Psilocybin in Bipolar II: New Study

A study led by Dr. Scott T. Aaronson, published in JAMA Psychiatry, offers new insights into treating treatment-resistant bipolar type II depression with synthetic psilocybin combined with psychotherapy. The study involved 15 participants, aged 18 to 65, who received a single 25mg dose of synthetic COMP360 psilocybin and psychotherapy sessions.

Significantly, 80% of the participants met the remission criteria 12 weeks post-treatment without experiencing an increase in bipolar II symptoms. These results indicate psilocybin's potential efficacy in treating bipolar II depression in a clinical setting. A controlled environment and the guidance of mental health professionals are important factors. They distinguish clinical applications from recreational scenarios.

"Individuals in this study displayed strong and persistent antidepressant effects with no signal of worsening mood instability or increased suicidality."​

The study indicates that psilocybin exhibits potential in treating specific mental health disorders within clinical settings. This research is hopeful about novel avenues in mental health treatment, particularly for conditions that have been difficult to manage with conventional therapies.

This study specifically excluded individuals with Bipolar I Disorder, widely recognized as a contraindication for the use of psychedelic medicines. However, if an individual with Bipolar I is not currently experiencing a manic phase, some researchers and clinicians believe that the use of such treatments may be acceptable under some conditions.

About Bipolar II

Bipolar II Disorder is characterized by a pattern of depressive episodes and hypomanic episodes, distinguishing it from other depressive disorders. Unlike Bipolar I, which involves more severe manic episodes, Bipolar II features milder hypomanic episodes that do not cause significant social or occupational impairment. This contrasts with Major Depressive Disorder, which involves depressive episodes without the accompanying manic or hypomanic phases seen in bipolar disorders.

For more detailed insights, you can access the full study here.

Esketamine Nasal Spray for MDD

In the ceaseless pursuit of unlocking viable treatment options for individuals grappling with Treatment-Resistant Depression (TRD), a recent study presented at Psych Congress 2023 piqued interest in the medical and mental health community. The findings, stemming from the ESCAPE-TRD trial, emphasized the potential economic and therapeutic benefits of esketamine (ketamine in the form of a nasal spray) in comparison to quetiapine extended-release treatment, particularly in the context of work productivity loss (WPL) improvements and associated cost implications.

TRD has many challenges for those directly affected but casts an economic shadow, notably affecting employers in the United States through healthcare costs and impaired work productivity. Esketamine nasal spray has demonstrated a promise in this regard, as outlined in the study, presenting a tangible reduction in WPL and thus suggesting not only a clinical but an economic advantage.

Diligent investigators navigated through an analysis involving participants with major depressive disorder (MDD), who were administered either esketamine nasal spray or quetiapine extended-release treatment in conjunction with specific reuptake inhibitors.

Upon evaluating the findings, a significant decrease in total WPL from baseline was evident in participants administered esketamine nasal spray, alongside weekly cost savings, which showcased a marked disparity when pitted against the alternative treatment group.

While the findings underscored in the study are palpably valuable, it's important to underscore that this research didn’t integrate psychotherapy as part of the delivery for Ketamine, an element often deemed instrumental in amplifying its efficacy. Ketamine, when paired with psychotherapy, frequently paves the way for a synergistic effect, enhancing treatment outcomes, particularly in mental health and well-being.

Moreover, while the study elucidated the merits of nasal delivery of esketamine, it's helpful to acknowledge the existence and potential of alternative delivery methods. The nasal approach is a pricier option of available treatment modes. However, it’s worth noting that in some instances, these costs may be mitigated through insurance provisions, softening the financial impact upon the individual receiving treatment.

Navigating through the myriad of treatment options in the mental health space demands a thorough, multi-faceted examination. While the findings from the study presented at Psych Congress 2023 undeniably carve out a niche of interest and promise within the TRD treatment landscape, it also sparks further curiosity. It opens doors to future research that interweaves psychotherapy and explores varied ketamine delivery methods, each with its own clinical and economic implications, all in pursuit of architecting a robust, accessible, and effective treatment paradigm for TRD.

I've seen transformative change when using ketamine with psychotherapy in my practice. I'm excited about emerging research that continues to demonstrate the results I see in my office.

Unraveling the Intricacies of the Internal Family Systems

Through my journey as a therapist, I see how every individual is a unique tapestry of “parts” that function in what is often called an “internal family system” (IFS). Each part plays a crucial role and is motivated by a specific need or concern. IFS authors describe two of these parts as ‘managers’ and ‘firefighters,’ both are types of protective parts.

In our internal family system, managers are the ones at the helm, the decision-makers and strategists, perpetually working to maintain balance, control, and harmony. They assess potential risks and plan, and avoid situations stimulating pain or trauma. On the other hand, firefighters rush to our aid when painful emotions or memories are triggered. They attempt to distract us or numb the pain, primarily through immediate gratification strategies.

To further understand these protectors, let’s employ a quadrant system for a more precise delineation. Visualize a square divided into four sections; the horizontal line represents the continuum from ‘healed’ to ‘unhealed,’ and the vertical one represents ‘managers’ at the top and ‘firefighters’ at the bottom.

In the upper-left quadrant are the healed managers, proactive and supportive. They nudge us towards personal growth, healthy decision-making and encourage us to confront our fears and insecurities. Conversely, in the upper-right quadrant are the unhealed managers, who often become hypercritical, obsessively controlling, and perfectionistic, driven by fear and anxiety.

Moving to the lower half, in the left quadrant, we find healed firefighters. These parts are responsive and insightful; they encourage self-care and healthy coping mechanisms to deal with stressors. However, in the right quadrant, we find unhealed firefighters. These parts often resort to unhealthy coping strategies such as substance abuse, binge eating, or self-harm in a desperate attempt to quell emotional discomfort.

As complex as our internal family system might be, navigating through the labyrinth and transforming unhealed parts into healed ones is possible. Here are some reflective techniques I’ve discovered to be invaluable in this transformation process:

1. Mindful Meditation: Sitting quietly, focusing inwardly, and identifying the different parts can be incredibly enlightening. This process enhances our understanding of our internal dynamics, thus empowering us to deal with them more effectively.

2. Professional Assistance: Working with a professional mental health therapist or counselor can provide a safe and supportive environment to explore, understand, and heal our internal parts.

3. Self-Compassion: Be gentle and understanding with yourself. Every part of you, even the wounded ones, are there to protect you.

4. Coping Strategy Evaluation: Acknowledge and appreciate the helpful coping strategies and extend empathy to the methods that haven’t. It’s all a part of the journey towards healing.

5. Social Connections: Surround yourself with friends who resonate with your values and goals. They can provide a supportive environment to nurture your healing process.

6. Healthy Boundaries: Draw lines around toxicity. Establishing healthy boundaries is crucial to protect your mental and emotional space.

My experience has taught me that understanding and healing our internal family systems is not a linear journey. It’s a process of exploration, acceptance, and transformation. The beauty lies in acknowledging our unhealed parts, understanding their intentions, and guiding them toward healing. Doing so makes us more compassionate and whole towards ourselves and others.