Medically Induced Coma For Depression

How Does Ketamine Work

Its not entirely clear how ketamine works. Because it exerts an antidepressant effect through a new mechanism, ketamine may be able to help people successfully manage depression when other treatments have not worked.

One likely target for ketamine is NMDA receptors in the brain. By binding to these receptors, ketamine appears to increase the amount of a neurotransmitter called glutamate in the spaces between neurons. Glutamate then activates connections in another receptor, called the AMPA receptor. Together, the initial blockade of NMDA receptors and activation of AMPA receptors lead to the release of other molecules that help neurons communicate with each other along new pathways. Known as synaptogenesis, this process likely affects mood, thought patterns, and cognition.

Ketamine also may influence depression in other ways. For example, it might reduce signals involved in inflammation, which has been linked to mood disorders, or facilitate communication within specific areas in the brain. Most likely, ketamine works in several ways at the same time, many of which are being studied.

Why Is There Confusion Over Where The Economy Is Heading

The weather forecast seems more predictable than the economy these days. That uncertainty remains, in part, because this current economic downturn isn’t like anything the U.S. has experienced in the past.

“Typically, our recessions have been induced because of an issue in the financial market, oil prices, monetary policy it’s usually induced from some sector in the economy,” Rouse says. “This is from a public health scare and a public health crisis, and so I think we just honestly don’t know.”

Furman agrees, saying that over the course of the last century, the U.S. hasn’t seen anything like what it’s experiencing now. “Economists are not at all confident,” he says.

There are two economic models that most experts are using to predict what effect coronavirus will have on the economy. One is based on what typically happens after a natural disaster. When a hurricane hits an area, for example, usually most people return to work and the economy snaps right back to normal, Furman says

But economists are also looking at the economic model for what typically happens after a financial crisis. After the U.S. experiences a financial crisis and a recession, it generally takes five to 10 years for the economy to return to normal,” Furman says.

What Causes Depression After Tbi

Many different factors contribute to depression after TBI, and these vary a great deal from person to person.

• Physical changes in the brain due to injury. Depression may result from injury to the areas of the brain that control emotions. Changes in the levels of certain natural chemicals in the brain, called neurotransmitters, can cause depression.
• Emotional response to injury. Depression can also arise as a person struggles to adjust to temporary or lasting disability, losses or role changes within the family and society.
• Factors unrelated to injury.Some people have a higher risk for depression due to inherited genes, personal or family history, and other influences that were present before the brain injury.

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Ketamine And Other Drugs

The following adverse drug interactions are possible:

• Theophylline or aminophylline : These drugs treat airway obstruction in people with asthma and chronic obstructive pulmonary disease. Taking one of them together with ketamine may lower the threshold for seizures, which would increase their risk.
• Vasopressin : This class of drugs constricts blood vessels and helps treat low blood pressure. Because ketamine also has this effect, a doctor should prescribe a lower dose to avoid the dangers of too much blood vessel constriction.
• Central nervous system depressants: The CNS consists of the brain and spinal cord. Drugs that suppress CNS action include benzodiazepines, which are antianxiety medications, such as diazepam , or opioid pain relievers, such as oxycodone . Taking one of these with ketamine may result in profound sedation, coma, and death.

Aside from the above drug interactions, a 2017 study reports that taking ketamine with amphetamine-like stimulants can produce undesirable effects.

Amphetamines may worsen the thinking disorders associated with ketamine, while ketamine may worsen depression, anxiety, and lack of energy.

A person taking ketamine should check with their doctor before taking any over-the-counter medications.Learn more about drug interactions here.

What Is Samhsa’s National Helpline

SAMHSAs National Helpline, , or TTY: is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 to find help near you. Read more about the HELP4U text messaging service.

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Are There Different Types Of Ketamine

Two main types of ketamine are used to treat major depression that hasnt responded to two or more medications .

• Racemic ketamine, which is most often given as an infusion into the bloodstream. This is sometimes called intravenous, or IV, ketamine. It is a mixture of two mirror-image molecules: “R” and “S” ketamine. While it was approved decades ago as an anesthetic by the FDA, it is used off-label to treat depression.
• Esketamine , which the FDA approved in March, is given as a nasal spray. It uses only the “S” molecule.

Thus far, most research has been on ketamine infusions.

The two forms of ketamine interact differently with receptors in the brain. The delivery of ketamine and the type given affect drug effectiveness and side effects. We dont yet know which type is more effective or how much side effects may differ. Further research comparing effectiveness and side effects is needed.

So Then What Is A Financial Depression

There’s no officially accepted definition of a depression, says Stiglitz, author of “People, Power, and Profits: Progressive Capitalism for an Age of Discontent.” A depression just means a long recession, Rouse says.

The difference between a recession and depression comes down to the length of time that the economic downturn lasts and also the depth, or severity, of the effects. The Great Recession, for example, lasted from December 2007 until June 2009 and unemployment peaked at 10%.

Yet during the Great Depression, which lasted about 10 years, from 1929 to 1939, unemployment reached 25%.

Transitioning from a recession to a depression is not just about how high the unemployment rate goes. “It just needs to stay high for some time,” Furman says. Currently, the U.S. unemployment rate is about 10%, but it’s expected to continue to grow. Economists with the St. Louis Federal Reserve estimate that the total number of Americans without a job could hit 47 million, or about a 32% unemployment rate.

“I would say if in December 2021 the unemployment rate is above 15%, then we’re in something like a depression,” Furman says. And yet he’s not convinced the U.S. is heading that way.

While two months of high unemployment is terrible, the U.S. government can protect families against that, he says. “A decade of high unemployment would represent a really epic failure of economic policy of a type that I think is very unlikely to happen now,” Furman adds.

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What Else Should You Know About Ketamine

• A much lower dose of ketamine is given for depression compared with the dose necessary for anesthesia.
• Like opioids, ketamine has addictive properties. Its important to understand this when weighing risks and benefits. If you have a history of substance abuse such as alcohol or drugs its especially important for you and your doctor to consider whether ketamine is a good option for you.
• When IV ketamine works, people usually respond to it within one to three infusions. If a person has no response at all, further infusions are unlikely to help. Instead, its probably best to try other treatments for depression.
• People who experience some relief from depression within one to three ketamine treatments are probably likely to extend these positive effects if the treatment is repeated several more times. The subsequent sessions may help prolong the effects of ketamine, rather than achieving further dramatic relief of symptoms. There are no standard guidelines for this. Many studies offer eight treatments initially . After this, patient and doctor decide whether to taper or stop ketamine treatments or continue treatments at longer intervals.

About the Author

Robert C. Meisner, MD, Contributor

Risks Of A Medically Induced Coma

Thankfully the risks associated with a medically induced coma are relatively low. The procedure is completely reversible, but problems can arise, such as:

• Heart problems
• Atrophy
• Bedsores

Heart problems associated with the use of pentobarbital are the most serious side effects. The drug can weaken the heart muscle and result in low blood pressure, impaired circulation, and heart failure.

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What Is A Traumatic Brain Injury

A traumatic brain injury is a damage done to the brain resulting from a forceful blow to the head, a sharp jolt causing the brain to be thrown against the skull, or penetration of the brain tissue.

The damage to the brain can include bruising, swelling, torn tissue, and bleeding. Long-term consequences can be severe, with death being a possibility.

The symptoms of a traumatic brain injury vary widely, and while some are immediately detectable, others may not present themselves until weeks after the incident occurs. Possible symptoms include:

• Confusion
• Anxiety

The Epidemiology Of Depression And The Evolution Of Treatment

The Epidemiology of Depression and the Evolution of Treatment

Robert M. A. Hirschfeld, MD

Depression is a prevalent and pernicious disorder. About 1 in 5 US adults have at least 1 lifetime episode of major depression. Of those with depression, the majority will relapse over the long-term and many will have poor mental health outcomes and psychosocial disabilities. Over the past century, a range of treatments, including medications with varying mechanisms of action, have been developed to manage depression. Treatments from seizure therapies to an array of medicationsamphetamine, tricyclic antidepressants, monoamine oxidase inhibitors, mixed-action antidepressants, selective serotonin reuptake inhibitors, and dual reuptake inhibitorshave evolved.

From the Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston.

This article is derived from the planning teleconference series “A Fresh Look at Monoamine Oxidase Inhibitors for Depression,” which was held December 2011 through February 2012 and supported by an educational grant from Mylan Specialty L.P. .

Dr Hirschfeld has received royalties from Jones and Bartlett, has received honoraria from Merck Manual Editorial Board, and has received CME support from CME Outfitters and Nevada Psychiatric Association.

Corresponding author: Robert M. A. Hirschfeld, MD, Department of Psychiatry, 301 University Blvd, Galveston, TX 77555 .

doi:10.4088/JCP.11096su1c.01

Epidemiology of Depression

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Do I Need Health Insurance To Receive This Service

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

Drug Detox Via Medically Induced Coma What An Experts Says

University of Toronto psychologist and author Jordan Peterson, who reportedly struggled with benzodiazepine dependency, made headlines in February 2020 when he went to Russia to seek coma detox treatment. The procedure involved medically inducing a coma that lasted for eight days, according to news reports. But the treatment is controversial although some treatment centers claim it helps people avoid withdrawal symptoms altogether and improves their prospects of recovery.

The full truth about coma-induced detox isnt so convenient. Just ask Dr. Albert Castellon, MD. He supervises the drug and alcohol detox process for patients at FHE Health and is well-versed in best practices for medically supervised withdrawal. In a recent interview, Dr. Castellon shared his expertise as it relates to the safety and efficacy of medically induced coma detox.

What Is a Coma or Comatose State?

First, what is a coma, and what happens in a comatose state? When a person is in a coma or comatose, they are in a deep, prolonged state of unconsciousness marked by unresponsiveness. Signs and symptoms can include:

• Closed eyes
• No responses to stimuli apart from reflex movements
• Depressed brainstem reflexes such as pupils not responding to light
• Irregular breathing

What Is a Coma-Induced Detox?

A coma-induced detox, on the other hand, takes place in a different medical context: When an addicted person is about to begin drug or alcohol withdrawal.

What Else Makes Rapid Detox a Risky Gamble?

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What Is A Medically Induced Coma And Why Is It Used

Medically induced comas are only used when other options are lacking

In the case of traumatic brain injurysuch as the bullet wound sustained by U.S. Rep. Gabrielle Giffords in Saturday’s assault outside a Tucson supermarket that killed six people and wounded 13 othersdoctors sometimes induce a coma. This effective shutdown of brain function naturally occurs only in cases of extreme trauma, so why would doctors seek to mimic it in patients, as they have with the congresswoman, already suffering from head wounds and other issues?The answer lies in the science behind general anesthesia, which some 60,000 patients undergo every day. A review paper in the December 30, 2010, issue of The New England Journal of Medicine reveals that such anesthesia is, essentially, a reversible coma.That is exactly what doctors are aiming for in the case of a true medically induced coma, often using the same drugs or extreme hypothermia induced by exposure to a cold environment to halt blood flow entirely and permit surgery on the aorta. Shutting down function can give the brain time to heal without the body performing radical triage by shutting off blood flow to damaged sections. To find out more about such medically induced comas and the reasons why doctors employ them, Scientific American spoke with anesthesiologist Emery Brown of Harvard Medical School, co-author of the NEJM review.

How To Find Help

• Many mental health professionals are qualified to treat depression. Psychiatrists have specialized training in medication management and counseling for depression, and psychologists are trained to provide counseling for depression. Some social workers and licensed professional counselors are also trained to provide counseling for depression.
• Physicianssuch as primary care physicians, neurologists and physiatristsand nurse practitioners with experience in treating depression can often get treatment started.
• When available, it is best to get treatment from a comprehensive brain injury rehabilitation program that can address all aspects of TBI recovery.
• For more general information about depression, contact the National Institute of Mental Health at 1-866-615-6464 or visit their website at .

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Immediate Intensive Care For Coma

• An intravenous line to provide fluids and drugs
• An oxygen mask
• Constant monitoring of their vital signs including pulse, breathing and blood pressure
• Intravenous glucose
• Pumping of the stomach, if it is thought the person ate or drank something poisonous
• Administration of a narcotic antidote, if a drug overdose is suspected
• A respirator, if the person is unable to breathe by themselves.

The Woman Who Nearly Died Ten Times To Defeat Depression

Getty

Getty

When Heather B. Armstrong agreed to an experimental therapy to treat her depression, she was already low on hope. Shed suffered for 18 months with a relentless bout of treatment-resistant depression that included ongoing suicidal ideation. Every day she fought through thoughts of no longer wanting to be alive.

The experimental therapy she agreed to participate in doesnt sound real. For ten sessions over three weeks, Armstrong was to arrive at a clinic to willingly let her brain come as close to death as possible while still breathing. In her words, she was going to undergo ten rounds of dying.

She tells her story in the new book, The Valedictorian of Being Dead: The True Story of Dying Ten Times to Live, a memoir that recounts what led her to such an extreme, and her harrowing experience along the way.

The therapy involves an injection with a potent, short-acting anesthetic called Propofol to induce a near-brain-death coma for about 15 minutes. The objective is to alleviate symptoms of depression through something called burst suppression quieting the brains electrical activity to a flatline and then bringing it back.

Quieting is a polite way of saying taking down to zero, Armstrong says in the book. Anesthesiologists refer to this induced coma as the abyss.

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Ketamine For Major Depression: New Tool New Questions

• By Robert C. Meisner, MD, Contributor

First things first: You may be asking yourself, “What is ketamine?” Well, it was once used mainly as an anesthetic on battlefields and in operating rooms. Now this medication is gaining ground as a promising treatment for some cases of major depression, which is the leading cause of disability worldwide. In the US, recent estimates show 16 million adults had an episode of major depression in the course of a year. Suicide rates rose substantially between 1999 and 2016, increasing by more than 30% in 25 states. Because of its rapid action, ketamine could have a role to play in helping to prevent suicide.

Whats A Financial Recession

A recession is generally defined as a period of significant decline in GDP in back-to-back financial quarters. Experts, however, defer to the private non-profit research organization National Bureau of Economic Research to officially determine when a recession begins and ends.

The NBER team considers more than just the GDP when declaring a recession. They also look for a significant decline in economic activity spread across the economy, lasting more than a few months, normally visible in real GDP, real income, employment, industrial production and wholesale-retail sales.

The negative impact of coronavirus on the U.S. economy has been swift and dramatic, and were already seeing some of the typical signs of a recession. Along with rising unemployment rates, retail sales plummeted 8.7% last month, while total industrial production fell 5.4% the largest drop since January 1946. The drop in retail sales was the biggest monthly decline ever recorded, blowing past the 4.3% slump that the U.S. experienced in November 2008 during the Great Recession, according to the National Retail Federation.

So where does that leave us? Likely in a recession, even if we cant officially call it one yet. Its almost impossible to imagine that were not already in a recession, Furman says. We wont be able to call it until we see all the data later on but almost certainly the recession started in the month of March.

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