FAQ

Integrative Medicine

Which injectable nutrients are used at Pacific Psych Centers?

Combinations of the following nutrients/medications are often used in our integrative treatments:

Vitamin B12 (methylcobalamin)
Folate
B-Complex
Magnesium Chloride
Glutathione
Vitamin C (ascorbic acid)
Biotin
L-Carnitine
Taurine
Zinc
MIC (Amino Acids)
Vit D (IM)

Prescription medications:
Toradol
Zofran

How are IV hydration and vitamin/nutrient therapy used in the integrative medicine service?

IV hydration and vitamin/nutrient therapy can quickly provide your body with the nutrients and minerals to ensure you’re operating at peak performance. Whether to prevent illness, or to aid in recovery after trauma or stress, the right IV therapy can be revitalizing.

What is integrative medicine?

Integrative medicine considers the whole person, including mind, body, and spirit. The integrative approach is a great complement to traditional mental health care, since many underlying nutritional deficits and genetic risks can affect your health. Through a comprehensive assessment, laboratory evaluation, and genetic analysis, we can better pinpoint risk on an individual basis and customize any appropriate treatments for you.

Ketamine

Are ketamine infusions appropriate for me?

The best way to find out if ketamine infusions might be a viable treatment option for you is to schedule a psychiatric evaluation. At this visit, you and your provider will discuss what treatment options, including but not limited to ketamine, are the most appropriate for you.

How many ketamine infusions will I need?
Initially, 6 infusions over the course of 2 weeks are recommended for treating depression. If the symptoms are successfully controlled with these initial 6 infusions, then patients will begin another series of 6 infusion spread out over the next 8 weeks. If symptoms are remain successfully controlled after this sequence of 12 infusions over 10 weeks, then patients will transition to what we call the “maintenance phase” where infusions are done every 2-5 weeks on average. We will discuss the specifics of our protocols during the initial psychiatric consultation.
What medical and psychiatric conditions could potentially exclude me from ketamine infusion treatments?

A history of schizophrenia, pregnancy, ongoing drug and alcohol misuse/abuse, uncontrolled blood pressure, glaucoma, and previous allergic reactions to ketamine will exclude people from being candidates for ketamine infusions. Additionally, unmanaged chronic medical conditions such as diabetes, cardiac or pulmonary disease, obesity (BMI 40 or higher), etc. may exclude this particular treatment. 

The most common medical condition that prevents and/or interferes with ketamine treatments is uncontrolled hypertension, so we encourage patients considering ketamine treatments to ensure their blood pressure is well controlled, not only for this reason but to safeguard your overall health. Please consult your primary care physician if you are not sure about your hypertension status. Ketamine infusions cannot be administered if your blood pressure is abnormal on the day of the treatment. Our protocols regarding blood pressure are very strict, to ensure your safety. 

Is ketamine safe to use in this setting?
Yes. Ketamine has been shown to be very safe. It is commonly used as an anesthetic in operating rooms around the world. The dose used in treating depression at our clinic is well below the doses typically used in the operation room for anesthesia. The specific risks, benefits, side-effects, and alternatives will be discussed during the initial consultation.
Can I get addicted to ketamine from being treated with it for depression?
It is highly unlikely. There is no evidence of any increased risk for abuse of ketamine in patients that have been treated for depression with IV ketamine infusions.
Do I need to be referred by a psychiatrist or therapist to be considered for ketamine infusions?
No. Patients may refer themselves, but it is required that patients have a qualified physician to manage their medication, and/or therapist that can monitor their symptoms on an ongoing basis as applicable.
Will my insurance cover the cost of the ketamine treatments?
No. Because ketamine for depression is not FDA-approved, health insurance organizations consider it investigation and/or experimental and will not reimburse for it.

However, we are contracted with most major health plans (not Medicare), including Aetna, Blue Cross, Blue Shield, United Healthcare, Tricare, HealthNet, MHN, Magellan, and Cigna. Because we are contracted with these companies, we can bill directly to them for psychiatric consultations and follow-ups.

What conditions does Pacific Psych treat with ketamine infusions?

Pacific Psych primarily uses IV ketamine in treatment-resistant depression, but other psychiatric indications can be discussed on a case-by-case basis. We do not treat pain conditions with any modalities, including ketamine, at Pacific Psych.

Ketamine is not FDA-approved for any of the above indications. Prescribing a medication for an indication that it has not been FDA approved to treat, is often referred to as prescribing “off-label.” Ketamine is FDA-approved only for use as an anesthetic. However, a nasal spray, esketamine (Spravato) is FDA-approved for depression, and we have extensive experience with it. 

What is the success rate for treatment of depression with ketamine infusions?
Research shows roughly 70% of people respond successfully to ketamine infusions.
What are the restrictions after I’ve had a ketamine infusion?
You are not allowed to drive until the morning following your appointment, and you should avoid illegal drugs and alcohol for 24 hours as well. You will need to arrange for transportation home from the clinic following the treatment.
Where is your clinic located?
Our clinic is located in downtown Del Mar, California, right off the Pacific Coast Highway and 14th street.
What days are treatments done?
Monday through Friday, 9am to 5pm and 9am to 2pm on Saturdays.

Spravato™ Esketamine

Is Spravato™ the same thing as ketamine?

Spravato™ and ketamine are drug “cousins.”

Spravato™ is also known by its generic name: esketamine. It was FDA-approved for treatment-resistant depression in 2019.

Ketamine, which was FDA-approved for use as an anesthetic in 1970, is a mixture of two mirror image molecules (“enantiomers”): 50% “R-ketamine” and 50% “S-ketamine.” Spravato™ contains only the “S-ketamine” enantiomer.

As a generic medication, ketamine was never commercially sponsored for FDA approval in depression, so it is not FDA-approved for that indication. However, we use it in IV and IM forms in treatment-resistant depression (TRD) because we have seen its safety and effectiveness firsthand, though it is not covered by insurance. 

Spravato™, on the other hand, is FDA-approved for the treatment of TRD, so, unlike ketamine, it may be eligible for insurance reimbursement depending on your medical history. It is administered in our office as a nasal spray, and requires two hours of observation after each dose. 

Each of these two options can be life-changing in the right situation. We would be happy to evaluate your unique needs. 

Does insurance cover the cost of Spravato™?

Sometimes. We provide all documentation needed for appropriate patients, and our staff is skilled in the process. Still, it is up to each plan as to whether this treatment is reimbursed. 

How is Spravato™ administered?

Spravato™ is administered intra-nasally (into the nose as a spray), and is done in an approved clinic. Patients have two treatments per week for the first four weeks, then weekly or every other week after that. Patients must be observed in the clinic for at least two hours following each dose.

What is Spravato™ (esketamine)?

Spravato™ is the brand name of the medicine called esketamine. It is an FDA-approved antidepressant that is indicated for “treatment-resistant depression.” That means, the FDA has only approved it for patients who have tried other treatments for depression, that have not worked well enough.

Transcranial Magnetic Stimulation

What is TMS therapy?
TMS therapy is a non-invasive treatment based on repetitive Transcranial Magnetic Stimulation (rTMS) which delivers magnetic pulses to stimulate nerve cells in the part of the brain controlling mood, which is often underactive in patients with depression. Repeated stimulation of this part of the brain has proved to produce an antidepressant effect on people suffering from depression.
What is a TMS treatment like?

TMS Therapy is an in-office treatment that takes approximately 20 minutes, is performed while the patient sits in a chair, and is administered five days a week, for up to six weeks. During each session the patient reclines comfortably in the treatment chair, awake and alert. The TMS device delivers focused magnetic stimulation directly to the target areas of the brain. There is a TV available with on demand services if you would like to watch your favorite show while receiving treatment. You can immediately resume normal activities after each session.

Is TMS therapy safe?

Clinical trials of 10,000 treatments demonstrated the safety of TMS therapy in treating patients who have had an inadequate response to prior antidepressant medications. Since receiving FDA approval in 2008, over 1,000,000 TMS treatments have been performed safely with minimal side effects.

What are the side effects of TMS?
TMS Therapy is free from the side effects often felt with medications. The most common side effect of TMS therapy is pain or discomfort around the treatment area, which usually goes away within a week.
Am I a good candidate for TMS?

You are a good candidate for TMS if you…

  • Have significant depressive symptoms that have not been controlled with antidepressant medication.
  • Have not been able to tolerate antidepressant medications because of side effects.
  • Are searching for a medication-free depression solution.
  • Want the safety of an FDA approved depression solution
  • Want to get help.
What is the difference between TMS and ECT?

During TMS, patients sit in a chair and are awake and alert throughout the entire procedure. Since there is no sedation, patients can travel unaccompanied to and from their treatment sessions. TMS is a non-convulsive procedure and has been shown to have no negative effects on memory function. In contrast, electroconvulsive therapy (ECT), also referred to as “shock therapy,” is invasive, requires inducing a seizure to exert its therapeutic effect, and therefore has to be delivered under general anesthesia. Short-term confusion and memory loss are common, but generally mild and transient side-effects. Anesthesia risks, cognitive side-effects, pre-operative fasting and post-operative recovery can all make ECT a less attractive treatment option.

Does TMS cause memory loss?

No. TMS was systematically evaluated for its effects on memory. Clinical trials demonstrated that TMS does not result in any negative effects on memory or concentration.

You may be thinking of ECT (electroconvulsive therapy), which can affect memory. TMS is a completely different form of treatment than ECT. We do not perform ECT.

How long do the TMS treatment results last?

The majority of participants are remitted of their depression symptoms for over 12 months.

Can I take antidepressant medication while receiving TMS?

Yes. TMS therapy can be safely used with or without antidepressant medications.

Will my insurance cover TMS Therapy?

Most private insurers will, with appropriate documentation, approve TMS for the treatment of Major Depressive Disorder (“MDD”). Our staff are experts in the approval process.

Telepsychiatry

Who is eligible for telepsychiatry appointments?

New and existing psychiatric patients who are located in California.  TMS and Ketamine consultations can be done for patients located in and outside of California.

Are telepsychiatry evaluations billable to health insurance?

Yes, for the patients that have health insurance plans that we are in-network for, we can bill the telepsychiatry visits directly. Patients are still responsible for any deductibles, coinsurance, or copays. 

What are the non-insurance/self-pay rates for telepsychiatry evaluations?

The self-pay rates for telepsychiatry rates are the same as non-telepsychiatry rates.  They are $100-150 for follow-ups depending on the time/complexity of visit, and $200 for new psychiatric evaluation and TMS/Spravato/IV ketamine consultations.

Can psychiatric medications be prescribed after a new psychiatric evaluation done via telepsychiatry?

Our policy is that psychiatric medications require at least a face-to-face evaluation by your provider prior to prescription being written/sent.  This evaluation can be done in the days/weeks following the telepsychiatry evaluation. In some cases a short supply (72 hours worth) of medications can be prescribed prior to the required face-to-face follow-up.

What are the hours that telepsychiatry evaluations are available?

Telepsychiatry is available from 9-5 M-F currently, but expanded hours of access for telepsychiatry are coming soon.

Where do I go for tech support, should I have problems with the telepsychiatry interface?

There is tech support available on the Chiron Health telepsychiatry website and app.

Can I receive good psychiatry care through telepsychiatry?

Absolutely!  Telepsychiatry technology has come a long way over the last several years, and we are able to provide the same quality care that patients receive in the office.  Periodically, depending on the circumstances, patients will be required to be seen in-office. However, if your provider believes that you should be seen in the office instead of via telepsychiatry, s/he will let you know.