Integrative Medicine

Which injectable nutrients are used at Pacific Psychiatric Intervention & Wellness Centers?
Combinations of the following nutrients/medications are often used in our integrative treatments:

B12 Methylcobalamine
Magnesium Chloride
Vit C Ascorbic Acid
MIC (Amino Acids)
Vit D (IM)

How are IV hydration and vitamin/nutrient therapy used in the integrative medicine service?
IV hydration and vitamin/nutrient therapy is an effective and rapid way to provide your body with the nutrients and minerals it needs to ensure you’re operating at peak performance. Whether to prevent illness, or to aid in recovery after an acute stress, our IV therapies will revitalize your body at a cellular level.
What is integrative medicine?
Integrative medicine is a unique approach to health that encompasses the whole person including mind, body, and spirit. The integrative approach is a great compliment to traditional mental health care, as many underlying nutritional and genetic deficits can contribute to disease. Through a comprehensive assessment, laboratory evaluation, and genetic analysis, we can better pinpoint deficits on an individual basis and customize treatments specifically tailored for you.


How can I find out if ketamine infusions may be appropriate for me?
The best way to find out if ketamine infusions might be a viable treatment option for you is to call our office to have psychiatric evaluation scheduled with one of our excellent providers. At this visit, you and your provider will discuss what treatment options might be 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?
Very few medical and psychiatric conditions make ketamine infusion treatments contraindicated. 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 may exclude people from ketamine treatments, such as diabetes, cardiac or pulmonary disease, obesity (BMI 40 or higher), etc.

Note regarding blood pressure: The most common medical condition that prevents and/or interferes with ketamine treatments is uncontrolled hypertension, therefore it is encouraged for patients considering ketamine treatments to ensure their blood pressure is well controlled. They should consult their primary care physician if there is any question regarding the status of their blood pressure. Ketamine infusions can not be administered to persons with abnormal blood pressure on the day of the treatment. Our protocols regarding blood pressure are very strict.

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 Psychiatric treat with ketamine infusions?
Pacific Psychiatric primarily treats patients with treatment resistant depression with IV ketamine infusions, 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 Psychiatric.

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.” It is FDA approved only for use as anesthetic.

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™ is very similar to ketamine, but it is not the same thing. Spravato™ is also known by the name esketamine. Ketamine, which was FDA-approved for use as an anesthetic in 1970, is actually a mixture of two mirror image molecules, 50% “R-ketamine” and 50% “S-ketamine”. R-ketamine and S-ketamine are also called enantiomers. Spravato™, or esketamine, contains only the “S-ketamine” enantiomers.

At Pacific Psychiatric we use ketamine for our IV and IM treatments of depression, which is not FDA-approved for the treatment of depression. Spravato™ is only administered intra-nasally, and is only done in the office, but it is FDA-approved for the treatment of “Treatment Resistant Depression.”

Does insurance cover the cost of Spravato™?
At this time insurance companies are putting policies and procedures in place to provide reimbursement for this medication, and Pacific Psychiatric’s staff is working closely with these companies to implement them for our patients. We have already had several patient approved for reimbursement. We are set to begin Spravato treatments in May.
How is Spravato™ administered?
Spravato™ is administered intra-nasally, and is done in an approved clinic. Patients will start by having 2 treatments per week for the first 4 weeks, then weekly or every-other-week after that. Patients are required to be observed in the clinic for at least 2 hours following each administration.
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.”

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 the typical course of treatment of TMS?
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. The patient can immediately resume normal activities after each session.
Is TMS Therapy Safe?
Clinical trials of 10,000 treatments proved 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 Therapy was systematically evaluated for its effects on memory. Clinical trials demonstrated that TMS Therapy does not result in any negative effects on memory or concentration.

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?

TMS Therapy is covered to treat Major Depressive Disorder by most private insurers, and our staff are experts in the approval process.


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 plans?

Yes, for the patients that have health insurance plans that we are in-network for, we can bill the telepsychiatry evals directly to them.

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. Not all cases are appropriate for telepsychiatry, and your provider has discretion to utilize telepsychiatry, and to defer to in-office evaluations.