Frequently Asked Questions About Stella
See answers to the most frequently asked questions about Stella and its innovative treatments, including ketamine and SGB treatments.
General Questons
Who is Stella?
Stella is an interventional psychiatry practice that advances the understanding and treatment of emotional trauma and symptoms caused by mental health conditions. We treat mental health challenges as injuries, not disorders. That is why we incorporate both traditional psychological approaches like medications and talk therapy with cutting-edge biological treatments like the dual sympathetic reset, Spravato, ketamine therapy and transcranial magnetic stimulation (TMS therapy). Our mission is to continue to innovate like lives depend on it -- because they do.
What treatments does Stella provide?
Our biological treatments include Spravato (esketamine) therapy, transcranial magnetic stimulation (TMS) therapy, dual sympathetic reset DSR (an advanced stellate ganglion block SGB), ketamine infusion therapy, medication management and integration therapy.
What conditions can treament by Stella address?
DSR SGB, TMS Therapy, ketamine therapy and Spravato can help people experiencing conditions such as: PTSD/PTSI, anxiety, depression, major depression disorder, treatment resistend depression, OCD, suicidal ideation, long-COVID and more.
Through medication management, we treat people experiencing anxiety, depression, emotional trauma and PTSD, OCD, Perinatal Mood Disorders, ADHD and more. Explore additional conditions and symptoms that we support here.
What does treatment by Stella include?
Treatment by Stella is a commitment to your recovery, from first contact to the moment you feel like yourself again. The Stella Standard of Care was created to meet your needs before, during, and after treatment. This is the new model of trauma treatment.
Getting To Know You:
The first step is to speak with a licensed Advanced Practice Provider (APP). The APP will conduct a bio-psycho-social assessment which includes a review of your symptoms and health history. Using this information, the APP will create a custom treatment recommendation for you.
Our APPs use validated measures to gauge your symptoms. These measures include the Post-traumatic Stress Disorder Checklist (PCL-5) for symptoms of PTSD/ emotional trauma, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, the Patient Health Questionnaire-9 (PHQ-9) for depression, and the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) for Traumatic Brain Injury.
Curated Care:
Throughout the journey, you will work with a dedicated Care Coordinator who will coordinate your care and help answer any questions along the way.
If receiving the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment, the entire procedure takes less than 20 minutes, but please plan on being at the facility for one to two hours. The positive effects of SGB are often immediate.
If receiving ketamine, each infusion session typically takes 45 minutes. Please plan on being at the facility for one to two hours. Most have relief from symptoms within hours of treatment.
Those on Care Plans will work with Stella's APPs over 6 months and receive an individualized treatment plan that combines biological and psychological interventions to provide the best outcomes possible.
Ongoing Support:
Following treatment, your APP will call to review the effectiveness of the procedure(s) you had and ask about any symptoms that you may be experiencing. Each patient will also have a 30-minute follow-up to continue that review and discuss how to maximize the positive effects of treatment. APPs are there to physically, mentally, and emotionally support a patient, as uniquely required, during this session.
Those on Care Plans will have additional follow-up sessions with Stella's APPs, which include completing standard mental health assessments, determining whether additional treatment is warranted, and discussing trauma-informed, healing-related topics such as getting better sleep, approaching grief, or mindfulness techniques.
How do I determine which treatment is right for me?
We'll be your expert guide to identify what treatments will work best for you. You'll be paired with one of Stella's licensed Advanced Practice Providers (APP) to discuss your symptoms and review your biological, sociological, psychological and medical history to determine which treatment can best support you. This may include a single treatment, or a combination of treatments across the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment, Spravato (esketamine), ketamine infusion therapy, transcranial magnetic stimulation (TMS), medication management and/or integration therapy.
We will discuss any health conditions that you have to ensure that they do not interfere with the treatment's ability to relieve your symptoms. Call 908-293-7559 to schedule your initial consultation with an APP.
Where are Stella clinics located?
Stella has over 20 locations in 10+ states in the US. To find out details, please visit https://stellamentalhealth.com/locations
How do I schedule treatment?
Stella offers concierge-level access to care and will help guide you through your care experience. After your intake appointment with a medical and mental health expert, you'll be connected to a patient care coordinator that is dedicated to your care. Our care team will work directly with you to schedule your treatments at the location nearest to you offering the modality clinical recommended for you.
We will be with you every step of the way and can help answer any questions about the day of treatment, what to expect, financing options, and more.
How soon can I receive treatment?
The first step is to meet with Stella's medical and mental health experts for an intake appointment. Similar to going to your primary care doctor, our experts will use this time to talk through your symptoms and concerns and work with you to identify what treatments may help you get back to your best self.
Most patients can start treatment within one to four weeks after receiving a clinical recommendation, depending on self pay vs insurance coverage, protocol longevity and clinic availability.
What are the prices of treatment by Stella?
Intake assessments, Spravato, TMS therapy and integration therapy may covered by insurances depending on your state and coverage. Please contact our care advocate for more information. Please see below for out-of-pocket pricing for DSR SGB and ketamine infusion therapy.
Dual Sympathetic Reset (DSR SGB)
- DSR SGB + Integration Therapy
- $2344: DSR + 4 Integration Sessions
- $3644: Bilateral DSR + 4 Integration Sessions
- DSR SGB
- $1650: DSR
- $2950: Bilateral DSR
Ketamine infusion therapy
- Ketamine IV Infusions + Integration therapy
- $4466: 6 Infusions & 6 Integration Sessions
- $673: 1 Maintenance Infusion & 1 Integration Session
- Ketamine IV Infusions only'
- $3475: 6 Infusions
- $475: 1 Maintenance Infusion
Multi-Modality Treatment
- DSR + Ketamine Infusions
- $4795: Bilateral DSR + 4 Ketamine Infusions
Is Treatment by Stella covered by insurance?
Stella accepts select insurances for intake assessments, Spravato, Transcranial Magnetic Stimulation, integration therapy, and follow-up appointments. Coverage will depend on your specific location and insurance plan. To find out your eligibility for insurance coverage, call our care advocate at 908-293-7559.
What financing options are available?
Stella offers the following financing options:
- In-house financing
Stella offers 0% down in-house financing for those looking to get care out-of-pocket. Through our partnership with Rectangle Health, we offer additional financing plans. *
- CareCredit:
If you have a CareCredit card, You can use it to pay for out of pocket services such as ketamine therapy,spravato out--of-pocket costs, the dual sympathetic reset and more. You can also use your CareCredit card to pay for any deductibles or co-pays you may have for insurance coverage services.
- FSA, HSA, and More,
Stella accepts multiple forms of payment such as Health Savings Accounts, Flexible Spending Accounts, and major credit cards. Superbills are also available.
DSR SGB
What is the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment?
DSR is an advanced Stellate Ganglion Block (SGB) treatment, during which a local anesthetic is injected next to the stellate ganglion, a bundle of the sympathetic nerves located in the neck that helps regulate many involuntary functions such as heart rate, blood pressure and sweating. The regular SGB treatment involves injecting anesthetic in the C4 level of the stellate ganglion, but the "Dual Sympathetic Reset" protocol requires injection on both C4 and C6 level to enhance the effect for treating PTSD and anxiety. The treatment is usually performed on the right side of the neck first, and typically repeated on the left side of the neck within 30 days. This is because many patients respond better following bi-lateral treatment.
Does Stellate Gangliong Block (SGB) work for trauma and PTSD?
Yes. Stella's Dual Sympathetic Reset (DSR) has helped thousands of patients find lasting relief from their PTSD and trauma-related symptoms.
While studies show that 70% - 75% of SGB treatment participants experienced high rates of rapid clinical improvement in PTSD symptoms, Stella's advanced DSR SGB protocol results in over 81% of clients finding relief from their PTSD symptoms.
In a study of 327 Stella patients who received DSR SGB between December 2016 and February 2020, on average, over 81% reported a 28.9-point decrease in their PCL score. The PTSD Checklist (PCL) is a self-report survey used to measure PTSD symptoms. According to the National Center for PTSD Guidance, a 10-point decrease in PCL score is a clinically significant improvement.
Source: Lipov EG, Jacobs R, Springer S, Candido KD, Knezevic NN. Utility of Cervical Sympathetic Block in Treating Post-Traumatic Stress Disorder in Multiple Cohorts: A Retrospective Analysis. Pain Physician. 2022 Jan;25(1):77-85. PMID: 35051147. https://pubmed.ncbi.nlm.nih.gov/35051147/
Does Stellate Ganglion Block (SGB) work for anxiety?
Yes, SGB has proven to relieve a cluster of anxiety symptoms like panic attacks, trouble sleeping, difficulty in concentration, agitation, etc. A 2023 research based on a case series of 285 patients showed that dual-level Stellate Ganglion Block can effectively reduce anxiety symptoms by 50% measured by Generalized Anxiety Disorder questionnaire (GAD-7) scores
Can DSR SGB treat Complex PTSD (C-PTSD)?
DSR, Stella's SGB procedure has shown efficacy for a wide range of traumas. Many of our patients have experienced multiple traumas over their life, including early childhood trauma. In fact, it is more rare to treat a patient with a single traumatic exposure, as opposed to an individual who has suffered from two or more different forms of trauma.
Because Stella treats a large number of veterans and first responders, a significant number of our patients have had high levels of cumulative, multi-layered trauma. Our research on the biggest sample to date of patients treated with SGB for trauma shows that regardless of the source of trauma, Stella's DSR procedure shows good outcomes for most patients regardless of the type of trauma and when it occurred.
In other words, we have seen great outcomes both with patients whose trauma was sustained during their early childhood and patients with more recent forms of trauma. While individual outcomes vary, there is reason to hope that Treatment by Stella can bring relief to suffering.
Is DSR SGB FDA-approved?
SGB has long been approved by the FDA as a pain management treatment. When used for trauma symptoms, licensed professionals can legally perform SGB as an off-label procedure for symptom relief, based on the body of supporting medical evidence for this application in peer-reviewed literature.
Off-label use of medications and treatments has been a common practice in medicine for many years, and many treatments used off-label have been proven effective in treating various conditions. An estimated 30% of all medications are prescribed off-label, including many cancer drugs, and are frequently used by physicians even though they are not FDA-approved for that particular purpose. For example, aspirin is often prescribed off-label to reduce cardiac risk factors, while Wellbutrin is commonly used off-label to treat ADHD.
Want to know more? Read here: https://stellamentalhealth.com/resources/9458/breaking-stigmas-off-label-medical-treatments-proven-effective-in-treating-mental-health-challenges
Is DSR SGB covered by insurance?
DSR SGB treatment is not currently covered by insurance. At this time, insurance companies only cover the SGB when it's used for pain management, shingles, excessive palm sweating, and additional conditions. All of our patients are considered self-pay. However, to help make treatment affordable, Stella accepts Health Savings Account (HSA), Flexible Spending Accounts (FSA), CareCredit and major credit cards as payment options. We also provide interest-free in-house financing plans along with financing plans through Rectangle Health.
How long does it take for DSR SGB to work?
The experience of relief after DSR SGB treatment varies per patient. Some people notice benefits within 30 mins after the treatment, such as feeling an overall sense of calm and relaxation. For others, it may take up to 2 weeks to feel the full effect of the treatment. Many patients report that friends and family members notice ongoing positive changes over time.
How long do the positive effects of DSR SGB last?
The duration of the Stellate Ganglion Block's positive effects varies from patient to patient, lasting months or years. It is common for many patients to return for additional treatments over time, as DSR SGB is a tool to support their ongoing mental health care journey. Others find long-lasting relief and continue to support their positive results through lifestyle changes such as eating better, exercising, continuing therapy, yoga, and so on.
Does DSR SGB have any side effects?
Serious side effects of DSR SGB are extremely rare (1 in 10,000). Stella's providers are all board certified MDsand DSR SGB requires image guidance techniques for correct needle placement.
Directly after DSR SGB, you may temporarily experience various symptoms such as a droopy, bloodshot eye, warmth in your face and arm, and congestion. Nearly half of Stella's patients experience hoarseness or trouble swallowing that resolves within 24 hours of the procedure.
Ketamine Infusion
Is ketamine therapy safe?
Yes. Ketamine has been used in medical settings around the world for more than 50 years. Stella follows strict protocols overseen by clinical experts. Our 45-minute in office infusion is medically guided, controlled and monitored.
What are ketamine infusion sessions like?
During the in-office ketamine treatment sessions, our medical personnel are always available to ensure individuals are comfortable and safe.
Entering the treatment, you'll sit down with your provider to go over any questions and discuss what the process will be. During this time, you will be invited to share the intentions you set for yourself if you would like.
As the treatment begins, you will be taking guidance from trained personnel on site and spend the next 45 minutes to receive the dose-controlled IV infusion. Remember, you are in control of your experience, so you can make requests like asking for an extra blanket, or adjust the volume of the music, etc.
At the start of the infusion, you may not have any noticeable effects, but as the infusion progresses, you may encounter a feeling of "lightness" or "floating," which for some describe as"weight being lifted off their shoulders", or a "dream-like state" with a calm sensation. Some patients report visions of colors, shapes, and images. Each person's experience can be different, and it can also vary from infusion to infusion. You will be monitored throughout the infusion, and we are prepared to treat any unpleasant side effects during the procedure.
Once the treatment nears the end, you'll regain awareness of the surrounding space. You'll then spend some time acclimating yourself with help from the clinical team on site. Generally, within 15 minutes of completing the infusion, you will feel fully grounded again, and you will have a sense of clarity and being fully immersed in the present moment. In most cases, your awareness and thinking will be clear within minutes after the session, but as a standard precaution, we require all patients to avoid driving home after their Ketamine treatment session.
Three common effects just after a ketamine infusion are temporary dizziness, disorientation, and fatigue. Feeling lightheaded or disoriented after the treatment is normal, and this typically goes away quickly. You may feel tired or fatigued after the treatment, which can be easily resolved with a nap. We recommend that you build in time to rest after each session if you should feel tired after one of your sessions. Remember that your experience can vary from session to session, so you may feel tired after some, but not all.
Are ketamine infusions addictive?
No, there is no evidence that ketamine infusions at low doses and frequencies used to treat mood disorders lead to dependence or addiction. (In fact, research suggests that ketamine can be an effective treatment for overcoming addiction. If you have a history of substance abuse, it does not exclude you from receiving ketamine infusions, but it is important to disclose this information during your assessment
How long do the positive effects of ketamine infusion therapy last?
For patients who go through our care plan that consists of 6 ketamine infusions, the positive effect can last for months. Many patients come back for 1 or 2 maintenance treatments based on their personal preference, severity of symptoms and logistics.
What are the side effects of ketamine infusion therapy?
The side effects directly after a ketamine session are minimal and usually only last an hour or two. Side effects may include mild drowsiness, nausea, and increased blood pressure.
We monitor your vital signs throughout the infusion session and will routinely administer medication to prevent nausea. Less common side effects include vivid dreams or agitation, which can be controlled by adjusting the dosage.
Many patients do not mind the relaxed and free feeling they experience during the infusion, and this feeling has been postulated to be beneficial.
Is ketamine infusion therapy covered by insurance?
Ketamine infusion therapy is typically not covered by insurance. However, to help make treatment affordable, Stella accepts Health Savings Account (HSA), Flexible Spending Accounts (FSA) and Care Credit as payment options. We also provide in house interest-free financing plans and financing plans through Rectangle Health.
Spravato
What is Spravato?
Spravato is an FDA-approved variant of ketamine that is delivered intranasally. Also known by its generic name, esketamine, it is one of the two mirror-image molecules that together make up regular ketamine. Ketamine is a chemical that is used medically as an anesthetic for induction and maintenance of anesthesia. It has also been researched and used for many years to treat depression symptoms.
Is Spravato approved by FDA?
Yes. Spravato has been approved by the Food and Drug Administration (FDA) since March 5, 2019 and is covered by major insurances.
What is Stella's Spravato protocol?
Stella follows the FDA-approved protocol, in sequence, the frequency of treatments will be:
- Introduction phase: Twice weekly for 4 weeks,
- Optimization phase: Once weekly for 4 weeks,
- Maintenance phase: Once every 2 weeks
- Ongoing maintenance phase: Once every 3-4 weeks if the patients' mood is stable
What symptoms and conditions does Spravato help with?
Spravato is approved by FDA as treatment for treatment-resistant depression (TRD) and major depressive disorder (MDD) with acute suicidal ideation. Symptoms of major depressive disorder (MDD) include low mood, lack of pleasure in activities, too much or too little sleep, feelings of guilt/worthlessness/hopelessness, low energy, poor concentration, too much or too little appetite, slowing of speech or movement, and/or suicidal thinking. Specifically, Spravato is indicated when individuals experience persistent depression symptoms after trying 2 or more antidepressants and talk therapy.
Who qualifies for Spravato treatment?
Spravato is FDA-approved for treatment-resistant major depressive disorder, that is, MDD that has not responded to at least two antidepressants, with adequate dose and duration. Patients must also be on an antidepressant during the Spravato treatment. Insurance coverage varies among locations and plans. Call our care advocate team to check your insurance eligibility.
How long do most people stay on Spravato?
A course of treatment with Spravato involves an induction phase, which consists of twice weekly treatments for 4 weeks, followed by once weekly treatments for 4 weeks. This phase is important to maximize the efficacy of the medication. After the induction phase comes the maintenance phase. Patients typically receive treatments once every other week, but may come as frequently as weekly, depending on their symptoms.
TMS Therapy
How does TMS therapy work?
Transcranial Magnetic Stimulation (TMS) therapy uses non-invasive magnetic fields to stimulate specific areas of the brain associated with mood regulation. Key points of how TMS's working mechanism:
- A magnetic coil is placed on the patient's scalp.
- The coil generates short pulses of magnetic fields.
- These pulses induce small electric currents in targeted regions of the brain that are mapped by licensed mental health experts.
- The currents activate nerve cells in the targeted areas of the brain and help improve its function of mood regulation.
Does TMS therapy hurt?
While there may be some minor discomfort at the treatment site (where the device touches your head), it generally subsides within the first week or treatment. There is no sedation, or impact on your alertness. You can read, watch TV, or talk with your treatment coordinator during your session, and you can drive home immediately after treatment.
Is TMS therapy covered by insurance?
Yes, TMS therapy is typically covered by major insurances. Below are some info regarding Stella's insurance coverage for TMS treatment for those who have not found relief from medication management in the past. In recent news, the FDA no longer requires adolescents to fail two drug trials before receiving approval, as TMS is now considered front-line treatment for adolescents experiencing MDD and TRD.
In the state of Illinois, PPO plans of the following treatments are accepted:
- Atena
- Blue Cross Blue Shield of IL
- Cigna
- Evernorth
In the state of Massachusetts, PPO and HMO plans of the following instances are accepted. Medicare is also accepted.
- Atena (Out-of-network benefits)
- Blue Cross Blue Shield of MA
- Evernorth
- Havard Pilgrim
- Mass General Brigham
- Optum
- Point32
- Tufts Health Plan
- United Healthcare
Other treatments may be eligible for insurance reimbursement through Superbills, which can be provided. For more questions on insurance coverage, please call our care advocate team at 908-293-7559.
How long does a TMS therapy course last?
The FDA approved treatment course for TMS is five days a week for 36 treatments continuously. However, our providers will work with you to accommodate your schedule without compromising the outcome of the treatment.
How long is a TMS session?
Each TMS session lasts about 20 minutes. Since TMS does not require anesthesia, patients can return to daily life, work, etc. immediately following a session.
Who is not a good candidate for TMS?
While TMS is a proven safe treatment, it is not recommended for the following types of patients due to safety concerns.
- Patients who have non-removable metallic objects near or around the head (excludes dental hardware)
- Patients who have conductive, ferromagnetic, or other magnetic-sensitive metals implanted or non-removable within 30 cm of the treatment coil
- Patients who have an implanted device that is activated or controlled by physiologic signals, even if the device is located outside of the 30cm distance (pacemakers, deep brain stimulation, cochlear implants)
- Patients who have wearable cardioverter defibrillators (WCD)
- Patients with Seizure history or family history
- Patients with disorders that cause electrolyte imbalances which can induce seizures (eating disorder, vomiting/diarrhea, kidney disease)
- Patients with TBI or other neurological disorders (structural brain lesions from head trauma, TBI, stroke, tumor, MS)
- Patients who have active substance use disorder or in withdrawal
- Patients who are pregnant
- Children
- Patients with unstable heart disease
- Patients with unstable diabetes
- Patients with PTCAs/antipsychotics
- Patients with bipolar disorder and psychotic disorders
Medication Management
How do I know if my condition needs psychiatric medication?
If you suspect that you might benefit from psychiatric medication, the first step is to work with a trusted health professional, whether it be your primary care physician or psychiatrist, to do a full assessment of your symptoms to determine if they are caused by mental health issues and if medication is warranted. Sometimes your symptoms can be caused by lifestyle changes or physical conditions, all of which can be evaluated by a health professional to determine if medication is the best plan for your health journey.
What is medication management in mental health?
Medication management in mental health, or psychiatric medication management, refers to evaluating, prescribing, monitoring, and adjusting medications for mental health conditions. The unique aspect of psychiatric medication management is that it involves the collaboration between the psychiatrist, the patient, and sometimes other healthcare providers like primary care physicians or therapists to work together to monitor the effects of the medication.
How do I know if my condition needs psychiatric medication?
If you suspect that you might benefit from psychiatric medication, the first step is to work with a trusted health professional, whether it be your primary care physician or psychiatrist, to do a full assessment of your symptoms to determine if they are caused by mental health issues and if medication is warranted. Sometimes your symptoms can be caused by lifestyle changes or physical conditions, all of which can be evaluated by a health professional to determine if medication is the best plan for your health journey.
What conditions can Stella's medication management services help with?
Our mental health professionals at Stella have extensive expertise in treating depression, anxiety, bipolar disorder, PTSD, OCD, ADHD and substance use disorders in patients ages 15-65, including LGBTQI individuals and women who are pregnant or planning a pregnancy.
What types of medications can Stella's mental health professionals prescribe?
Some of the mental health medications Stella prescribes fall into one of the following groups:
- Antidepressants (including SSRIs, SNRIs, NDRIs)
- Anti-anxiety medications
- Mood Stabilizers
- Antipsychotics
- Sleeping Pills
- Stimulants
Psychiatric drugs are formulated to address different types of imbalances in neurochemistry, and prescriptions from a physician or psychiatrist are required for patients to obtain them.
How long does it take to get prescribed medication?
If a medication is indicated for treatment, your provider will be able to send the prescription directly to the pharmacy of your choice via computer on the same day.
What is the difference between medication management and other treatments by Stella?
Stella is best known for our innovative and interventional treatments like Spravato, DSR SGB, TMS or Ketamine Infusion Therapy. These are biological treatments that are time-limited in nature. While treatment is not intended to replace current medications, many patients report lowering the medication they are currently on in partnership with their on-going healthcare provider. Medication management is ongoing and fosters a therapeutic relationship where a patient is followed as closely as needed by the provider. Recurring appointments are needed for medication management to manage overall psychiatric symptoms and to ensure appropriate medications and doses are utilized.