely out of it. No, this is completely kind of just relaxed, maybe?
Yeah. You come in the office, in a recliner, sometimes you’re just listening to music if you bring your headphones — or, if we’re doing therapy, you’ll be working with one of our therapists in the office. And, it usually takes about an hour, and then about a half hour recovery process until you’re ready to leave the office ,and you need somebody to drive you home.
Tell me about your perfect client for ketamine infusion therapy for depression. Who do you see come into your office, or who do you recommend come in for the procedure?
That’s a great question. So there’s a couple of different types of patients that we recommend for ketamine. The first one is a patient who has failed all the traditional antidepressants. They’ve been working for years with their psychiatrist and their therapist, tried a lot of different medications, and they just don’t work, and they need to go to something else.
You need another modality, and there’s a couple of different options out there. Some people look to electroconvulsive therapy, or ECT, which is effective, but has some negative side effects that people don’t like (like memory loss) and can be a pretty intense experience. There’s another modality called transcranial magnetic stimulation, which uses magnetic waves, which can be another effective method. So each modality is a little different.
And then ketamine infusion therapy is another option, where we start off with an infusion in the office twice a week for two to three weeks, and then we start tapering off from there — where we go to every three weeks, then four weeks, and sort of taper that off depending on how the person responds to the medication.
Some people end up doing great after you lift the initial depression, and it’s not done in a vacuum. So we’re also working with a therapist to continue therapy and try to get you to start exercising and socializing and sleeping better and all the other things that help lift the depression. Sometimes we’re able to do that and you might not need continued therapy, and some people tend to need what we call maintenance infusions, where they might come in once a month to the office for an infusion and that’s able to hold their depression.
So the first patient is the one who nothing else has worked for, who needs to come in for something something stronger.
Another type of patient could be somebody who can’t really tolerate the side effects from all the traditional antidepressants — it can be very difficult to be taking one or several pills every day. And the side effects that go with them can really impact somebody’s wellbeing. You know, if you have a 30 year old woman and say, I’m going to start you on these medications and you might gain a lot of weight, and you can no longer have an orgasm, by the way — which nobody likes to talk about in traditional antidepressants, but these are real things that impact people’s lives, right?
It’s important. Depression doesn’t just affect one facet of your life. So when, when is the patient going to feel better? When does the patient feel better with the infusions?
I would say on average, after the third or fourth infusion. So the second week is when you really start to see the majority of people start to feel better. When we start off doing the infusions, we do the first two in the first week. Some people start to feel better after the first or second one. And people that research it will find case reports of people saying that they felt great immediately after the first one. I don’t really see that too often, but usually after the third infusion, their functionality starts to improve.
They’re able to start accomplishing more in their day or do better at work or in their relationships, and their family starts to notice they do better. And by the fourth infusion is when the patient starts to report feeling better.
That’s really quick, because from what I know about antidepressants, sometimes you need to wait weeks for them to start working.
Exactly. All that brings me to the third type of patient that this is helpful for, the one that might do well with traditional antidepressants. But we know that it could take four to six weeks for them to start working. I’ll see this type of patient as being, like, the busy mom who had a history of depression, was on an antidepressant that maybe worked for them, was doing well and stopped it, and then just got very busy taking care of the kids, trying to work, putting yourself last, realizing alright, I’m starting to feel depressed.
A couple of stressful things happen at work or with the kids or your relationship, and you keep kind of putting it off until it’s too late, until you feel overwhelmed and say, I need help quickly. I need to feel better now.
So you know, we can restart that medication. We know it worked for them in the past, but they don’t really feel that they can safely wait two months for it to start working. So ketamine can be used as a bridge to get them starting to feel better now until the other medication starts to work. So that’s another example of a patient that might just need it for a month or two until the other medication starts working and we start doing the other things that help with your mood.
Tell us a little bit more about how we can use these infusions for maybe other health concerns, and how they actually work in changing our brain.
So the name of our of our business is called Initia Nova, which in Latin means new beginning. So we’re really trying to provide novel and advanced medical treatments for some very common conditions, specifically depression, anxiety, PTSD and alcoholism. I think everybody out there would realize that almost all of us have been affected by these things, either personally or through a loved one or a family member at some point. The impact that it has on not only the individual, but on their whole family, can be pretty severe.
So we take each person as an individual and develop a sort of comprehensive treatment strategy based on that individual. So they first start out with an evaluation by myself and my one of my therapists, and we determine what their needs are. If it’s more of depression, anxiety, then it can just be straight ketamine infusions and let the medication do the work.
What we’re really trying to do is reset the balance of their neurotransmitters. That can get really out of whack over a number of years of depression, anxiety, stress — the GABA and glutamate levels can get out of alignment, and we’re trying to reset that and get you back to, to your real self.
I love the science behind it — people don’t really think of mental health as being something that’s in our brain. They think, oh, you’re emotionally charged, or you’re a little sad, or you’re remembering the past too much. And in reality, our brain is modified with these diseases.
Yeah, I mean our mood and our behavior are completely driven by the neurotransmitters. The longer you go — whether it’s feeling anxious and depressed and then maybe drinking or using other substances to deal with that, or if you have a primary alcohol problem, which then causes anxiety and depression — we’re not treating this in a vacuum. We really have to tackle it from a couple of different ways.
Particularly if alcohol’s involved, the longer you go using alcohol as a sort of self-treatment, the more it changes your brain chemistry. Alcohol and the benzodiazepines (like Xanax, Valium, and Ativan) bind to the GABA receptors in your brain, and that’s the calming neurotransmitter. So at the time when you are under the influence, it relaxes you.
It calms you, but your body starts adjusting to this saying, well, you’re putting something into your body that’s giving me this calmness, so I no longer need to make this. So the next day, your GABA levels are low, you’re starting to get anxious, you start getting that overwhelming urge and craving to do something about it. So what you do is have more more alcohol to deal with it.
At the same time, the excitatory neurotransmitter, glutamate, rises over time with stress and alcohol. So if you’re a daily drinker, if you go one day without drinking, your glutamate levels start to rise through the roof. It’s excitatory, so you start to get signs of withdrawal — so you get sweaty, you get anxious and a fast heartbeat, and eventually you get to the point of full blown delirium tremens (or DTs) where you can have a seizure.
So you need to reset the balance of these neurotransmitters. There’s a couple of different medications that we use for alcohol use disorder. One of them is called Baclofen, which binds to the GABA B receptor. It’s a little bit of a different mechanism than alcohol, so it doesn’t cause tolerance, soyou don’t need to keep increasing the dose and it’s not addictive. It’s not a controlled substance. So baclofen is a great choice.
Naltrexone is also a great choice that we use for alcoholism, to sort of extinguish the behavior. And it’s used in something people could research their own — look up the Sinclair Method, where they take the medication along with drinking. It’s a whole different sort of scenario than people are used to as a way of addressing these issues.
The American Psychiatric Association just came out with new guidelines sort of advocating this medical approach towards treating alcoholism. A lot of people get turned off of the idea to say, “I have to just use willpower and just go to an AA meeting.” Although they’re great, most people need more — they need help to sort of level the playing field. So that’s where we come in, using some medications to reset your neurotransmitters and allow the other things to work better, like counseling. Especially if you have someone that has been dealing with this for a long time and is completely in need of a reset, we can’t just say, “Brain, work better.” You have to have a little intervention.
So we can use those medications to help to reduce the drinking, and then then the ketamine can come into play simultaneously if they also have a lot of depression and anxiety. The ketamine also works on the glutamate receptor, the NFDA glutamate receptor amongst several other receptors. But it’s helping to restore the GABA and glutamate imbalance in your body. And so they’re all coming together in a sort of comprehensive way, along with the counseling that we do on our office, and showing some tremendous success rates — far greater than, I think, anything else that’s out there.
So I think it’s important to get the word out, not only amongst people but amongst other physicians to who aren’t familiar with either of these modalities.
How do we make an appointment with you?
You can reach out to us a number of ways. Maybe the easiest thing is just to go to the website first, which is www.myinitianova.com. And on there there’s information about ketamine, about the alcohol treatments.
And so a lot of times, we could start out just by having a phone conversation with Mitchell that can explain things, field your questions. If you have any medical questions, I’d be happy to talk to you over the phone and find out if this is right for you. Mitch will work with you with looking into insurance to find out if this is something that we can get partially covered through your insurance.
As we said, ketamine has been around for a long time, but it’s not specifically FDA approved to treat depression. But if you have out of network benefits through your insurance, we can help call and try to verify how much deductible you have left, and we can usually get covered for an office visit and the counseling sessions. So hopefully get you reimbursed for a portion of the costs.
And mental health, if you’re not healthy itself, is expensive. The medications, the alcohol isn’t that cheap. So it’s something that you might have to say, I’m willing to put myself first. This isn’t the most important part of my life.
Exactly. We’re really looking at it as in an investment in yourself, really. Because people are getting so overwhelmed and it’s interfering with their ability to work, or just be happy, or interact with your loved ones that. If this is something that works for you, then the people that have done it and have benefited from it have told me it’s the best money that they’ve ever spent.
And you have a testimonial you brought with you.
Yeah. So I wanted to try to give, you know, a flavor to people who have been thinking about it,to try to give them an idea of what it might be like. So I asked one of my patients to write her experience with going through the process. A young woman that came to me, really a remarkable girl, very intelligent, but was struggling with some pretty severe depression that really impacted her life. So this is her story:
When I say that ketamine saved my life, I am by no means exaggerating. Four months before my first ketamine treatment, I made a serious attempt on my life. Eight months after my first ketamine treatment, I am not just surviving, I’m thriving. I was not new to the world of mental health before my first suicide attempt. Five years ago, I was admitted to intensive outpatient treatment, and since then, I had been hospitalized six times, seen four different routine therapists, and been prescribed over 10 separate medications. Ketamine therapy was truly my last hope. I knew beyond the shadow of a doubt that I would not be alive for my birthday in September. And I believe that my parents knew this as well. I was barely living, despite doing everything I should have been doing. I was working regularly taking my medications, seeing my therapist and psychiatrist, staying social and trying to live asemi active lifestyle.
Nevertheless, I had lost hope. I was desperate, as were my parents, and we were willing to try anything. I found ketamine therapy while browsing online, but I was incredibly nervous, as I had been given ketamine several years before as an alternative anaesthetic in the operating room and had a very negative reaction. Nevertheless, I scheduled an intake session, and Dr. Sullivan explained everything to me, answered all of my questions and alleviated my many qualms. As I went into my fifth infusion out of a series of six, I was the closest to my genuine personality as I’d been in almost a year. Dr. Sullivan noted that I came in smiling, something he had not seen me do before. My family and friends noticed a drastic difference in my disposition, but I was worried that this would only be a temporary fix. It has since been about eight months since my initial infusion. And I’m happy to say that with regular therapy, daily medications, and maintenance ketamine infusions, the difference has not been temporary.
About a year ago, my family was planning to take a winter vacation to Disney world. I was certain that I wouldn’t be alive for that trip. Just last week, I came back from the magical 10 days in which I wore Mickey hears and the genuine smile, all thanks to ketamine therapy.
And that’s not one out of thousands. I mean, that’s a very common reaction. And you know, this can be an end game for you, or it may be just something that you need to start. So we need to open the conversation, get them in touch with you.
Give us a call or send us an email, and you can come in and have a free evaluation with myself or one of the therapists, and we’ll determine what’s right for you. And maybe it’s just coming in and starting therapy, or starting other medications. But you know, the ketamine therapy is an option.