Spencer ElmerARNP, PMHNP-BC In the complex world of mental health treatment, the quest to find effective therapies for conditions like depression has been ongoing. Despite advancements in medication and therapy, there remains a subset of individuals who do not respond to conventional treatments. For these people, hope may lie in the innovative approach of ketamine treatment.
Ketamine, once primarily used as an anesthetic, has garnered attention in recent years for its potential in treating treatment-resistant depression (TRD). TRD is a form of depression that persists despite treatment with multiple antidepressants or other therapies. This debilitating condition affects millions worldwide, leaving individuals and their loved ones searching desperately for relief. Most antidepressants can take 4-6 weeks before one sees improvement in depressive symptoms. Ketamine can often improve depression in 24 hours, according to a study by Mandal et al. (2019). There is a short time while receiving the medication where dissociation, dizziness, etc. can occur, but these subside quickly, and most people can resume their daily activities. This rapid onset of action can be life-changing for those in the depths of despair, providing almost immediate relief from symptoms. But how does ketamine work, and why is it effective for TRD? While the exact mechanisms are still being researched, ketamine is believed to act on neurotransmitters such as glutamate, which plays a crucial role in mood regulation. Additionally, ketamine has been found to promote the growth of new synaptic connections in the brain, a process known as synaptogenesis, which may help repair circuits that are disrupted in depression. A landmark study done by Berman et al. (2000) showed the potential role for NMDA receptor-modulating drugs in the treatment of depression. It’s not the medication itself that heals, but rather the person’s reaction to the medication. It can create new neural pathways to make you more resilient and also resistant to returning symptoms. The results of ketamine treatment for TRD have been promising. Many individuals who have not responded to other treatments experience significant improvements in mood, often describing a lifting of the heavy fog that depression casts over their lives. Some report feeling like themselves again for the first time in years, able to engage in activities they once enjoyed and reconnect with loved ones. Ketamine works best when combined with lifestyle changes and therapy. There’s also strong evidence to support ketamine’s increased efficacy when combined with other antidepressant medications (Daly et al., 2018). Anecdotal evidence is strong for the reduction of anxiety and PTSD symptoms as well. Typically, patients receive a series of treatments over several weeks, followed by maintenance sessions as needed to sustain the benefits. Ketamine stands as a beacon of hope for those who have exhausted other options in their battle against TRD. While the journey towards mental wellness may be long and arduous, innovations like ketamine treatment offer a lighthouse in the darkness, reminding us that healing is possible, even in the most challenging of circumstances. Ketamine treatment is already available at Integrative Family Medicine through Dr. Fitch and myself (psych NPs). We’ve had many patients tell us that their experience with ketamine has been very positive and that they wish this was a solution they’d found sooner. Most people have noticed immediate improvements in various symptoms, and we want to make these benefits available to as many people as possible! Stay tuned for some very exciting news about new ketamine treatment options that offer even more efficacy in the fight against TRD. References Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger, G. R., Charney, D. S., & Krystal, J. H. (2000). Antidepressant effects of ketamine in depressed patients. Biological psychiatry, 47(4), 351–354. https://doi.org/10.1016/s0006-3223(99)00230-9 Daly, E. J., Singh, J. B., Fedgchin, M., Cooper, K., Lim, P., Shelton, R. C., Thase, M. E., Winokur, A., Van Nueten, L., Manji, H., & Drevets, W. C. (2018). Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA psychiatry, 75(2), 139–148. https://doi.org/10.1001/jamapsychiatry.2017.3739 Mandal, S., Sinha, V. K., & Goyal, N. (2019). Efficacy of ketamine therapy in the treatment of depression. Indian journal of psychiatry, 61(5), 480–485. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_484_18
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As a mental health nurse practitioner (NP), I've had the privilege of witnessing firsthand the transformative impact that accessible and comprehensive mental health care can have on individuals and families. I am privileged to be an in-network mental health provider in the Tricare network, ensuring that those in the military community receive the support they deserve. This is a big step for making sure soldiers, sailors, airmen, Marines, and their families can receive care more quickly and efficiently.
Whether it’s conducting initial assessments to developing personalized treatment plans, I strive to provide holistic and patient-centered care to every individual I encounter. Whether it's a service member grappling with deployment-related stress, a veteran navigating the challenges of civilian life, or a family member in need of support, I approach each case with empathy, understanding, and a deep respect for the unique experiences of those I serve. You are all my heroes. One of the most rewarding aspects of my role is the opportunity to make a tangible difference in the lives of my patients. By offering timely access to care, I help individuals navigate their mental health challenges more effectively, reducing wait times and ensuring that no one falls through the cracks. Through therapy sessions, medication management, and ongoing support, I empower my patients to take control of their mental wellness and embark on a journey towards healing and recovery. I am also focused on promoting preventive care in our community. By addressing mental health concerns early on, we can prevent crises, improve overall health outcomes, and foster a culture of resilience and well-being within the military community. I believe that vulnerability is strength and I am dedicated to serving those who have served our country. Together, we can continue to break down barriers to mental health care, ensure access for all, and create a future where every individual has the opportunity to thrive mentally, emotionally, and physically. Robust federal and state confidentiality laws ensure privacy and respect when it comes to mental health care. I challenge you to take a concrete step for your well-being and schedule an appointment with us! You’re never out of the fight. Semper Fidelis “Always Faithful” Let's talk about trauma and the misconception that experiencing trauma means “we're doomed” to a lifetime of psychological pain. Trauma does indeed result in horrible memories which are distressing when they come to mind; but, it does not define us or our lives. As a mental health counselor, I want to share a possibly new perspective on how we can navigate through trauma using principles to understand the mind and see the past for what it really is. Looking in this direction brings fresh hope for what getting beyond trauma looks like and how to activate healthfully moving on with life. Take a moment and think, what could it mean to you to realize that your thoughts do not “think you,” but you are the thinker, directing your own thinking? Imagine your mind as a garden in Spring with thoughts blooming like flowers. Trauma memories can be like a weed that appears to take all the nutrients from the garden, but remember, you are the gardener. The soil will provide for all that’s planted but you can sustain life for the plants you water and choose to plant in the light to flourish. We all have the power to cultivate a vibrant and resilient garden, even in the face of weeds like trauma, worries, guilt, resentment, overanalysis and unresolved grief. With insight, we can see that our thoughts are passing weather patterns. Traumatic memories may come. But, it does not diminish the shining of the sun itself. However, it affects our experience of the sun, how much we feel and see it in that particular moment. We acknowledge the weather and it informs our clothing choice or drive time allowance. This points to us caring and taking precautions if we are in a negative state of mind aka some clouds are in attendance. For instance, we may think, “I will send that email/text in the morning when my anger has time to cool off. If it still looks right for me to send when I feel better, then I can trust my clarity in the matter.” Basically, we all trust that our state of mind changes, as we also naturally trust the weather to pass and the sunshine to return. We wake up in the morning or simply exit the next meeting and the storm has passed by. The sun is just as powerful and bright as before, and we are able once again to experience more fullness of sunshine. This is the process of tending to our garden of well-being and knowing we can trust our thoughts more when we feel clarity. It is often common sense to appreciate clarity, though we can be blinded to the nature of thoughts and the role of state of mind when the clouds are compelling content of trauma from the past. When we ‘know’ how it works, we can trust that we'll feel our sunshine again. In this case, acknowledging that we will feel our everpersent well-being again soon. We do our best to get out of the way and let the mental atmosphere regain equilibrium. Human’s well-being is as reliable as the sun. The past is carried through time like photos in a picture album - full of snapshots of our experiences. Trauma may be a part of that album, but it doesn't have to be the front page or the picture that we frame. We can flip through the pages, appreciating the good times, gleaning depth from the tough moments, and recognizing we are more than the sum of our past experiences and experiences are not our true identity. This premise is how we ‘catch up’ our life to the present moment and come home to our peace of mind after trauma. So, how do we grow in insight to better move forward after trauma? Look in the direction of first awakening to the fact you have done the best you could see to do in every moment, and the journey of forgiveness will kickstart. Secondly, turn curious about embracing the power of resilience and the beauty of growth. Just like a seed that pushes through the soil to reach the sunlight, we have the innate ability to heal and thrive. It's not about erasing the past, but about knowing what the past is and what is on offer in the present, laden with pure potential and hope for creating a thriving future. Trauma may plant seeds of challenge. With the right care and nurturing, those seeds can blossom into your unique expression of natural resilience and story of how the “bounce” is what counts. Restoration is possible for your garden of well-being within yourself, where trauma’s place is understood, but it does not hold the power. I do not want you to take my word for it! You need to see that one for yourself. My wish today is that a seed of hope is planted. If you would like to talk more about this possibility for a change in perspective, please reach out. Happy Spring! With love and light, Daly Hardy |
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