All Posts By

Scott Bienenfeld, M.D.

Ketamine + Mindfulness Therapy Treats Cocaine Addiction

By Addiction, ADHD, Anxiety, Bipolar Disorder, Co-Occurring, Cocaine, Depression, Ketamine, Mental Illness, PsychopharmacologyNo Comments

This image shows cocaine addiction

A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial

Am J Psychiatry 2019; 176:923–930; doi: 10.1176/appi.ajp.2019.18101123

Elias Dakwar, M.D., Edward V. Nunes, M.D., Carl L. Hart, Ph.D., Richard W. Foltin, Ph.D., Sanjay J. Mathew, M.D.,
Kenneth M. Carpenter, Ph.D., C.J. “Jean” Choi, M.S., Cale N. Basaraba, M.P.H., Martina Pavlicova, Ph.D., Frances R. Levin, M.D.

A study recently published in the American Journal of Psychiatry found that Ketamine, an NMDA blocker that promotes synaptogenesis, plus Mindfulness Therapy effectively treated cocaine dependent patients. Fifty five cocaine dependent subjects were treated with either ketamine or midazolam combined with mindfulness behavior therapy. The study found that ketamine was significantly more effective in treating cocaine cravings and was associated with a significantly higher rate of abstinence than patients treated with midazolam, a medication used as a control. Craving scores were 58.1 % lower in the Ketamine group than the control group. At six month follow up, 44% of patients treated with Ketamine were abstinent compared with 0% of patients in the control group. The authors found that ketamine infusions given at a dose of 0.5mg/kg over 40 minutes was well tolerated, and promoted abstinence in cocaine addicted patients. Ketamine was associates with a lower likelihood of cocaine use, lower levels of cocaine craving and longer time to relapse. This study represents a promising treatment modality for cocaine addiction, an illness for which, until now, has had no effective treatments. 

Why Is Anxiety So Prevalent In Kids?

By Anxiety, Depression, Ketamine, Mental Illness, OCD, Panic Attacks, Psychotherapy, RecoveryNo Comments

This picture shows anxiety

Session Reflections

 

Why has anxiety become such an integral word in our kids’ vocabulary?

 

            More and more in my office, I am seeing tweens, teens and young adults who describe themselves as anxious.  I have children as young as 10 years old ask their parents to bring them in for their “anxiety”.  College students are requesting face time sessions for anxiety at a concerning rate.  When did our kids become so overwhelmed and stressed that they are using a clinical term for their feelings?

 

            We can definitely thank social media for part of the increased stress and anxiety our kids experience.  It is one thing to be “left out” or not thought of by peers, but when they see it in pictures on Instagram or snapchat, it takes the disappointment to a whole new level.  And the dreaded “group chat” can be another great source of anxiety; are they included and/or are their texts responded to. These social medias issues span from elementary school through college and beyond.

 

            Stress about grades seems to be at an increasingly high level as well.  I see kids in 5th and 6th grade express worry about “what college they will get into”.  The SAT/ACT were not tests designed to be studied for.  Yet, kids are tutored and drilled and pre-tested and pressured to raise their scores.  How about letting our kids get into a school that fits their aptitude and where they can succeed and flourish?  Once in college, I see kids scrambling, cramming, and having great difficulty balancing social life and academics. 

 

            With young adults, I see increasing anxiety about being undecided about a career choice at the outset of their college journeys.  Isn’t it ok and even organic to be unsure of what you want to do with your life when you are 18 years old? 

           

What can we do to help our kids with their anxiety?  Encourage a break from social media.  When I ask teens and young adults to do an “experiment” and shut down Instagram for a day or two, they invariably feel better emotionally. Helping our kids, teens, and young adults with time management when it comes to balancing schoolwork and social outlets, sports, etc. is also a great anxiety reducer.  Encourage them to make lists, use white boards, and calendars; putting to do items into a structured format reduces anxiety and increases a sense of control.  Also, discourage “what if” thinking, which is at the core of much anxiety; help them steer away from this kind of thinking.  Try asking them, “what if……I am fine”. 

 

            When is it time to seek the help of a mental health professional for anxiety?  These are some signs to look for:

            -Isolation

       -Insomnia

            -Increased irritability

            -Restlessness or being keyed up

            -Difficulty relaxing

-Frequent verbalizations about worry

-Grades dropping

-Use of alcohol or weed to self-medicate

 

Stacey Cohen-Meissner, Ph.D.

Ketamine: An Effective, Novel Approach To Treating Depression

By Addiction, Anxiety, Depression, Ketamine, Mental Illness, PsychopharmacologyNo Comments

The purpose of this image is to show ketamine molecule

Ketamine, an anesthesia medication, is an old drug that has emerged over the past several years as a rapid and effective treatment for depression and suicidal thinking. Most people who seek out ketamine have tried other treatments such as medications and even psychotherapy with either little success, or an inability to tolerate side effects. Some people who have had earlier success with conventional antidepressants, have found that over time, efficacy has worn off.

Ketamine was approved in 1970 as an anesthetic, and since that time it has been widely used, mainly by anesthesiologists for that purpose. It has been used for decades to treat refractory pain syndromes.  Unlike most anesthesia drugs, ketamine does not require that a patient be intubated since it actually opens the airways and increases circulation.  

Ketamine is known as a “dissociative anesthetic” because at doses required for anesthesia, it causes hallucinations and feelings of dissociation – an “out of body” experience.

Ketamine is used at significantly lower doses to treat depression, and while patients receiving ketamine for this purpose often feel some dissociative feelings, they are of a much lower magnitude and most often described as being pleasant.

            Ketamine for depression is usually delivered by IV infusion over a 45-50 minute period under the guidance of experienced, licensed staff. It can also be given as an intramuscular injection or even as a nasal spray.

After the infusion, most people relax for about 20-30 minutes and then go home accompanied by someone.

            Many people feel better after only one infusion! However, many people do require several infusions before they notice improvement.  Also, patients vary in terms of how long the benefits of ketamine will last.

            Ketamine is normally well tolerated and treats depression via a different mechanism of action than other antidepressants. While most antidepressants work by blocking the re-uptake of serotonin, ketamine actually works by blocking another receptor called the NMDA-receptor which modulates the excitatory neurotransmitter known as Glutamate.  In fact, lab experiments have shown that ketamine actually re-generates neurons in the brain that are damaged due to long-term depression. This is known as synaptogenesis (see Fig 1 below) which may also help explain ketamine’s mechanism of action.

            If you are someone who has suffered from long-standing depression, or have had difficulty tolerating, or adequately responding to antidepressant medication, then ketamine may be appropriate for you.

Please call us for more information, or to be medically evaluated for Ketamine.

 

This picture shows the mechanism of action of ketamine to treat depression

Fig 1.

Scott Bienenfeld, M.D. 

Stacey Cohen-Meissner, Ph.D.

Synthetic Drugs – Beware…

By Addiction, Mental Illness, RecoveryNo Comments

K2 – “Spice”

K2, Spice, Bath Salts

 Parents and Doctors Beware and Be Prepared!

Over the past several years, there has been increased concern about kids using “synthetic” drugs – substances that are developed in a laboratory and intended to mimic more “familiar” drugs such as marijuana and amphetamines.  Two factors make these compounds particularly frightening: 1) They are packaged as “legal” substances in order to avoid DEA scrutiny, and 2) They are quite difficult to test for using routine drug screens.  

A synthetic form of marijuana known as “K2” or “Spice” which is usually marketed legally as plant food or incense and is obtainable at head shops, gas stations and via the internet, has been a matter of serious concern in recent years.   Emergency rooms nationwide have reported an increase in the number of kids presenting with an array of bizarre symptoms and negative drug screens.  Symptoms usually consist of agitation, hallucinations, panic-like reactions, suicidal ideation, seizures and strange behavior.   Now technically illegal in The United States (http://www.deadiversion.usdoj.gov/fed_regs/rules/2011/fr0301.htm), these compounds are still relatively easy to get a hold of, especially via the internet.  Certain labs can test for the presence of these synthetic cannabinoids, but routine testing will not detect them.  Brand names of these compounds include: Spice, K2, Chill Zone, Sensation, Chaos, Aztec Thunder, Red Merkury, and Zen.

“Bath Salts” are another example of synthetic substances that mimic more familiar drugs of abuse.  The compounds, which are marketed as bath products, mimic amphetamines, which are powerful stimulants.  As with synthetic marijuana, “Bath Salts” are very hard to detect with routine drug testing, and increasing numbers of cases of kids in emergency rooms are popping up.  Kids high on these drugs often have increased blood pressure, rapid heart-beat and even hallucinations and other psychotic symptoms.  Street names for these compounds include: drone, bubbles, meow-meow, MCAT, Ivory Wave, Vanilla Sky, Cloud 9, Red Dove, and White Rush.

It is important for clinicians and parents to be both aware of and educated about these new types of substances that are becoming widely abused by kids.  The DEA is beginning to crack down on these dangerous products, but as one substance becomes illegal, another one is likely to take it’s place.

Scott Bienenfeld, M.D.

Alpine Psych Solutions