<![CDATA[Cornerstone Psychiatric Care - Blog]]>Thu, 25 Feb 2021 17:56:21 -0800Weebly<![CDATA[Patient Perspective: "The Tears Would Just Come"]]>Sun, 21 Feb 2021 17:06:22 GMThttp://cp.care/blog/patient-perspective-the-tears-would-just-come​Uncontrollable crying for no reason was my sign.  The slap in the face I needed to finally admit I needed help. But let me back up and start from the beginning.

I used to be the happy girl.  If you asked my friends, the first thing they would say was that the party didn’t start until I walked into the room.  I was the vivacious smiling girl, bubbling over with enthusiastic excitement.  It was always easy for me to walk into a room full of strangers and befriend them.  I woke up happy, with or without a boyfriend.  I loved waitressing and bartending all through school and, after graduation, I loved nursing even more.  I was 33 when my husband died, but I pressed on and fell in love and suffered break-up’s more than once.  I don’t say this to brag; rather, I say this to explain who I used to be before my dark depression.

I had never experienced depression before.  Sure, I had had sad moments and I had experienced grief, but neither were depression.  In my early 20’s I struggled with PMDD (premenstrual dysphoric disorder), when my PMS turned me into an irritable, angry person for a few days every month.  Thanks to an advertisement in a magazine, I tried Sarafem (aka Prozac/fluoxetine) for a brief time, and once again my life was sunshine and rainbows ... until it wasn't.

I met my future ex-husband on Labor Day of 2017, and we were married exactly one year later.  I was blissfully happy but, apparently, I had ignored the signs that he never was … less than a year later, I found myself divorcing the man of my supposed dreams.  My second year of graduate school was suddenly becoming insanely difficult.  I was diagnosed with ADHD that had gone unnoticed my entire life.  I have since learned that depression and anxiety are closely linked to ADHD because our disability is a glaring reminder of our seeming ineptitude as compared to our 'normal' or 'neurotypical' peers.  My life seemed to be unraveling before my eyes.  The 4.0 honors student in me was now struggling to cope every day, lacking any sense of purpose, sad for no tangible reason, avoiding friendships, and nearly failing grad school.

My brain believed that the ‘nurse’ in me had failed.  I felt beyond embarrassed and ashamed of my inability to accept and overcome my increasingly depressed mood.  My psychiatrist prescribed Prozac again since it had once worked but, as is not uncommon, it let me down the second time around.  (This is often referred to as the 'poop-out syndrome').  Then he prescribed Wellbutrin, then Lexapro, then Pristiq, all with sub-effective results and miserable side effects (insomnia, headaches, fatigue, sexual side effects, etc.).

But one day, I remembered how Ketamine infusions had changed a former colleague's life.  Firsthand, I had witnessed her practically overnight transition from near catatonic depression to happiness.  That was the day I picked up the phone and spoke to Jessica, my former colleague and current dear friend, who worked at the same Ketamine clinic my friend had visited (Cornerstone Psychiatric Care).  When I expressed hesitation at the cost for Ketamine infusions, which she recommended as the gold standard for depression and PTSD, I will never forget what Jessica said to me: “Sure, you might be better on your own in a year ... but do you really want to waste a year of your life being depressed?  How much is your life worth to you?”

You see, dear reader, at this point and for the first time in my life, I suddenly understood the meaning of the word ‘depression’.  Despite what you may think, mine was no ‘situational’ depression; it had persisted for over one year before it became impossible for me to pretend anymore.  My passive suicidal ideation was growing by the day and, while my pride refused to share the extent of my seemingly shameful secret with even my bestest of friends, I was suddenly overcome by the seriousness of it all.  And so, as a last-ditch effort, I decided to try Ketamine infusions.

To this day there do not exist adequate words to express my gratitude at Jessica and Dr. Ettensohn's compassion during what I perceived to be my flawed state of depression.  Realize that I was the nurse who encouraged patients to seek help; yet that same nurse in me so arrogantly lacked the courage to take my own advice until it was almost too late.  Their kind-hearted empathy made all the difference in my sad heart.

During his amazing TED talk, "Depression, The Secret We Share," Andrew Solomon so presciently stated, "... but the brain lies".  To this day, when I listen to his incredibly perceptive talk, I still shed tears at the realization of how close I came to giving up … but my tears turn to sobs when I ponder the mental struggles endured by so many others; by patients whose faces I can’t forget who have cried in front of me.  And then I weep for people I will never know for whom the struggles were unendurable, and for the loved ones I have lost including my beloved nephew, and my niece's husband.

In the very near future, the USA will witness the FDA's approval of Ketamine, as it has already approved its stepsister, intranasal Esketamine.  When this happens, and I promise you that it will as evidence-based research concurs, I hope against hope that other depressed individuals, as I once was, will be educated regarding this fast-working life-saving treatment option.  That their psychiatrists or psych NP's, or their family and friends, will suggest and encourage them to try Ketamine.  That people will learn how Ketamine infusions are currently being used in select Emergency Departments nationwide for patients presenting with suicidality.  How on earth do we expect depressed and often suicidal patients to wait 4-6 weeks for an antidepressant to work?

I am writing this in an effort to stop the shame associated with depression and mental illness.  There is a reason that you are still reading my experience and so I implore you to grab onto this life preserver called Ketamine ... because it will undoubtedly save your life as it once did mine.

-- [Cornerstone Psychiatric Care removed the patient’s name and contact for compliance purposes.]

If you or your loved one suffers from mental illness, give us a call at (561) 531-7818 or email us at info@cp.care to learn more about how ketamine can help.]]>
<![CDATA[Ketamine: Taking the Obsessions Out of Obsessive-Compulsive Disorder]]>Wed, 10 Jun 2020 00:33:36 GMThttp://cp.care/blog/ketamine-taking-the-obsessions-out-of-obsessive-compulsive-disorderObsessive compulsive disorder (OCD) is a diagnosis that has been subject to frequent indiscriminate use outside the mental health field; however, The National Comorbidity Survey Replication estimates lifetime prevalence of OCD to be 2.3 percent in a 2010 study by Ruscio AM et al.  

OCD is defined by the presence of obsessions, compulsions or both. Obsessions are defined as recurrent, persistent thoughts that are intrusive and unwanted. They can include things like fear of dirt and/or contamination by germs, fear of causing harm to another, fear of thinking evil thoughts, and the need (obsession) for order, symmetry, or exactness. Those suffering from OCD often attempt to ignore or suppress such thoughts but find it difficult to do so. Compulsions are defined as behaviors or mental acts (like counting or repeating words) that the person feels driven to perform in response to an obsession. These compulsions can be attempts at reducing anxiety/distress but are excessive.  Often times, patients diagnosed with obsessive compulsive disorder have obsessions or compulsions that last on average at least one or more hours per day.  

Patients with OCD frequently take selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine, fluoxetine, sertraline, or citalopram. Such SSRIs have been a boon to OCD patients, however response can take up to several months and dosages often have to be quite high, leading to increased risk of unpleasant side effects.

In 2013, Rodriguez et al. examined ketamine treatment for OCD patients who were not taking standard treatment with serotonin reuptake inhibitors. Although the study only involved 15 patients the design was randomized, double-blinded, placebo-controlled, and utilized patients with "near constant obsessions". Results from this study showed that 50% of the patients receiving ketamine met criteria for treatment response, while 0% of those who did not receive ketamine met this same criteria. In this case, “treatment response” meant a 35% reduction in OCD symptoms, including things like: distress from obsessive thoughts, time occupied by obsessive thoughts, amount of control over obsessive thoughts and effort put forth to resist obsessions amongst other OCD symptoms.  

Perhaps more striking, however, is that Rodriguez et al. published some patient reactions to the remarkable effects of ketamine:

  • “I feel as if the weight of OCD has been lifted… I want to feel this way forever”
  • “I feel like someone is giving me an explanation [for my OCD]”
  • “I don’t have any intrusive thoughts. I was laughing when you couldn’t find the key, which normally is a trigger for me. This is amazing, unbelievable. This is right out of a movie” 
  • “I tried to have OCD thoughts, but I couldn’t”

Psychotherapy, and in particular a type of cognitive behavioral therapy called exposure therapy, has always been considered a major and necessary treatment for OCD patients. After receiving ketamine treatments, exposure therapy may help OCD patients maximize their therapeutic gain. Given ketamine may help facilitate neuroplasticity, or the brain's ability to form new connections, patients often times find ketamine and therapy to be synergistic when used in conjunction. 

As of now, a ketamine protocol similar to that used with major depressive disorder is used when treating OCD. This protocol has provided relief to many patients suffering with OCD.  Further studies will be helpful in elucidating a standard protocol that may be more specific to obsessive-type and compulsive-type OCD. This may be sooner rather than later as multiple OCD related ketamine trials are currently underway.

If you or your loved one suffers from continued symptoms of Obsessive Compulsive Disorder following interventions from your psychiatrist, psychologist, or other mental health provider, give us a call at (561) 531-7818 or email us at info@cp.care to learn more about how ketamine can help with OCD.

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<![CDATA[Depression and Sleep Problems]]>Tue, 09 Jun 2020 03:57:33 GMThttp://cp.care/blog/depression-and-sleep-problemsMajor Depression (Major Depressive Disorder) is one of the most common mental health disorders, but how often are we working up sleep as a cause or contributing factor? A large epidemiologic study by Ford DE et al in 1989 found that at least 40% of patients with either insomnia or hypersomnia had a concurrent psychiatric disorder, such as depression. Along the same lines, more complicated sleep disorders such as obstructive sleep apnea and restless leg syndrome are more likely to be found in the population of depressed patients compared to the general population.  

Evidence suggests a bidirectional relationship between common sleep disorders and depression, meaning that one may elevate the risk for the other. Although we do not understand the exact mechanisms, sleep seems to ‘clean the brain’ at night (Xie et al. 2013); depression can lead to worsening cognitive function. It is hard to deny that improving sleep is important for brain health and for alleviating depressive symptoms! In fact sleep studies demonstrated that after patients were treated for depression, there were positive brain changes on polysomnography and electroencephalogy. In such studies, slow wave sleep (what we will term "good" sleep) is increased and REM sleep (what we will term "not-as-good" sleep) is decreased.  

Interestingly, antidepressants have been linked to decreased total REM sleep. Although some antidepressants play a positive role in sleep disorders, it is important to talk to your psychiatrist about the positive and negative effects of your antidepressant on any given sleep disorder. Some antidepressants may be more useful for certain types of sleep disorders but vary largely based on the type of sleep disorder. For example, extended release bupropion may worsen insomnia disorder but help regimented patients overcome hypersomnia (sleeping too much) that accompanies circadian rhythm dysregulation. Bupropion may be more neutral and even beneficial for restless legs syndrome, whereas other antidepressants can worsen restless legs syndrome.  

As more evidence becomes available regarding the importance of sleep, it is becoming more important for patients and physicians to become educated on sleep disorders. Because sleep disorders and depressive disorders both produce similar symptoms of excessive daytime sleepiness, fatigue, poor concentration, weight gain and irritability, among many others, we must not overlook sleep disorders before coming to the conclusion that depression is the only cause of such common symptoms.  

An important note on obstructive sleep apnea: Although there many different types of sleep disorders, obstructive sleep apnea has a high prevalence in the general population and especially in depressed patients. It is worth noting that this sleep apnea frequently goes untreated and can be harmful to the brain over a long period of time. This disorder causes hypoxic episodes, meaning that your body and brain do not get enough oxygen for short periods of time. This is why patients with sleep apnea frequently have headaches in the morning. If you have depressive symptoms such as those mentioned in the paragraph above in addition to snoring, along with certain risk factors such as obesity, diabetes, hypertension and heart disease, you should consider talking with your doctor about a referral to a sleep physician or sleep study. In fact, you can find a number of sleep apnea screeners online such as http://www.stopbang.ca/osa/screening.php, but please remember that it is not diagnostic and only your physician can rule sleep apnea in or out. 

If you suffer from continued depression despite following interventions from your sleep and/or other physician(s), give us a call at (561) 531-7818 or email us at info@cp.care to learn about how ketamine can help with depression. Of note, ketamine is not a treatment for primary sleep disorders.

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