THINK IN A NEW WAY

INTEGRATIVE PSYCHIATRY

Many people with addiction are also challenged by anxiety, mood, sleep disorders, and attention problems due to use of addictive substances, or it may have been the initial cause of the substance use. This combination of psychiatric issues and addiction is called "dual diagnosis". For these reasons, we offer integrative psychiatric consultation for clients who are part of the C4R and IOP programs at Sovegna. Stabilizing and optimizing mental health increases function and sustained recovery.

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Holistic or integrative psychiatry blends principles of allopathic (traditional) psychiatry and functional medicine. Functional medicine focuses on pathways of cellular metabolism that are influenced by nutrition, movement, mindfulness, sleep, and emotional regulation. Creating balance among these pillars often leads to:

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• Optimizing health and wellness

• Potentially minimizing the number or dosing of medication(s)

• Potentially resolving psychiatric and related physical health issues

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Integrative psychiatry works best with active collaboration between the provider and client (patient), and can assist with healthy and sustained changes in the brain and body.

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Violence, trauma, and abuse often result in functional impairment, and is linked to serious health issues that affect both the body and the brain. Those who have experienced violence, trauma, and/or abuse may experience psychiatric, cardiovascular, autoimmune, addiction, and hormone disorders, among others. Resolving trauma-related symptoms allows for improving function and often healing the neurobiological pathways associated with the long-term effects of unresolved trauma. Integrating therapeutic principles, medications, and functional medicine can optimize healing, allow recovery, and build resiliency.

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Collaborating with therapists who are skilled in trauma resolution techniques is often part of the treatment plan when complex trauma is present. Learning to treat oneself with gentleness and kindness allows for deeper integrated healing.

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For more information about Dr. Susie Wiet's philosophy and approach to treatment, visit Susie Wiet, MD

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CUTTING-EDGE PSYCHIATRY

KETAMINE IN PSYCHIATRY

Ketamine is a medication that has been used for anesthesia for decades. Ketamine is also known for antidepressant and anti-anxiety effects, and has started to play a role in psychiatry.

Ketamine, delivered through an IV or injected into muscle, has been studied to be an effective and relatively rapid treatment for:

• refractory depression

• severe anxiety

• post traumatic stress disorder

• severe suicidal states

• certain aspects of addiction

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Ketamine is known to block the NDMA receptor. This means that it changes the amount of the neurochemical glutamate in the brain. It  causes a complex stimulation and release of key neurotransmitters that assists with a "reset" of hormones and other neurochemistry that influence two key systems: 1) the stress-management hormone pathway and 2)  the reward pathway. 

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Improvement from ketamine treatment is typically quick, compared to traditional psychotropic medications. While most anti-depressant medications show full response-benefit at 4-6 weeks, ketamine typically results in benefit within the first week of an induction series.

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What is Treatment-Resistant Depression and Post -Traumatic Stress Disorder? 

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Refractory depression or post-traumatic stress disorders are severe and debilitating states that is usually chronic and that have not responded to traditional treatments such as medications, therapy and lifestyle changes. 

Medications may have included: 

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• SSRIs (fluoxetine, paroxetine, sertraline, citalopram, es-citalopram) 

• SNRIs (duloxetine, venlafaxine, des-venlafaxine, milnacipran, levomilnacipran) 

• NDRIs (bupropion) 

• TCAs (amitriptyline, desipramine.) 

• MAOIs (selegiline, tranylcypromine, phenelzine) 

• Others (vilazidone, vortioxetine, mirtazapine, trazadone, nefazadone) 

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Lifestyle changes may have included: 

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• Nutrition 

• Exercise 

• Meditation/prayer 

• Stress-reduction 

• Sleep regulation  

• Abstinence from substances of abuse 

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Most people will have tried talk therapy, exercise, and alternative treatments with little or no progress in their symptoms. 

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How is Ketamine given? 

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Ketamine is usually injected under the skin, into muscle tissue, or infused via an IV. 

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• In our clinic, we use an intra-muscular (IM) injection to avoid problems with IVs. 

• We give 6 treatments over 2 to 3-weeks for an induction series 

• Most patients return for a single booster treatment every 2 to 6 months. Some may need less often or not at all.

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Ketamine can also be given as a nasal spray. However, we have  typically not found this necessary after an initial protocol is completed. 

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Maximizing the benefit from ketamine is important. Options include combining treatments with mindfulness and therapeutic practices. Sustaining the positive benefits from ketamine treatments can be enhanced by pairing other services.

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• We encourage participation in group therapy 

• Most patients will continue with traditional talk therapy

• We encourage nutrition counseling, and other health-promoting resources 

These are important for supporting and/or creating a healthy lifestyle, which helps natural neurobiology to sustain the effect and continue to heal on a path toward wellness. 

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Who is eligible for Ketamine? 

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Patients with Treatment Resistant Depression (TRD) will be assessed by our psychiatric and medical team to determine the necessity and safety of ketamine treatments in this clinical setting. Ketamine does cause temporary sedation, which means that a client with moderate-severe medical problems may not be eligible. Patients who are in active addiction, who have active psychosis, or who have not tried an adequate course of other treatment interventions will likely not be eligible.  

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What will I experience? 

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You will begin the session in one of our serene therapy rooms or meditation room. You will receive an intention card, and we will suggest that you set a positive intention to assist with directing your journey into yourself. You will also be offered an eye mask, essential oil selection, music selection and cozy blanket. You may request to have a loved one in the room with you during the duration of your treatment. If you do elect to do so, your guest will be requested to remain silent during the conscious sedation portion of your treatment.  

Once you are feeling comfortable laying down, you will receive an injection or an IV-push dose of ketamine. The first-time dose will require at least 2 doses: 1) initial test dose to check for sensitivity then 2) full expected dose. Subsequent induction sessions will be based off of the effective dose of the first session. (Induction is typically comprised of 6 sessions across 1-2 weeks.) 

You will quickly drift into a state of conscious sedation. This means that you will likely remain aware of the surrounding environment even though sedated (similar to a state of drifting off to sleep but not yet asleep). The medication takes effect within about 30 seconds to 2 minutes. The sedative effects typically remain for 25-30 minutes. Time perception is often altered during the conscious sedation (either shortened or lengthened). You may experience an interior journey that many have described as a spiritual journey into self or, "being reborn", or "remade". And, each treatment will most probably vary in experience.  

As you are reawakening, you will be greeted by our staff and are welcome to describe and/or process your experience. We do encourage you to journal your experience as you feel capable. Insights may be helpful to reflect upon or revisit at future times, too.  

You may request the option to pair your experience with one of our therapists or our psychiatrist during the conscious sedation portion of your treatment. The therapist can assist with directed guidance/therapy during the portion of conscious sedation. This may be of particular benefit for those with complex trauma. 

You will be required to remain at the clinic until you are fully recovered. We encourage you to enjoy relaxing in your designated serene space or in our tranquil reception lounge. You should plan for about a 2-hour visit in total.  

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In addition to ketamine, other therapies available for TRD and complex PTSD include: 

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• Alpha Stimulation: may be purchased on-line 

• Transcranial Magnetic Stimulation (TMS): upcoming service at Sovegna 

• Electroconvulsive Therapy (ECT): offered in select hospital-based settings 

FITNESS FOR WORK EVALUATIONS

Fitness For Work (FFW) evaluations at Sovegna are designed to comprehensively assess addiction-related problems that have or may be effecting a professional’s workplace. Very often, the professionals who we assess for a FFW evaluation have been ordered to complete and assessment by a professional governing body or an employer. Our multi-disciplinary assessments are very thorough and include pragmatic and effective recommendations to best address concurrent therapeutic, medical, psychiatric, considerations.  Sovegna is dedicated to this mission by: 

• Conducting high-quality assessments by a multi-disciplinary team of skilled providers who have expertise in addiction and related fields 

• Formulating comprehensive, multi-perspective evaluations for the professional at any point of recovery 

• Establishing comprehensive treatment recommendations to best ensure success with sobriety and long-term recovery 

ADVANTAGES OF SOVEGNA’S FITNESS FOR WORK EVALUATIONS

• Consistency of report structure and content 

• Reliability of report 

• Comprehensive synthesis of complex issues 

• Collaborative multi-disciplinary perspectives 

• Turn-around time 

• Availability 

• Clinical competency by known experts 

• Accessibility