Frequently Asked Questions
Alessi Psychiatry and Life Center has clinicians with substantial knowledge and experience base in the evolution of psychiatric conceptual models of conditions and interventions that span 40 years.
This is most evident by the involvement of Dr. Norman Alessi who is an academic in child and adolescent psychiatry with 225 publications and presentations.
Further, in 1978, he was the first psychiatrist to ever administer an antidepressant to a child at the children’s psychiatric hospital at the University of Michigan.
He also identified the existence of treatment-resistant depression in children in the early 1980s and has published much about comorbidities and polymorbidities in mental conditions and treatments in children and adolescents since the early 1980s.
Our Center is only one of two such programs in the state of Michigan that offers psychiatry Ketamine infusions, and the only one in which a dual board-certified psychiatrist in child and adolescent and general psychiatry is involved.
It is also one of the only clinics or programs that offers a comprehensive approach by recognizing the significance of psychiatric conditions, not only the presentation of mental conditions, but also in attempting to characterize its functional impact.
The center offers functional interventions to improve overall executive functioning, daily life skills, and life functional skills.
Contact the center via phone at 734-222-6222, and you will be directed to our screening intake specialist who will review your case and go over significant issues with you. This may include questions like are we the best clinic for you? can you pay for services? and what can you anticipate in terms of commitment to being involved with the clinic?.
Following the intake, if you are still interested in pursuing participation, then you will be given information about how to join the patient portal. Then, you will receive the necessary forms to start your participation and schedule an evaluation.
You may pay at time of service in person with cash, check, Zelle, bank transfer, or credit card. If having a telehealth appointment, you may pay via the patient portal at time of service.
If you think you will not be able to make payments at the time of service, please let us know beforehand so that we can walk you through the financing option.
Our center has chosen to use Advance Care as the financing option available for our patients. Please submit an application online via their website below. Our staff is available to answer questions regarding this process as well.
Although we do not accept insurance directly. We can provide superbills for patients to be reimbursed directly by their insurance companies.
The patient portal is a central component of a number of facets of patient care. It will allow the center to communicate with you regarding your clinical services, educational materials, and allow you to make credit card payments.
When you become a patient, you will register to have patient portal access, and going forward, you will actively receive forms to review and complete through the portal. This will facilitate communication and improve overall delivery of services to you.
There are three components to an evaluation.
The first component will involve the center collecting clinically-oriented forms with specific questions about demographics and other clinically-relevant information. These will be sent to you via the patient portal, and we will review this information and incorporate it into your evaluation.
Following, the second component will be a formal evaluation and will involve either your being evaluated online via the Telehealth component of the patient portal or in an in-person session. This session will last approximately two hours and will involve review of the information you have provided to us and a traditional clinical assessment.
At the completion of this component, further testing might be indicated. This may be done within the clinic or referred to outside professionals with desired skills that are required for the formal evaluation.
From the first two components will come the more traditional identification of significant mental, emotional, and behavioral conditions. Major symptoms will be identified and a treatment plan and prescriptions will be identified and, if you would like, will be implemented.
The third component will be a functional evaluation and will involve the characterization of your functioning in multiple areas. This component will often occur after we have begun treatment since these areas of functioning will take time to improve.
We will be evaluating your executive functioning, your daily living skills, and your functioning in the areas of work, school, family, interpersonal relationships, and potentially illness and preparation for death.
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Complete psychiatric evaluations
It is our belief that without a complete psychiatric evaluation, it is often that the most significant and difficult conditions will not be dealt with.
It will be up to our judgment what the evaluation will include. Some evaluations may be within the center while others may be referred to outside professionals. From this, major mental conditions will be identified, and time will be taken for these to be explained to you.
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Psychoeducation
It is important that you understand your conditions, how they affect your life, and to what degree might an improvement in your conditions result in an improvement of the quality of your life.
This is particularly important in children and adolescents since not understanding these conditions can lead to harmful effects on a person’s life forever.
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Psychopharmacology
There are a broad range of psychopharmacological agents, medications, or drugs that can be of assistance in bringing about a stabilization of mental, emotional, and behavioral conditions.
We have vast experience in dealing with almost all medications in these areas as either single therapeutic agents or in conjunction. We will do everything possible to choose the right medications, monitor these medications, and combine them in a judicious fashion to help you as much as possible while minimizing side effects.
But, we are aware that oftentimes medications alone will not bring about the types of changes that people need to function better and have a more fulfilling life.
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Psychiatry Ketamine Infusions
New to the growing list of potential psychopharmacological agents is Ketamine. We see Ketamine as being an adjunct treatment and not a singular treatment for any psychiatric condition.
What this means is that after an infusion, a patient might be maintained on a combination of antidepressants and mood stabilizers with ketamine administration. Further, it is not clear that Ketamine administration will ever be able to be discontinued and a person might need to be on Ketamine, at least sublingual preparations, forever.
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Psychotherapies
There are a broad range of psychotherapies that can be implemented to improve the quality of your life.
These include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and insight oriented therapy for individuals, couples, and families.
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Functional remediation
After your functional assessment, we will have a fairly specific understanding of the types of functional difficulties you have, at what level, and in what areas. We offer work with therapists who will help grow in these areas specifically either individually or in groups.
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Integrative psychiatry modalities
Given that we believe that the core of everyone’s being is a balance between the mind, body, and soul, we will be offering classes dealing with specific topics in these areas.
These may include yoga, mindfulness training, self compassion training, and lectures from religious organizations such as the catholic church or buddhist temples. Further, classes may deal with proper diet and exercise. Classes offered are always evolving and will be updated frequently.
Ketamine Treatment Questions
Originally, Ketamine was recognized as an FDA-approved anesthetic agent. It was developed in 1962 and was widely accepted due to its having aesthetic qualities without there being respiratory depression. It has been used extensively in both medicine and veterinary medicine; hence, it is often referred to as “horse tranquilizer”.
It is true that it is used extensively in veterinary medicine, but to only recognize this aspect of its use is rather naive in appreciating its utility. During the 1970s and 80s, it then became popularized and misused as a recreational drug. This has given it a bad reputation which is not deserved and undermines the understanding of its potentially positive qualities.
In 2002 and 2006, there were two reports indicating its utility as an antidepressant, and since that time, there have been over 600 publications investigating its underlying psychopharmacological mechanism of action and its clinical impact. It has been shown to be effective in the treatment of depression, especially treatment-resistant depression, and other psychiatric conditions.
According to published studies, Ketamine infusions have been shown to be effective in treating depression in 50-70% of individuals. A question we are continuing to explore is what constitutes success.
If a patient takes 6-8 sessions to see the effects, is that a success? If effects only last for a few days and not the reported several weeks to months, is that a success? What is remission when Ketamine is used? Is it the same as remission when classic antidepressants are used?
We are still exploring and discovering Ketamine and its clinical effects.
Ketamine can be administered as an intravenous infusion, sublingual, subcutaneous, intranasal, or rectal suppository administration.
If there is a lack of response during the initial sessions, an increase of concentration may be utilized. If a person does not show a treatment response after the first 8 sessions, we will not continue to pursue this and deem that Ketamine is not a viable therapeutic intervention for them.
Including a 30-minute session before the infusion to evaluate the patient for the presence of depression using both subjective and observational scales, it will take approximately 2 and half hours. The actual infusion or sublingual administration lasts for 40 minutes
This is the standard time frame that is recommended for the purpose of treating someone with treatment-resistant depression.
At the completion of this time, it is preferred that a patient wait in the Center until they are feeling stable and then can leave with their ride.
It is not uncommon that during the latter part of the 40-minute infusion that a person would experience alterations in their thinking that would be classified as psychedelic or non-ordinary states of consciousness.
We have not seen the presence of auditory or visual hallucinations but have seen alterations in thinking.
At this time, it is unknown to us. There are people who are treated for depression for their entire lives, and this will be the same for Ketamine. A person could remain on it for years, if not for the remainder of their lives.
It varies depending on the mode of delivery. If given as an intravenous infusion with a psychiatrist present, this could cost up to $1200 a session. If given as an intravenous infusion with only a nurse present, this could cost $400-$600 a session. There are no industry standards for how much Ketamine infusions cost.
Beyond intravenous infusions is the possible use of intranasal preparation (S-Ketamine). This might cost as much as $1000 per administration.
There is also the use of Ketamine via sublingual administration which is the most cost-effective option. Sublingual administration in the home is not supported by the American Psychiatric Association, but it may be a route that those seeking treatment may want to explore.
Given that it is not an FDA-approved treatment for depression and other conditions, it is up to the discretion of the insurance company.
No, any person can seek treatment as long as they have a history of chronic mental conditions and a history of failures using at least two SSRIs or antidepressants.
To date, we are allowing patients to continue taking the psychotropic medications that they are on. We have found that if we discontinue them during the infusion process, patients will often not have a positive response to the Ketamine and will become even more depressed. Therefore, we maintain their psychotropic medications throughout and any changes made will be after they are stable for a period of weeks.
We are unsure, but this has happened in a number of cases. This challenges the myth that Ketamine is the “magic drug” for the treatment of treatment-resistant major depressive disorders. It is important to note that if Ketamine were not used in addition to current medications, the current medications would not be adequate. Ketamine plays a significant role in treatment of depressive disorders.
There are several medical conditions including high blood pressure, cardiac conditions, pulmonary conditions, history of strokes, etc. and also psychiatric conditions such as psychosis, addictions to Ketamine, or other active addictions that would prevent you from receiving treatment.
Please contact the Center to explore if you are eligible for Ketamine treatment.
No, pain management is not an area of expertise that the Center feels they can use Ketamine for. If this were being sought, we would refer patients to other Ketamine clinics.
Yes, it has been shown to be an agent which could help people deal with existential dread and associated anxiety and depression. Each person would have to be evaluation on a case-by-case basis.
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