Frequently Asked Questions
Answers to all your interventional mental health questions.
Table of Contents
Dual Sympathetic Block (DSB) FAQS:
Common Questions
Do you ever feel heightened nervousness, hypervigilance, difficulty sleeping, or trouble concentrating? These symptoms can surface as the results of an overactivated fight-or-flight response following a trauma experience.
DSB alleviates these physical symptoms by targeting your sympathetic nervous system with a local anesthetic. This gives your body the chance to reset its fight-or-flight response.
Good question. Here are the facts:
In a study of 327 patients who received DSB between December 2016 and February 2020, over 83% reported a 28.9-point decrease in their self-reported PTSD checklist score.
These patients experienced a result that’s almost three times better than that of other treatments measured by the National Center for PTSD Guidance, which considers a 10-point decrease on the PTSD checklist scale to be a clinically significant improvement.*
At Hudson Medical, we are proud partners of the world-renowned Stella Center. Our pain management providers have been personally trained by Dr. Eugene Lipov to perform his specialized “2-site” Dual Sympathetic Block treatment. In a 2020 study, the “2-site” technique proved more effective than the single-site technique utilized by most clinicians.
*This data has been reviewed by an Institutional Review Board and submitted to a peer-reviewed journal for publication
Following your DSB treatment, you may temporarily experience some eye drooping and redness, congestion, and extra warmth in your face and arm. Don’t worry–these effects are normal and typically dissipate within 6-8 hours, but can linger for up to 24.
Serious side effects of a DSB are extremely rare at Hudson Mind. Our team uses two different imaging techniques to ensure accurate placement.
The DSB treatment will not erase your memory. Actually, some patients find that their memory becomes more clear and their concentration levels sharpen.
Great question. And, yes! DSBs work well in conjunction with other treatments, like psychotherapy. You may find that DSBs actually boost progress with your psychotherapist because the treatment encourages a new sense of calm. If you have ever experienced symptoms of PTSD you may find that you are able to recall past traumatic events without feeling as though you are reliving—and without sparking a fear response.
DSB is administered as an injection, so you will feel it. Our providers will give you a local anesthesia beforehand to diminish any discomfort. If it makes you feel more comfortable, you can also request conscious sedation. Any pain really depends on your pain tolerance, but we do everything we can to make you feel as relaxed as possible throughout the experience.
DSB
You’ve heard of “fight-or-flight,” the response activated in your sympathetic nervous system following a traumatic experience. The source of this response actually lives in a nerve bundle located in your neck called the stellate ganglion.
Your fight-or-flight response can sometimes remain activated long after the traumatic event. This over-activation can lead to nerve growth in the part of your brain that modulates your body’s fear response. This growth can actually stop your sympathetic nervous system from returning to normal levels for your body.
To support your sympathetic nerve response, we administer a local anesthetic directly into your stellate ganglion. This injection acts as a blocker, temporarily “turning off” the stellate ganglion nerve center to stop it from sending more “fight-or-flight” signals to your brain. This temporary “off-mode” gives your body a chance to reset, and return to its pre-trauma state.
While we can’t promise you an exact length of time, we can tell you that alleviation of symptoms following DSB typically last anywhere from several months to several years.
Following your DSB treatment, you may temporarily experience some eye drooping and redness, congestion, and extra warmth in your face and arm. Don’t worry–these effects are normal and typically dissipate within 6-8 hours, but can linger for up to 24.
Serious side effects of a DSB are extremely rare at Hudson Mind. Our team uses two different imaging techniques to ensure accurate placement.
DSB alleviates the physical symptoms of PTSD and anxiety by targeting your sympathetic nervous system with a local anesthetic. This gives your body the chance to reset its fight-or-flight response.
DSB does not remove your fight-or-flight response, or stop you from being able to recognize danger. Rather, this treatment de-escalates your overactive fight-or-flight state.
You should choose the best healing path for you. Although it is not required, we do highly recommend working with a talk therapist before and after your DSB procedure. DSB can alleviate the symptoms that may be making it difficult for you to talk about an experience without reliving it.
We’re happy to share our network of Mental Health Providers and submit a referral on your behalf.
After receiving an evaluation from our team, any patients under the age of 18 will be asked to provide signed consent from a parent or legal guardian.
Transcranial Magnetic Stimulation (TMS) FAQS:
Common Questions
Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment that utilizes electromagnets to affect the way neurons fire in the brain.
TMS creates a magnetic field that directly stimulates neurons in the brain, to help “reawaken” cells that were under-active or dormant. This helps to stimulate the release of certain chemicals in the brain involved in mood, such as serotonin and dopamine.
Everybody’s mental healing journey is different, and that’s okay. TMS might be for you if you have not felt significant relief from medications and/or psychotherapy.
Yes! You can continue taking your prescription once you begin TMS. Actually, we recommend it. Just be sure to communicate any dosage changes with our team.
Every body is different. You might notice improvement in mood within the first few weeks of starting treatment, or you may not feel any change until the completion of treatment.
Results tend to vary from patient to patient, but studies do show that patients who experience a significant reduction in symptoms are more likely to show continued positive response from anywhere between six months to one year after completion of treatment.
If your insurance covers TMS, it may reauthorize treatment after a six-month period in case any maintenance is needed.
The sensations from TMS may feel a little weird at first. Although some describe the feeling as “uncomfortable,” most people acclimate after their first couple of sessions.
Always remember that you can communicate with your technician if the treatment feels too intense. The technician will work with you to find a pulse level that is tolerable for you.
As long as it was only a one-time seizure and you have not had any episodes since, and are not currently on anti-epileptic medications, TMS is safe for you.
Great question. Here are the facts:
At Hudson Mind, we use BrainsWay’s cutting-edge Deep TMS technology. Research shows that for patients receiving Deep TMS treatment, 64% showed a positive response after 20 sessions, with 42% of patients meeting remission criteria. After about 30 sessions, 75% of patients showed a positive response, with 51% meeting remissions criteria. We will never make you promises, but the data is promising.
Although TMS is currently only FDA-approved for the treatment of Major Depressive Disorder, Obsessive-Compulsive Disorder and Smoking Cessation, many new research and clinical trials have shown safe and effective use in the treatment of:
- Anxiety
- PTSD
- Parkinson’s Disease
- ADHD
- Addiction/Substance Use disorders
- Bipolar Disorder
You can safely receive TMS treatments throughout your pregnancy, and research shows successful results among pregnant people. However, you should know that insurance will not cover treatment for you if you are pregnant.
It’s always a good idea to connect with your provider if you are pregnant, or may become pregnant.
Insurance
That depends on the type of TMS treatment. As of right now, TMS for Major Depressive Disorder/Obsessive-Compulsive Disorder is covered by most major insurances (with some exceptions) as long as certain clinical requirements are met. The amount of coverage varies and depends on your specific plan. Once authorized, insurance will only cover one treatment per day, so while we also offer an accelerated version of TMS where you can receive multiple treatments in a day, this will be a private pay treatment only. Call us for a free consultation to discuss.
Yes! TMS for depression is covered by both Medicare/Medicaid as long as you meet certain clinical requirements:
1) You have been clinically diagnosed with depression.
2) You have completed antidepressant trials with no significant results.
3) You have completed therapy trials with no significant results.
*Please note: Fidelis Medicaid plan does not cover TMS.
We want to ensure this treatment is as accessible to you as possible, and we will certainly work with your insurance carriers. But there may be some plans that are not willing to cover treatment at all due to specific diagnoses or contraindications.
We understand how challenging it is to navigate insurance. We are always here to discuss payment plan options so that cost does not keep you from healing.
The Treatment Experience
Your treatment will likely take place over the course of three months, as this is the most common treatment plan.
Most of your sessions may be as short as 15 minutes, but your first session may take up to an hour because of the included consultation.
For the first four weeks, you can expect to come in for five days of treatment each week. After these initial 20 treatments, your provider will review how you’ve responded to treatment, and may taper your schedule. Some patients occasionally need an extra week of five days of treatment before tapering.
Every body responds to TMS treatments differently, but side effects are not unusual. The most common side effects reported are headaches, fatigue, light nausea, and jaw pain.
If you feel any discomfort, it is okay to take over-the-counter pain relievers, like Tylenol or Advil. You can also take over-the-counter pain relievers before you come in for an appointment to mitigate any discomfort. Side effects tend to decrease over time, especially as your body gets acclimated to treatment.
The most serious, though rare, side effect is an increased risk of seizures. It’s important to be as communicative as possible with your technician, especially if you experience any changes in medication, sleep, or drug/alcohol consumption. Depending on the differences you report, your technician may advise skipping a day of treatment. Any risks will be thoroughly covered in your initial consultation.
During your session, the technician will first place a special helmet on your head. This helmet is equipped with H-Coil technology that generates electro-magnetic fields to safely reach deep within your brain structures and manipulate neural activity in specific areas.
That really depends on the type of treatment you’re receiving. If you’re getting treated for depression, we recommend bringing materials that will elevate your mood. The materials can range from books, pictures, a meditation app, a playlist of your favorite songs or YouTube videos.
Some people choose not to bring in extra materials as they actually prefer to chat with their technician throughout the session.
If you are receiving treatment for Obsessive-Compulsive Disorder or PTSD, your session will feel a bit different. Before starting treatment, you will work with the technician to devise specific provocations that can be played for you during each session. The point of these provocations is to push you to a certain level of distress right before the session begins.
Great question. During your first session the technician will perform a “brainmap.” A brainmap is exactly what it sounds like: a map of your brain. The technician will place the helmet on your head and send single pulses to your motor cortex. These pulses do not hurt–most people say they feel like someone is lightly tapping on the helmet. These pulses will then prompt involuntary movement in your hand or foot (depending on the part of the brain that needs to be stimulated). Based on the strength of your involuntary reactions, the technician will be able to precisely determine the coordinates of your brain they need to target in subsequent TMS sessions.
Ketamine FAQS:
Common Questions
Psychedelic medicine harnesses the therapeutic qualities of psychedelic substances to treat symptoms of depression, anxiety, OCD, and PTSD.
Please visit our pricing page or contact us for questions about pricing.
Absolutely. We know that people’s financial situations vary, and we do not want a fear of financial burden to keep you from healing. Our team is here to work with you to create a financing plan that fits your needs. Call or email us to discuss financing eligibility.
Most insurance companies do not currently cover ketamine for depression. We are hopeful that this will change as more published research continues to prove the efficacy of this treatment.
The medicinal power of ketamine is widely documented, and we are optimistic that the FDA will approve more variations of ketamine in the near future. (The FDA approved Spravato’s Esketamine, a nasal spray in 2019). We want ketamine therapy to be as accessible as possible, so we are partnering with notable institutions to conduct ground-breaking research to further support FDA recognition.
Yes! How you choose to care for yourself is completely up to you, but we highly encourage people to continue seeing a talk therapist or psychiatrist once they’ve started ketamine treatment. Working with a talk therapist may help you to unpack any breakthroughs you experience during a ketamine journey.
Our team prefers to receive referrals before beginning treatment, but they are not required. We find that we are able to help people achieve the best results when we are able to work with a mental health provider to better understand your history, and develop a post-treatment plan. If you are not currently seeing a psychotherapist or psychiatrist, our physicians will perform a medical and psychiatric history screening. Additionally, we can assist you with a referral to work with a ketamine-assisted psychotherapist in our expansive network.
If you would like to schedule an appointment, please fill out the pre-screening questionnaire. After completing the form, a member of our medical staff will reach out for your telehealth consultation, where they will review your information. After your telehealth consultation, our team will reach out directly to schedule your infusions.
Based on your medical history discussed in the screening, our team will determine if ketamine is safe for you. If you have any recent brain injuries, ketamine allergy, or a history of psychosis, you may be denied.
The following contraindications will be weighed on a case by case basis:
- Obstructive sleep apnea
- Uncontrolled hypertension
- Respiratory issues due to weight
- Medication risks (benzodiazepines, opioids)
- Active substance use
- Personality disorders
- Acute suicidal ideation
- Significant past substance abuse
Ketamine
There’s a good chance you’ve heard of ketamine as a recreational substance, but its medicinal value far outweighs its party persona. For decades, ketamine has been a FDA-approved anesthetic. But it has also been proven to effectively treat symptoms of anxiety, depression, PTSD, and OCD.
Ketamine is safe when it is administered under the guidance of certified medical professionals. Physicians in operating rooms actually tend to favor ketamine over other anesthetics because of its low side effect profile—which is especially necessary for patients with low blood pressure and respiratory issues. Your IV ketamine treatment will be administered at an even lower dose than what is used as an anesthetic in operating rooms.
Side effects from IV ketamine treatments are rare, and we conduct thorough medical pre-screenings to mitigate any chances of you feeling discomfort post-treatment. But every body is different. While most people walk away from ketamine treatment feeling relaxed and comfortable, some do report feelings of dizziness, elevated heart rate, nausea, hallucinations, and increased blood pressure. During treatment our certified physicians are always close by to monitor—don’t hesitate to let them know if you have any questions.
Ketamine is regulated by the FDA and legal for medical use in the United States when administered by certified medical providers.
Traces of ketamine may be detected in your urine sample for about two weeks, in your blood for four days, and in your hair follicles for up to 90 days. It’s important to note that a chemical trace is not the same as chemical activity. The dissociative feelings induced by the treatment will wear off after about two hours.
Our team prefers to receive referrals before beginning treatment, but they are not required. We find that we are able to help people achieve the best results when work with a mental health provider to better understand your history. If you are not currently seeing a psychotherapist or psychiatrist, our physicians will perform a comprehensive screening. We can also refer you to a ketamine-assisted psychotherapist within our expansive network.
- Treatment Resistant Depression
- Chronic Pain
- Anxiety
- PTSD
- OCD
Ketamine challenges the breakdown in the brain’s information synthesis capability by resetting brain structures and creating new neural connections.
We always recommend discussing dosage changes or continuation with your psychiatrist. But it is safe to continue taking antidepressants once you’ve begun ketamine treatment, as ketamine does not interact with the majority of antidepressant medications. Although it is safe to continue, many people actually are able to lower their antidepressant dosage following ketamine therapy.
Currently, we only offer ketamine treatment. However, if more clinical studies emerge and legalization of these substances for treatment occurs, our team will conduct an in-depth review of clinical data to determine whether or not to add more psychedelic treatment offerings.
Our Treatment
Our ketamine treatments are administered by physicians and ICU-trained physician assistants who are supervised by board-certified anesthesiology physicians.
The infusion portion of your ketamine treatment may last anywhere from 45 minutes to one hour. You may continue to feel dissociative effects for 30 minutes following the infusion—some people even report lingering effects for a few hours. We give you as much time as you need to relax and readjust in the room.
Research shows that significant healing breakthroughs typically occur around the fourth or fifth ketamine treatment. We recommend completing six sessions over the course of three to four weeks.
We offer two types of ketamine treatments The first is an infusion drip administered intravenously. The second is an injection, administered intramuscularly. We recommend new patients begin with infusions as this mode of administration gives our team more control over the speed at which the ketamine is delivered to your system, ultimately delivering a more gradual journey.
Everyone experiences ketamine differently. Generally, though, the treatment takes people on one of, or a combination of, four types of journeys:
- Empathogenic journey: This colorful, dream-like journey heightens awareness of your body from a relaxed state. It also induces empathy and compassion, and reduces your ego.
- Out-of-body journey: You may visit mythical realms or interact with spiritual beings or ghosts. You may even slip into dreams of the past, present, or future.
- Near-death journey: Along this path, you may experience the complete dissolution of your ego, which can sometimes feel like dying and observing your past life.
- Ego-dissolving, transcendental journey: Welcome to the complete dissolution of boundaries between yourself and your external reality. You may feel like you’re transcending normal space and time, boosted by feelings of collective consciousness and unity with a higher power.
To maximize your comfort and ensure you get the most out of your experience, we recommend bringing the following:
- Have a favorite eye mask? Bring it! If not, we’ve got you covered (literally). Wearing an eye mask will block out light and help you focus on your journey.
- Try not to eat or drink for four hours before your journey, as an empty stomach will reduce nausea.
- Wear comfortable, loose-fitting clothes so that you feel as relaxed as possible. Non-restrictive clothing will also help with IV accessibility.
- Set your intentions beforehand. Carve out some time to think about what you are hoping to get out of treatment and the changes you want to prompt in your life.
- Avoid violent media. Watching TV shows and movies with excessive amounts of violence can have a negative impact on your ketamine experience.
- Avoid alcohol, marijuana, and other mind-altering substances or stimulants, as they can influence your experience.
Bad trips are rare, but it is always possible that your journey may not feel pleasant. For some people, bad trips can feel like being trapped in a dark space while others relive their past traumas. If you feel at all anxious about your journey, rest assured that you will not be left alone. We regularly check in during your infusion and there is a call button available if you need assistance. Stopping or slowing the infusion is also always an option.
Aftercare (Including Maintenance)
Every body is different. But you’ll likely feel calm and uplifted following your treatment. You might feel the dissociative effects of the ketamine for up to two hours after the infusion. Some people report feeling a bit light-headed and nauseous—especially when they are new to ketamine. Feel free to take as much time as you need to readjust and re-acclimate in our recovery lounge.
We recommend bringing along a friend if this is your first time receiving ketamine treatment. It’s not a requirement, but sometimes knowing that a familiar face is waiting can put you at ease.
We recommend taking it easy following a treatment. Block the rest of your day off from work, exercise, and appointments. Give your mind and your body the time to relax and re-acclimate. If you’re up for it, grab a journal and write about your ketamine experience to later revisit with your talk therapist. It’s also a good idea to avoid violent or stressful media, as this may aggravate your mood.
