This is How Ketamine Works

Ketamine acts in hours, not weeks like traditional antidepressants. Ketamine works on a completely different part of the brain than other antidepressants. Traditional antidepressants act on the monoamine system of the brain, targeting serotonin, norepinephrine or similar neurotransmitters.

Ketamine is different. It targets a completely separate system called the glutamate system.

By targeting the glutamate system, it stimulates a molecule called Brain-Derived Neurotrophic Factor (BDNF), which has been coined “Miracle-Gro for the brain”  because it is associated with the growth of new branches on nerve cells as well as more connections between the neurons. Under electron microscopy, you can see these nerve connection reach out and flourish.



Damaged neuron before ketamine

  The above photo demonstrates a rat neuron before ketamine treatment. There are few “dendritic spines” – the connectors that nerve cells use to talk with other neurons.  In depression, areas of the brain have been shown to lose these branches and connections.  These dysfunctional nerve structures lose the ability to communicate with each other and may be responsible for symptoms of depression.



New and fuller dendritic spines appear representing new connections in the brain after ketamine treatment.
After treatment with ketamine, the neuron rapidly grows new dendritic buttons, each one connecting with other nerve cells, thus creating a web that allows a fuller, more interconnected brain.  This is how ketamine is thought to actually reverse some of the damage brought about by depression, chronic stress and PTSD.
Since ketamine works differently from other antidepressants, even if you have failed other meds or ECT, ketamine may still work for youSince ketamine works differently from other antidepressants, even if you have failed other meds or ECT, ketamine may fKetamine often works for patients who have not responded to traditional therapies such as antidepressants, ECT (Electroconvulsive Therapy) or TMS (Transcranial Magnetic Stimulation).
Click here to learn more about our Ketamine Therapy Program
Ken Starr MD FACEP, ABAM is the Founder and Medical Director of the Ken Starr MD Wellness Group in Downtown Arroyo Grande, California. The clinic is both state licensed and CARF accredited. Dr. Starr is Board Certified in Addiction Medicine and serves as Medical Director of Addiction Medicine Services for Dignity Health on the Central California Coast. The Wellness Group is the longest running established NAD+ Therapy program on the West Coast. The Wellness Group believes in ethical and transparent business practices and holds our patients in the highest regard.
Since ketamine works differently from other antidepressants, even if you have failed other meds or ECT, ketamine may still work for you.
Ken Starr MD on Precipitated Withdrawal

Hey, Dr. Ken Starr with the Wellness Group in Arroyo Grande. I wanted to take a minute to fully explain, what is precipitated withdrawal? You’ve probably heard about precipitated withdrawal, maybe you’ve experienced it. Here’s what precipitated withdrawal is. Buprenorphine or trade name or brand name Suboxone, has a higher binding efficiency, it’s a stronger magnet at that opiate receptor in the brain than any other opiate for the most part. So if you have any other opiates in your system, whether it’s fentanyl, heroin, pain pills, whatever, there’s anything down to that receptor and you take Suboxone, boom, it pulls it off.

Alright? It’s a stronger magnet. It’s a stronger affinity, that receptor, and there’s much less activity. OK, so precipitated withdrawal is that opiate receptor has opiates on it to some degree, enough that when you take buprenorphine, it’s binding it, it is pulling it off and it’s causing precipitated withdrawal. How do you avoid that? One, you have to wait a long time. You have to wait until your full withdrawal so that opiate receptors empty, right? Just like a cold drink of water on a hot day. Your opiate receptors empty, you take that Suboxone and you feel better. The other way you do it is you start with very small doses. I have my patient start with two milligrams of buprenorphine or Suboxone, two milligrams every hour or two hours and take… Every hour, two hours, you take that until you have eight milligrams and then you’re good, then you’re… You’re OK. And you can just take eight once a day. You can take eight twice a day or whatever you need. But a lot of people think, like “Oh I’m allergic to Suboxone.”

They took it and had withdrawal. That’s not an allergy. That’s just precipitated withdrawal. So you understand that precipitated withdrawal is really the buprenorphine binding that opiate receptor that still has some degree of opiate on it? You’re not quite ready or maybe too much, and then it pulls it off and it’s very unpleasant. When you go into withdrawal, naturally, kind of a natural off gassing of, you gradually get sicker and sicker and sicker. With precipitated withdrawal, boom, it yanks it off all at once.

Ok, that’s what precipitated withdrawal is. The other misconception, what you need to know is that it’s not the Naloxone and the Suboxone that’s causing this. So a lot of my patients think, well, if I just take the generic Subutex eight milligram tablet, I can take it earlier, it won’t cause that. You’re wrong. It’s the buprenorphine. It’s not the Naloxone. That’s a whole different conversation. But it’s not the Naloxone, trust me.

You have to wait till you’re in full withdrawal. I tell people the wait til you’re totally ready to tap out. Maybe it’s one day, maybe it’s two day, maybe it’s 18 hours, whatever. You just can’t take it anymore. Start with low doses, two milligrams every couple of hours build up. You have that first eight milligrams on board and you can just do eight once a day or eight twice a day or whatever, OK? That’s how you avoid precipitated withdrawal. It’s very important. It’s not the Naloxone component and also not starting too much at once.

If you’re totally ready, you’re super ready, you can’t wait any longer, you’re in full withdrawal, but then you take eight milligrams: that can make you feel unwell too. And that has to do with different opiate receptor binding types. There’s alpha, gamma, mu, other receptors that get stimulated preferentially and that can make you feel bad. Precipitated withdrawal: that’s what it is. That’s how to avoid it. Thank you. Please share. Subscribe. Dr. Ken Starr, the Wellness Group in Arroyo Grande.

Thank you.


An opioid vaccine, new drugs for chronic pain, yet alcohol use disorder not a priority for NIH HEAL Initiative?

A week ago, I was drinking my morning cup of tea while reading several ‘addiction news’ articles
(as this is part of my morning routine) when I came across something novel. I saw a press
release on an opioid vaccine that targets fentanyl, which is being developed by the National
Institutes of Health (NIH) Helping to End Addiction Long-Term Initiative.

According to Heal.NIH.Gov, “The Helping to End Addiction Long-Term Initiative, or NIH HEAL
Initiative is an aggressive, trans-agency effort to speed scientific solutions to stem the national
opioid crisis. Almost every NIH Institute and Center is accelerating research to address this
public health emergency from all angles.”

The main goals of the NIH HEAL Initiative are to improve prevention and treatment for opioid
misuse and addiction and enhancing pain management. It aims to create new medications (for
opioid withdrawal, cravings, relapse prevention, overdose, pain management, and more) and
optimize treatment and treatment outcomes.

This is a big deal for individuals with opioid use disorder (OUD) and/or chronic pain, however,
alcohol use disorder (AUD) treatment appears to get no love in the NIH HEAL Initiative’s 6-point
plan that is estimated to take 5-6 years.

Why The Massive Initiative?

On average, 130 people die from opioid overdose daily. Worse still, rates of opioid use disorder
and opioid overdose deaths spiked drastically in 2020 and continue to rise at alarming rates. In
2018, the Centers for Disease Control and Prevention (CDC) documented that it was the first
year in decades overdose deaths were finally decreasing. Unfortunately, that trend has not

A combination of the covid pandemic and massive amounts of black-market pills and heroin
being cut with fentanyl is no doubt two major contributors to these elevated rates of opioid
addiction and overdose deaths.

Fentanyl is a synthetic opioid up to 50-100x more powerful than heroin, so if a person doesn’t
know the heroin, oxycodone, etc. they bought from a drug dealer is laced with fentanyl, they are
in serious jeopardy of overdosing. Black market opioids cut with fentanyl have been so
devastating that the CDC has named it the deadliest drug in America.

Fortunately, innovations in medicines for preventing opioid overdose and for treating opioid
addiction are in the works. The most interesting of these medicines (to me at least) is an opioid

How Will The Opioid Vaccine Work?

The vaccine being studied by the NIH HEAL Initiative is an adjuvant opioid use disorder
vaccine. An adjuvant molecule boosts the immune system’s response to vaccines, a critical
component of the effectiveness of anti-addiction vaccines.

adjuvant (noun) – a substance that enhances the body’s immune response to an antigen.

The vaccine targets fentanyl and it protects the brain and nervous system by stimulating the
body to create powerful antibodies that target and bind to opioid molecules.

Next, it sequesters the opioid molecules in the blood in a peripheral area. This prevents opioids from crossing
the blood-brain barrier (BBB) and reaching the central nervous system (CNS).

Since it blocks opioids from reaching the brain, it also prevents the massive respiratory
depression caused by opioids getting into the brain, and that’s why it’s so beneficial for
preventing opioid overdose.

When Will The Opioid Vaccine Be Available?

It would be extraordinary if the NIH HEAL Initiative’s anti-opioid vaccine and other medicines it’s
working on for the prevention and treatment of opioid addiction were available now, however,
these things take time. The process of getting FDA approval for a new vaccine or drug is long
and costly.

Fortunately, the NIH HEAL Initiative appears to be more than capable of developing, studying,
and getting FDA approval for these drugs… medicines that will help with damage control of the
opioid epidemic that keeps raging on amidst the covid pandemic.

More Drugs for Opioid Addiction, Non-Addictive Drugs for Pain, Yet No
Alcohol Treatment Innovations?

I’m very excited to track the development of the opioid vaccine and the other opioid addiction
and chronic pain treatment solutions the NIH HEAL Initiative is working on, however, after
reading the entire NIH HEAL Initiative Research Plan and not seeing alcohol addiction treatment
in their overall strategies, I felt sad for that population. Why?

6% of adults in the U.S. have alcohol use disorder. 15… million… people. 88,000 people in
America die every year as a result of alcohol. It’s estimated that approximately 2.1 million
Americans have opioid use disorder.

Thus, there are over 700% more Americans with AUD than there are with OUD.
Fortunately, even though the NIH HEAL Initiative appears to be focusing its efforts on
preventing overdose deaths, opioid addiction, and chronic pain, people like Chris Scott, an
Alcohol Recovery Coach and founder of Fit Recovery, and Ken Star, M.D., a board-certified
addiction physician and founder of Ken Starr MD Wellness Group, are leading the way for
biochemical innovations in AUD treatment like customized alcohol detox supplement protocols,
neuro-nutrient therapy, nutrigenomics, and much more.


Rates of substance use disorders, as well as behavioral addictions like gambling and others,
are all rising across the board. America is undergoing a ‘Twindemic’ of addiction/overdose and
covid and these are both synergistic with each other. The covid pandemic is causing elevated
rates of substance use disorders and, according to the CDC, people with a substance use
disorder are more susceptible to catching covid and having negative outcomes with covid

The NIH HEAL Initiative is actively combating the addiction/overdose issue. Will its work pay
off? Only time will tell. I have high hopes for it to achieve all of the goals it has set out to
accomplish. It may not be focusing on alcohol use disorder treatment, but then again, one has
to start somewhere.

According to the NIH HEAL Research Plan, the first 2-3 years will be focused on chronic pain
and the next couple of years will be focused on opioid addiction. Perhaps alcohol treatment will
be next on the list? Yet again… only time will tell.

Mistakes To Avoid When Helping Someone Recover From Drug Addiction


Drug addiction may be a treatable condition, but addiction recovery is a lifelong process that
requires all hands on deck to improve its chances of success.
When you’re helping a friend or a loved one recover from drug addiction, you’re bound to run into
more than a few challenges.
Sometimes, we make mistakes when helping a drug-addicted family member or friend. Some of
these mistakes could deeply hurt a recovering addict’s feelings. Others may even push them to
begin using again.
No one would ever want to see friends or loved ones get involved in situations like getting arrested
for DUI prescription drugs or worse, overdosing on any addictive substance.
If you really want to help them recover from drug addiction, you must avoid committing the
following mistakes:

Not Educating Yourself About Addiction

You cannot possibly help anyone struggling with drug addiction if you know little to nothing about
You would be in a much better position to help a friend or loved one recover from addiction if you
understand the causes of addiction, the symptoms associated with it, and the treatment options
By educating yourself about addiction, you will come to understand better what your friend or
relative is going through. The more you know about the condition, the more you will be able to help
them overcome it.

Not Watching What You Say

We all should keep in mind that a friend or relative facing drug addiction struggles may tend to be a
a bit more insecure, emotional, and sensitive about their current situation.
You might be close to that person, but you still have to be careful about what you say to or around

You may mean well when you say something like, “I know what you’re going through.”
However, unless you’ve struggled with drug addiction yourself and managed to overcome it, those
words will ring empty.
Better say that you’re sorry and that you’re there to support them than mouthing off about knowing
what they’re going through when you actually don’t.
If possible, avoid cracking jokes at their expense, even when you’re bosom buddies with the
recovering addict.
They might be smiling or laughing with you when you’re making light of their situation, but there’s
no way we would know if they’re really okay with the jokes.
To be on the safe side, keep your jokes away from anything resembling their current state.

Making Decisions For Them

It’s understandable when you’re eager to help family members or friends recover from drug
However, if your eagerness leads you to sign them up for rehab or choose addiction recovery
programs without running it past them first, then you are overstepping your bounds.
Entering rehab is a major decision that no one should ever force on a person facing addiction
problems. For treatment to have a much better chance at success, it must be something that they
should choose for themselves, not by anyone else.

Assuming That Addiction Is Gone After Completing Rehab

Some might assume that completing a treatment program means a person is cured of his or her
drug addiction. However, as mentioned above, drug addiction recovery is a lifelong process.
It’s not unheard of for former drug addicts to be sober for years but end up relapsing after
something like a memory or sudden access to drugs triggers their cravings.
If anything, we all need to be consistent in our support for their recovery.
Over time, we should keep on helping them avoid social gatherings where people might use
addictive substances and build relationships with sober friends, among other things.
Rebuilding their lives is key to their full recovery, and we should be there for them every step of the

Neglecting Your Own Well-being

The recovery process takes a lot out of the person recovering from addiction. What many don’t
realize, however, is that recovery takes quite a toll on the people providing them support, too.
Worse, people helping a friend or loved one recover tend to forget about their own well-being in the
If you intend to help someone on their lifelong journey towards recovery, you have to attend to
your own needs, too.
Take the time to take care of yourself physically, mentally, and emotionally, even as you do the
same for someone else.
Eating right, getting enough exercise, and enjoying life, in general, makes you healthier and happier,
which will enable you to provide continuous and consistent support for a friend or loved one in
addiction recovery.
Addiction recovery may not be the easiest thing in the world, but by avoiding the mistakes listed
above, the entire process can go a bit smoother for everyone, and that’s always a win.

Learn more about our outpatient treatment program or detoxification programs.

What Does PTSD Feel Like?

PTSD (post-traumatic stress disorder) is a mental health condition where the body and brain are unable to recover after experiencing or witnessing something traumatic. It is normal to have difficulty coping with something traumatic, so it may be hard to tell the difference between normal coping and more serious PTSD.

What does PTSD feel like?


Flashbacks are intrusive thoughts that make you feel like you are reliving the traumatic experience that led to your PTSD. Flashbacks are often triggered by things like noises, sights, smells, etc. that remind you of the event, but sometimes can come out of nowhere.

PTSD flashback symptoms include the following:

Seeing images or visions of what happened in the initial event
Feeling sensations or pain, often when there is nothing actually hurting you
Reliving the emotions of the original event (often fear or distress)
Increased heart rate
Panic attacks
Difficulty breathing


With hypervigilance, you never truly feel relaxed and are always on edge. You may seem jumpy or irritable.

Hypervigilance symptoms include the following:
Being easily startled
Irregular sleeping patterns
Trouble concentrating


PTSD will make a person want to avoid anything that reminds them of the traumatic event in the hopes that they can avoid flashbacks or other symptoms.

Symptoms of avoidance include the following:

Avoiding places, people, or things
Substance abuse
Feelings of detachment or dissociation

Panic Attacks

Panic attacks are sudden onsets of symptoms of fear and stress, accompanied by the following physical symptoms:

Heart palpitations
Trouble breathing
Tingling hands


Similar to flashbacks, PTSD often brings on terrifying nightmares. This leads to many people with PTSD avoiding sleep in fear of these dreams.

Causes and Risk Factors

Causes and risk factors that contribute to the development of PTSD may include the following:

Stressful experiences and traumatic events
Family history of PTSD or other mental health conditions
History of abuse (especially childhood abuse)
Substance abuse
Personal history of depression, anxiety, or other mental health conditions
Personality and temperament
The way your brain responds to stress.

Treatment for PTSD

PTSD can be an incredibly debilitating condition that makes it near impossible to carry out everyday activities. Fortunately, treatments both old and new may help you along your road to recovery. For decades, doctors have prescribed trusted treatments like antidepressants or psychotherapy, but innovative new options like ketamine may signal an optimistic new era of PTSD treatment.

Ketamine for PTSD

Ketamine was first approved by the FDA for use as an anesthetic, but in recent years has been shown to be a powerful, rapid-acting treatment for mood disorders like PTSD. Research speculates that ketamine plays a role in the treatment of mood disorders through its interaction with the neurotransmitter known as glutamate. Glutamate is a powerful neurotransmitter that mediates the body’s response to stress and traumatic memories.

To learn more about ketamine and its use as PTSD treatment, contact us today to schedule a free consultation.

How To Deal With A Loved One With Chronic Pain

Watching someone you care about struggle with something you can’t see can make you feel helpless. Chronic pain affects everyone around you, and it can become difficult to care for your loved one when you don’t know how to help their condition.

It can be discouraging when you feel that your support is not accomplishing as much as you want it to, but it is important to remember that someone struggling with chronic pain needs a support system more than anything.

“Patients who described their families as being supportive reported significantly less pain intensity, less reliance on medication and greater activity levels” per this study.

What is Chronic Pain?

Any pain that lasts longer than six months is considered chronic pain, and chronic pain is often still around even after the initial injury or condition has healed. Unlike acute pain – which is almost always the result of a specific injury – chronic pain sometimes does not have an identifiable source.

If you have never had chronic pain, it may be difficult to understand the extent and complexity of it. You may not know the best ways to help support your loved ones, but fortunately, there is a lot you can do to help ease the pain.

How To Deal With A Loved One With Chronic Pain

Educate Yourself

Chronic pain is often a unique, individualized experience that does not show visible symptoms. Perhaps the most important way to help your loved one is to learn as much about chronic pain as possible. The good news is you have already started this process.

Try asking your loved one some starter questions to help understand their pain, such as the following:

  • Where is the pain?
  • When did the pain start?
  • Do you have a coexisting condition?
  • How does your pain affect your everyday life?
  • What helps your pain?

The answers to these questions can provide you with valuable insight that allows you to better empathize with your loved one.

Learn the Pain Scale

The pain scale can be a valuable tool for understanding the intensity of pain at a given moment. The pain scale goes from 1 to 10, typically, with 0 meaning the person has no pain and 10 meaning the worst possible pain.

Encourage Healthy Habits

Maintaining a good diet and engaging in some physical activity are some of the best ways to treat chronic pain, so it is important to encourage these habits in your loved one.

Encourage Getting Treatment

It can be difficult to maintain treatments like medication or physical therapy, but it is very important to hang on to your treatment plan. It is important to encourage them to continue on this treatment path in order to
manage their symptoms.

Respect Their Limitations

They may not be able to do everything they used to do. They may not want to spend as much time being social as before. It is important that you remember they are suffering from something you cannot see.

If you or a loved one are dealing with chronic pain, contact us today to learn more about our innovative new treatments for chronic pain.

Things To Consider Before Using CBD As A Depression Aid
Ken Starr MD Wellness Group CBD Experts
Ken Starr MD CBD post

















Depression is an all-consuming black cloud, looming over your life. There is a reason so many
artistic representations of depression feature a dark rain cloud over someone’s head. Many
people today turn to the eureka effects of full-spectrum CBD oil to help lift that cloud. Scientists
are still working to prove the conclusive link between depression and CBD. However, a number
of promising studies and thousands of personal testimonials point to its potential effectiveness.
Taking daily supplements or the best CBD cream for pain may improve your mood and functionality.

There are many potential causes of depression,
and each person’s brain chemistry is unique. CBD
is not a miracle cure, and on its own is unlikely to
have massive effects. CBD when taken as a part
of a general wellness regimen, and under the
consultation of your care professional, could assist
with symptoms of depression.
You should consider several things before
deciding to use CBD as a depression aid. Again,
the advice of your care provider or trusted health professional is best when deciding if CBD is right for you.
● Is your depression chronic or situational?
● Do you take other medications?
● How much CBD should you take?

How Does CBD Work?

CBD works in your body by binding to
receptors in your endocrine system. CBD,
short for cannabidiol, is a molecule found in
hemp cannabis plants called a
cannabinoid. These cannabinoids,
including CBD and THC, are the beneficial
compounds in cannabis, along with
The more cannabinoid and terpenes
molecules a plant contains, the more it will
be able to bind with your endocannabinoid
receptors. These receptors, located
throughout your body in the glands of your
endocrine system, send hormones. These
hormones go throughout your bloodstream
and body to promote, halt or encourage
certain biochemical functions.


Eureka Effects Full Spectrum CBD Provides
Almost every function in our body, including mood, is controlled by the chemical messengers.
According to scientific studies, when CBD binds to endocannabinoid receptors, like when you
use the best CBD pain cream, “their activation inhibits adenylyl cyclase’s and certain voltage-dependent calcium channels and activates several MAP kinases and inwardly rectifying potassium channels.” Furthermore, “activation of CB1 or CB2 receptors exerts diverse
consequences on cellular physiology, including synaptic function, gene transcription, cell
motility, etc.” This eureka effect full spectrum CBD provides has a number of potential benefits.
Scientists are still working to understand exactly how these diverse consequences assist in the
improvement of depression. They do know that CBD can assist with many underlying causes of
depression, such as chronic stress or pain.


Is CBD Right For You?

There are a number of things to consider when asking if CBD is right for you as a depression
aid. Is your depression situational/temporary or chronic? Always talk to your trusted health care
provider if you experience symptoms of depression for more than a few days.

CBD may be great for depression but must be
combined with an overall health regimen to see any
positive effects. If you already take other medications
or supplements, such as ones for depression, talk to
your doctor before adding CBD. CBD may interact with
or negate the effects of certain medications.
Finally, knowing how much CBD to take is crucial to
seeing positive effects. Every person is different, and a
variety of factors contribute to CBD’s success as a
depression aid. Finding a balance between the best
CBD cream for pain and sublingual oil doses could be
the key for you. Or, a combination of other products
could be ideal for your needs. You may have to try a few different products and combinations to determine what works best.

If you’re interested in learning about the highest quality CBD Oil from Switzerland click here to learn more.

Review of NAD+ for Detox, Recovery and Post Acute Withdrawal


Hello. I’ve had a history of using drugs and alcohol and I’ve been clean and sober for almost five months, but I was still experiencing a lot of brain fog and a lot of just not certain with my own thoughts, not being able to trust myself. So I decided to come and see Dr. Starr And to do the NAD+ therapy. And I’ve been doing it for a few days now and each day I’m seeing great progress, feeling a lot of clarity. It was recommended to me by a friend who did it, who experienced great results. And I can say from experience now that this has helped me in ways I never even expected what it looks like each day as you come in and the beautiful Arroyo Grande day, they check your vitals and they give you a little infusion and throughout the day it’ll be dripping.

It could take anywhere from four to maybe eight hours depending on how you take it and you have this feeling inside of your body where, at least for me, I felt like a heaviness, but it just felt extremely healthy. I felt like I was getting out of a steam room or something of that sort. So after doing it for a few days, now I can tell it’s definitely progressive as I’m feeling better each day, I have an increased curiosity like into when I was 16 years old and everything seems fresh, everything seems new, and I highly recommend this to anybody and everybody was able to do it as I’m feeling great, better than ever before. So I think Dr. Starr and the whole staff here, it’s been a great experience.






The Ken Starr MD Wellness Group is the place to learn about addiction recovery strategies that have the ability to help you attain freedom. We’re innovative leaders in the treatment of medical detox, recovery, and wellness care. The Wellness Group provides substance abuse treatment, detox, counseling and Ketamine treatments. Come visit us on the California Central Coast.

Ken Starr MD is an expert in NAD+ treatments, Board Certified in Addiction Medicine and an experienced Ketamine provider. We Biohack recovery and detox so our patients can live their best life.


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