Tried the usual treatments? There are still real options.

Interventional psychiatry uses procedures, rather than daily pills alone, to treat depression and related conditions that haven't responded to standard care. The main options are IV ketamine, Spravato (esketamine nasal spray) and TMS (transcranial magnetic stimulation). Each one works on brain circuits differently from typical antidepressants, which is why they can help when several medications haven't. At this practice, those treatments are paired with medication management and structured therapy, so the improvement has something to build on.

You may be a candidate if you've tried at least two antidepressants at an adequate dose and length without enough relief, or if side effects made them hard to continue. People with PTSD, anxious depression or OCD may also qualify for specific treatments. Some conditions, like uncontrolled high blood pressure, active psychosis or certain seizure histories, rule out particular options. Julian reviews your full history at your first consultation and tells you plainly which treatments fit and which don't.

Both act on the brain's glutamate system, but they're different medicines given differently. IV ketamine is a racemic mixture given as a monitored infusion, and its use for depression is off-label. Spravato is esketamine, one half of the ketamine molecule, given as a nasal spray and FDA-approved for treatment-resistant depression. Spravato is more often covered by insurance. IV ketamine allows more precise dosing and many people feel effects sooner. Julian has worked with both and will explain the tradeoffs for your situation.

Most major insurance plans are accepted. TMS and Spravato are usually covered once you've tried a few antidepressants, though plans often require prior authorization, which our team handles. IV ketamine for depression is usually self-pay, and many patients use HSA or FSA funds. CJ verifies your benefits before your first visit so you know your costs up front.

It depends on the treatment and the person. Many people notice a change within days of starting IV ketamine. Spravato and TMS tend to show change over two to four weeks. No treatment works for everyone, and results vary. That's why progress is tracked with standard symptom measures throughout, so the plan can be adjusted rather than continued blindly.

No referral is needed to book a consultation. If you have a therapist, psychiatrist or primary care provider, Julian can coordinate with them, with your permission, so everyone is working from the same plan.

Yes. Psychiatric evaluations, medication management and follow-up visits are available by telehealth anywhere in California. IV ketamine, Spravato and TMS take place in person at the Larchmont office in Los Angeles.

Julian Macias is a board-certified psychiatric mental health nurse practitioner (PMHNP-BC) in Los Angeles. He spent more than four years at Ketamine Clinics Los Angeles under Dr. Steven Mandel, monitoring thousands of IV ketamine infusions, and holds MagVenture TMS certification. He earned his MSN at Western University of Health Sciences and his BSN cum laude at CSU Northridge. He sees patients at Conscious Health on Larchmont Boulevard.