Frequently asked questions

Spravato is the brand name for esketamine, a nasal spray FDA-approved for treatment-resistant depression. It works on the glutamate system through NMDA receptors, a different pathway than serotonin-targeting antidepressants. Many patients feel a shift within hours to days rather than the weeks SSRIs require.

Yes. The FDA approved Spravato in 2019 for treatment-resistant depression and in 2020 for major depressive disorder with acute suicidal ideation or behavior. It is administered under medical supervision through the Spravato REMS program at certified clinics.

Spravato is the FDA-approved esketamine nasal spray with broad insurance coverage. IV ketamine uses a related compound off-label, with limited insurance coverage and out-of-pocket costs of $400 to $750 per infusion. Both work on glutamate, but Spravato's regulatory status changes both access and cost.

Most patients describe a temporary dissociation ~ feeling slightly removed from their body, time stretching, or a floating sensation. The two-hour monitoring window covers the peak experience. By the time you leave, the acute effects have faded.

Some patients notice mood improvement within hours of their first session. The first four weeks of twice-weekly induction are designed to consolidate that response. Full benefit typically emerges by the end of induction, with maintenance sessions sustaining it.

Yes, most major commercial and Medicare plans cover Spravato with prior authorization. Coverage is broader than IV ketamine because of FDA approval. Your Psycle coordinator runs a free benefits check and submits the prior authorization on your behalf.

No. You cannot drive on the day of treatment. You will arrange a ride or use a rideshare after your two-hour monitoring period ends. Most patients feel clear-headed by the next morning.

Yes. The FDA approval requires Spravato to be taken alongside an oral antidepressant. Your prescribing psychiatrist coordinates with the Spravato clinic so the two work together. Most patients continue their existing medication throughout.

TMS uses targeted magnetic pulses, similar to those in an MRI, to stimulate the part of the brain that regulates mood. Sessions take 20 to 40 minutes, you sit in a chair, and you drive yourself home. No drugs, no anesthesia, no downtime.

Yes. TMS has been FDA-cleared for treatment-resistant depression since 2008 and for OCD since 2018. Research is ongoing for anxiety and PTSD, where it may be used off-label under psychiatric supervision.

Most patients describe a tapping sensation on the scalp during pulses. Some feel mild discomfort or a brief facial twitch in the first few sessions, which usually fades. There is no sedation, and you remain fully awake the entire time.

Many patients notice changes by the third or fourth week of the six-week acute phase. Full benefit typically consolidates by the end of treatment. Your prescribing psychiatrist tracks symptom scores throughout to confirm response.

A standard course is 36 sessions over six to nine weeks ~ five sessions per week during the acute phase, then a brief taper. Accelerated protocols compress the timeline into one to two weeks for select patients.

Most major commercial insurance plans and Medicare cover TMS for treatment-resistant depression. Coverage typically requires documentation of two or more failed antidepressant trials. Your Psycle coordinator runs a free benefits check before you commit.

TMS uses focused magnetic pulses while you sit awake in a chair. ECT uses electrical current under general anesthesia. TMS has no memory side effects and no recovery time. ECT remains an option for severe, treatment-resistant cases that need a stronger response.

Yes. TMS does not require sedation or anesthesia, so you can drive yourself to and from each appointment. Most patients return to work or normal activities the same day.

Yes, and a huge proportion of adults are now being diagnosed had the condition all along. To meet formal criteria, symptoms have to have been present before age twelve, even if they weren't recognized or labeled then. A thorough evaluation includes childhood history, current symptoms, rule-outs for other causes (sleep disorders, thyroid issues, depression, anxiety, trauma), and often collateral information from family or old school reports when possible.

It depends on the psychiatrist, the evaluation, and your specific picture. Stimulants are first-line for ADHD and work well for most adults with the condition, but they are controlled substances and require a proper evaluation, ongoing monitoring, and in-person or strict telehealth compliance. Some psychiatrists in our network prescribe them; some prefer to start with non-stimulant options; some work in states where telehealth stimulant rules are tighter. We factor all of this into your match.

That's a valid choice, and there are evidence-based options that don't involve meds. ADHD coaching, cognitive behavioral therapy adapted for ADHD (CBT-ADHD), skills-based therapy, and structural workarounds (environmental redesign, external accountability, medication-free approaches that are actually researched) can all help. A good psychiatrist or therapist will take your preferences seriously rather than push a default.

Because your depression may not be the whole picture. When untreated ADHD drives chronic underperformance and shame, the resulting depression won't fully lift on an SSRI alone; the ADHD is still there, still creating the conditions that trigger the mood symptoms. Many people experience what feels like treatment-resistant depression when the actual missing piece is ADHD. This is one of the more useful conversations to have with a psychiatrist.

There is early research on TMS for adult ADHD, but it is not FDA-cleared for this indication, and it is not a first-line treatment. Ketamine and Spravato are not indicated for ADHD at all. If you have both ADHD and treatment-resistant depression, those depression treatments may be appropriate for the depression side, and our partners will typically want the ADHD treated or in process first, because untreated ADHD can undermine any depression treatment.

Psycle is a free matching and coordination service, not a prescriber. We connect you with psychiatrists in our partner network who do the evaluation and prescribing. We do not rush intake, and we do not treat ADHD care as a five-minute transaction. If you've had a bad experience with rushed telehealth ADHD services, we'll try to repair this by inviting you to our slower, more considered process.

An evaluation for ADHD usually involves one to two longer appointments, often plus some screening tools for ADHD and co-occuring conditions, and history-gathering. Finding the right medication and dose, if you go that route, typically takes weeks of adjustment rather than days. ADHD treatment rewards patience at the start and usually gets better over time.

No. The clinical term is "substance use disorder," and it exists on a spectrum from mild to severe. You don't have to identify with the word addiction, or any type of culture around it, to qualify for care or to benefit from it. A clinician will use the language that fits, and adapt their own langugue to ensure you're both on the same page about your care.

It depends on the substance. For alcohol, medications like naltrexone and acamprosate plus therapy have strong evidence. For opioids, medication-assisted treatment with buprenorphine or methadone is the first-line approach, and reduces overdose deaths significantly. For stimulants, there is no FDA-approved medication yet, but therapies like contingency management and CBT have good evidence. Peer support (AA, SMART Recovery, others) adds real value for many people. The SAMHSA helpline and FindTreatment.gov can match you with programs that offer these.

Because addiction care requires specialized support that Psycle doesn't provide, and often also requires medications that require specific licensing and infrastructure. Treatment-resistant depression is what our network is built for. So the honest move is to point you to the right specialty programs for you right now. Once you've got the right addiction treatment arranged, we can collaborate with your providers to address depression in tandem.

There is early research on all three, especially around alcohol and cocaine use disorders, and ketamine has been studied for craving reduction. None of this is yet standard of care, and none of it is FDA-approved for treating substance use disorders. Psycle's network of providers does not offer any treatments for addiction, but we can address depression if it's identified alongside it. If addiction is an issue for you, finding you an addiction specialist always comes first.

Not according to the research. People with co-occurring substance use and mood disorders do better when both are treated together, an approach called integrated dual diagnosis treatment. If you've been told to choose, the better path is usually to find a program or a combination of providers that can hold both at once. That's one of the things a coordinator call can help sort out.

Not always. If you've been drinking heavily and daily for a sustained period, stopping abruptly can trigger dangerous withdrawal, including seizures and delirium tremens. The same applies to benzodiazepines. Please talk to a doctor or call the SAMHSA helpline before stopping cold turkey. Supervised detox, medication support, and a tapered plan are much safer than white-knuckling it.

Federal law (42 CFR Part 2) gives substance use treatment records an extra layer of confidentiality beyond HIPAA. Most employer-sponsored insurance covers SUD treatment and the Affordable Care Act requires parity between mental health and medical coverage. If you have a professional license, most fields have physician health or professional recovery programs that exist specifically to help without career consequences. SAMHSA can point you to them.

Everyone feels anxious sometimes. An anxiety disorder is different. It's persistent worry or fear that interferes with work, relationships, or daily life, usually for six months or more. If the anxiety is running the day instead of passing through it, that's the sign most clinicians look for.

That's common. Some people find SSRIs help depression more than anxiety, or vice versa. A psychiatrist can look at whether a medication adjustment, an SNRI, a different class entirely, or an interventional option makes sense given your history.

None of the three is FDA-approved specifically for anxiety. TMS is being studied for anxiety; research suggests it may help, especially when depression is also present. Spravato is FDA-approved for treatment-resistant depression, not anxiety, though many patients have both. IV ketamine is used off-label, with some research supporting benefit for treatment-resistant anxiety. The psychiatrist we'll connect you with can walk you through what applies to your situation.

Benzodiazepines work well short-term but long-term use carries dependence risk. A psychiatrist can discuss daily medications like SSRIs or SNRIs, talk therapy (CBT has strong evidence for anxiety), and when appropriate, interventional options that don't carry the same dependence profile.

Coverage follows FDA indications. TMS and Spravato are typically covered when depression is the primary diagnosis; anxiety alone is harder to get covered. IV ketamine for psychiatric use is off-label, so coverage is limited. Psycle verifies your benefits for free before any appointment.

For many people, yes. Cognitive behavioral therapy (CBT) and exposure therapy have strong evidence bases. For some, medication or an interventional option alongside therapy works better than either alone. A psychiatrist can help you decide the right combination.

Psycle is a care-matching platform. A coordinator talks with you about your history, symptoms, insurance, and location, and matches you with a vetted clinic in our partner network. We don't deliver treatment directly; our partners do. There is never a cost to talk with a Psycle care coordinator.

A panic attack peaks in about 10 minutes and passes, even though it doesn't feel that way. Slow your breathing, name five things you can see, and remind yourself you've survived every panic attack you've ever had. If you're in crisis or worried about your safety, call 988 or go to your nearest emergency room.

Good days don't usually come with sleeplessness, racing thoughts, impulsive spending, or behavior that worries the people who know you. A manic or hypomanic episode is a sustained shift that lasts days to weeks, affects sleep and judgment, and tends to be followed by a depressive crash. If you're unsure, a psychiatrist can help you tell the difference.

This is one of the hardest parts of bipolar disorder, and it's why many people take years to seek treatment. The reason is that untreated mania tends to be followed by deeper depression, damaged relationships, financial harm, and a rising risk of psychosis. Good treatment doesn't flatten you, but instead aims to keep you out of the extremes.

Not on their own. Antidepressants given without a mood stabilizer can sometimes trigger mania or rapid cycling in people with bipolar disorder. That's why getting a correct diagnosis matters so much, and why a psychiatrist experienced in bipolar care will usually start with a mood stabilizer first.

The evidence-based foundation is mood stabilizers (lithium, valproate), atypical antipsychotics, and therapy; often cognitive behavioral therapy or interpersonal and social rhythm therapy. Many people need a combination. Finding the right mix can take time and close collaboration with a psychiatrist who knows bipolar care well.

Psycle is a care-matching platform. Our partner clinics include psychiatrists who treat bipolar disorder using evidence-based care. We don't deliver treatment directly; our partners do. Talking with a coordinator is free.

If you're in crisis (not sleeping for days, thinking about harming yourself or someone else, or experiencing psychosis), this is a clear psychiatric emergency. Call or text 988 (Suicide and Crisis Lifeline), call 911, or go to your nearest emergency room. Mania is treatable, and the first step when it's acute is getting to safety.

Short episodes of feeling low are part of being human. Depression is different. It's a persistent low mood, loss of interest, and loss of energy lasting at least two weeks and getting in the way of daily life. If you've been dragging for months, sleep doesn't help, and things you used to care about don't reach you anymore, a psychiatrist can talk through what's going on.

It's a clinical term used when someone has tried two or more standard antidepressants without reaching full remission. It isn't a judgment of you. It's a signal that a different pathway may be worth exploring. About one in three people who try antidepressants fall into this group.

You're in the group the interventional options were built for. TMS is FDA-cleared for treatment-resistant depression. Spravato is FDA-approved for the same. IV ketamine is used off-label with strong published research behind it. A psychiatrist can match you based on your history, symptoms, and coverage.

For some people it's a single episode. For others it comes in waves. For some it's chronic. Whatever the pattern, the goal of care is remission. This looks like the absence of meaningful symptoms, and thriving rather than just getting by. Many patients who didn't respond to first-line treatment reach remission with an interventional option paired with therapy.

TMS has been FDA-cleared for depression since 2008. Spravato (esketamine nasal spray) was FDA-approved for treatment-resistant depression in 2019 and for major depressive disorder with acute suicidal ideation in 2020. IV ketamine is prescribed off-label for psychiatric use; it has been FDA-approved as an anesthetic since 1970. Off-label does not mean experimental.

TMS is covered by most major insurance plans for treatment-resistant depression. Spravato is covered by most major plans for its approved indications. IV ketamine coverage is limited because the psychiatric use is off-label. Psycle's care team always verifies your benefits for free before any appointment, so you'll go in knowing what to expect financially.

Psycle is a care-matching platform. A care coordinator talks with you about your history, symptoms, insurance, and location, and matches you with a vetted clinic in our partner network. We don't deliver treatment directly; our partners do. There is no cost to speak with a coordinator, and no commitment to start treatment.

If you are in crisis or having thoughts of self-harm, please contact the 988 Suicide & Crisis Lifeline, text HOME to 741741, or go to your nearest emergency room. Psycle is not an emergency service. We are here for the longer conversation about care.

No. Loneliness is a feeling and an experience, not a DSM diagnosis. But chronic loneliness is a recognized health risk, and it frequently overlaps with clinical depression. If loneliness has been with you for months and comes alongside low mood, low energy, or loss of interest in things, a conversation with a psychiatrist is a reasonable step.

You can be lonely without being depressed, depressed without feeling lonely, or both at once. Clinical depression typically includes persistent low mood or loss of interest for two or more weeks, alongside changes in sleep, appetite, energy, concentration, or thoughts about self-worth. A psychiatrist or primary care doctor can help tell them apart.

No medication is approved or indicated specifically for loneliness. When loneliness is one face of clinical depression, treating the depression often quiets the loneliness alongside. That's the means by which Psycle may be able to help if you're experiencing loneliness.

Loneliness is about the felt sense of connection, not the number of people in the room. You can feel lonely in a busy office, a full household, or a long-term relationship. This is called emotional loneliness, and it's more common than most people say out loud.

There's no perfect threshold. If loneliness has been with you for months, if it's affecting your sleep or work or relationships, if it's making you withdraw further, or if it comes with persistent low mood, then it's worth talking with someone.

Often, yes. Cognitive behavioral therapy, group therapy, and relational therapy all have evidence for loneliness-related distress. A psychiatrist may recommend therapy alongside, or instead of, medication. There is no single right path. The best approach for you depends on finding out fully what's underneath.

Psycle is a care-matching platform. If you've been feeling persistently lonely and wondering whether it's something more, a coordinator can talk with you about what you're experiencing and connect you with a psychiatrist from our partner network if it makes sense. Talking with a coordinator is free.

Yes. PTSD is defined by the nervous system's response to what was overwhelming for you, not by whether anyone else would have rated the event. Car accidents, medical trauma, sexual assault, sudden loss, childhood abuse, and being present for a violent event all qualify. The DSM-5 criteria are about the response, not the rank of the event.

Trauma-focused therapy (CPT, PE, EMDR) works for many people and incompletely for others. That isn't failure ~ it often means a layer of the nervous system response hasn't shifted. A psychiatrist can discuss medication adjustments, combining therapies, or, when appropriate, an interventional option alongside continued therapy.

Two: sertraline (Zoloft) and paroxetine (Paxil). Other SSRIs, SNRIs, and off-label medications like prazosin (for nightmares) are also used. A psychiatrist can decide with you what fits your history.

None of the three is FDA-approved specifically for PTSD. TMS research is promising, particularly when depression is also present. IV ketamine has research supporting use off-label, especially for PTSD with co-occurring depression. Spravato is FDA-approved for treatment-resistant depression and may be relevant when PTSD and depression appear together.

Coverage follows FDA indications. When depression is also diagnosed, TMS and Spravato are often covered; PTSD alone is usually not. IV ketamine for psychiatric use is off-label, so coverage is limited. Psycle verifies your benefits for free before any appointment.

PTSD develops after a traumatic event, or a series of them. Complex PTSD (C-PTSD) follows prolonged or repeated trauma, often starting in childhood. C-PTSD includes the classic PTSD symptoms plus persistent difficulty regulating emotions, a damaged sense of self, and patterns in relationships. Treatment usually overlaps, but the timeline and emphasis may differ.

Trauma is any experience that overwhelms your nervous system's ability to cope. That includes events that are obviously traumatic, like assault, combat, accidents, or sudden loss, and also experiences that many people don't call trauma, like medical procedures, childhood neglect, bullying, chronic illness, emotional abuse, or the long aftermath of caring for someone who suffered. What makes it traumatic is the response, not the category.

Trauma is an experience. PTSD is a specific diagnostic pattern of responses that can follow trauma. Most people who experience trauma don't develop PTSD, but many carry trauma responses in ways that still affect their lives. PTSD is diagnosed when symptoms like intrusive memories, avoidance, hyperarousal, and negative changes in mood or thinking persist for more than a month and interfere with daily functioning.

Yes. This is especially common with childhood or developmental trauma. The nervous system holds the pattern even when explicit memory doesn't, or when you can't find the words. If you notice chronic hypervigilance, attachment patterns that feel out of your control, or a baseline level of fear or shutdown that you can't explain, working with a trauma-informed clinician can help, with or without specific memories.

Not always, and not all at once. Modern trauma treatment is much more than talking through the event. Some approaches, like EMDR, work on how the memory is stored in the nervous system without requiring extensive verbal processing. A good trauma clinician will move at your pace and will not push you past what your nervous system can integrate.

Many people heal from trauma without medication, using talk therapy alone. Some people find that medication, often an SSRI, helps stabilize their baseline enough to do the deeper therapy work. For people whose symptoms meet criteria for PTSD and haven't responded to standard care, newer options like TMS, Spravato, or IV ketamine may be considered. Our PTSD page walks through that evidence in detail.

Psycle is a care-matching platform. Our partner clinics include psychiatrists and therapists who work with trauma and PTSD. We don't provide therapy directly; our partners do. For trauma specifically, a call with our care coordinator is about helping you figure out what kind of clinician fits where you are. Often that's a trauma-focused therapist first, and a psychiatrist second if medication becomes part of the plan.