Podcasts about Esketamine

About this episode: Ketamine is in the news again. In this episode: a conversation about the differences between ketamine and esketamine—an FDA-approved medicine for treatment-resistant depression—why we're hearing so much about ketamine right now, and the importance of administering esketamine in a clinical setting as part of a broader comprehensive mental health strategy. Guest: Dr. Paul Kim is a psychiatrist and director of the Johns Hopkins Treatment Resistant Esketamine Antidepressant Targeted (TREAT) Depression Clinic. Dr. Paul Nestadt is a psychiatrist and co-director of the Johns Hopkins Treatment Resistant Esketamine Antidepressant Targeted (TREAT) Depression Clinic. Host: Lindsay Smith Rogers, MA, is the producer of the Public Health On Call podcast, an editor for Expert Insights, and the director of content strategy for the Johns Hopkins Bloomberg School of Public Health. Show links and related content: What to Know About Ketamine—Johns Hopkins Bloomberg School of Public Health Esketamine for Treatment-Resistant Depression—Hopkins Medicine What Ketamine Does to the Human Brain—The Atlantic Transcript information: Looking for episode transcripts? Open our podcast on the Apple Podcasts app (desktop or mobile) or the Spotify mobile app to access an auto-generated transcript of any episode. Closed captioning is also available for every episode on our YouTube channel. Contact us: Have a question about something you heard? Looking for a transcript? Want to suggest a topic or guest? Contact us via email or visit our website. Follow us: @‌PublicHealthPod on Bluesky @‌JohnsHopkinsSPH on Instagram @‌JohnsHopkinsSPH on Facebook @‌PublicHealthOnCall on YouTube Here's our RSS feed

This week, I'm diving into a personal experience that's a little different from my usual fitness content. I've been open about my struggles with mental health—OCD, anxiety, depression—but 2024 pushed me to my limits.After losing $24K to a business coach who wrecked my confidence and left me questioning everything, I found myself in a deep hole.I've tried therapy, TMS, antidepressants… and nothing really got me where I needed to be.So I decided to give Esketamine (Spravato) a shot. In this episode, I break down exactly what it was like, how it made me feel, what went wrong, and if it's actually helping.If you've ever been curious about ketamine therapy, are struggling with your own mental health, or just want to hear an unfiltered take on what it's like, this one's for you.

atai Life Sciences (NASDAQ:ATAI, ETR:9VC) CEO and co-founder Dr Srinivas Rao talked with Proactive's Stephen Gunnion about the promising results in strategic investee Beckley Psytech's Phase 2a study of BPL-003 for alcohol use disorder. Rao highlighted the significant unmet need in treating alcohol use disorder (AUD), which affects approximately 400 million people globally and contributes to 3 million deaths per year. The Phase 2a trial, though small with 12 participants, yielded promising results. Patients received a single dose of BPL-003 alongside cognitive behavioral therapy, leading to a 50% abstinence rate over three months. Additionally, heavy drinking days were reduced from 56% to 13%, while abstinent days increased from 33% to 81%. Looking ahead, atai Life Sciences is anticipating data from a larger Phase 2b study. Rao explained that BPL-003, a 5-MeO-DMT benzoate nasal spray, is being evaluated for its potential to provide long-lasting therapeutic effects with a single administration. This approach contrasts with existing treatments like Esketamine, which require frequent dosing. Rao emphasized that shorter-duration psychedelic treatments could ease the burden on patients and healthcare providers. By reducing the need for frequent visits, these therapies could make mental health treatment more accessible and scalable. To stay updated on atai Life Sciences' research, subscribe to Proactive's YouTube channel, like this video, and enable notifications for future updates. #ataiLifeSciences #PsychedelicTherapy #MentalHealth #AlcoholUseDisorder #BPL003 #DepressionTreatment #PharmaceuticalResearch #MedicalBreakthrough #InvestorNews #Biotech

Thank you Ben Ballard, PMHNP-S for developing this podcast topic! This podcast addresses the use of Esketamine in treatment resistant depression. Thank you to the physicians that blazed the podcast pathway over half a decade ago. Thank you to the new students that carry the torch! Thank you to the immortal Jordan Turner for creating the perfect bumper music! Most of all, thank you to everybody that listens in and learns with us.

Unlock new, well-reimbursed services: Spravato, a needle-mover for pain practices. Discover how Spravato, an FDA-approved esketamine treatment for depression, can drive significant financial reimbursement for your practice while improving patient outcomes. Join me as I meet with Yakov Kagan, CEO and co-founder of Big Leap Health, as he highlights the clinical efficacy of Spravato, its comparison to ketamine, and its financial impact. Learn key considerations for launching—whether independently or via an MSO—and actionable steps to get started, from staff training to billing essentials. Yakov will also share insights into future developments like monotherapy developments, helping your practice stay ahead in this rapidly evolving field. For more information and to integrate Spravato into your Pain Practice go to https://www.bigleaphealth.com Host David Rosenblum, MD Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education. Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Garden City Office 516 482 7246 NRAP Academy also offers: Board Review Anesthesiology Pain Management Physical Medicine and Rehabilitation Regenerative Medicine Training  Live Workshops Online Training The Virtual Pain Fellowship (online training program with discount to live workshops)         Regional Anesthesia & Pain Ultrasound Course   Private Training Available Email Info@NRAPpain.org **Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns.

Unlock new, well-reimbursed services: Spravato, a needle-mover for pain practices. Discover how Spravato, an FDA-approved esketamine treatment for depression, can drive significant financial reimbursement for your practice while improving patient outcomes. Join me as I meet with Yakov Kagan, CEO and co-founder of Big Leap Health, as he highlights the clinical efficacy of Spravato, its comparison to ketamine, and its financial impact. Learn key considerations for launching—whether independently or via an MSO—and actionable steps to get started, from staff training to billing essentials. Yakov will also share insights into future developments like monotherapy developments, helping your practice stay ahead in this rapidly evolving field. For more information and to integrate Spravato into your Pain Practice go to https://www.bigleaphealth.com Host David Rosenblum, MD Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education. Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Garden City Office 516 482 7246 NRAP Academy also offers: Board Review Anesthesiology Pain Management Physical Medicine and Rehabilitation Regenerative Medicine Training  Live Workshops Online Training The Virtual Pain Fellowship (online training program with discount to live workshops)         Regional Anesthesia & Pain Ultrasound Course   Private Training Available Email Info@NRAPpain.org **Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns.

Unlock new, well-reimbursed services: Spravato, a needle-mover for pain practices. Discover how Spravato, an FDA-approved esketamine treatment for depression, can drive significant financial reimbursement for your practice while improving patient outcomes. Join me as I meet with Yakov Kagan, CEO and co-founder of Big Leap Health, as he highlights the clinical efficacy of Spravato, its comparison to ketamine, and its financial impact. Learn key considerations for launching—whether independently or via an MSO—and actionable steps to get started, from staff training to billing essentials. Yakov will also share insights into future developments like monotherapy developments, helping your practice stay ahead in this rapidly evolving field. For more information and to integrate Spravato into your Pain Practice go to https://www.bigleaphealth.com Host David Rosenblum, MD Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education. Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Garden City Office 516 482 7246 NRAP Academy also offers: Board Review Anesthesiology Pain Management Physical Medicine and Rehabilitation Regenerative Medicine Training  Live Workshops Online Training The Virtual Pain Fellowship (online training program with discount to live workshops)         Regional Anesthesia & Pain Ultrasound Course   Private Training Available Email Info@NRAPpain.org **Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns.

Episode Title: Ketamine for Cancer and Pain Management - Journal Club Host: David Rosenblum, MD Upcoming Free Webinars: 1. Exploring Innovative Mental Health Treatments which are well reimbursed    Discussing Spravato, Transmagnetic Stimulation, and Ketamine Infusion, sponsored by Big Leap Health. Register! 2. Understanding Scrambler Therapy    Learn about this revolutionary approach to pain management. Register! 3. Cervical Ultrasound: Anatomy and Interventional Pain Targets    Sponsored by Clarius, this session will explore advanced imaging techniques. Register! Sign up for the webinars and check out our full calendar of events. Join us for this insightful episode as we explore the potential of ketamine in transforming pain management practices! Summary In today's episode, we delve into the emerging role of ketamine in managing cancer and chronic pain. Our discussion is anchored around a comprehensive review article titled "Ketamine Use for Cancer and Chronic Pain Management," published in Frontiers in Pharmacology on February 1, 2021. This review, authored by Clayton Culp, Hee Kee Kim, and Salahadin Abdi, explores ketamine's potential as an analgesic in chronic pain conditions, particularly cancer-related neuropathic pain. Key Points from the Review Article: - Mechanism of Action: Ketamine functions as an N-methyl-D-aspartate receptor antagonist, providing analgesic effects at sub-anesthetic doses. Its ability to counteract central nervous system sensitization makes it effective in opioid-induced hyperalgesia. - Clinical Efficacy: Recent studies highlight ketamine's potential to reduce pain scores and opioid consumption, offering a promising alternative for patients with refractory pain. - Safety Profile: At lower doses used for analgesia, ketamine's safety and adverse event profile are significantly improved compared to its use as an anesthetic. - Pharmacogenomics and Interactions: The article discusses how genetic variations can affect ketamine metabolism and highlights potential drug interactions that clinicians should be aware of. Reference Culp, Clayton, Hee Kee Kim, and Salahadin Abdi. "Ketamine use for cancer and chronic pain management." Frontiers in Pharmacology 11 (2021): 599721.

Cybin CEO Doug Drysdale talks to Jason Najum about transforming treatment of mental health disorders with psychedelics (0:45). CYB003, Phase 2 results for depression, moving into Phase 3 (3:00). How deuterated psilocin differentiates Cybin from competiton (10:00). IP and patents - critical to ROI (12:45). Esketamine and is JNJ's Spravato blazing a trail for psychedelics? (14:15) FDA challenges and Lykos lessons (21:20). Strong balance sheet will get it through Phase 3 data (25:50) Stock consolidation and attracting new buyers (30:35).Episode transcriptsShow Notes:Imran Khan On Psychedelics - More We Don't Know Than We DoPsychedelic Stocks: Focus On Their CashFDA's MDMA Decision A Setback, But Long-Term Outlook For Psychedelic Stocks UnchangedDe-Risking Psychedelics: Compass Pathways, Cybin And AtaiFor full access to analyst ratings, stock quant scores and dividend grades, subscribe to Seeking Alpha Premium at seekingalpha.com/subscriptions

Send us a Text Message.In dieser Folge besprechen wir die Arbeit von Yang et al. zum Einsatz von Dexmedetomidin plus Esketamin zur Schmerzreduktion während der Sectio Caesarea:Yang JR, Li YY, Ran TJ, et al. Esketamine Combined with Dexmedetomidine to reduce Visceral Pain During elective Cesarean Section Under Combined Spinal-Epidural Anesthesia: A double-Blind Randomized Controlled Study. Drug Des Devel Ther. 2024;18:2381-2392. Published 2024 Jun 18. doi:10.2147/DDDT.S460924Mit im Studio dabei: Dr. Eike Pfefferkorn, wissenschaftlicher Mitarbeiter der Klinik für Anästhesiologie

Ketamine and esketamine represent significant advancements for patients with treatment-resistant depression. Their rapid action provides much needed relief for patients who do not respond to traditional antidepressants. Their use, however, introduces challenges that necessitate ongoing research and careful consideration to maximize their potential, which Dr. Balwinder Singh, MD, MS, details in this podcast. Important challenges include unregulated or poorly monitored use of these potentially addictive products and risks related to the creation of compounded ketamine options. Dr. Singh is an assistant professor of psychiatry at the Mayo Clinic in Rochester, Minnesota, and the medical director of the mood program at the Mayo Clinic Depression Center. His guest editorial, titled “Ketamine and Esketamine for Depression in Daily Practice: Opportunities and Challenges,” is published in the September-October 2024 issue of the Journal of Clinical Psychopharmacology.

Atai Life Sciences co-founder and CEO Florian Brand discussed initial results from Beckley Psytech's phase 1 trial of its patent-protected psilocin ELE-101 in patients with major depressive disorder. Brand explained that ELE-101 is an intravenous (IV) formulation of psilocin, the active metabolite of psilocybin, developed for depression treatment. The IV formulation aims to reduce treatment duration to two hours, compared to the longer sessions required by traditional psilocybin and LSD treatments. Phase one trials in healthy participants showed that ELE-101 was well tolerated with no serious safety concerns and had a predictable pharmacokinetic profile, supporting dose selection for phase two trials. Brand highlighted the commencement of phase 2 trials with the first patient already dosed. This study involves 6 to 12 patients, with data expected in the second half of this year. atai Life Sciences is optimistic about the shorter treatment duration, potentially making it more convenient for patients and less burdensome for the healthcare system. Additionally, Brand mentioned their involvement with Compass Pathways, which is developing psilocybin therapy, and noted the importance of the two-hour treatment paradigm established by the intranasal esketamine spray, Spravato. This paradigm could be leveraged for their other compounds, such as BPL-003 and DMT, also being developed for depression treatment. #AtaiLifeSciences, #Elly101, #Psilocin, #Psilocybin, #DepressionTreatment, #IVFormulation, #Pharmacokinetics, #ClinicalTrials, #MentalHealth, #Psychedelics, #PhaseTwoTrials, #HealthcareInnovation, #CompassPathways, #Spravato, #Esketamine, #ShortDurationTherapy, #BPL003, #DMT, #Neuropsychiatry, #FlorianBrand #ProactiveInvestors #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

Finally, new prospects in depression treatment! Listen in as Dr. Jennifer Reid and Dr. Michael Thase discuss antidepressants, ketamine, psychedelics, and much more!Professor Thase is renowned as a teacher, mentor, administrator, researcher and clinician. One of the world's most highly cited psychiatrists, he has more than 1300 publications, as well as 18 books, including the award-winning Learning Cognitive Therapy, now in its second edition.Dr. Michael Thase is a Professor of Psychiatry in the Perelman School of Medicine of the University of Pennsylvania, and a member of the medical and research staff of the Corporal Michael J Crescenz Veterans Affairs Medical Center:Some questions Dr. Thase considers: 1)   You have been treating patients with depression for decades. How would you describe how your work has changed since you first started your career?2)   Looking back, do you think there were any missed opportunities when it comes to depression treatment?3)   How do you conceptualize difficult-to-treat depression, and is this something you discuss with patients? 4)   You're coauthor on a paper titled “The Neglected Role of Psychotherapy for Treatment-Resistant Depression.” What is its role?7)   What are your opinions about ketamine treatment in its various formulations: IV, sublingual, Esketamine?8)   What about psychedelics? Cannabis?9)   What are you hopeful about in the field of psychiatry?Thank you for checking out Our Reflective Minds. This post is public, so feel free to share it with anyone who may benefit from listening!A 1979 graduate of The Ohio State University College Medicine, Professor Thase completed internship, residency, chief residency, and post-doctoral training in clinical research at the University of Pittsburgh Medical Center (UPMC), where he rose to the rank of Professor of Psychiatry and was Chief of the Division of Academic Adult Psychiatry until 2007, when he moved to Philadelphia.  He is a Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the American College of Neuropsychopharmacology and a member of the American College of Psychiatrists. He is a Past President of the American Society of Clinical Psychopharmacology, for which he was a member of their Board of Directors for more than two decades.  A Founding Fellow of the Academy of Cognitive Therapy, Professor Thase is a member of advisory boards for the Anxiety and Depressive Disorders Association, the National Network of Depression Centers, the Depression and Bipolar Support Alliance and the American Foundation for Suicide Prevention. In 2018 he was elected to the membership of Penn Medicine's Academy of Master Clinicians, an honor bestowed to only 2% of the medical school's faculty. Professor Thase's research has been continuously funded by various federal agencies for the past 37 years and currently focuses on novel therapies for difficult to treat depressive disorders and dissemination and implementation of cost-effective forms of cognitive behavior therapy.Jennifer Reid, MD on Instagram: @JenReidMDLooking for more from The Reflective Doc? Subscribe today so you don't miss out!Also check out Dr. Reid's regular contributions to Psychology Today: Think Like a ShrinkThanks for reading Our Reflective Minds! Subscribe for free to receive new posts and support my work.**********************Seeking a mental health provider? Try Psychology TodayNational Suicide Prevention Lifeline: 1-800-273-8255Dial 988 for mental health crisis supportSAMHSA's National Helpline - 1-800-662-HELP (4357)-a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.Disclaimer:The views expressed on this podcast reflect the host and guests, and are not associated with any organization or academic site. The information and other content provided on this podcast or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. All content, including text, graphics, images and information, contained on or available through this website is for general information purposes only.If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment. Never disregard professional medical advice or delay in seeking it because of something that have read on this website, blog or in any linked materials. If you think you may have a medical emergency, call your doctor or emergency services (911) immediately. You can also access the National Suicide Help Line at 1-800-273-8255 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thereflectivemind.substack.com

Dr. John Krystal is Chair of Psychiatry at the Yale School of Medicine. He is best known for leading the discovery of the rapid antidepressant effects of ketamine, which paved the way for the first major new antidepressant drug in decades. Here, Dr. Krystal talks about what we've learned in the five years since esketamine nasal spray was approved by the FDA, including efforts to predict treatment response, dosage and frequency, safety, and long-term impact. He also discusses advances in our understanding of alcohol use disorder and weighs in on the search for psychiatric biomarkers.00:00 Introduction01:01 Dr. Krystal's Research Journey03:32 What We've Learned Since Esketamine's FDA Approval05:59 Avoiding Misuse08:11 Optimizing Dosage16:25 Predicting Treatment Outcomes24:17 Ketamine vs. Psychedelics25:48 Advances in the Treatment of Alcohol Use Disorder32:33 Precision Psychiatry and Personalized Treatment Approaches39:49 Psychiatric Biomarkers41:03 The Future of Psychiatric Research and TreatmentVisit our website for more insights on psychiatry.Podcast producer: Jon Earle

“I feel like I'm living a dream in many ways. It's really gratifying to be working in this area,” says Dr. Peter Hendricks, a clinical psychologist at University of Alabama Birmingham who is pursuing a long-held interest in the therapeutic potential of psychedelics. In addition to being chair of Psychiatry there, he is also a professor in the Center for Addiction and Pain Prevention and Intervention which explains why he is researching the use of psilocybin in patients with fibromyalgia, a condition which commonly involves chronic pain. “Pain involves a physiological sensation but also a psychological reaction to that pain. If we can alter psychological processes, we might be able to help people better cope with the experience of pain,” he tells host Michael Carrese. Although Hendricks has been excited about the prospect of being able to add this “new” tool to help treat addictions, PTSD, depression and other mental health conditions that are not well served by current therapies, he realizes the dangers of hype and the need for a balanced perspective. “I think it's important to note that those of us who were enthusiastic were never under the impression that this would cure everything for everybody. It could really change your life or it may not -- and that's OK -- but it would be nice for that to be an option for those who could benefit from it.” Tune in for a super thoughtful Raise the Line episode on both the promise and challenges of psychedelics and the daunting amount of work left to be done to develop sustainable therapeutic protocols and business models. Mentioned in this episode: https://www.uab.edu/cappi/

Our most prestigious guest to date joins Mariska and I for an exploration of transcranial magnetic stimulation and Esketamine for treatment resistant depression. I have been so curious about both of these forms of treatment so to get an expert on both was incredible! --- Send in a voice message: https://podcasters.spotify.com/pod/show/daniel-j-maigler/message

Do you need support overcoming your mental health struggles? If you've been resistant to other forms of medication, it's time to try the Spravato treatment from Relevance Recovery (866-245-1497). Learn more at https://relevancerecovery.com/treatment-services/spravato/ Relevance Behavioral Health City: Freehold Township Address: 61 W Main Street Website https://relevancerecovery.com/ Phone +1 866 245 1497 Email info@hucenters.com

Esketamine therapy is a groundbreaking new approach to mental health treatment and New Jersey-based Relevance Behavioral Health (+1-866-245-1497) now offers the treatment as part of its integrative plans. Go to https://relevancerecovery.com/ for more information. Relevance Behavioral Health City: Freehold Township Address: 61 W Main Street Website https://relevancerecovery.com/ Phone +1 866 245 1497 Email info@hucenters.com

Ketamine is among the most unique pharmaceutical agents on the market. Join us on an exploration of the research on its neuropharmacology and use for depression, and discussion of risks and benefits. References: Article referenced in the beginning: Martinez-Marmol, et al. Hericerin derivatives activates a pan neurotrophic pathway in central hippocampal neurons converging to ERK1/2 signaling enhancing spacial memory. Journal of Neurochemistry. 2023(165);6: 791-808   Ballard E and Zarate C. The role of disassociation in ketamine's anti-depressant effects. Nature Communications. 2020: 6431 Bobo WV, et al. Ketamine for treatment resistant unipolar and bipolar major depression: Critical review and implications for clinical practice. Depression and Anxiety. 6 April 2016. Esketamine [package insert]. Janssen Neuroscience. July 2023. Fava M, et al. Double blind, placebo controlled dose ranging trial of intravenous ketamine as adjunctive therapy in treatment resistant depression (TRD). Molecular Psychiatry. 2020(25): 1592-1603 Gales A, Maxwell S. Ketamine: recent evidence and clinical uses. World Federation of Societies of Anesthesiologists. 12 June 2018. Johnston JN, et al. Ketamine in neuropsychiatric disorders: an update. Neuropsychopharmacology. 2023 Loo CK, et al. Placebo-controlled pilot trial testing dose titration and intravenous, intramuscular, and subcutaneous routes for ketamine in depression. Acta Psychiatria Scandinavica. 30 March 2016. Mandal S, et al. Efficacy of Ketamine therapy in the treatment of depression. Indian Journal of Psychiatry. 2019 Sept-Oct; 61(5). VA/DoD Clinical Practice Guideline. (2022). The Management of Major Depressive Disorder. Washington, DC: U.S. Government Printing Office

Dr. Alan Schatzberg is a Professor of Psychiatry and Behavioral Sciences at Stanford Medicine, and Director of the Stanford Mood Disorders Center. His research examines the biology and psychopharmacology of depressive disorders. An NYU School of Medicine alumnus, Dr. Schatzberg was President of the American Psychiatric Association from 2009-2010.Topics:Ketamine and Esketamine (incl. mechanisms of action)Ketamine and obsessive-compulsive disorderOpioidsPsychedelic medicineFor more information:https://med.stanford.edu/profiles/alan-schatzbergVisit our website for more insights on psychiatry.Podcast producer: Jon Earle

Daniel Jamieson - Former Royal Australian Army Infantry Sergeant.  In this episode, Dan talks about his career in the military, and the accident that almost killed him in East Timor and his subsequent struggles with PTSD resulting from a massive head injury.  We cover Accredited Assistance Dogs, alternative treatments for PTSD including Esketamine and different ways people can apply mindfulness in their day._______Listener discretion is advised; some episodes raise issues regarding mental health, suicide and other matters that might not be suitable for all listeners.  If you need support check out our support page here._______In this episode, Matt talks to Dan Jamieson, a former Royal Australian Army Infantry Sergeant and survivor a terrible accident on deployment in East Timor in 2000 that almost cost him his life, leaving him with an injury that would cause long term battles with PTSD.  Dan talks about his last 12 months with Accredited Assistance Dog 'Miley' his new inseparable mate who accompanied him to the PTSD group therapy sessions where Dan and Matt met.This is a deep and diverse chat about so many aspects of life with PTSD.  Beyond life with an Accredited Assistance Dog, Dan talks about the various treatments he has tried, right through to his current Esketamine treatment and associated therapies for PTSD and its symptoms.We also get to hear how Dan has applied activities in his life that he is passionate about that demand total concentration as a form of mindfulness in managing his PTSD related symptoms.  In true Dan form, these range from extreme rock climbing on some of Australia's largest cliffs through to the art of 'Horology' - the profession of timekeeping and all things watches.So get ready for a great casual chat while we hear from Dan about everything from military life to fixing watches!Dan's song choice is: Duran Duran - Ordinary World.  Listen to the episode to find out why!We also talk about a YouTube video on watchmaking.  See it here: https://youtu.be/4hZGCguYUj8____________________________Get it now on Apple Podcasts, Spotify and others: https://linktr.ee/h2hwalk www.heart2heartwalk.orgSpotify Walk Song Playlist#assistancedogs #H2hwalkpodcast #heart2heartwalk2023 #triplezeroalliance #heart2heartwalk #firstresponderfamily #firstrespondermentalhealth #firstrespondersaustralia #firstresponder #firstresponderfamily #FirstResponderPTSD #firstrespondersuicide #ptsd #mentalhealthawareness

Major Depressive Disorder (MDD) is common psychiatric condition that causes significant disability and disease burden.  Treatment for this condition may require multiple medication trials.  Up to thirty percent of individuals with MDD do not receive adequate benefit from several antidepressant drug trials and are considered treatment resistant.  The management of treatment resistant depression (TRD) often requires novel approaches.  One such approach is to use N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine or esketamine.  This session will review the use of ketamine and esketamine for TRD. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Dan Iosifescu, MD, is an Associate Professor of Psychiatry at the NYU Grossman School of Medicine and director of clinical research at the Nathan Kline Institute for Psychiatric Research. His research has led to the validation of novel treatments for patients with severe mood and anxiety disorders, including pharmacological treatments such as ketamine and other glutamatergic drugs, and devices such as novel forms of magnetic stimulation.Topics covered:Ketamine and EsketamineWhy certain people respond better to certain medicationsSSRI mechanism of actionTranscranial magnetic stimulationVisit our website for more insights on psychiatry.Podcast producer: Jon Earle

On this episode of Students of Mind, Zen is back to interview Jayde on her experience with psychedelic assisted therapy. Jayde details her entire journey from start to finish—including what a typical session is like. They also discuss some of the less than glamorous experiences so we get a true look at what all the therapy entails. We also get to learn more about the two different types of ketamine therapies, the cost with and without insurance, and how it has significantly improved Jayde's life.Episode Resources (full episode resources on episode webpage)Get affordable online therapy with Better Help*:  www.betterhelp.com/studentsofmindgo to newsly.me and use code "Students" to get a 1 month free premium subscriptionPsychedelic Assisted therapy resources Connect with Our GuestsFollow Jayde:IG: @jaydembarberTiktok: @jaydembarberbook a Sister Session today!Follow Zen: IG: @zeneminzenspencerharris.comConnect with Students of Mindwww.studentsofmind.comIG: @studentsofmindFB: www.facebook.com/StudentsofMindPodcast/Host IG: @jaydembarberJohn Tyler (music): @johntylersounds*affiliate link 

The Science Behind The Psychedelics Boom There's been an explosion of new research into therapeutic uses for psychedelics. This includes drugs like psilocybin, the hallucinogenic chemical found in “magic mushrooms,” and ketamine—which was originally used as an anesthetic, and later became a popular party drug also known as “special K.” Esketamine, a form of ketamine, was approved by the FDA in 2019 for use in treatment resistant depression. And just last month Colorado residents voted to legalize medicinal use of psilocybin. Following on the heels of Oregon's legalization in 2020, which is now in the process of being implemented. A recent study published in the New England Journal of Medicine showed promising results in using psilocybin to help patients with treatment-resistant depression. About a third of those who received the highest dose were in remission 3 weeks later. This was the largest look at psilocybin's effect on depression to date, involving 233 participants across ten countries in Europe. Ira talks with Dr. Steve Levine, senior vice president of patient access and medical affairs at COMPASS Pathways, the company that funded the study. Later, Ira takes a closer look into the latest psychedelic research and takes listener calls with Dr. Gerard Sanacora, professor of psychiatry and director of the Yale Depression Research Program at the Yale School of Medicine, and Dr. Alissa Bazinet, Clinical Psychologist, Co-Founder and Director of Research and Development at the Sequoia Center, and Associate Director of the Social Neuroscience and Psychotherapy Lab at Oregon Health and Science University.     How Will AI Image Generators Affect Artists? Back in August, controversy erupted around the winning submission of the Colorado State Fair's art content. The winning painting wasn't made by a human, but by an artificial intelligence app called Midjourney, which takes text prompts and turns them into striking imagery, with the help of a neural network and an enormous database of images. AI-based text-to-image generators have been around for years, but their outputs were rudimentary and rough. The State Fair work showed this technology had taken a giant leap forward in its sophistication. Realistic, near-instant image generation was suddenly here—and reactions were just as potent as their creations. Tech enthusiasts lauded the achievement, while artists were largely concerned and critical. If anyone could make a painting in just a few seconds, why would someone need to commission an artist to produce an illustration, or even bother spending years learning art at all? Read the rest on sciencefriday.com. Transcripts for each segment will be available the week after the show airs on sciencefriday.com.  

In this episode, Greg W. Mattingly, MD, and Vladimir Maletic, MD, have a conversation about the ongoing bipolar disorder research and developments expected to have an impact in the coming year. They elaborate on the various  neurotransmitters being investigated and how this research might change the future of patient care. From investigating new mechanisms of action to increased uptake of more novel therapeutics such as esketamine and neuromodulation, there is a lot to look forward to. As they note in the podcast: It's an exciting time to be in the field of brain science!Presenters:Greg W. Mattingly, MDAssociate Clinical ProfessorPsychiatryWashington University School of MedicineSt Louis, MissouriPresidentSt Charles Psychiatry AssociatesSt Charles, MissouriVladimir Maletic MDClinical ProfessorDepartment of PsychiatryUSC School of MedicineGreenville, South CarolinaThis content is based on a CE/CME program supported by independent educational grants from AbbVie and Intra-Cellular Therapies, Inc.For more programs in this series, visit:https://bit.ly/3ft1rYI

Taran Goodballet is here to talk about Medication Assisted Treatment or MAT. Taran has a PharmD or Doctorate of Pharmacy. She is a licensed pharmacist and part of Camelback Integrated Health and Wellness. She is a neuropharmacology expert with extensive training in treating psychiatric disorders and patient-tailored pharmaceutical approaches. She's passionate about helping people with mental health and continued recovery. She has intricate knowledge of polypharmacy and drug interactions and can prescribe medications and adjust dosages.  In this interview, she shares her background and why she is passionate about mental health and recovery. We also dive into Medical Assisted Treatment and talk about what it is and how it can be used to help overcome addiction and become a bridge to wellness. We talk specifically about the three main MAT therapies consisting of buprenorphine or suboxone, methadone, and naltrexone. We discuss the importance of continued recovery and finding the underlying issues that started the addiction. We also talk about other modalities and how healing is a continuing process.   [01:56] Starting in 1999, all pharmacists have to have a PharmD or Doctorate of Pharmacy. After that, they can get licensed as a pharmacist.  [03:09] Taran knew she was going to go into the medical field. She loved the chemistry aspect of being a pharmacist.  [04:18] She's been working in mental health care for four years. She's done pharmacology in every medical category. Taran has a lot of experience with Medication Assisted Treatment or MAT.  [06:33] Because of her childhood, doing mental health work as a pharmacist was extremely appealing to Taran. She grew up around substance abuse. [08:01] She wanted to assist people in finding help.  [09:13] She's always doing continuing education and looking for new certificates. [11:06] Anyone with a diagnosis of a substance abuse disorder, could be a candidate for medication assisted treatment. It may depend on what substance they use and the available treatments. [13:09] The three main MAT therapies are buprenorphine, methadone, and naltrexone.  [14:00] Naltrexone can be used for opioids, alcohol and even gambling. It binds to opioid receptors and blocks cravings.  [15:39] There should be a plan to come off of it, but it can be used long-term. [16:28] Buprenorphine or suboxone is used to help with detox and withdrawal cravings. A good candidate would be someone who uses opioids and is having cravings after withdrawing. [20:17] Taran talks about using suboxone and then starting naltrexone. They also have other comfort meds that can help with the transition. They have new modalities to help come off of the suboxone.  [22:49] There's an underlying reason why substance abuse starts. MAT is to help survive, not heal the underlying reason. They need to get in a state of mind to work on cognitive modalities to heal the underlying problems.   [26:28] Diet, nutrition, and sleep also needs to be addressed. Our nervous systems need to be protected. The brain can constantly change. Medication can help get to a point to do the work and address the underlying problems.  [29:36] Taran talks about ESKetamine and patient benefits of building new neural pathways combined with therapy. [33:50] Methadone is used at Methadone clinics. It can be a helpful harm reduction tool. Taran prefers the other modalities and their benefits. [35:50] Her vision is to help people deal with substance abuse and recovery. She knows there is beauty on the other side.  [37:10] Camelback Integrated Health and Wellness has the goal of continuing support for people who go through recovery. We offer all of the needed support to stay in recovery.  [37:54] Anyone who needs extra support with recovery or mental health is a good candidate for Camelback.  [39:27] The goal is to help people after they go through a program with continued support. [40:55] Taran shares her morning routine.  [43:40] Let us know what resonated with you!  Links mentioned in this episode: Camelback Recovery I Love Being Sober YouTube Taran Goodballet, PharmD LinkedIn

What are some of the major differences between intravenous or IV ketamine and intranasal esketamine? How are you building on these research findings and what associated avenues have been explored? In this episode, we interview the poster winner from last year's NEI Congress, Dr. Balwinder Singh on his research comparing intravenous ketamine and intranasal esketamine. The study, conducted at Mayo Clinic rendered interesting findings that may be important for clinicians. Dr. Balwinder Singh is a Consultant and Assistant professor in the Department of Psychiatry at Mayo Clinic in Rochester, Minnesota. He is a psychiatrist specializing in mood disorders, and his research is focused on novel treatments for treatment-resistant depression and identifying biomarkers for ketamine response.  He is also involved in the ketamine and esketamine clinic practice at the Mayo Clinic Depression Center.   This is one of the first studies to highlight a faster response to intravenous ketamine as compared to intranasal esketamine in an observational study.

今天的问题是： 您好，听了您关于抑郁症的讲述我觉得受益很大。作为一名数学专业的学生，我自己对以数学为基础的现代科学孵化出来的西医很不满意，但却不知道何去何从。 我妹妹前一段时间精神失常，量表诊断是中度精神分裂症。就像您说的，到各大医院花费巨资排除这个排除那个啥病没有，最后只能被迫出院。当然中间也尝试过神婆子、中医等，取得一定效果，但都是很短暂的，不解决根本问题。中间有那么一周左右的时间她自己从幻觉中走了出来(走出来的那两天还没有入院)，我以为当她能非常理性的反思自己犯病时的所作所为时她就已经真正好起来了。但回家以后又有些许反弹现在在吃思贝格和安坦维持着。我不忍心看着自己 20 来岁的妹妹，就这么一辈子疯疯癫癫下去(村里很多人都是这样结束自己生命的)，却也不知道该做些什么。 真诚希望您能就这个具体问题谈谈自己的一些看法，也许我可以获得一些启发。其实现代人多多少少都会有一些精神层面的问题，相信您在这方面的思考大家都会受用。 ------问题结束的分割线------ 过去我们有三期关于“抑郁症”的节目，翻电SPECIAL16-18，是关于精神障碍“疾病”与否的一个挺有争议的探讨，现在两年半过去，对于这个问题，有什么新的看法和理解吗？我们今天再来谈精神障碍的“疾病化”问题，就从药物的角度入手，来看出精神障碍与现代医学不相容之处 今天的内容包括： 04:44 既是生理的，也是认知的，能让问题简单一些吗？ 09:19 如果精神障碍是生理基础的，我们应该发现些什么？ 21:59 遍历主流精神药物，检查是否与认知症状对应 40:23 大断裂：认知症状并不与药理相容 48:41 原因探究：精神障碍生理化研究的三个主要障碍 59:40 从两个前沿抑郁症研究看药物研发的问题 01:12:10 神经制药：不是医学问题，而是社会学问题 01:17:11 几个很不乐观的近期研究 相关文献： 《Insula activity in resting‐state differentiates bipolar from unipolar depression: a systematic review and meta‐analysis》 《Augmentation with Atypical Antipsychotics for Treatment-Resistant Depression》 《Common and distinct patterns of intrinsic brain activity alterations in major depression and bipolar disorder: voxel-based meta-analysis》 《Efficacy and Tolerability of Combination Treatments for Major Depression: Antidepressants plus Second-Generation Antipsychotics vs. Esketamine vs. Lithium》 《Advances toward precision medicine for bipolar disorder: mechanisms & molecules》 《Predicting the future of neuroimaging predictive models in mental health》 《ENIGMA MDD: seven years of global neuroimaging studies of major depression through worldwide data sharing》 《Beyond antipsychotics: a twenty-first century update for preclinical development of schizophrenia therapeutics》 《Bipolar depression: the clinical characteristics and unmet needs of a complex disorder》 《Neural network of bipolar disorder: Toward integration of neuroimaging and neurocircuit-based treatment strategies》 《Is it possible to stage schizophrenia? A systematic review》 [ 欢迎在Patreon和爱发电支持翻转电台 ] 如果你过去有在Patreon支持其他项目的经验，优先推荐使用Patreon，因为其有按月订阅的制度： https://www.patreon.com/flipradio 如果你从来没有在Patreon支持其他项目的经验，可以在爱发电： https://afdian.net/@flipradio 感谢大家对翻转电台的支持。 如果你要提问请将问题邮件发到 ask@flipradio.club 非常感谢提问！

Ketamine and Esketamine are the first truly “new” medications to treat depression. Dr. Rachel Dalthorp discusses these revolutionary treatments, how they're delivered and who can benefit.  Learn more about Spravato Learn more about Lifestance Health: Lifestance.com Follow LifeStance Health:  Instagram Facebook LinkedIn    

Madhukar Trivedi, MD, and Manish Jha, MD, MBBS, review the evidence on the efficacy of esketamine and ketamine as a treatment for major depressive disorder. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/968556). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Symptom Clusters as Predictors of Late Response to Antidepressant Treatment https://www.psychiatrist.com/jcp/depression/symptom-clusters-predictors-late-response-antidepressant/ Intranasal Esketamine https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/SPRAVATO-pi.pdf Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study https://www.nimh.nih.gov/funding/clinical-research/practical/stard Clinical Results for Patients With Major Depressive Disorder in the Texas Medication Algorithm Project https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482026 Efficacy and Safety of Olanzapine/Fluoxetine Combination vs Fluoxetine Monotherapy Following Successful Combination Therapy of Treatment-Resistant Major Depressive Disorder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207330/ Esketamine Nasal Spray for Rapid Reduction of Depressive Symptoms in Patients With Major Depressive Disorder Who Have Active Suicide Ideation With Intent: Results of a Phase 3, Double-Blind, Randomized Study (ASPIRE II) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816667/ Esketamine Nasal Spray for the Rapid Reduction of Depressive Symptoms in Major Depressive Disorder With Acute Suicidal Ideation or Behavior https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407443/ Ketamine Versus Midazolam for Recurrence of Suicidality in Adolescents https://clinicaltrials.gov/ct2/show/NCT04592809 Youth Depression and Suicide Research Network (YDSRN) https://clinicaltrials.gov/ct2/show/NCT04572321 The Neurobiology of Depression, Ketamine and Rapid-Acting Antidepressants: Is it Glutamate Inhibition or Activation? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165688/ Effect of Ketamine on Limbic GABA and Glutamate: A Human In Vivo Multivoxel Magnetic Resonance Spectroscopy Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507577/ Identifying Novel Mechanisms and Treatment Targets for Irritability and Aggression in Psychiatric Disorders https://www.nature.com/articles/s41386-021-01166-4 Ketamine Versus Midazolam for Recurrence of Suicidality in Adolescents https://clinicaltrials.gov/ct2/show/NCT04592809 Ketamine for Depression: An Update https://www.biologicalpsychiatryjournal.com/article/S0006-3223(16)32579-3/fulltext MDMA-Assisted Therapy for Severe PTSD: A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study https://www.nature.com/articles/s41591-021-01336-3 Trial of Psilocybin versus Escitalopram for Depression https://www.nejm.org/doi/full/10.1056/NEJMoa2032994 The Clinical Pharmacology and Potential Therapeutic Applications of 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) https://onlinelibrary.wiley.com/doi/10.1111/jnc.15587

Peter Simons covers a clinical trial that found lithium ineffective at preventing suicide attempts, an essay by Allen Frances on the overdiagnosis of depression and overprescription of antidepressants, a review of the ineffectiveness and dangers of antidepressants, and an analysis that revealed that esketamine failed five of its six clinical trials. Lithium No Better Than Placebo for Preventing Suicide Attempts New Review: Antidepressants Come with Minimal Benefits, Several Risks Allen Frances Takes on the Over-Prescription of Antidepressants Esketamine Failed in Five of its Six Efficacy Trials Ketamine Withdrawal Has Severe Consequences New Study of Ayahuasca Users Shows Placebo Effect in Action  

Esketamine is the first non-monoaminergic based medication which is FDA approved and indicated for treatment refractory depression. A longer duration of undertreated depression is associated with poor longitudinal functional outcomes. Instead of cycling patients through monoaminergic antidepressant trials and cognitive behavioral therapy approaches, according to Dr. Kitay, providers should consider treatments like esketamine much sooner in the treatment course. Link to full blog Link to Resource Library. 

Had a great time talking to Rick. We talked about how Metal band t-shirts are often a part of someone's identity, we talked about PTSD, Esketamine, and history of course. Timestamps 00:00:00 Intro 00:01:21 Metal band t-shirts, a part of my identity 00:19:54 Was Bon Jovi ever considered Metal? 00:34:03 PTSD - The Denial Phase 00:39:07 Willy says hi on the podcast :) 00:43:26 Depression - There are solution 00:45:35 How Ketamine was discovered as an anti depressant 00:46:34 Link to the video "The Man Who Can't Feel Pain Or Pleasure" 00:30:15 Realizing that most people hate Monday 00:33:50 Chipmunk moment 00:42:05 Climbing Mt. Denali 00:49:20 Willy visits the Podcast 00:55:00 Finding your second wind 01:01:40 How to avoid dangerous partners

How risky is esketamine? In this episode, we examine the safety of esketamine using postmarketing data that have been reported since the drug was approved and released. Faculty: Jim Phelps, M.D. Hosts: Jessica Diaz, M.D.; Flavio Guzman, M.D. Learn more about Premium Memberships here Earn 0.5 CMEs: Quick Take Vol. 27 Postmarketing Safety Concerns With Esketamine: A Disproportionality Analysis of Spontaneous Reports Submitted to the FDA Adverse Event Reporting System  

Individuals with major depressive disorder and suicidal ideation are particularly vulnerable and may not respond as well to standard treatment as patients without suicidal ideation. In this author podcast, Dr. Dong-Jing Fu and Dr. Carla Canuso discuss the results of a pooled analysis of data from the ASPIRE studies, randomized placebo-controlled trials of esketamine, plus comprehensive standard-of-care treatment. The results, published in the September-October 2021 issue of the Journal of Clinical Psychopharmacology, suggest that esketamine can provide rapid relief of depressive symptoms in patients with MDD and acute suicidal ideation or behavior, especially in those with a history of prior suicide attempt.

Dr. Autumn Walkerly provides an overview of Spravato (esketamine) nasal spray for treatment resistant depression. References: Gaynes BN, Lux L, Gartlehner G, et al. Defining treatment-resistant depression. Depress Anxiety. 2020;37(2):134-45. Irwin MN, VandenBerg A. Retracing our steps to understand ketamine in depression: A focused review of hypothesized mechanisms of action. Ment Health Clin. 2021;11(3):200-10. Rush AJ, Trivedi MH, Wisniewski SR, et al. "Acute and longer-term outcomes in depressed outpatient requiring one or several treatment steps: A STAR*D report". Am J Psychiatry. 2006. 163(11):1905-17. Daly EJ, Trivedi MH, Janik A, et al. Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA Psychiatry. 2019;76(9):893-903. Fu DJ, Ionescu DF, Li X, et al. Esketamine nasal spray for rapid reduction of major depressive disorder symptoms in patients who have active suicidal ideation with intent: double-blind, randomized study (ASPIRE I). J Clin Psychiatry. 2020;81(3):19m13191. Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: a randomized double-blind active-controlled study. Am J Psychiatry. 2019;176(6):428-38.

Authors Nicholas A. Mischel and Richard Balon discuss their commentary, “Esketamine: A Drug to Treat Resistant Depression That Brings More Questions Than Answers.” Their commentary asks: How does this treatment fit into the broader repertoire in treating resistant depression and suicidal ideation or behavior, with both concepts ill-defined?

I sat down w DJ and producer Jeevus Christ, whose got a number of mixes up on Soundcloud, the most recent of which is "Esketamine". He grew up between Milwaukee and Las Vegas. We discussed Jeev's early interest in classic rock and metal, getting hooked on EDM through Zeds Dead, starting DJing through warehouse parties, finding an eclectic sound for his production, and the video game consoles we grew up with. --- Support this podcast: https://anchor.fm/ben-slowey/support

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers ketamine for treatment-resistant depression (TRD) with Dr. Sandhya Prashad, a psychiatrist and the founder and medical director of Houston Ketamine Therapeutics. She has extensive expertise using ketamine and is one of the most experienced ketamine psychiatrists in the United States, with her clinical practice focusing on TRD and incorporating transcranial magnetic stimulation (TMS), sometimes in conjunction with ketamine. Dr. Prashad is also a founding member and current president of the American Society of Ketamine Physicians (ASKP), a non-profit organization created to advocate for the safe use of ketamine for mental illness and pain disorders and to expand access to ketamine therapy.   We’re also experimenting with something new for this episode — providing a transcript of the entire interview! The transcript can be found at psychedpodcast.org/transcripts/ketamine. We’d love to hear your feedback as listeners on this as a feature, including whether it’s something you’d be interested in seeing for other episodes moving forward!   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Describe ketamine and how it came to be used in the field of psychiatry. Develop an appreciation for benefits and potential harms associated with ketamine and how this compares to other treatments for depression. Understand how ketamine fits into the treatment of depression and suicidality, patient characteristics to consider before initiation, potential mechanisms of action, different models of administration, and incorporation of psychotherapy.   Guest expert: Dr. Sandhya Prashad   Hosts: Jimmy Qian (MS2), Dr. Nikhita Singhal (PGY2), Dr. Chase Thompson (PGY3)   Audio editing by: Dr. Chase Thompson   Show notes by: Gray Meckling (MS4)   Interview transcript by: Gray Meckling   00:00 – Introduction 03:00 – Learning objectives 03:30 – History of ketamine 06:20 – Recreational use of ketamine, phenomenology of the ketamine experience 09:45 – Where does ketamine fall in the algorithm for treatment of depression? 11:50 – Ketamine’s use in acute suicidality 13:40 – Ketamine contraindications 14:40 – Ketamine efficacy 19:00 – Combining ketamine with rTMS 21:15 – Limitations to ketamine 24:35 – Ketamine mechanism of action 26:05 – Ketamine formulations, and integrating ketamine into psychotherapy 33:10 – Combining ketamine with traditional antidepressant treatment 37:30 – Practicalities of administering ketamine 39:40 – Ketamine as treatment for OCD and PTSD 41:40 – Closing remarks   Resources: American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP) Sandhya Prashad, MD (Website) NEJM interview with Dr. Roy Perlis: Esketamine for Treatment-Resistant Depression — First FDA-Approved Antidepressant in a New Class   References: Berman, R., Cappiello, A., Anand, A., Oren, D., Heninger, G., Charney, D.. (2000) Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 47: 351–354. Daly, E. J., Trivedi, M. H., Janik, A., Li, H., Zhang, Y., Li, X., ... & Thase, M. E. (2019). Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA psychiatry, 76(9), 893-903. J.W. Murrough, D.V. Iosifescu, L.C. Chang, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two site randomized controlled trial. Am. J. Psychiatry, 2013 (170) (2013), pp. 1134-1142 Kim, J., Farchione, T., Potter, A., Chen, Q., & Temple, R. (2019). Esketamine for treatment-resistant depression-first FDA-approved antidepressant in a new class. N Engl J Med, 381(1), 1-4. McIntyre, R. S., Rosenblat, J. D., Nemeroff, C. B., Sanacora, G., Murrough, J. W., Berk, M., ... & Stahl, S. (2021). Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. American Journal of Psychiatry, appi-ajp. Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJA, Curran HV. Journey through the K-hole: Phenomenological aspects of ketamine use. Drug and Alcohol Dependence [Internet]. 2008 Jun 1;95(3):219–29. Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA psychiatry. 2017 Apr 1;74(4):399-405. Williams NR, Heifets BD, Blasey C, Sudheimer K, Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons DM, Rodriguez CI, Schatzberg AF. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry. 2018 Dec 1;175(12):1205-15. Williams NR, Heifets BD, Bentzley BS, Blasey C, Sudheimer KD, Hawkins J, Lyons DM, Schatzberg AF. Attenuation of antidepressant and anti suicidal effects of ketamine by opioid receptor antagonism. Molecular psychiatry. 2019 Dec;24(12):1779-86. Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., Luckenbaugh, D.. (2006a) A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 63: 856–864.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Esketamine is a REMS program drug that is currently brand only known as Spravato. It is a Non-Selective Non-Competitive NMDA Receptor Antagonist and typically administered in a healthcare setting that is enrolled in the REMS program. Spravato is used along with an antidepressant when treating patients with treatment-resistant depression or a major depressive disorder with acute suicidal ideation and behavior. It is not recommended for pediatric use and the efficacy in reducing and preventing suicide or suicidal behavior has not been proven. Spravato comes in a nasal spray in a 56 mg and 84 mg strength. In addition to the more common CYP pathways, Spravato is primarily metabolized via the CYP2B6 pathway. Esketamine is the S-enantiomer of racemic ketamine. Spravto should be administered by the patient under the supervision of a healthcare provider. Go to DrugCardsDaily.com to find past FREE PDFs of the drug card sheets that were used for the show. SUBSCRIBE on Spotify or Apple Podcasts or search for us on your favorite place to listen to podcasts. I plan to continue going over the Top 100-200 Drugs as well as occasionally throwing in one of the newly released drugs that peak my interest. Also, if you'd like to say hello, suggest a drug, or leave any constructive feedback on the show thus far I'd really appreciate it! Leave a message on my hosting site HERE. --- Send in a voice message: https://anchor.fm/drugcardsdaily/message

Founder & executive chairman of Field Trip Health Ronan Levy joins us this week to discuss the therapeutic benefits of psychedelics and the work he is doing with Field Trip Health. With clinics in Toronto, New York, LA, Chicago and Atlanta, Field Trip Health is a new kind of mental wellness company, that combines the wisdom and science of psychedelic medicine with personalized psychotherapy and mental health wellness practices. Stay Connected!!! https://www.fieldtriphealth.com/ https://www.instagram.com/fieldtriphealth/ https://twitter.com/fieldtriphealth https://www.facebook.com/fieldtriphealth/ The Airey Bros. IG @aireybros / https://www.instagram.com/aireybros/ https://www.blacksheependurance.com/podcast Premium Content : AB/DC Programming / B-Role & Mix Tapes / Accountability Coaching https://www.patreon.com/AireyBros Value for Value https://venmo.com/Richard-Airey https://venmo.com/Jimi-Airey https://www.paypal.com/donate?hosted_button_id=BHCAKFGH6TNF2 If Y'all are ever curious about any of the beers we discuss during the episodes, often times we are using the Tavour app and their selection never disappoints. To get some of the best beers we've ever have had, try Tavour. There is no commitment and you can customize what beers you're offered based on your individual preferences. Sign up by clicking on this link https://account.tavour.com/?invitedby=630189 and we both get $10 after you purchase a beer. Handmade in Longmont, Colorado, 42% of every Honey Bunchies Gourmet Honey Bar is pure honey with peanuts, pecans and sunflower kernels. Our bar contains simple, clean ingredients and are gluten-free, grain-free and soy-free. A perfect salty-sweet combination packed with all-natural energy that will make your tastebuds jump for joy! Use ABR1512 at check out for 10% off your next order https://honeybunchies.com/ Do you enjoy a well made pour over but don't have the time for set up, brew time and clean up? Check out Mount Hagen Coffee. Organic, Fair Trade, instant, freeze dried. https://www.mounthagen.de/en Have you tried Keto Soups from Kettle and Fire they are delicious and they are essential for any ultra marathon crew. Don't get stuck using powdered broths and top ramen at your next ultra, use Kettle and Fire, you won't regret it. Order now and save up 30% on your order https://offers.kettleandfire.com/bfcm-2019/?afmc=runningwod People always ask us about supplements my answers vary from time to time with what using at any given moment but one constant since 2013 has been Cordyceps Mushrooms from Onnit. Shroom TECH Sport helps you turn up your training volume. Whether you’re a recreational exerciser or a dedicated athlete, this means MORE: reps, circuits, miles, laps, more of the hard work you love to hate. Best of all, Shroom TECH Sport delivers improved performance all without the use of stimulants like caffeine. It's designed to be used before exercise or for a daily energy boost. http://onnit.sjv.io/c/478343/349600/5155

Founder & executive chairman of Field Trip Health Ronan Levy joins us this week to discuss the therapeutic benefits of psychedelics and the work he is doing with Field Trip Health. With clinics in Toronto, New York, LA, Chicago and Atlanta, Field Trip Health is a new kind of mental wellness company, that combines the wisdom and science of psychedelic medicine with personalized psychotherapy and mental health wellness practices. Stay Connected!!! https://www.fieldtriphealth.com/ https://www.instagram.com/fieldtriphealth/ https://twitter.com/fieldtriphealth https://www.facebook.com/fieldtriphealth/ The Airey Bros. IG @aireybros / https://www.instagram.com/aireybros/ https://www.blacksheependurance.com/podcast Premium Content : AB/DC Programming / B-Role & Mix Tapes / Accountability Coaching https://www.patreon.com/AireyBros Value for Value https://venmo.com/Richard-Airey https://venmo.com/Jimi-Airey https://www.paypal.com/donate?hosted_button_id=BHCAKFGH6TNF2 If Y'all are ever curious about any of the beers we discuss during the episodes, often times we are using the Tavour app and their selection never disappoints. To get some of the best beers we've ever have had, try Tavour. There is no commitment and you can customize what beers you're offered based on your individual preferences. Sign up by clicking on this link https://account.tavour.com/?invitedby=630189 and we both get $10 after you purchase a beer. Handmade in Longmont, Colorado, 42% of every Honey Bunchies Gourmet Honey Bar is pure honey with peanuts, pecans and sunflower kernels. Our bar contains simple, clean ingredients and are gluten-free, grain-free and soy-free. A perfect salty-sweet combination packed with all-natural energy that will make your tastebuds jump for joy! Use ABR1512 at check out for 10% off your next order https://honeybunchies.com/ Do you enjoy a well made pour over but don't have the time for set up, brew time and clean up? Check out Mount Hagen Coffee. Organic, Fair Trade, instant, freeze dried. https://www.mounthagen.de/en Have you tried Keto Soups from Kettle and Fire they are delicious and they are essential for any ultra marathon crew. Don't get stuck using powdered broths and top ramen at your next ultra, use Kettle and Fire, you won't regret it. Order now and save up 30% on your order https://offers.kettleandfire.com/bfcm-2019/?afmc=runningwod People always ask us about supplements my answers vary from time to time with what using at any given moment but one constant since 2013 has been Cordyceps Mushrooms from Onnit. Shroom TECH Sport helps you turn up your training volume. Whether you're a recreational exerciser or a dedicated athlete, this means MORE: reps, circuits, miles, laps, more of the hard work you love to hate. Best of all, Shroom TECH Sport delivers improved performance all without the use of stimulants like caffeine. It's designed to be used before exercise or for a daily energy boost. http://onnit.sjv.io/c/478343/349600/5155

Dr. B at Mentally STRONG in Colorado Springs interviews a special guest. She bravely shares her story in the hope that it will help someone else. She had tried 16 different medications for depression and dozens of therapies with no relief, she speaks on her struggle with addiction and how she was able to recover. She knew that if she just kept looking, she would find something that would work. Spravato ended up being the treatment that worked for her depression.The message: Never Give Up! There will be something, it will get better. Remember, you ARE Mentally STRONG#mentalhealth #mentalhealthawareness #selfcare #selflove #motivation #depression #health #mentalhealthmatters #life #wellness #inspiration #healing #mentallystrong

The paper we discuss in this episode is V Popova et al. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined with a Newly Initiated Oral Antidepressant in Treatment Resistant Depression: A Randomized Double-Blind Active-Controlled Study. Am J Psychiatry  2019; 176(6): 428-438.For a deeper understanding of the factors that contribute to placebo response, check out  BR Rutherford and SP Roose. A Model of Placebo Response in Antidepressant Clinical Trials. Am J  Psychiatry  2013; 170:723-733.Lots of data about the placebo response in antidepressant clinical trials:BT Walsh et al. Placebo Response in Studies of Major Depression: Variable, Substantial, and Growing. JAMA 2002; 287(14):1840-1847.W Rief et al . Meta-analysis of the Placebo Response in Antidepressant Trials. Journal of Affective Disorders 2009; 118:1-8.TA Furukawa et al. Placebo Response Rates in Antidepressant Trials: A Systematic Review of Published and Unpublished Double-Blind Randomised Controlled Studies. Lancet Psychiatry 2016; 3:1059-1066.     

For links to all the stories featured on this weeks episode check out the written briefing at https://reportonpsychedelics.com/#briefings Never miss an episode by signing up for our weekly newsletter: https://reportonpsychedelics.com/#briefing-signup

For links to all the stories featured on this weeks episode check out the written briefing at https://reportonpsychedelics.com/#briefings Never miss an episode by signing up for our weekly newsletter: https://reportonpsychedelics.com/#briefing-signup

This week there's more COVID vaccine developments; A first-of-its-kind trial assessing a drug for preventing COVID in long term care facilities; A cannabidiol treatment gains another indication; Depression treatment gains indication for major depressive disorders with acute suicidal ideation or behavior; And the FDA requests more information for their review of the peanut allergy treatment, Viaskin.

Today we sniff out a conspiracy to control the world and then we travel to Eureka, Nevada to uncover a story of revenge, murder, and a fiery ghost!   Patreon  https://www.patreon.com/user?u=18482113   MERCH STORE!!! https://www.redbubble.com/people/deadrabbitradio/works/35749420-dead-rabbit-radio?asc=u   Minecraft Server Is Back! 147.135.54.93:25879   Help Promote Dead Rabbit! Dual Flyer https://i.imgur.com/OhuoI2v.jpg "As Above" Flyer  https://i.imgur.com/yobMtUp.jpg “Alien Flyer” By TVP VT U https://imgur.com/gallery/aPN1Fnw “Ouija Flyer” By Robert Paulsen https://imgur.com/gallery/CdJymvZ     Links:   Nasal spray approved for treating suicidal people https://medicalxpress.com/news/2020-08-nasal-suicidal-people.html   Elon Musk's Neuralink Brain Chip Will Soon Allow Users to Take Charge of Moods and Emotions https://www.techtimes.com/articles/251574/20200804/elon-musk-neuralink-update-mood-control.htm Esketamine https://en.wikipedia.org/wiki/Esketamine   HISTORY OF CRISFIELD AND SURROUNDING AREAS ON MARYLAND'S EASTERN SHORE https://www.amazon.com/HISTORY-CRISFIELD-SURROUNDING-MARYLANDS-EASTERN/dp/B0042L84TW   Hookman 2 Full Length Horror/Comedy Film https://www.youtube.com/watch?v=ptoWu3KNCcY   Crisfield, Maryland https://en.wikipedia.org/wiki/Crisfield%2C_Maryland   Laudanum https://en.wikipedia.org/wiki/Laudanum   Listen to the daily podcast anywhere you listen to podcasts! ------------------------------------------------   Logo Art By Ash Black "As Above" Art By Grant Scott Dead Rabbit Skull By John from the SCAR Group Dead Rabbit Exposed By Smashers_25 (Instagram) Halloween Monster By Finn Ouija By Robert Paulson   Opening Song: "Atlantis Attacks" Closing Song: "Bella Royale" Reptilian Strip Song EP 374: “Empty Beds” Music By Dr. Huxxxtable Rabbitron 3000 created by Eerbud Thanks to Chris K, Founder Of The Golden Rabbit Brigade Dead Rabbit Archivist Some Weirdo On Twitter AKA Jack   http://www.DeadRabbit.com Email: DeadRabbitRadio@gmail.com Twitter: @DeadRabbitRadio Facebook: www.Facebook.com/DeadRabbitRadio   Paranormal, Conspiracy, and True Crime news as it happens! Jason Carpenter breaks the stories they'll be talking about tomorrow, assuming the world doesn't end today.   All Contents Of This Podcast Copyright Jason Carpenter 2018 - 2020

Dr. Julia Schaletzky explains why the U.S. is having a hard time testing everyone for the coronavirus. Plus: learn about how ketamine can help with depression and anxiety; and how an anonymous Anime fan on 4chan helped solve a 25-year-old math puzzle. Additional resources from Dr. Julia Schaletzky, Executive Director of the Henry Wheeler Center for Emerging and Neglected Diseases at University of California, Berkeley: Center for Emerging and Neglected Diseases (CEND) http://cend.globalhealth.berkeley.edu/ CEND COVID-19 Outbreak Watch http://cend.globalhealth.berkeley.edu/coronavirus-outbreak-watch/ Immunotherapy and Vaccine Research Institute (IVRI) https://ivri.berkeley.edu/ Department of Molecular & Cell Biology (MCB) faculty bio for Julia Schaletzky, PhD https://haas.berkeley.edu/biology-business/academics/faculty/ Follow @CENDUCBerkeley on Twitter https://twitter.com/CENDUCBerkeley Follow  Dr. Schaletzky’s CEND profile http://cend.globalhealth.berkeley.edu/julia-schaletzky-phd/ How can ketamine treat anxiety? by Ashley Hamer (Listener question from Brock in Utah) Chen, J. (2019, March 21). How New Ketamine Drug Helps with Depression. Yale Medicine; YaleMedicine.org. https://www.yalemedicine.org/stories/ketamine-depression/   Meisner, R. C. (2019, May 22). Ketamine for major depression: New tool, new questions - Harvard Health Blog. Harvard Health Blog. https://www.health.harvard.edu/blog/ketamine-for-major-depression-new-tool-new-questions-2019052216673   U.S. Department of Justice Drug Enforcement Administration (2017). Ketamine. In Drugs of Abuse: A DEA Resource Guide. (pp. 68.) https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf#page=68  Gao, M., Rejaei, D., & Liu, H. (2016). Ketamine use in current clinical practice. Acta Pharmacologica Sinica, 37(7), 865–872. https://doi.org/10.1038/aps.2016.5   Ketamine vs. Esketamine for Depression. (2019). Psychology Today. https://www.psychologytoday.com/us/blog/two-takes-depression/201904/ketamine-vs-esketamine-depression   Office of the Commissioner. (2019). Understanding Unapproved Use of Approved Drugs “Off Label.” U.S. Food and Drug Administration. https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label   Makin, S. (2019, April 12). Behind the Buzz: How Ketamine Changes the Depressed Patient’s Brain. Scientific American. https://www.scientificamerican.com/article/behind-the-buzz-how-ketamine-changes-the-depressed-patients-brain/   An anonymous 4chan post helped solve a 25-year-old math puzzle by Grant Currin Sci-Fi Writer Greg Egan and Anonymous Math Whiz Advance Permutation Problem | Quanta Magazine. (2018). Quanta Magazine. https://www.quantamagazine.org/sci-fi-writer-greg-egan-and-anonymous-math-whiz-advance-permutation-problem-20181105/  Superpermutations — Greg Egan. (2018). Gregegan.Net. http://www.gregegan.net/SCIENCE/Superpermutations/Superpermutations.html  Anonymous 4chan Poster, Houston, R., Pantone, J., Vatter, V. (2018). A lower bound on the length of the shortest superpattern. Posted online. https://oeis.org/A180632/a180632.pdf Subscribe to Curiosity Daily to learn something new every day with Cody Gough and Ashley Hamer. You can also listen to our podcast as part of your Alexa Flash Briefing; Amazon smart speakers users, click/tap “enable” here: https://curiosity.im/podcast-flash-briefing

For links to all the stories featured on this weeks episode check out the written briefing at https://reportonpsychedelics.com/#briefings Never miss an episode by signing up for our weekly newsletter: https://reportonpsychedelics.com/#briefing-signup

This week on MIA Radio we chat with Professor John Read of the University of East London. John worked for nearly 20 years as a Clinical Psychologist and manager of mental health services in the UK and the USA, before joining the University of Auckland, New Zealand, in 1994, where he worked until 2013. He has published over 140 papers in research journals, primarily on the relationship between adverse life events (e.g. child abuse/neglect, poverty, etc.) and psychosis. He also researches the negative effects of biogenetic causal explanations on prejudice, the opinions, and experiences of recipients of antipsychotic and antidepressant medication, and the role of the pharmaceutical industry in mental health research and practice. John joins us to discuss the UK licensing of esketamine nasal spray (Spravato) for so-called ‘Treatment Resistant Depression’. John led a group of 12 academics and professionals who wrote to the UK regulator expressing concerns about esketamine. We Discuss: Concerns about the basic concept of using derivatives of hallucinogenic, addictive street drugs to address complex human problems. The particular details of the clinical trials that raise concerns about treatment with esketamine. How the US Food and Drug Administration approved Spravato in January 2019 and the European Medicines Agency recommended that member states approve it on October 17, 2019, giving 67 days for member states to comment. That the Medicines and Healthcare products Regulatory Agency approved esketamine for UK use. That there have been no trials of the efficacy of esketamine in the medium or long term, with most trials being only four weeks duration. That only one of the trials found a benefit for esketamine over placebo, yet this was deemed sufficient for licensing by the USA’s FDA. That there were deaths and suicides recorded during the esketamine clinical trials. The relationship between the drug regulators and funding from the pharmaceutical manufacturers. How there was no response from the MHRA to the concerns raised by John’s group. In addition, no reply was made to concerns raised by Sir Oliver Letwin writing on behalf of the All Party Parliamentary Group on Prescribed Drug Dependence as well as letters from independent researchers from Kings College London and a group of service users. A recent response to the approval by the UK National Institute for Health and Care Excellence. A response to the NICE announcement from the Science Media Centre.

Super excited to present this episode to you. I had Dr. Steven Mandel on episode 137 of the podcast to talk about the amazing and life-saving treatment of Ketamine infusions, which have been shown to be an incredibly effective treatment for depression, suicidality, and trauma that doesn't respond well to other treatments. In this episode, we talk more about the difference between these IV infusions of Ketamine and a new player in the game, Ketamine nasal spray. Recently, an Esketamine nasal spray called Spravato was approved by the FDA for use in individuals with treatment-resistant depression. We explore what this means for your treatment and for your wallet. This episode of Hardcore Self Help is sponsored by Future.

In this episode, Dr. Adam Kaplin joins Cody to share his work with esketamine, a newly approved drug for depression that works differently from existing treatments. Find out the good and bad, and when to think about it as an option for yourself or someone you care about!

In this podcast episode we learn the core concepts surrounding ketamine and esketamine; a very hot topic in psychiatry today. We have Dr. Sam Wilkinson and Dr. Joseph Goldberg joining us. Download a PDF of this interview here Become a premium member of the Psychopharmacology Institute

Did you know that oral medications only help 3-5/10 people? Today we learn about ketamine and esketamine (Spravato) and how it can start helping your depression within only a few hours! It's amazing! If you're interested in seeing me either in person or through telepsychiatry then head to https://www.cedarpsychiatry.com/Call/text the podcast voicemail 650-762-5713Email me at DiagnosisExplainedPodcast@gmail.com.Join me on Patreon at https://www.patreon.com/diagnosisexplained.Please rate and subscribe to the program at https://podcasts.apple.com/us/podcast/id1458994414&ls=1Subscribe on Android: http://www.subscribeonandroid.com/rss.whooshkaa.com/rss/podcast/id/6869

In this episode, hosts Kyle and Joe sit down with Psychologist, David Luke, Executive Director of Breaking Conventions, a conference on the better understanding of psychedelics. In the episode, they cover research on psychedelics and transpersonal ecopsychology. 3 Key Points: Transpersonal experiences are super powerful and can be valuable if integrated properly. Getting access to drugs at affordable prices for research is difficult for the progression of the psychedelic movement. There is a lot of red tape in studying psychedelics. There is a growing field for mapping altered states of consciousness using science and research. Support the show Patreon Leave us a review on iTunes Share us with your friends – favorite podcast, etc Join our Facebook group - Psychedelics Today group – Find the others and create community. Navigating Psychedelics Trip Journal                                               Integration Workbook   Show Notes About David David is a Psychologist He works at the University of Greenwich He is a co-founder of the Breaking Convention Conference Breaking Convention August 16-19, 2019 in London England There are over 180 speakers, a variety of workshops, and more David will be speaking about Shamanic perspectives and mapping altered states of consciousness The topic of David’s speech for the conference is Ecodelia: Towards A Transpersonal Ecopsychology Through Psychedelics. Parapsychology Parapsychology is a study of phenomena that questions what we think we know about science David has conducted pre-cognition experiments with ayahuasca, san pedro, mescaline Research David says it's tricky doing this work because there is a serious amount of red tape around psychedelic studies Getting access to the drugs and to get a lab to make them specifically for research is outrageously expensive David says that Compass Pathways is making the research side of things easier He says that he wants the proper research to be done so that it can be available for all those who need it, and for that he supports Compass Pathways, but if they were to pull something like what happened with Esketamine and making an isomer of Ketamine extremely expensive, then he will not support it Nature and Psychedelics Psychedelics provide a feeling of connectedness with nature People prefer to take psychedelics outside, but overall prefer to have amazing, transformative experiences, which in turn makes them more tuned in to nature Transpersonal Experience An experience that is genuinely transpersonal can be useful Typically after a transformational experience, people question their sanity, they have cognitive dissonance, their world view just isn't suitable enough to contain a normal sense of reality anymore Its common for a lot of experiences to need a lot of integration afterward David leads breathwork sessions He sees people who have taken loads of psychedelics come in with skepticism about Breathwork, and then leave having the most transformative experience they've ever have “There are no limits to the human mind, and there are many ways to get there, and psychedelics are just the more obvious route.” - David We get further and further away from figuring out psychedelics as a whole the more hyper-specialized we become in our individual fields The psychedelic space is a really interesting territory The things that Terrence McKenna would talk about years ago, we are finally starting to explore with science Links Otherworlds: Psychedelics and Exceptional Human Experience (Muswell Hill Press) About David David is Senior Lecturer in Psychology at the University of Greenwich where he teaches the Psychology of Exceptional Human Experience. He was President of the Parapsychological Association between 2009-2011 and has published more than 100 academic papers on the intersection of transpersonal experiences, anomalous phenomena and altered states of consciousness. He has co-authored/co-edited four books on psychedelics and paranormal experience, directs the Ecology, Cosmos and Consciousness salon at the institute of Ecotechnics, and co-founded Breaking Convention.

Dr. Bennett and I discuss FDA approval of a filtered (and more expensive) Ketamine product called Esketamine, ethics of Ketamine use, advantages for mental health, concerns in the field, various approaches for Ketamine use in a clinical setting and much more! www.kriyainstitute.com

In the latest episode of The Psych Review Dave reviews esketamine use in the relapse prevention of treatment resistant depression, Shakira finds out that antidepressant doses may not need to be as high as you might have thought, and Mazz questions the usefulness of CT scanning in first episode psychosis.The articles covered in this month's episode are:- Dave: Daly, E. J., Trivedi, M. H., Janik, A., Li, H., Zhang, Y., Li, X., ... & Thase, M. E. (2019). Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA psychiatry.- Shak: Furukawa, T.A., Cipriani, A., et al. (2019). Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis. The Lancet Psychiatry. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30217-2/fulltext- Mazz: Harris, G. et al. (2019). How often does computed tomography (CT) of the brain demonstrate a cause for psychosis? A 7-year retrospective study at a tertiary metropolitan hospital. Australasian Psychiatry, 27(2), pages 183-186 DOI: 10.1177/103985621881571The Psych Review was brought to you by Call to Mind, a new telepsychiatry service that you can learn more about at www.calltomind.com.au. The original music in our podcast was provided by the very talented John Badgery, and our logo was designed by the creative genius of Naz.

Dr. Roy Perlis is the director of the Center for Quantitative Health at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. J. Kim and Others. Esketamine for Treatment-Resistant Depression — First FDA-Approved Antidepressant in a New Class. N Engl J Med 2019;381:1-4.

Download In this episode, Joe interviews Raquel Bennett, Psy.D. at Kriya Institute. In the show, they cover topics surrounding the properties and paradigms of therapeutic Ketamine use. 3 Key Points: The Kriya Institute is devoted to understanding the therapeutic properties of Ketamine. Raquel Bennett specializes in using Ketamine therapy for patients with severe treatment resistant disorders. There are three questions that should be used when determining if someone is fit for Ketamine therapy. Is it safe? Is it legal? Is it ethical? There are many different paradigms for Ketamine Therapy, but determining the best method for each individual patient is the goal. Support the show Patreon Leave us a review on iTunes Share us with your friends – favorite podcast, etc Join our Facebook group - Psychedelics Today group – Find the others and create community. Navigating Psychedelics Trip Journal                                             Integration Workbook Show Notes Kriya Institute The Kriya Institute deals with how to work with Ketamine specifically in Psychiatry and Psychotherapy Kriya provides clinical services to patients, training for other clinicians, and Kriya conference The conference is a big collaborative meeting Raquel is trying to create a patient assistance fund to make services more available to people Ketamine Ketamine isn't addictive physically It is possible to become psychologically addicted to Ketamine Raquel thinks its a property of the person not of the object It's possible to become addicted to anything, shopping, sex, etc. About Raquel She first encountered Ketamine in 2002 when she was suffering from severe depression She was seeing a therapist that took her to a psychedelic shaman where she took Ketamine From the way she felt after taking Ketamine, she wanted to know if it was replicable for other people She is interested in people with treatment resistant mood disorders, such as severe depression, unusual bipolar disorder and people living with active suicidal ideation She remembers her teachers (who gave her Ketamine) saying they don't use it often, and don't know if it will work They were not seeking an antidepressant effect, they were helping her to connect to the cosmos and the universe, to find out why she was having such severe depression The fact that it acted as a rapid-acting antidepressant was a surprise to them, and that's what triggered her curiosity with it “Most of what I know of being a Ketamine provider, I learned from being a patient” - Raquel Ketamine and Patents Johnson and Johnson just came out with a filtered Ketamine product that they patented $850 for 84mg of filtered Ketamine $1.59 for 100mg of generic Ketamine They are only providing it as a nasal spray Companies tried to make a new molecule, but they couldn't Instead, they modified it, and filtered it, and then patented it (Esketamine) Ketamine Treatment Paradigms There is a lot of disagreement on the route, the dose, the setting importance, etc This was the reason she created the Kriya conference, to share ideas, to find the best possible methods One way is to give it as a low dose infusion out of the anesthesiology model (0.5mg of Ketamine per kg of bodyweight in an infusion center) They aim to get enough ketamine in the patient's body without the psychedelic effects They take the normal dose, divide it by 6, and space it out to avoid the psychedelic nature The patient is being forced into a passive role, they aren't being called to heal themselves, they are just showing up for the medicine Raquel says that's not all that there is to it, the medicine is only half of it Another paradigm for using Ketamine is facilitated Ketamine Psychotherapy In this way, the Ketamine is used as a lubricant for talk therapy We are using Ketamine to help people to talk about material that is too painful or too shameful to get to otherwise” - Raquel In this paradigm, the emphasis is on the therapy, not the Ketamine, the Ketamine is a lubricant and a tool In this way, the patient and the therapist are both participating 50%, the patient is not passive She says the psychedelic effects are to be avoided, or else the patient becomes too far out The third paradigm would be to induce mystical experience on purpose As a provider, it is believed that the visions are meaningful Only about 1 in 6 patients are actually a good candidate for psychedelic dosing The patient is willing to offer their body up as a vessel, and the messages they receive are from God The provider's role is to make sure the journey is safe, and then help the patients to help construct meaning from what they saw, create actionable steps on how to change their lives Raquel says that all of these paradigms are helpful, different methods work for different patients That’s her job as a Ketamine Specialist, to determine which method is best for patients “This is where the direction of the field needs to go, being aware of the spectrum of the services available, and then matching the treatment to the patient. Individualized treatment.” - Raquel Proper Use Is it safe? Is it legal? Is it ethical? Is it appropriate to give Ketamine Treatment to someone without a profound impairment or disorder? The literature supports the use of Ketamine for the following psychiatric or psychological disorders; major severe refractory depression, bipolar depression, physical pain with depression, recurrent suicidality and obsessive compulsive disorder Do the potential benefits verify the potential risks? Raquel doesn't believe that making this experience available to everyone is the right way, her goal is to demonstrate that Ketamine is safe and useful for refractory problems Group Administration They can work with 6 clients at a time It includes carefully selected individuals that all fit into the group This provides a much lower cost for patients Ketamine Types There are 3 Types of Ketamine The molecules themselves are not flat, they are 3 dimensional and fold in space Some molecules are ‘right handed’ and others are ‘left handed’ Right handed molecules are Arketamine and left handed are Esketamine Generic Ketamine is an even amount of Arketamine and Esketamine molecules What Johnson and Johnson did with Esketamine was patenting the filtration process of removing Arketamine from the Esketamine molecules Kriya Institute Site Kriya Conference in November A list of providers working with therapeutic Ketamine A resource list of books and journey music A Contact option Links Website About Raquel Bennett Dr. Bennett is a Post-Doctoral Fellow in Clinical Psychology (PSB 94022544), working under the supervision of Dr. Bravo. Dr. Bennett primarily works with people who are experiencing severe depression, who are on the bipolar spectrum, or who are contemplating suicide. She has been studying the therapeutic properties of ketamine since she first encountered it in 2002. In addition to her clinical work, Dr. Bennett’s practice has evolved to include consultation services for medical professionals who wish to add ketamine services to their offices. She also lectures frequently about therapeutic ketamine. Dr. Bennett is the Founder of KRIYA Institute and the Organizer of the KRIYA Conferences.

In this episode we discuss the recent FDA approval of esketamine (Spravato) for the management of treatment resistant depression as an add on to oral antidepressant therapy. The agent is novel though so, too, may be its adverse effect profile and logistics of administration.

Are grudges necessary? Why do we have them? Also Coachella and Kanye West’s Sunday Service are covered!

Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. Jeff: As a quick survey of our audience before we begin, how many of you routinely encounter co-morbid psychiatric conditions in your ED patients, especially depression? Nachi: That would certainly be all of our listeners! Jeff: And how many of you struggle to admit or transfer patients for a formal psychiatric eval? Show More v Nachi: Again, just about all of our listeners I’m sure! Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? Nachi: That would certainly be helpful. So now that we are all in agreement with just how necessary this episode is, let’s dive in. Jeff: This month’s issue was authored by Dr. Bernard Chang, Katherine Tezanos, Ilana Gratch and Dr. Christine Cha, who are all at Columbia University. Nachi: In addition, it was peer reviewed by Dr. Nicholas Schwartz of Mount Sinai School of Medicine in New York and Dr. Scott Zeller of the university of California-Riverside. Jeff: Quite the team, from a variety of backgrounds. Nachi: And just to put this topic into perspective - annually, there are more than 12 million ED visits for substance abuse and mental health crises. This represents nearly 12.5% of all ED visits. Of note, among these visits, nearly 650,000 individuals are evaluated for suicide attempt. Jeff: Looking more in depth, of the mental health complaints we see daily, mood disorders are the most common, representing 43%, followed by anxiety disorders, 26%, and then alcohol related conditions at 23% Nachi: And as is often the case, these numbers are likely underestimates, as many psychiatric complaints, especially depression, often go unnoticed by the patients and providers alike. In one study of patients who presented with unexplained chest and somatic complaints, 23% met the criteria for a major depressive episode. Jeff: Sad, but terrifying, though I suppose it all makes this issue so much more valuable. Nachi: Before we get to the evidence and an evidence-based approach, let’s start with some definitions. Jeff: Certainly a good place to start, but let me preface this with an important point - arriving at a specific psychiatric diagnosis in the ED is likely neither feasible nor realistic due to the obvious limitations, most namely, time - instead, you should focus on assessing and collecting information on the presenting symptoms and taking a comprehensive psychiatric and medical history. Nachi: According to DSM-5, to diagnose a major depressive disorder you must have 5 or more of the following: depressed mood, decreased interest or pleasure in most activities, body weight change, insomnia or hypersomnia, restlessness or slowing, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate or indecisiveness, or finally recurrent thoughts of death and or suicide. In addition, at least 1 of the symptoms must be either a depressed mood or loss of interest. Jeff: These symptoms must last most of the day, nearly every day, for 2 weeks. Nachi: And these symptoms must cause clinically significant distress or impairment across multiple areas of functioning. Jeff: So those were criterion A and B. Criterion C, D, and E state that a MDD does not include factors from substance use or medical conditions, psychotic disorders, or manic episodes. Nachi: Once you’ve had the symptoms for 2 years with little interruption, you likely qualify for a persistent depressive disorder rather than a MDD. Jeff: And if your symptoms repeatedly co-occur around menses, this is more likely premenstrual dysphoric disorder. Nachi: Moving on to suicide and suicide related concepts. Suicidal ideation is the consideration or desire to kill oneself. Jeff: These can be active or passive thoughts, for example, “I don’t want to be alive” vs “I want to kill myself.” Nachi: Other important terms include, the suicide plan, suicide attempt, suicide gesture and nonsuicidal self-injury. The plan typically includes the how, where, and when a person will carry out their attempt. Jeff: A suicide gesture is an action or statement that makes others believe that a person wants to kill him or herself, regardless of the actual plan. Nachi: I think that’s good for definitions, let’s discuss some more epidemiology. Based on 2005 data, the prevalence of 1 month MDD was 5% with a lifetime prevalence of major depression of 13%. Jeff: If those figures seem a bit high, another CDC study found that in a general population survey of a quarter million people between 2006-2008, 9% met the criteria for major depression. Pretty big numbers... Nachi: Sadly, though outpatient visits for depression and suicide related complaints have decreased over the years, while ED visits remain stable, implying that the ED is a critical entry point for depressed and suicidal patients. Jeff: It’s important to also recognize at risk populations. In several studies, the prevalence of MDD is reported as being nearly twice as high in women as it is in men. Nachi: MDD is also much more common in younger adults, with a prevalence of about 20% in those under 65 and a prevalence of just 10% in those 65 and older. Jeff: Additionally, being never-married / widowed / or divorced, being black or hispanic, having poor social support, major life events, and have a history of substance abuse are all serious risk factors for depression. Nachi: In terms of suicidality, nearly half of depressed adults in one study felt that they wanted to die, with ⅓ having thought about suicide. Taking it one step further, somewhere between 14-31% of depressed adults have attempted suicide, and roughly 1 in 10 depressed adults ultimately die by suicide. Jeff: And while it seems crass to even mention the financial impact, the number is shocking - suicide has an estimated economic burden of $5.4 billion per year in the US. Nachi: That’s an incredible amount and much more than I would have guessed. Jeff: In terms specific risk factors for suicide and suicide related complaints - white men over 80 have the highest rate of suicide death in the US, with 51.6 deaths per year per 100,000 individuals. Nachi: You snuck in an important word there - suicide DEATH. While old people die the most from suicide, younger adults attempt suicide more often. Jeff: Along similar lines, while women attempt suicide nearly 4 times more frequently than men, men are 3 times more likely to die by suicide, likely related to their respective choice of suicide methods. Nachi: Lesbian, gay, and bisexual men or women are another at risk population, with rates of suicidal ideations being nearly twice that of their heterosexual counterparts Jeff: Despite the litany of risk factors we just ran through, the strongest single predictor for suicide related outcomes is a prior history of suicidal ideation or attempt, with individuals who have made a previous attempt being nearly 6 times more likely to make another. Nachi: And lastly, those who have had symptoms severe enough to warrant psychiatric admission have an increased lifetime risk of suicide also at 8.6% vs 0.5% for the general population, in one study. Jeff: Alright, so that wraps up the background, let’s move on to the actual evaluation. Nachi: When forming your differential, a crucial aspect is identifying potential secondary causes of depressive symptoms, as many depressive symptoms are driven by etiologies that require different management strategies and treatment. Be on the lookout for toxic-metabolic, infectious, neurologic disturbances, medication side effects, and recent medical events as the etiology for depressive episodes and suicidality. Jeff: Excellent point, which we’ll reiterate a few times throughout the episode - always be on the lookout for medical causes of new psychiatric symptoms. Next, we have my favorite, prehospital care - when doing your scene assessment, look out for possible signs of overdose such as empty pill bottles lying around. It’s also important to assess for the presence of firearms. Of course, this should not be done at the expense of acute medical stabilization. Nachi: And don’t forget to consider transport directly to institutions with full psychiatric services, especially for those with active suicidal ideations. Jeff: Once in the ED - start by maximizing the patient's privacy. Always use a nonjudgmental approach and use open-ended questions. Nachi: If feasible, map the chronology of depressive symptoms and their impact on the patient’s functional status. It’s also important to elicit any psychiatric history, including prior hospitalizations. Jeff: Screening for suicidality is critical in all patients with depressive symptoms given the elevated risk in this population. Though not broadly adopted in many EDs, there are a number of screening tools to assist you in this process, including the PHQ-9, ED SAFE PSS-3, and C-SSRS, which all asses for severity of suicide risk. These have been developed primarily for the outpatient and primary care settings. Nachi: And not surprisingly, MDCalc has online tools to help you use these risk assessments, so you can easily pull up a scoring tool on your phone should the appropriate clinical scenario arise. Jeff: The PHQ-9 was validated in various outpatient settings, including the ED. This is a self-administered depression questionnaire that has been found to be reliable across genders and different cultures. Interestingly, the PHQ-9 questionnaire contains one question about suicidality - how often is the patient bothered by thoughts that you would be better off dead or hurting yourself. Responding “nearly every day” increases your odds from 1 in 250 to 1 in 25 of attempting suicide. Nachi: The next tool to discuss is the ED-Safe PSS-3. The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt. Jeff: In one study, using this tool doubled the number of suicide-risk cases detected. Nachi: Once someone has screened positive for recent suicidal ideations, further screening must be done via a secondary screener. Jeff: In one study, following this approach decreased the total number of suicide attempts by 30% following an ED visit. Nachi: And what would you advise to clinicians that are concerned that questioning a patient about suicidal ideation may actually encourage or introduce the idea of suicide in those who hadn’t already considered it? Jeff: Great question - It has been found that there has been no associated introduction of negative effect when a patient is asked about suicidal ideations. Concerns about iatrogenic effects should not prevent such evaluations. Nachi: Definitely reassuring that this has been looked into. Let’s move on to the physical. Jeff: The physical exam should include a cognitive assessment that focuses on identifying medical conditions, as well as a behavioral mental health status exam that focuses on identifying the presence and degree of depression. Nachi: And as you said, we would mention it a few times -- In the ED, you always want to make sure you aren’t missing an underlying medical condition that manifests as depression. Jeff: So important. Alright, let’s move on to diagnostic studies. And thanks to a systematic review of 60 studies on this topic, there is actually reasonably good data here. Nachi: According to this review, in patients with a known psychiatric disease presenting with exacerbating psychiatric complaints, routine serum and urine tox screening is not recommended. Additional screening tests should be considered in those with new psychiatric symptoms who are 65 years or older, those who are immunosuppressed, and those with concomitant medical disease. Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. They too call for a focused history and physical to guide testing. Nachi: It’s also worth highlighting one other incredibly important point from that ACEP policy - urine tox screens for drugs of abuse should not delay patient evaluation for transfer to a psychiatric facility. Jeff: Definitely a great policy to check out if you find yourself in all too frequent disagreements with your local psychiatric receiving facility. Nachi: You should also consider serum testing in those taking psychotropic medications with known toxic effects, such as lithium, as toxicity would change management. Jeff: Ok, last point about the work up, imaging studies of the brain should not be routinely ordered unless you have a high degree of suspicion. Nachi: That wraps up testing. Let’s move on to treatment. Jeff: First and foremost, you must maintain a safe environment. Effective precautions include alerts to staff about the potential safety risk in addition to searches of the patient and his / her belongings if applicable. Nachi: With the staff notified and the patient searched, the patient should be placed in a room without potentially dangerous items, like tubing or needles. Those who are at a very high risk may warrant continuous observation. Jeff: Speaking of safety, you will definitely want to engage in safety planning with the patient. Safety planning can be completed by any emergency clinician and should take about 20-45 minutes. Nachi: And while this is typically done by a psychologist or psychiatrist, this is something any emergency clinician can also easily do. Jeff: Safety planning beings with a brief interview. Next you establish a list of personalized and prioritized steps to help the patient through his or her next crisis. In a full plan, you should identify: warning signs, internal coping strategies, people and social settings that provide distraction, people whom the patient can ask for help, professionals or agencies whom the patient can contact during a crisis, and lastly how to make the environment safe (for example, lethal means counseling). Nachi: Of course, while the plan is meant to be a step by step approach for the patient, you should encourage the patient to seek professional help at any time if it is necessary. Jeff: Great point. And while safety planning typically is most effective when combined with other interventions, research suggests that it does enhance outpatient treatment engagement after an ED visit and in one study, reduce subsequent suicide attempts by 30% vs usual care. That’s a huge win for something that’s not that hard to do. Nachi: Similar to safety planning, let’s discuss no-suicide contracts. No-suicide contracts or no-harm contracts are verbal or written agreements between the patient and the clinician to articulate that he or she will not attempt to hurt him or herself. Though there isn’t a ton of evidence, at least one RCT showed that safety planning was superior to contracts. Jeff: Lethal-means counseling on the other hand is a potentially helpful prevention strategy. In lethal means counseling, you merely have to address the patient’s access to lethal means. By slowing their access to their lethal means, it is thought that the relatively short-lived suicidal crises may pass before they could access said means. Nachi: For example, you could provide options for restricting access to lethal means, such as disposal, locking up and giving the key to someone else, or temporarily giving the means to a friend. Jeff: And this may be a good time to involve friends and or family, especially when dealing with suicidal youths. Nachi: This is such an important and simple intervention that has actually been shown to reduce suicide attempts and deaths. Unfortunately, few ED clinicians address lethal means. Jeff: Pro tip: since most ED clinicians chart with templates, add something to your standard suicidality / psychiatric template about lethal means. This will serve as an important reminder to address it in real time. Nachi: That is a really great idea to ensure you don’t skip over this underutilized counseling. Jeff: The next aspect of treatment to discuss is follow up. Follow up is critical for both depressed and suicidal patients. Follow up can come in many forms and at a minimum should include the national suicide prevention lifeline. Nachi: The authors even simplify this for us a bit, providing 5 easy steps to help make sure patients follow through with ED discharge recommendations. Jeff: First, provide a standard handout that includes a list of outpatient providers. Next provide the patient the 24 hours crisis line number. After that, ask the patient to identify the most viable resources and address any barriers the patient may have in getting there. Next, schedule a follow up appointment, ideally within a week of discharge, and lastly, document the patient’s preferred follow up resources and steps taken to get them there. Nachi: And if this seems too burdensome for a single provider, think about identifying a staff member who may help the patient with follow up - perhaps a social worker or case manager. Follow up is so important, it’s critical that the ball not be dropped after you’ve put in so much hard work to make the plan. Jeff: As always, the team approach is preferred. Alright so the last treatment to discuss is actual pharmacotherapy. Since commonly prescribed antidepressants take up to 6-8 weeks to have a clinical effect, the administration of psychotropic medications is not routinely initiated in the ED. Interestingly, there may be a role for ketamine, yes, ketamine, in conjunction with oral meds. More on that in a few minutes though... Nachi: Let’s talk first about special populations - the only one we will discuss this month is military veterans. Jeff: Recent evidence has demonstrated an association between exposure to blast and concussive injuries and subsequent depressive and anxiety symptoms. Nachi: In part, because of this, among veterans presenting for emergency psychiatric services, approximately 52% reported suicidal ideations in the prior week and 70% reported current depressive symptoms. Clearly this is a major problem in this population. Jeff: But to bring it back to ED care, in one study, among depressed veterans with death by suicide, 10% had visited a VA ED in the 30 days prior to their death. Nachi: And this is in no way meant to be a knock-on VA ED docs - they are dealing with a very at risk population. But it is worth highlighting the importance of the ED visit as an excellent opportunity to begin to engage the patient in long term care. Jeff: Exactly, every ED visit is an opportunity that shouldn’t be missed. Nachi: Let’s talk controversies and cutting-edge topics from this issue. Jeff: First, let’s start by returning to ketamine and the treatment-resistant depression and suicidality. Nachi: Recent trials, including RCTs have found that low doses of ketamine administered via a variety of routes, may have a significant therapeutic effect towards reducing suicidality in patients in the acute setting. Jeff: To this end, Esketamine, an intranasal version of ketamine has already been FDA approved for treatment resistant depression. Nachi: This has huge implications for some of the psychiatrically sickest patients, so be on the lookout for more in the future. Jeff: Next we have the zero-suicide model. This is a program of the national action alliance for suicide prevention that involves a multi pronged approach to reducing suicide based on the premise that suicide is preventable. This model involves educating clinicians on best practices, identifying screening and assessment tools for engagement, treatment, and disposition. Nachi: Though not yet implemented in the ED setting, this may offer a novel approach to ED patients with psychiatric emergencies in the ED. Jeff: The next controversy is a big one - alcohol intoxication and suicide risk. There is a bidirectional relationship between depression and alcohol abuse and dependency. Not only is alcohol abuse a lifetime risk factor for completed suicide, those who make suicide attempts or present with suicidal ideations are more likely to be intoxicated. Nachi: In addition, formerly intoxicated patients may deny their previous thoughts and intentions when sober. Interestingly, though such patients have an increased lifetime risk of death by suicide. Jeff: Given this paradox and the evidence that exists, the authors recommend observing the patient until they have reached a reasonable level of sobriety. This effective level of sobriety should be based on clinical assessment and not blood alcohol levels. If the patient unfortunately has reached a place where they are at risk of withdrawal, this should be treated while in the ED. Nachi: It’s worth noting that ACEP guidelines and guidelines from the american association for emergency psychiatry have both supported a personalized approach that emphasize evaluating the patient’s cognitive abilities rather than a specific blood alcohol level to determine when to pursue a formal psychiatric assessment. Jeff: Very important point - in this high-risk population, you are targeting a clinical endpoint, not a laboratory end point and this is backed by several national guidelines. Nachi: Moving on to the next topic - let’s discuss post discharge patient contact. Jeff: Though not something many ED clinicians routinely do, this may be something to consider implementing in your department. And this doesn’t even have to be something as time consuming as a phone call. In one study, sending a brief postcard 9 times a year with a quick “hope things are well” type message to patients discharged after deliberate self-harm reduced self-poisonings by 50%. Nachi: Though other studies including other methods of follow up have not shown as drastic results, generally the results have shown a positive impact. Jeff: Next we have to discuss the various screening tools. Though we previously mentioned screening tools in a positive light, using such decision-making tools is still of limited utility due to the fact that they rely on self-reporting and suicidal thoughts and behaviors are complex and may require the consideration of hundreds of risk factors. Nachi: And while implicit association tests are being developed to predict suicidal thoughts and behaviors, and computer models and machine learning are being used to enhance our screening tools, there is still a long way to go before such tools perform more independently with acceptable performance. Jeff: The last cutting-edge topic to discuss is telepsychiatry. Nachi: Just as telestroke has changed stroke care forever, as technology advances, telepsychiatry may provide a solution to easily expand access to outpatient services and consultation in a cost effective manner - offering quick psychiatric care to those that never had access. Jeff: Let’s move on to the final section of the article. Disposition, which can be a bit complicated. Nachi: The decision for discharge, observation, or admission depends on clinical judgment and local protocols. Appropriate disposition is often fraught with legal, ethical, and psychological considerations. Jeff: It’s also worth noting that patients with suicidal ideations tend to have overall longer lengths of stay when compared to other patients on involuntary mental health hold. Nachi: There are however some suicide risk assessment tools that can help in the disposition decision planning such as C-SSRS, SAFE-T, and ICARE2. C-SSRS is a series of questions that assess the quality of suicidal ideation. SAFE-T is 5 step evaluation and triage tool that assesses various qualities and makes treatment recommendations. ICARE2 is provided by the American College of Emergency Physicians as a result of an iterative literature review and expert consensus panel. It also integrates many risk factors and treatment approaches. Jeff: It goes without saying that none of these tools are perfect. They should be used to assist in your clinical decision making. Nachi: For depressed but not actively suicidal patients, ensure close follow up with a mental health clinician. These patients typically do not require inpatient hospitalization. Jeff: Let’s also touch upon involuntary confinement here. Patients who are at imminent risk of self harm who refuse to stay for evaluation may need to be held involuntarily until a complete psychiatric and safety evaluation is performed. Nachi: Before holding a patient involuntarily, it is important to fully familiarize yourself with the state and county laws as there is wide variation. The period of involuntary confinement should be as short as possible. Jeff: With that, let’s close out this month’s episode with some high yield points and clinical pearls. Risk factors for major depression include female gender, young or old age, being divorced or widowed, black or Hispanic ethnicity, poor social support, and substance abuse. The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt. When evaluating a patient with depressive symptoms, try to identify potential secondary causes, as this may influence your management strategy. When assessing for depression, perform a complete history and consider underlying medical causes that may be contributing to their presentation. Consider serum testing for the patient’s psychiatric medications if the medications have known toxic effects. 1. Routine serum testing and urine toxicology testing are not recommended for psychiatric patients presenting to the emergency department. Imaging of the brain should not be ordered routinely in depressed or suicidal patients. Depression places patients at a significantly increased risk for alcohol abuse and dependence. In addition to providing appropriate follow up resources to your depressed patients, emergency clinicians should consider making a brief follow up telephone call to the patient. Telepsychiatry may improve access to mental health providers and allow remote assessment and care from the ED. Suicide risk assessment tools such as C-SSRS, SAFE-T, and ICARE2 can help when deciding on disposition from the ER. It may be necessary to hold a patient against their will if they are at immediate risk of self-harm. Though not routinely administered in the ED for this purpose, psychotropic medications, such as ketamine, have proven helpful in acute depressive episodes. Patients who are actively suicidal should be admitted to a psychiatric observation unit or inpatient psychiatric unit. Nachi: So that wraps up Episode 28! Jeff: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Nachi: And don’t forget to check out the lineup for the upcoming Clinical Decision Making in Emergency Medicine conference hosted by EB Medicine, which will take place June 27th-30th. Great speakers, great location, what more could you ask. Jeff: And the address for this month’s cme credit is ebmedicine.net/E0519, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References 1. Owens PL, Mutter R, Stocks C. Mental health and substance abuse-related emergency department visits among adults, 2007: statistical brief #92. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. (US government report) 12. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington DC: American Psychiatric Association; 2013. (Reference book) 15. Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807-816. (Survey data; 49,093 patients) 16. Centers for Disease Control and Prevention. Current depression among adults---United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep. 2010;59(38):1229-1235. (Government survey data analysis; 235,067 subjects) 97. Murrough J, Soleimani L, DeWilde K, et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med. 2015;45(16):3571-3580. (Randomized controlled trial; 24 participants) 100. Griffiths JJ, Zarate CA, Rasimas J. Existing and novel biological therapeutics in suicide prevention. Am J Prev Med. 2014;47(3):S195-S203. (Review article)

Medical Notes for the week of March 31, 2019 including: A nasal spray to treat depression called Esketamine. Then, parent skills that can help navigate conflict with teens. Finally, fast food now accounts for 11% of the energy intake in the United States.

Rafael Coira, MD, JD and James Sherer, MD discuss the new FDA approval of the Esketamine nasal spray for treatment of depression. Marketed under the trade name Spravato, Esketamine promises to reverse depression in one day, but what are the risks of taking a medication derived from the drug PCP?

MS is an equal opportunity neurological disease. It doesn't seem to discriminate against any particular ethnic or racial group. It affects Latinos and African-Americans, as well as Caucasians. And if you're an MS research scientist, who's hoping to create a viable treatment that's going to be safe & effective for the diverse population living with multiple sclerosis, then having that diversity represented in your clinical research seems like it would be important. Unfortunately, it doesn't always happen that way. Minority populations are frequently overlooked and under-represented in MS clinical research.   My guest on the podcast is Dr. Mitzi Joi Williams, a neurologist and MS Specialist with a strong interest in better understanding the course of MS in ethnic minority populations, and in increasing diversity in clinical research.      We're also talking about important MS stem cell research that's being funded by the Department of Defense, the risks associated with stem cell tourism, a new oral Disease Modifying Therapy for relapsing-remitting MS, and a newly-approved prescription medication for treatment-resistant depression.   We have a lot to talk about! Are you ready for RealTalk MS?!   ___________ Promising MS Stem Cell Research Funded by Department of Defense  1:33 National MS Society Announces Strategic Partnership with U.S. Department of Veteran Affairs  4:32 The Risks of Stem Cell Tourism 5:26 Celgene Seeks EMA Approval of Ozanimod  11:29 FDA Approves Esketamine for Treatment-Resistant Depression  12:50 My Interview with Dr. Mitzi Joi Williams  16:27 ___________ ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jonstrum@RealTalkMS.comPhone: (310) 526-2283 ___________ LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com Download the RealTalk MS App for iOS Download the RealTalk MS App for Android Give RealTalk MS a Rating & Review Using Reprogrammed Stem Cells as a Therapy for MS Complications of Stem Cell Tourism in Multiple Sclerosis & Other Neurological Diseases: Results From First Nationwide Survey of Academic Neurologists Celgene Submits Application to EMA for Ozanimod for the Treatment of Relapsing-Remitting Multiple Sclerosis FDA Approves Esketamine Nasal Spray for Treatment of Resistant Depression MS Made Simple by Dr. Mitzi Joi Williams ___________ Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 82 Hosted By: Jon Strum Guest: Dr. Mitzi Joi Williams Tags: MS, MultipleSclerosis, MSResearch, mssociety, Ozanimod, Esketamine, iConquerMS, Stemcells, RealTalkMS

Welcome to episode 2.1 of the Infusion Room. In this quick episode, you will hear from our host and LMHC May Nunez and Francisco Cruz, MD, Psychiatrist about all the buzz of Esketamine being FDA approved. We are excited about the news and so will you!

As the P.R. machine kicks into gear to support the launch of Spravato/Esketamine, the first FDA approved Ketamine-derived treatment, Kevin Nicholson (President, CEO of Ketamine Wellness Centers) digs into the details that tend to receive less attention. This episode focuses on the cost of Spravato to the provide, end user, and insurer: - What are the preliminary cost estimates for Spravato (wholesale) - Can we estimate the cost to the patient? - Will insurance cover the drug? - How will the treatment schedule effect the cost? www.ketaminewellnesscenters.com/category/podcast/

Download In this episode Kyle and Joe sit down and discuss Esketamine, a new FDA approved drug that is a derivative of Ketamine. They invite quotes from professionals who have experience with generic Ketamine and to voice their opinions. 3 Key Points: Janssen Pharmaceutica has announced an FDA approved derivative of Ketamine, Esketamine, called Spravato. The new drug is facing critique on its pricing, route of administration as well as functional differences when compared to the traditional, generic Ketamine. Joe and Kyle invite professionals in the field who have experience with generic Ketamine to voice their opinions, hopes and concerns about Spravato. Support the show Patreon Leave us a review on iTunes Share us with your friends – favorite podcast, etc Join our Facebook group - Psychedelics Today group – Find the others and create community. Navigating Psychedelics Trip Journal                                               Integration Workbook             Show Notes Esketamine Janssen Pharmaceutica, a Johnson & Johnson Subsidiary has created a derivative of Ketamine called Esketamine and has gone through the whole FDA approval process There has been some concern about a big pharmaceutical company, Janssen coming in and creating a ‘new molecule’ and introducing an FDA approved ‘psychedelic’ to make generic Ketamine obsolete Pricing There is going to be price differences based on routes of administration (Intravenous vs lozenges) $1.59 at 100 milligrams (93% bioavailable when administered IM) The list price of Esketamine through Janssen will be $590-$885 per treatment session based on the dosage taken which will vary between patients During the first month of therapy, that would add up to $4720-$6785 After the first month, maintenance therapy could range from $2300-$3500 Joe says Ketamine should be cheap Scott Shannon Scott Shannon, Director of the Wholeness Center Joe reads a quote from Scott that says that the new Janssen Esketamine product is overpriced, the research data showed that only 2 out of 5 studies demonstrated effectiveness, and generic Ketamine is much more effective and cheaper than Esketamine Insurance Insurance might cover Esketamine Kyle says he hasn't heard of too many generic Ketamine sessions being covered by Insurance Jessica Katzman The approval of Esketamine by the FDA is controversial based on the route of administration, cost and functional differences Only 8-50% of the Esketamine dose is effective Some of the benefits of Esketamine are it's legitimizing of the existing generic Ketamine use as well as an Insurance overview of Ketamine and Esketamine via cost analysis Esketamine is not new, it has been around for a long time Dr. Matt Brown Physicians have been able to provide Ketamine for decades Janssen was able to get the FDA to approve literally half of what generic Ketamine is There are a lot of unknowns for Esketamine yet, it hasn't even hit the shelves yet Kyle says Ketamine has been used to bring patients internally, like most psychedelic sessions Kyle also says Ketamine is more dissociating, where classic tryptamines like psilocybin are more activating Contraindications Hypertension, stroke, intracranial mass/hemorrhage and cautions like pregnancy, substance abuse, etc. It's pretty available in the underground, so it could have the potential for risk of abuse Recreational experiences have the opportunity to be the most therapeutic and eye-opening experience Audiobook - Function of Reason by Alfred North Whitehead "I need not continue the discussion. The case is too clear for elaboration. Yet the trained body of physiologists under the influence of the ideas germane to their successful methodology entirely ignore the whole mass of adverse evidence. We have here a colossal example of anti-empirical dogmatism arising from a successful methodology. Evidence which lies outside the method simply does not count.We are, of course, reminded that the neglect of this evidence arises from the fact that it lies outside the scope of the methodology of the science. That method consists in tracing the persistence of the physical and chemical principles throughout physiological operations." - quote from Function of Reason Opinions Joe invites listeners to ask questions and leave a message of opinions and such (either anonymously or using your name) Google voice 970-368-3133 About Kyle Kyle’s interest in exploring non-ordinary states of consciousness began when he was 16-years-old when he suffered a traumatic snowboarding accident. Waking up after having a near-death experience changed Kyle’s life. Since then, Kyle has earned his B.A. in Transpersonal Psychology, where he studied the healing potential of non-ordinary states of consciousness by exploring shamanism, plant medicine, Holotropic Breathwork, and the roots/benefits of psychedelic psychotherapy. Kyle has co-taught two college-level courses. One of the courses Kyle created as a capstone project, “Stanislav Grof’s Psychology of Extraordinary Experiences,” and the other one which he co-created, “The History of Psychedelics.” Kyle is currently pursuing his M.S. in clinical mental health counseling with an emphasis in somatic psychology. Kyle’s clinical background in mental health consists of working with at-risk teenagers in crisis and with individuals experiencing an early-episode of psychosis. Kyle also facilitates Transpersonal Breathwork workshops. About Joe Joe studied philosophy in New Hampshire, where he earned his B.A.. After stumbling upon the work of Stanislav Grof during his undergraduate years, Joe began participating in Holotropic Breathwork workshops in Vermont in 2003. Joe helped facilitate Holotropic and Transpersonal Breathwork workshops while he spent his time in New England. He is now working in the software industry as well as hosting a few podcasts. Joe now coordinates Dreamshadow Transpersonal Breathwork workshops, in Breckenridge, Colorado.

A Closer Look at Spravato (Esketamine): How will it be administered? As the P.R. machine kicks into gear to support the launch of Spravato/Esketamine, the first FDA approved Ketamine-derived treatment, Kevin Nicholson (President, CEO of Ketamine Wellness Centers) digs into the details that tend to receive less attention. This episode focuses on how Spravato is administered: Is intranasal delivery effective? What type of clinical environments can provide Spravato to patients? What duration of time will patients have to commit to treatment? www.ketaminewellnesscenters.com/category/podcast/

This episode of the NAMI Radio Hour features Clint Fletcher, CRNA and owner of Complete Ketamine, located in Brentwood, Tennessee. Clint opened Complete Ketamine Solutions in Sept 2018. He tells us about Ketamine and how he has administered treatments in his clinic as a treatment for depression and related disorders. We also discuss FDA approval and the off label use of Ketamine as well as the upcoming new nasal spray Esketamine. The NAMI Radio Hour is hosted by Jeff Fladen, NAMI TN Executive Director and is broadcast live Wednesdays at 10 AM CT at www.radiofreenashville.org.

Welcome to our first episode of the Infusion Room. In this episode you will hear from our host and LMHC May Nunez and our doctors Francisco Cruz, MD, Psychiatrist, Raul Cruz, Anesthesiologist, and  Dennis Diaz, CRNA about how Ketamine Health Centers came together. We hope you enjoy this episode. Stay tuned for some amazing testimonials in the upcoming episodes. 

In this mind altering episode of the Dudes n Beer podcast host Christopher Jordan welcomes Ibogaine treatment specialist and Dudes n Beer Psychoactive Correspondent Byron Burkhammer of Beginnings Ibogaine Clinic to the program to discuss the incredible possibilities of using Ketamine for depression, decriminalizing psilocybin and medicinal MDMA.With the recent announcement from Janssen Pharmaceutical (Johnson and Johnson) that they are in final trials for FDA approval for the use of SPRAVATO whose active ingredient is Esketamine, a form of Ketamine, as a nasal spray for the treatment of extreme depression, a whole new world of treatments have come to light. If approved it will mark the first new course of treatment for depression in 30 years. What does the possible use of a drug with such a stigma mean for ongoing research in the realm of psychedelics and other traditional and ethno-centric treatment options? Now that eyes have been opened to new medications can we begin to change how society views compounds such as Ketamine and begin to open the minds of scientist and researchers?In January 2019 an organization called Denver for Psilocybin announced its intent to file for decriminalization of magic mushrooms in the state of Colorado so that more access could be given to those the fungus may help as well as for research purposes. How can traditional medications and plants such as Mushrooms, Marijuana and even Ibogaine and Ayahuasca help researchers better understand how to free our bodies and minds of past trauma and more? What do studies like those being looked at with MDMA mean for the future of brain medicine and treatment?Join the Dues and Beer podcast as we explore these questions and more on the topic of using new and groundbreaking treatments in the world of depression and addiction therapy with Ibogaine treatment specialist and Dudes n Beer psychoactive correspondent Byron Burkhammer of Beginnings Ibogaine Clinic. The Dudes n Beer podcast is a proud member of the HC Universal Network family of podcasts. Download the FREE HC Universal Network app for Android and iDevices or visit our LISTEN LIVE page and join the conversation.

In this mind altering episode of the Dudes n Beer podcast host Christopher Jordan welcomes Ibogaine treatment specialist and Dudes n Beer Psychoactive Correspondent Byron Burkhammer of Beginnings Ibogaine Clinic to the program to discuss the incredible possibilities of using Ketamine for depression, decriminalizing psilocybin and medicinal MDMA. With the recent announcement from Janssen Pharmaceutical (Johnson and Johnson) that they are in final trials for FDA approval for the use of SPRAVATO whose active ingredient is Esketamine, a form of Ketamine, as a nasal spray for the treatment of extreme depression, a whole new world of treatments have come to light. If approved it will mark the first new course of treatment for depression in 30 years. What does the possible use of a drug with such a stigma mean for ongoing research in the realm of psychedelics and other traditional and ethno-centric treatment options? Now that eyes have been opened to new medications can we begin to change how society views compounds such as Ketamine and begin to open the minds of scientist and researchers? In January 2019 an organization called Denver for Psilocybin announced its intent to file for decriminalization of magic mushrooms in the state of Colorado so that more access could be given to those the fungus may help as well as for research purposes. How can traditional medications and plants such as Mushrooms, Marijuana and even Ibogaine and Ayahuasca help researchers better understand how to free our bodies and minds of past trauma and more? What do studies like those being looked at with MDMA mean for the future of brain medicine and treatment? Join the Dues and Beer podcast as we explore these questions and more on the topic of using new and groundbreaking treatments in the world of depression and addiction therapy with Ibogaine treatment specialist and Dudes n Beer psychoactive correspondent Byron Burkhammer of Beginnings Ibogaine Clinic. The Dudes n Beer podcast is a proud member of the HC Universal Network family of podcasts. Download the FREE HC Universal Network app for Android and iDevices or visit our LISTEN LIVE page and join the conversation.

In this mind altering episode of the Dudes n Beer podcast host Christopher Jordan welcomes Ibogaine treatment specialist and Dudes n Beer Psychoactive Correspondent Byron Burkhammer of Beginnings Ibogaine Clinic to the program to discuss the incredible possibilities of using Ketamine for depression, decriminalizing psilocybin and medicinal MDMA. With the recent announcement from Janssen Pharmaceutical (Johnson and Johnson) that they are in final trials for FDA approval for the use of SPRAVATO whose active ingredient is Esketamine, a form of Ketamine, as a nasal spray for the treatment of extreme depression, a whole new world of treatments have come to light. If approved it will mark the first new course of treatment for depression in 30 years. What does the possible use of a drug with such a stigma mean for ongoing research in the realm of psychedelics and other traditional and ethno-centric treatment options? Now that eyes have been opened to new medications can we begin to change how society views compounds such as Ketamine and begin to open the minds of scientist and researchers? In January 2019 an organization called Denver for Psilocybin announced its intent to file for decriminalization of magic mushrooms in the state of Colorado so that more access could be given to those the fungus may help as well as for research purposes. How can traditional medications and plants such as Mushrooms, Marijuana and even Ibogaine and Ayahuasca help researchers better understand how to free our bodies and minds of past trauma and more? What do studies like those being looked at with MDMA mean for the future of brain medicine and treatment? Join the Dues and Beer podcast as we explore these questions and more on the topic of using new and groundbreaking treatments in the world of depression and addiction therapy with Ibogaine treatment specialist and Dudes n Beer psychoactive correspondent Byron Burkhammer of Beginnings Ibogaine Clinic. The Dudes n Beer podcast is a proud member of the HC Universal Network family of podcasts. Download the FREE HC Universal Network app for Android and iDevices or visit our LISTEN LIVE page and join the conversation.

Contact us: podcasts@mdedge.com FDA panels back intranasal esketamine for refractory depression. http://bit.ly/2TOKrfp ONC aims to help doctors, patients with information sharing in proposed rule. http://bit.ly/2X3SVkP Survey: Health care costs unlikely to improve in 2019. http://bit.ly/2SwSIYJ Vaccination and antiviral treatment don't lower stroke risk after shingles. http://bit.ly/2tjYQVa