FAQ – Outpatient Mental Health in South Florida

Ketamine is a derivative of phencyclidine. It is an anesthetic drug developed in 1962 and has been used in many different settings. It is a very different type of anesthetic in its own category. Ketamine acts as an antagonist of the NMDA (N-methyl-D-aspartate) receptor to target glutamate, which is an excitatory amino acid transmitter.

Ketamine has been used to induce and maintain anesthesia for more than 30 years and is on the World Health Organization’s List of Essential Medicines. Additionally, Ketamine is FDA-approved and boasts a safe track record. Unlike other drugs (opioids, benzodiazepines, propofol), Ketamine does not cause respiratory depression while maintaining its sedative effects.

Through extensive research, Ketamine has proven an effective treatment for depression, PTSD, and trauma. It also has been shown to be beneficial to the detox process. It is particularly effective in treatment that has not responded to other therapies and medication interventions. Ketamine has a beneficial impact on suicidal ideation. However, Ketamine is not indicated for schizophrenia.

Yes. Over the last two decades, researchers have consistently found that low doses of Ketamine, when administered with an IV over a short period of time, produce effects that can counteract symptoms of depression, PTSD, trauma, and anxiety. These studies originated from such reputable institutions as Yale, the National Institute of Mental Health, and Mayo Clinic, to name a few.

Research suggests that, by blocking the NMDA receptors in the brain, Ketamine tells the brain to increase the production of signaling proteins in the prefrontal cortex. The prefrontal cortex is critical in the regulation of mood. Ketamine promotes the growth of new pathways, resulting in greater connectivity in the prefrontal cortex. Thus, this is the reason for its rapid anti-depressant effects.

Ketamine’s effect can begin to take place between one to 12 hours after the first infusion. Patients may continue to experience “bad periods” either during or after the infusions. Overall, mood symptoms trend positive following serial ketamine infusions.

A series of infusions have been shown to have a more positive and longer-lasting effect than singular infusions. The typical number of Ketamine infusions is six over a two or three-week period. Some choose to have maintenance of the Ketamine infusion over a longer period of time. Our care is personalized to each individual.

The length of response to Ketamine infusion varies with each patient. Patients may feel symptoms return in the four to six months following the initial series. Patients may receive a booster maintenance infusion of Ketamine at this time to stave off symptom relapse. Of course, booster maintenance is personalized to each patient based on initial infusion, patient history, and current health status. Thus, each patient continues with outpatient mental health around South Florida based on their needs and symptoms.

Most individuals experience few to zero side effects. Those who do may experience mild nausea, drowsiness, headache, blurry vision, dizziness, increased blood pressure, dissociation, and vivid dreams. However, nearly all of these symptoms disappear within 15 minutes after infusion. Also, an adjustment to the infusion dose of Ketamine can control these symptoms.

The answer is no, provided a trained medical professional prescribes Ketamine to treat legitimate medical conditions. However, as with any medication, people can abuse it at higher doses. In fact, the amount used for treatment is only eight to 12% of the amount used when Ketamine was abused as a “club drug” in the 1990s. However, even at high doses, Ketamine does not cause physical dependence.

You will arrive, check in, and fill out paperwork. Your provider will ask questions as a pre-treatment assessment. They take vital signs before placing the IV, give anti-nausea medication, and the infusion begins.

Ketamine infusion lasts for approximately 45 and 60 minutes. After the infusion, you will relax in your recliner or bed (if desired) for approximately 20 minutes. Then someone can drive you home. The initial visit—with paperwork, infusion, and recovery—takes approximately two hours. Subsequent infusions take less than 90 minutes, typically.

All you have to do is sit or lie back and relax. The staff does everything to make sure you have the most comfortable and relaxing experience with your infusion. You can watch our large-screen TV, and listen to music with provided headphones that connect to your cell phone. We recommend calming spa-like music. You can use earplugs and a sleep mask for complete peace and quiet. The choice is yours. Your provider will remain available.

You should not stop taking your psychiatric or other medications at the time of your infusions. You should not adjust the dose or frequency of any med without consulting your physician.

There are some meds to avoid if receiving a Ketamine infusion. Aminophylline for asthma or COPD runs a risk of seizures. Lamictal may affect the dose of Ketamine. No MAOIs within two weeks of infusion. Patients taking large doses of benzos may experience a reduced response to Ketamine. Taking SSRIs and Tricyclics should continue as prescribed.

At this time, Ketamine infusions are not covered by most insurance providers. While Ketamine is an FDA-approved anesthetic medication and backed by extensive research, it is not yet approved for the treatment of depression or other psychiatric conditions.

Conditions preventing the treatment of Ketamine infusions include uncontrolled high blood pressure, uncontrolled hyperthyroidism, and severe pulmonary issues. Additionally, they include seizure disorders, severe glaucoma, and severe cardiac issues. Some conditions may require clearance from a primary care physician.

You should not stop taking your psychiatric or other medications at the time of your infusions. You should not adjust the dose or frequency of any med without consulting your physician.

There are some meds to avoid if receiving a Ketamine infusion. Aminophylline for asthma or COPD runs a risk of seizures. Lamictal may affect the dose of Ketamine. No MAOIs within two weeks of infusion. Patients taking large doses of benzos may experience a reduced response to Ketamine. Taking SSRIs and Tricyclics should continue as prescribed.

No. You should maintain contact with your psychiatrist, therapist, or primary care physician during and after treatment for ongoing medical and mental health needs. Ketamine infusions allow the patient to become “unstuck” in rigid negative thought patterns and behaviors. This empowers the patient to re-engage with life and the therapeutic process. It also allows other psychiatric medications to have an effect.

Yes. You are not allowed to drive yourself home from our outpatient mental health center near South Florida, so please make arrangements. Do not operate heavy machinery or make any significant life decisions for 24 hours. Please do not eat a large meal for two hours prior to the appointment. You may drink clear liquids up to one hour prior to the appointment.

Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum.

Extensive research suggests that suggests Botox can ease the symptoms of depression.

Yes. For the past five to 10 years, there has been statistically significant research that Botox is a safe and effective treatment for patients living with major depression. The research is in journals like the National Institute of Health.

Botox works by weakening or paralyzing specific muscles or by blocking certain nerves that release acetylcholine.

Botox’s effects can be felt immediately upon injection to the glabella, or between and above eyebrows and around the forehead.

An initial treatment to the eyebrow and forehead should last three to six months. Additional treatment appointments can be made three to six months after each treatment. These additional treatments can be part of a patient’s plan for outpatient mental health near South Florida.

Most individuals experience few to zero side effects. However, possible side effects include pain and swelling or bruising at injection sites, headache or flu-like symptoms, droopy eyelid or brow, eye dryness, or excessive tearing.

At this time, Botox is not covered by most insurance providers. While Botox is FDA-approved for some conditions and backed by extensive research, it is not yet approved for the treatment of depression or other psychiatric conditions.

No. You should not stop taking your psychiatric and other medications at the time of Botox injection. You should not adjust dose or frequency of any med without consulting your physician.

There are some meds that should be avoided if receiving Botox, due to their possibly risky interactions. These include certain antibiotics (aminoglycosides such as gentamicin and polymyxin), anticoagulants such as Coumadin, Alzheimer’s drugs like galantamine, rivastigmine, tacrine; and myasthenia gravis drugs like ambenonium, pyridostigmine, and quinidine.

No. You should maintain contact with your psychiatrist, therapist, or primary care physician during and after treatment for ongoing medical and mental health needs. Propofol treatments may allow the patient to become “unstuck” in rigid negative thought patterns and behaviors. This empowers the patient to re-engage with life and the therapeutic process. It also allows other psychiatric medications to have an effect.

Yes. After your Botox injection (and for the next 24 hours):

• Do not rub your face
• Do not take a nap right after your appointment
• Avoid strenuous exercise
• Do not drink alcoholic beverages
• Do not take blood thinners
• Do not wash your face
• Avoid the sun and the heat

Propofol is a drug that restricts the movement of a key protein known as syntaxin 1A. This protein is required at the synapse of all neurons and causes a sedative effect.

Low-dose propofol infusions have been shown to effectively treat chronic, refractory insomnia.

Yes. Propofol IV infusion is given at a low-dose, typically 12% to 20%. A licensed and trained anesthesia provider with at least 20 years of experience administers the propofol infusion. The patient receives oxygen for support, vital signs measured frequently throughout a procedure, and gets continuous and uninterrupted monitoring.

Yes. The last five to eight years have seen statistically significant research suggesting that low-dose propofol infusion is a safe and effective treatment for patients with chronic insomnia. The research is published in journals such as the National Institute of Health, with studies conducted here in Florida.

Propofol therapy is safe and effective in restoring normal sleep to patients through a series of consecutive, medically-induced evenings.

The onset of sleep with propofol is immediate. As mentioned, treatment consists of a series of consecutive evenings. By the end of treatment, the brain and body are retrained for continuous, high-quality sleep.

The treatment consists of five consecutive evenings of the propofol IV infusion over a course of two hours.

There aren’t many. In this setting, propofol rarely produces rapid or profound decreases in the level of consciousness and cardiorespiratory function. These may be treated by our licensed anesthesia provider. Of note, propofol, when given as an IV infusion, actually has a strong anti-nausea property. However, antiemetics will still be administered with an IV.

At this time, propofol is not covered by most insurance providers. While FDA-approved for some procedures and backed by extensive research, propofol is not yet approved for the treatment of chronic insomnia.

Patients with severe sleep apnea or difficult airways, or those taking other CNS depressant medications on a daily basis, are prevented from propofol treatments. Those who are also prevented are people with severe hypertension, liver disease, severe cardiac disease, and allergies to eggs and egg products, soybeans or soy products.

You should not stop taking your psychiatric and other medications at the time of propofol treatments. You should not adjust dose or frequency of any med without consulting your physician.

No. You should maintain contact with your psychiatrist, therapist, or primary care physician during and after treatment for ongoing medical and mental health needs. Propofol treatments may allow the patient to become “unstuck” in rigid negative thought patterns and behaviors.

This empowers the patient to re-engage with life and the therapeutic process. It also allows other psychiatric medications to have an effect. Thus, IV sedation is just one part of treatment for outpatient mental health near South Florida.

Yes. Do not drive or do anything that requires you to be awake and alert for 24 hours after treatment. Please arrange for transportation. Do not operate heavy machinery or make significant life decisions for 24 hours. Do not eat for six hours before treatment. You may drink only clear liquids up to two hours before treatment.

Ativan is a benzodiazepine, or “benzo.” It works by attaching to gamma -aminobutyric acid (GABA) receptors. GABA is a neurotransmitter used in the brain and nervous system and works by slowing down signals sent through the Central Nervous System (CNS). Ativan attaches to GABA receptors and increases the signals sent by GABA to the body.

Ativan is a widely used medication. It is utilized often in the treatment of anxiety, status epilepticus (emergent seizures), and anxiety before surgery/procedures. Ativan is also used for other indications, including detox and the treatment of withdrawal symptoms. People undergoing detox from alcohol and other benzodiazepines tend to respond well to Ativan, since, like Ativan, these substances also affect the GABA transmission in the CNS.

When a person undergoes withdrawal, their GABA receptors are not working well, which creates symptoms like anxiety and seizures. Ativan makes the GABA receptors more sensitive, helping to reduce withdrawal symptoms. Also, Ativan is a longer-acting benzodiazepine. This means it takes several days to leave the body. This makes it more useful than other medications, which metabolize quickly and leave the body vulnerable to symptoms of drug withdrawal. 

Detoxing from opioids, alcohol, and benzodiazepines affects the heart, breathing, and other essential bodily functions. NRPA offers medical detox for people detoxing from alcohol, opioids, benzodiazepines, stimulants, marijuana, and prescription drugs.

The benefits of medical detox include reducing the intensity of withdrawal symptoms. This occurs safely under the supervision of medical professionals, allowing the patient to focus on their recovery and prepare for the rehab process. In addition, withdrawal from certain substances without medical supervision can cause seizures, disorientation, dehydration, depression, nausea and, in some cases, death. NRPA aims to help you stay as comfortable as possible while undergoing addiction treatment.

The benefits of detox with NRPA include a shorter detox period, no required hospital stay, and customized medications to reduce discomfort. As well, they get access to caring medical professionals and access to recovery support services. After all, drug withdrawal can be dangerous without medical intervention. NRPA can help patients avoid or decrease the negative effects of withdrawal. These negative effects include insomnia, anxiety, headaches, diarrhea, tremors, hallucinations, psychosis, DTs, and seizures.

The detox programs typically run between three and 10 days. However, overall detox can very depend on several factors, including the type of detox program, which substance or substances have been abused, the length of substance abuse, the quantity consumed, age, gender, medical history, and the presence of pre-existing health issues.

In many cases, insurance provides partial or full coverage of medical detox. Still, you will want to speak with your individual insurance provider to see which type of coverage is offered for medical detox programs.

No! You should maintain contact with your psychiatrist, therapist, or primary care physician during and after detox for ongoing medical and mental health treatment. You can also continue with a psychiatrist during outpatient mental health near South Florida.

NRPA offers three different types of medical detox. Which type is right for you depends on multiple factors, including your specific needs:

1. Ketamine IV infusion at NRPA. Typically, three to six visits with each visit lasting one to two hours in a comfortable, spa-like setting.
2. Ativan given in combination of IV and by mouth. Day one takes place at NRPA and includes two IV doses and one oral dose of Ativan given in a comfortable spa-like setting. The patient is then sent home with oral Ativan taken on day two. NRPA medical professionals determine additional appointments with an extended detox regimen.
3. Taken orally, Ativan tapers daily over the next 10 days. The treatment is outpatient but the patient must come in daily for a quick assessment and receive the next day’s Ativan dosage.

A small catheter is placed into a vein. Then hydration, vitamins, minerals, amino acids and other supplements are administered directly into the bloodstream.

Even with a good healthy diet, most people are depleted of necessary daily requirements for optimal health. People lacking a complete diet, or have underlying medical conditions are already depleted of necessary daily requirements for optimal health. By going directly into the bloodstream, your body can absorb 100% of the contents of your IV Vitamin Therapy. If taken orally, your body is only able to absorb approximately 20% to 30% of the same ingredients.

All of the contents of your IV Vitamin Therapy are FDA-approved and go through high levels of testing. A highly-qualified medical professional (ARNP/CRNA) administers the treatment and under the Medical Director. Prior to treatment, your health history is evaluated. Side effects of treatment are typically non-existent or mild. On occasion, you may experience some slight discomfort, bruising, itching, inflammation, or redness at the site of injection. However, true allergic reactions are extremely rare.

The actual infusion process takes 30 to 45 minutes. There are a few forms to complete prior to the treatment. The entire process typically takes one hour or slightly more.

There really isn’t any. Unlike typical “procedures” there is no requirement in regard to eating or drinking. It is requested you don’t arrive with a very full stomach but you may eat or drink right up to the procedure time. In addition, there is no need for adjunctive medications, such as sedatives, so you may drive yourself to and from your appointment.

The typical infusion offered during outpatient mental health near South Florida is the traditional Myer’s cocktail. It contains many of the nutrients the body needs and will 100% absorb for optimal health including high doses of all B Vitamins, Vitamin C, Magnesium, and Calcium. In addition, we work with a nearby compound pharmacy. We can fulfill specific requests and add to the typical infusion, such as adding glutathione (great for concentration and many other functions), Alpha Lipoic Acid (gaining popularity for weight loss), N-Acetyl Cysteine (for flu, cough, and other lung conditions) and many more.

We pride ourselves on providing the best spa-like experience and catering to your needs. While receiving the treatment, you may relax in our recliners, therapeutic bed, listen to music of your choice, watch our large screen TV with multiple streaming options, and many more comfort options.

The Stellate Ganglion is a bundle of nerves in the neck that when active, trigger the sympathetic nervous system and initiate the “fight or flight” response leading to increases in heart rate, blood pressure, heightened awareness, and need to be active. The Stellate Ganglion Block is the injection of local anesthetic to the area surrounding the Stellate Ganglion to block the “flight or flight” response feeling.

The SGB has been used for nearly 100 years to relieve chronic pain and depression as well as in the military for PTSD. It is safe and even safer now with the use of ultrasound guided placement to view real time injection.

Along with treating pain, as a regional anesthesia blocks, SGB has also been shown to be an effective treatment for PTSD, Anxiety, and Depression.

Yes. As mentioned previously, for decades, SGB has much research to support SGB to counteract symptoms of depression, PTSD, and trauma. Studies have originated from many reputable institutions.

Immediately after injection, you will feel the arm on injection side getting warm. You may notice any pain decreasing. Additionally, you may also notice a “lump in the throat.”

One single initial injection of local anesthetic to the Stellate Ganglion should last four to six months.

Length of response varies with each patient. Patients may feel symptoms return in the four-to-six-period after the initial injection. As well, patients may receive an additional injection at this four-to-six-month time to stave off a relapse of symptoms and in this same time period thereafter.

Hoarse voice, droopy and red eye, nasal congestion, pupil constriction, flushing of extremities, pain at the injection site. Very rare-–fever or chills, infection, nerve damage, seizure, collapsed lung.

You will arrive at your clinic for outpatient mental health near South Florida, check in, and fill out paperwork on your own and asked questions by your provider as pre-treatment assessments. We take your vital signs and place an IV, and you receive antinausea and sedative meds in the IV. Next, you will be lying on a bed with you head lifted and turned to the side. Lastly, a local anesthetic goes into to the skin for the injection.

Using Ultrasound, a very small needle is placed into the Stellate Ganglion area, where we inject a small amount. The actual SGB injection process takes approximately 15 minutes. After the infusion is completed, you will relax in your bed for approximately 15 to 20 minutes. Then you can be driven home by an arranged driver.

At this time, SGBs are not covered by most insurance providers. While SGB is an FDA-approved regional anesthetic technique and backed by extensive research, it is not yet approved for the treatment of PTSD, anxiety, depression or other psychiatric conditions.

You should not stop taking your psychiatric and other medications at the time of your SGB. You should not adjust dose or frequency of any med without consulting your physician.

Yes. You are not allowed to drive yourself home, so please make arrangements. Do not operate heavy machinery or make any significant life decisions for 24 hrs. Please do not eat a large meal six hours prior to the appointment. You may drink clear liquids up to two hours prior to appointment.

No. You should maintain contact with you psychiatrist, therapist, and/or primary care physician during and after treatment for ongoing medical and mental health needs. SGBs allow the patient to become “unstuck” in rigid negative thought patterns and behaviors. This facilitates the patient in re-engaging in life, the therapeutic process, and allows other psychiatric medications to have an effect.