Our Clinical Interests

We are experienced in treating psychiatric conditions, commonly including depression, anxiety, bipolar illness, psychosis, dual problems with alcohol or drug abuse, mental trauma, and other conditions affecting the brain and causing abnormal changes in mood or thought.

Psychotherapy

Typically psychotherapy consists of meeting with a pyschotherapist or counselor one 50 minute hour per week for a series of around 10 sessions, requiring about three months.  Usually 10 sessions will allow enough time to confront current issues and make progress on resolving them.  Psychotherapy can go beyond this, but often the focus shifts more to character and personality rather than to specific issues that are causing distress.

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Attention Deficit Disorder

People with attention deficit disorder (ADD) do not actually have a problem with attention.  For instance children with this diagnosis may be able to attend to video games or favorite television shows — things that are inherently attention grabbing.  it would be better to call the problem concentration deficit disorder.  The problem has more to do with willful concentration — that is the ability to willfully force oneself to attend to something that is not inherently interesting.  Memorizing the times tables is an example.  The concept of willful concentration is a subclass of the general phenomena of willpower — the ability to push oneself to do something that’s not inherently pleasant to do.

Depression

Depression is the most common illness treated by psychotherapists.  According to some estimates, 30% of people experience a severe clinical depression at some time during their life.  A smaller group — perhaps 6% — have chronic recurring bouts of depression.  Depression exacts an enormous toll in life satisfaction and productivity.

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Electroconvulsive Therapy

Depression is the most common psychiatric illness.  Medications work in about 60% of cases of severe depression.  Electroconvulsive therapy works in 90%.  There is an unfortunate 10% who don’t do well with either.  Despite enormous public relations problems, ECT persists in the treatment of depression, and for one very good reason — it works!

Intranasal Ketamine

Intranasal ketamine is not FDA approved as a treatment for chronic depression.  Ketamine is FDA approved as a treatment for other conditions – e.g., surgical anesthesia.  Ketamine has been proven safe and is not an experimental drug. What is not FDA approved is the particular application for treatment of depression.  There is an extensive literature on using ketamine for treatment of depression demonstrating that it does have immediate and remarkable effects to remediate depression.  Typically it has been administered IV. There is a recent article in JAMA Psychiatry describing a study in which esketamine was administered intranasally. Esketamine is racemically pure whereas regular ketamine is a mixture of levo and dextro enantiomers of ketamine.  There is no reason to believe that esketamine is more effective or safer than ordinary racemically mixed ketamine. Side effects that you should consider are that ketamine can produce a dissociative state. Some people describe it as being “dreamy,” or out of body or confused.  At higher doses people can become agitated. Most people experience it as “a two beer buzz.” Occasionally people experience nausea, headaches, or dizziness. PAA doctors consider themselves expert in the application of ketamine because they administer it routinely for anesthesia for ECT at much higher doses and have been doing this for several years.

Ketamine will be compounded for you at a concentration such that an intranasal squirt is 10 mg.  You’ll receive 40 mg under supervision at the Psychiatric Associates of Arkansas office. If things go well, you will take the ketamine home and self administer in the presence of a friend or family member twice the first week, twice the second week, once the third week, once  the fourth week, and then as needed thereafter. At each self administration you must transmit a report through the portal in order to document your experience. Report your subjective rating of your depression on a 0 to 10 scale with 0 being severely depressed and 10 being in a good mood.  Report blood pressures and anything remarkable that happens. You will also receive a PHQ-9 checklist of symptoms of depression through the portal; fill this out.

An additional warning: ketamine is a potential drug of abuse.  At raves and clubs, it is referred to as “Special K,” and people who get in trouble with ketamine are said to “go down the K hole.”  Treatments will be discontinued if you do not comply with protocol.

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