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)
Vitamin 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 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.
Is ketamine therapy appropriate for me?
The best way to find out if ketamine therapy might be a viable treatment option for you is to schedule a psychiatric evaluation. At this visit, you and the doctor will discuss what treatment options, including but not limited to ketamine, are the most appropriate for you.
How many ketamine treatments will I need?
Initially, 6 ketamine treatments (IV infusions or IM injections) over the course of 2 weeks are recommended for treating depression. If the symptoms are successfully controlled with these initial 6 treatments, then patients will begin another series of 6 treatments spread out over the next 8 weeks. If symptoms are remain successfully controlled after this sequence of 12 treatments over 10 weeks, then patients will transition to what we call the “maintenance phase” where treatments are done every 2-6 weeks on average. We will discuss the specifics of our protocols during the initial psychiatric consultation.
How is ketamine administered at Pacific Psych Centers?
Ketamine is administered either intravenously or intramuscularly. The intravenous (IV) method is delivered through and IV catheter and is infused over 40 minutes by an infusion pump. The intramuscular (IM) method is delivered via a single injection into the shoulder muscle. The details of both methods are discussed in detail during the consultation. Some basic information comparing both methods can be found on our website.
What are the differences and similarities between the intravenous (IV) and intramuscular (IM) administration methods of ketamine?
IV ketamine infusions require an intravenous (IV) catheter to be placed, and intramuscular (IM) ketamine injections do not. IM ketamine treatments are administered using a single injection to the shoulder muscle.
The duration of an IV ketamine infusion is 40 minutes, plus a 20 minute recovery period. The duration of an IM ketamine treatment is between 20-40 minutes, plus a similar 20 minute recovery period.
The IV treatment can be stopped at any point during the 40 minute treatment, whereas once an IM treatment is delivered, it cannot be stopped.
Both methods have the same efficacy for the treatment of depression, and have very similar side effect profiles.
Cost of treatment is one of the most significant differences with IV treatments costing $550 each and IM treatments costing $375 each.
The protocols, regarding induction phase, maintenance phase, number of treatments recommended are the same.
Both IM and IV are treatments done in the office, and have the same restrictions post treatment with regards to driving.
How do I decide between the intravenous (IV) and intramuscular (IM) administration methods of ketamine?
In general, at Pacific Psych Centers (PPC), we recommend the intramuscular (IM) method over the intravenous (IV) method. Sometimes we may suggest IV over IM, but the cost savings of the IM method is significant. The efficacy of IV over IM is not higher, so IM is a more cost effective treatment. At PPC we have many years of experience with both IV and IM modalities. Recently we have decided to shift the focus of our ketamine treatments to IM. During a patient’s initial consultation, amongst other things, we will discuss in detail the two administration modalities to help patients decide on what method would be best for them.
Where are the treatments done and can I get ketamine prescribed to take at home?
All ketamine treatments are done in the office in private treatment rooms, whether it is an IM injection, or an IV infusion. Ketamine treatments generally take about 90 minutes.
Under no circumstances will ketamine (injectable, lozenge, inhaler, etc.) be prescribed for home use by Pacific Psych Centers. All treatments are done in the office under the direct supervision of board certified physicians.
What medical and psychiatric conditions could potentially exclude me from ketamine therapy?
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 ketamine therapy.
Do I need to be referred by a psychiatrist or therapist to be considered for ketamine therapy?
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 therapy 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, Magellan, and Cigna. Because we are contracted with these companies, we can bill directly to them for psychiatric consultations and follow-ups.
What does ketamine therapy cost at Pacific Psych Centers?
At Pacific Psych Centers we offer both Intramuscular (IM) ketamine injections, and Intravenous (IV) ketamine infusions.
IM ketamine injections are $375 and IV ketamine infusions are $550 (effective 1 February 2021).
There will be no change to pricing for patients seen previous to 1 February 2021 unless they let 6 months or more elapse between their last ketamine treatment, which at that time they will be subject to the current rates.
Discounts: If 6 IM or 6 IV ketamine treatments are pre-purchased, then a 15% discount will be applied to the total.
What conditions does Pacific Psych Centers treat with ketamine therapy?
Pacific Psych Centers primarily uses ketamine therapy 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 Centers.
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 therapy?
Research shows roughly 70% of people respond successfully to ketamine therapy.
What are the restrictions after I’ve had a ketamine treatment?
Where is your clinic located?
What days are ketamine treatments done?
Ketamine treatments are administered on weekdays (Monday through Friday), and usually one to two Saturdays per month.
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?
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?
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.
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 a face-to-face evaluation prior to our transmitting a prescription. This evaluation can be done 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?
For problems connecting with your provider with our telemedicine platform please call our office at (858) 261-4622.
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.