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Your questions, answered
The start of any journey can feel daunting. We’re here to answer your questions about starting your journey at Heading.
The Basics

Heading is a mental health care provider that offers personalized and collaborative care, guided by innovative research and technology. No matter where you are in your journey, we’ll collaborate with you (and other doctors, if needed) to create your unique treatment plan. We offer a range of treatment options, including: talk therapy, medication management, transcranial magnetic stimulation (TMS), Spravato®, and intramuscular ketamine. 

1. Getting Started: Whether you’re brand new to treatment or have tried other approaches, we like to begin by getting to know you with a comprehensive consultation. Schedule yours by completing our simple intake form. You may also be referred to Heading.

2. Telehealth Consultation: Connect with a Heading clinician from the comfort of your home for your virtual consultation. During this time, you’ll discuss your history, symptoms, and treatment options.

3. Personalized Treatment: You and your provider will work together to create a personalized treatment plan, which may include medication, combining medication and teletherapy, or our other in-person treatment options.

Psychiatry and therapy sessions, including initial consultations, are typically delivered via telehealth — right from the comfort of your home. All of our immersive treatments (TMS, Spravato®, and ketamine) are delivered in-person at our center. 

Currently, we’re based in Austin, Texas and can provide both in-person and virtual care to patients throughout the state. Be sure to keep checking back with us, as we’re growing quickly and plan to expand into other states.

Getting Started

To schedule your consultation, complete our brief form and an intake specialist will reach out about scheduling. You may also be referred to us for treatment by your doctor, psychiatrist or therapist. We’re also always happy to chat by phone, so feel free to book your appointment by calling us at (512) 777-2591.

We know many of you have had to endure long waits to see providers in the past. We’re here to change that and aim to see all new patients within 2 weeks (but we’re often able to do so within days!).

At Heading, our clinicians are trained in treating a range of conditions and mood disorders. The following is a list of conditions that may qualify you for our treatments: post-traumatic stress disorder (PTSD), depression, generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder, and bipolar depression.


We’re not able to care for patients under the age of 18, nor can we treat patients in an acute manic state, with a primary psychotic disorder or a primary substance use disorder. Additionally, our psychiatry providers do not prescribe controlled substances via telepsychiatry. This includes amphetamine-based medicines for ADHD (e.g. Adderall, Ritalin), as well as benzodiazepines (e.g. Xanax, Klonopin) prescribed for acute anxiety, panic disorder, and insomnia

At Heading, you’re never alone on your journey. During your consultation, you and your clinician will discuss your treatment options and create a plan personalized for your symptoms and needs. Together, you’ll continue to evaluate your treatment plan and make adjustments as needed.

It’s up to you and your provider to determine what’s most comfortable and appropriate for you. If you ever want to schedule additional sessions, we always aim to maintain availability to give our patients the support they need.

Absolutely! You’ll receive outcome measure surveys to track your progress by email along with other digital tools to measure your progress. We’re continuously adding new measurement tools to our platform to increase the precision of our approach to care.

Insurance and Payment

We accept most major insurance plans including: United Healthcare, CIGNA, TRICARE, Blue Cross Blue Shield, Aetna, Humana, Amerigroup, Molina, and Medicare among others. Our intake specialists will work with you to determine your eligibility, verify your coverage, and communicate with your plan as needed. Not on this list yet? Keep checking back, as we’re adding new plans every day.

Don’t worry! We’ll work with you and your new policy to ensure you can continue receiving care without interruption or billing issues. Just try to contact us with your new insurance information as soon as possible.

Yes, you can still get treatment with our self-pay pricing. Just reach out to our team and we’d be happy to discuss self-pay options.

Treatments
Telepsychiatry/Teletherapy

The key difference between psychiatry and therapy is that psychiatry is a medical field that primarily treats mental health conditions with medication. Therapy, also called “talk therapy,” is a broader term that typically refers to counseling sessions facilitated by a licensed therapist. A primary goal of therapy is to help patients develop clarity, coping techniques, and other skills through interactions with their therapist.


While the two fields are often siloed, we aim to bring them together. Our psychiatrists are committed to facilitating open dialogue with patients, while our therapists are uniquely trained to collaborate with psychiatrists and other clinicians for a comprehensive approach.

All Heading providers have a reasonable caseload so they can offer you their undivided attention during sessions. Initial consultations for both psychiatry and therapy are 60 minutes. Psychiatry follow-ups are approximately 30 minutes, while ongoing therapy sessions are typically 50 minutes.

If you choose to do both psychiatry and therapy with us, think of Heading as your mental health homebase. Your providers are a team, and will collaborate with each other — and with you — to ensure that your treatment matches your needs and goals at every step. If you receive a referral from an existing provider (i.e. primary care doctor, psychiatrist, or therapist), we’re also happy to work in partnership with them to personalize your treatment.

No, our psychiatry providers are not able to prescribe controlled substances via telepsychiatry. This includes amphetamine-based medicines for ADHD (e.g. Adderall, Ritalin), as well as benzodiazepines (e.g. Xanax, Klonopin) prescribed for acute anxiety, panic disorder, and insomnia.

Our psychiatry team is a diverse community of clinicians, each with unique experiences and areas of expertise. While we currently do not treat patients under 18, nor do we provide specialized care to geriatric patients with complex medical comorbidities (e.g. Alzheimer’s disease and other dementias), we’re routinely bringing on more providers with unique subspecialties.

Spravato®

Spravato® is the brand name for esketamine (a version of ketamine) nasal spray, which is prescribed as a fast-acting treatment for treatment-resistant depression. At Heading, we offer Spravato® to patients who qualify under their insurance plan and in accordance with FDA requirements. Most insurance companies require at least two prior antidepressant trials, and for patients to be taking an oral antidepressant, during the course of Spravato® treatment.

Although the exact mechanism of action is not yet known, Spravato® is thought to create new connections in the brain by targeting the glutamate system, which is responsible for facilitating communication between nerve cells. This is referred to as neuroplasticity — the ability of the brain to change and adapt. By increasing neuroplasticity, Spravato® appears to help behavioral and cognitive changes occur more rapidly in patients with treatment-resistant depression.

There are several differences between Spravato® and ketamine, though more data is needed to fully understand how both work. On a basic level, Spravato® is the brand name for the compound esketamine, which is derived from isolating one component of ketamine. Ketamine has a longer history, as well, though it’s not FDA-approved to treat depression. That brings us to a key difference in terms of access and cost: Spravato® is covered by insurance, while ketamine is not. Clinical trials have shown a 69% response rate and 52% remission rate in patients treated with Spravato®.

The most common side effects of Spravato®, which can occur both during and after treatment, include: feelings of dissociation (disconnectedness from your body/thoughts/feelings); lack of energy or fatigue; dizziness; increased blood pressure; feeling drunk or excited; nausea or vomiting. Unlike the side effects associated with oral antidepressants, which are persistent and systemic, side effects from Spravato® typically go away within hours of treatment. To avoid nausea and vomiting, it’s recommended that you avoid eating two hours before your treatment.

Yes, most major insurance plans and Medicare cover the cost of Spravato® for patients who meet their criteria. Typically, insurance companies require at least two prior antidepressant trials, and for patients to be taking an oral antidepressant, during the course of Spravato® treatment. After your initial consultation, our team will review your benefits in depth and work directly with you and your plan to determine your eligibility.

If Spravato® treatment is not covered by your insurance plan, we encourage you to consider intramuscular ketamine as an alternative, more affordable treatment. If you choose to self-pay for Spravato®, the cost will likely vary based on dosage and the current retail price, but typically lands between $800-$900 per treatment, in addition to the cost of office visits.

After your initial consultation, Spravato® sessions are typically scheduled twice a week for the first month. In the second month, sessions are reduced to once a week. After this two month period, you and your provider can discuss whether or not to continue Spravato® treatment (and at what frequency) based on your progress and insurance coverage. Each session lasts about 2 hours.

During your treatment session, you’ll self-administer the nasal spray under the supervision of your prescriber — then sit back, relax, and allow the effects to unfold. Patients describe the effects of Spravato® in a number of ways, but many describe feeling relaxed, tired, and calm. You may experience a sense of dissociation, as if floating above yourself and your thoughts. Just remember that there’s no right or wrong way to have the experience. Your provider will be there throughout the session and afterward to ensure you feel comfortable and safe.

Many report feeling relaxed and at ease after Spravato treatment. Others describe feeling tired and a bit dazed. For your safety, we require that you refrain from driving for 24 hours following your treatment, so please arrange to be picked up from our center about two hours after your scheduled appointment time. We also recommend taking it easy the rest of the day: relax, journal, read a great book. This is time to focus on you.

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment for treatment-resistant depression that uses a targeted magnetic pulse on the scalp to stimulate specific regions of the brain responsible for mood regulation.

TMS uses a magnet similar to what’s used in magnetic resonance imaging (MRI) to stimulate neuron activity in underactive areas of the brain associated with depression and related symptoms. By sending repeated magnetic pulses to these areas, TMS reconditions nerve cells to fire differently and create new, healthier connections. Research has shown that TMS is an effective, safe, and well-tolerated treatment for treatment-resistant depression, as well as PTSD, generalized anxiety disorder, OCD, and smoking cessation.

Since TMS is a localized treatment — it does not circulate through the blood as oral antidepressants do — it’s not associated with the same common side effects like weight gain, dry mouth, and loss of libido. Some patients report mild scalp discomfort and/or headache during sessions, though these typically decrease as the body adjusts to the treatment.

Yes, most major insurance plans cover TMS for patients who meet their criteria for treatment-resistant depression. After your initial consultation, our team will review your benefits in depth and work directly with you and your plan to determine your eligibility.

After your initial consultation, TMS sessions are typically scheduled five days a week for 6 weeks. That may sound like a lot, but remember that each session lasts less than an hour and won’t disrupt your day: you’ll be able to drive yourself to and from your treatments, and resume normal activities immediately.

During sessions, you get to relax in the treatment chair while the technician administers stimulation to your scalp that targets specific areas of the brain. This is done through a localized magnetic coil placed next to your head. While some patients initially experience mild scalp discomfort and/or headache, these unfamiliar sensations tend to decrease as your body gets used to the treatment.

Intramuscular Ketamine

Ketamine was initially developed as an anesthetic, but has been rediscovered as a fast-acting treatment for depression and anxiety disorders when administered at low doses in combination with therapy. Ketamine has been shown to be an effective treatment for a range of conditions, including depression and anxiety, but also suicidal thinking, PTSD, OCD, chronic pain, migraine, and fibromyalgia.

Physical illness and mental health conditions like depression and anxiety put stress on our bodies, which leads to damaged neural pathways in the brain over time. Ketamine helps regenerate these pathways by targeting specific brain receptors that help promote new, healthy connections between nerve cells. Its therapeutic effects include pain relief, relaxation, and more flexible thinking.

Given its dissociative effects, ketamine may cause the following side effects during and immediately following treatment: drowsiness, slurred speech, and/or confusion; a sense of impaired balance; perceptual distortions of vision, hearing, and other senses; nausea and/or vomiting.

While your initial consultation will be covered, ketamine is not yet FDA approved as a mental health treatment so unfortunately isn’t covered by insurance. The good news is that Heading also offers the insurance-covered treatment Spravato®, which is the brand name for esketamine, a version of ketamine.

After your initial consultation, ketamine infusions are typically scheduled six times over three weeks. From there, you and your provider will discuss your progress and whether to continue with maintenance sessions (and at what frequency). Each session lasts about 45 minutes.

The experience of ketamine varies from patient to patient — and may even vary for you from one session to the next. However, patients consistently describe feeling a sense of calm or weightlessness. Another common sensation is that of dissociation — feeling disconnected from your body, thoughts, and feelings. Some people notice changes in their heart rate or energy level. Your provider will be there before, during, and after treatment to provide support and help you integrate insights from the experience.

As the ketamine wears off, you may continue to feel lingering effects for a few hours after your appointment. Many patients describe feeling an almost immediate boost in their mood after treatment — and clinical trials support this: ketamine’s rapid antidepressant effects have been shown to peak at 24 hours after treatment. More commonly, 3-6 treatments may be required prior to seeing significant benefits.

 

For your safety, we require that you refrain from driving for 24 hours following your treatment, so please arrange to be picked up from our center about an hour after your scheduled appointment time. We also recommend taking it easy the rest of the day: relax, journal, read a great book. This is time to focus on you.

Ketamine was initially FDA approved in 1970 as an anesthetic for surgery. Although some know it for its recreational use, ketamine remains on the World Health Organization’s (WHO) list of “essential medicines” because of its unique, life-saving properties. Research beginning in the 1990s and 2000s found that ketamine also has important benefits for psychiatric conditions. This research has only gained momentum as scientists continue to discover more about the compound and its mental health benefits.

Ketamine briefly induces a unique state of mind, which is why we prescribe it at low doses, in a controlled medical setting, and with preparation and support from our team. A small number of people may experience a temporary feeling of anxiety or discomfort, though these kinds of challenging experiences can often be therapeutic to move through with the right support.

Yes. Medical conditions such as uncontrolled hypertension or other unstable cardiovascular conditions; other psychiatric conditions such as mania, psychosis, and substance use; and some medications may exclude you from safely getting ketamine treatment. Additional safety considerations may be addressed by your provider during the initial consultation.

Try your best to get a good night’s rest and avoid any alcohol for at least 24 hours before and 48 hours after your treatment. If you can, try to avoid stressful environments and major life decisions around the time of your sessions. As best you can, try to create space and openness for healing.

Can’t find the answer you’re looking for?
Don’t hesitate to contact us!

We’re available by email at info@headinghealth.com

or phone at (512) 777-2591.

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