Anonymous wrote:

Anonymous wrote:I failed ketamine as well - did it twice due medication. Second time with Washington Interventional Psychiatry - ended up switching my care with them after being treatment resistant for 15 years. They are worth the price and I was able too see Dr Racynski, but anyone working there is much better than everyone else in the area.

What has this practice done that has been helpful?

He presented three medication options that had not been trialed (after god knows how many that had not have worked). One was in a class that had I hadn't tried, and two were not, but these options were more specific to the nature of my anxiety. I left the intake hesitant thinking these would just like all the other ones I tried before (and what we ended up selecting worked). Also has many PRN options - truly was shocked when he said "well lets figure out something for as needed." Its become very clear he knows his stuff in a way I haven't seen before is up to date on all the new treatments, and doesn't run out of ideas so I would imagine the team at WIP is also similar. He gave me a lot of time and thought during free 30 min check-ins during ketamine as well. When things aren't working, fresh eyes on the case is important!

TMS absolutely works - the downside is weekly / frequent appointments so it has to be a clinic close by.

Inspire Behavioral Health has it in their Fairfax office:
https://inspirebehavioralhealth.com/

Integrative Neurology Services have it in their Falls Church office:
https://integratedneurologyservices.com/

Both also offer Ketamine / Spravato which is also very effective.

You'll want to meet with their psychiatrists first to review what medications she's tried or the steps to getting these treatments approved by insurance.

Anonymous wrote:I failed ketamine as well - did it twice due medication. Second time with Washington Interventional Psychiatry - ended up switching my care with them after being treatment resistant for 15 years. They are worth the price and I was able too see Dr Racynski, but anyone working there is much better than everyone else in the area.

What has this practice done that has been helpful?

How much integration support did your daughter get after ketamine treatment? Ironically, the suicide attempt may have been a sign that the ketamine was working: typically, the most depressed people cannot attempt suicide because planning and task initiation is too difficult. When depression begins to lift can be the most lethal time because the despair is still there but they may have more energy and more ability to act on their symptoms. With a safety plan in place, and more support around her, it is possible that another few treatments with ketamine might lift her mood well beyond suicidality and in an upward spiral. I know it is difficult to contemplate now though and I would not suggest it without a lot more support including a safety plan.

I'm very sorry for your situation—it's truly difficult. Look for a psychiatrist with experience in DBT and working with suicidal risk, preferably through large clinics or university centers—their standards are usually higher. Be sure to check whether BCBS accepts patients and whether they have experience with young adults.

TMS can sometimes help with persistent depression, but this should be discussed only with your treating psychiatrist. After a reaction to ketamine, it's especially important to choose your treatment carefully.

And please, don't go through this alone—you also need support (at least a counselor or a parenting group).

I failed ketamine as well - did it twice due medication. Second time with Washington Interventional Psychiatry - ended up switching my care with them after being treatment resistant for 15 years. They are worth the price and I was able too see Dr Racynski, but anyone working there is much better than everyone else in the area.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Look into TMS. LIFE CHANGING!!

I don’t have direct experience with it but know it can covered by insurance which likely means it has been found to be effective and beneficial.

LMAO. That's hilarious. Efficacy tied to whether insurance covers it or not. THis has absolutely NOTHING to do with whether it's an effective treatment.

For us--was mostly covered but we did have to pay a fair chunk.

I def can say it was effective!

We liked Emily rizzo and Nicole Fayard at counseling center of Maryland. I know they used to take bcbs. They do DBT which might be effective for your daughter — it has better evidence behind it than just talk therapy and teaches coping mechanisms rather than trying talking out the problems. Some of the therapists there also do art therapy if that might be helpful for your daughter.

Good luck to you—it’s such a hard age.
If you need a prescribing doctor, we like Dr Steven Pankopf in bethesda. He doesnt take insurance though. I will say that one benefit of in patient is that they can try some different things with medcatioj in a managed way so if that’s a big concern, then in patient might be a good way to go.

OP, how are you doing and what’s going on? Separate issues from your daughter? Very rough to feel broken while trying to help another. I hope you have resources and support for yourself, too.

Metropolitan Counseling in Bethesda has a young adult program that is FANTASTIC- they have a range of treatment options, and the IOP changed my DD’s life at about the same age as your DD (it includes DBT). They submit to insurance.

We ended up with Newport Academy which, thankfully, got our kid to a better place. Time, therapy, residential treatment and pharmaceuticals. There was no golden cure for our kid, we just kept trying different things until it worked well enough.

Along the way we burned through over $100k.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Look into TMS. LIFE CHANGING!!

I don’t have direct experience with it but know it can covered by insurance which likely means it has been found to be effective and beneficial.

LMAO. That's hilarious. Efficacy tied to whether insurance covers it or not. THis has absolutely NOTHING to do with whether it's an effective treatment.

It may sound weird, but what you are saying is just not true.

Insurance companies have a vested interest in keeping you healthy— they will not pay for treatments considered investigational/ineffective , but many policies cover accepted, effective treatment options. Such as TMS, because it does work.

They use evidence based decision tools like Interqual to make those determinations.
Don’t want to take this off topic.
OP how are things going

Anonymous wrote:

Anonymous wrote:Look into TMS. LIFE CHANGING!!

I don’t have direct experience with it but know it can covered by insurance which likely means it has been found to be effective and beneficial.

LMAO. That's hilarious. Efficacy tied to whether insurance covers it or not. THis has absolutely NOTHING to do with whether it's an effective treatment.

Our son has been dealing with depression for years with a number of suicide attempts. He went through so many treatment programs and inpatient hospitalizations, each with their own psychiatrist and therapy staff. FWIW, what helped most was getting into a regular routine of work and school and getting out of the house along with medication - all of which required family help to get in place. Therapy has never helped. It's like this thing that has been dangled that everyone tells us should help but it never has.

Recently, I have been told by providers that I need to step back and let my son secure his own medical care, which is tough. But he's done it. And he's much happier and more compliant with the providers he's chosen. The sole thing he researched was insurance coverage. Everything else was about how he felt and how close to home they were because he likes the convenience. So, I'm not sure researching is the answer. Also, different doctors work better for different people. Doctors with bad reviews still have patients who think they walk on water and doctors with good reviews still have patients who think they are the worst ever.

Anyway, good luck.