FAQ | McLean Neuropsychiatric Treatment Center

Frequently Asked Questions

Your Questions, Answered

This FAQ is designed for patients, families, and referring clinicians. It is educational and does not replace a psychiatric evaluation.

Emergency : If you are in immediate danger, call 988, call 911, or go to the nearest emergency department.

Starting Care

What kind of clinic is McLean Neuropsychiatric Treatment Center?

McLean Neuropsychiatric Treatment Center is a psychiatrist-led interventional psychiatry and neuromodulation center in McLean, Virginia. We focus on treatment-resistant depression, obsessive-compulsive disorder, complex mood disorders, and patients who need treatment options beyond standard outpatient medication management. Our services include TMS, esketamine, ketamine treatment, OCD TMS using MagVenture B80 technology, vagus nerve stimulation evaluation and coordination, and medication management.

Who is McLean NTC best suited to help?

We are often a good fit for patients with persistent depression, recurrent depression, OCD, or complex mood symptoms that have not responded adequately to prior care. We are also a good fit for patients and families who need a serious discussion of advanced treatment options. The best fit depends on prior treatment history, current symptoms, medical safety, substance use, suicide risk, treatment goals, insurance criteria, and the patient's ability to participate in outpatient care.

Who may need a different level of care first?

Some patients need emergency, inpatient, residential, or intensive outpatient care before an outpatient interventional psychiatry clinic is appropriate. This includes patients with imminent suicide risk, inability to maintain safety, severe psychosis, catatonia, delirium, severe substance use interfering with outpatient treatment, or unstable medical illness. If there is a safety emergency, call 988, call 911, or go to the nearest emergency department.

What happens during the first consultation?

The first consultation is designed to answer a basic but important question: what is the most appropriate next step? The clinician will review symptoms, diagnosis, prior treatment trials, medication history, psychotherapy history, medical conditions, safety concerns, and treatment goals. The result may be a recommendation for TMS, esketamine, ketamine treatment, medication management, OCD TMS, VNS evaluation, ECT referral, psychotherapy referral, or a higher level of care.

What should I send before my appointment?

Please send as much relevant treatment history as you can. Useful records include medication names, doses, duration of trials, side effects, psychotherapy history, hospitalizations, prior TMS, esketamine, ketamine, ECT, and/or VNS exposure, relevant medical history, lab results if available, and current insurance information. Rating scales such as PHQ-9, MADRS, GAD-7, or Y-BOCS are also helpful if available.

Depression and Treatment Resistance

What is treatment-resistant depression?

Treatment-resistant depression usually means that major depressive disorder has not improved adequately after at least two appropriate antidepressant treatment trials. Some patients appear treatment-resistant because prior medication trials were too short, doses were too low, adherence was difficult, the diagnosis was incomplete, bipolar spectrum illness was missed, medical contributors were not addressed, or other conditions complicated the picture. A good evaluation asks whether the depression is truly treatment-resistant, difficult-to-treat, undertreated, misdiagnosed, or complicated by another condition.

Does treatment-resistant depression mean nothing will work?

No. Treatment-resistant depression means prior treatment has not worked well enough. It does not mean future treatment is hopeless. It does mean that the next step should be more thoughtful than simply repeating the same approach. Treatment options may include medication changes, augmentation strategies, psychotherapy, TMS, esketamine, ketamine treatment, ECT referral, VNS evaluation, or a higher level of care depending on the clinical situation.

Why does diagnosis need to be reviewed before choosing treatment?

Different conditions can look like depression or worsen depression. Bipolar disorder, OCD, PTSD, substance use disorders, sleep disorders, cognitive disorders, medication side effects, thyroid disease, chronic pain, and other medical conditions can all affect mood and functioning. If the diagnosis is wrong or incomplete, the treatment plan may fail even if the treatment itself is reasonable.

TMS for Depression

What is TMS?

Transcranial magnetic stimulation, or TMS, is a noninvasive neuromodulation treatment that uses magnetic pulses to stimulate targeted brain regions involved in mood regulation. TMS does not require anesthesia, sedation, or an implanted device. The MagVenture TMS Therapy System we use is FDA-cleared for major depressive disorder and MDD with comorbid anxiety symptoms in adults who have not achieved satisfactory improvement from prior antidepressant medication.

What is a typical TMS treatment course like?

A standard TMS course usually involves treatment sessions five days per week for several weeks, although protocols vary. Each session is performed in the office. Patients are awake during treatment and can usually return to normal activities afterward. The first session takes longer because the team determines treatment location and stimulation parameters.

What are common side effects of TMS?

TMS is generally well tolerated. Common side effects can include scalp discomfort, headache, facial muscle twitching during stimulation, lightheadedness, or temporary discomfort at the treatment site. Serious adverse events such as seizure are rare, but screening is important. Patients should tell the clinical team about seizure history, implanted medical devices, metal in or near the head, neurological conditions, pregnancy, and current medications.

Esketamine and Ketamine

What is esketamine (Spravato)?

Esketamine is an intranasal medication sold under the brand name Spravato. It is FDA-approved for treatment-resistant depression in adults as monotherapy or with an oral antidepressant, and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. Esketamine is administered in our certified REMS-compliant clinic under direct clinical observation. It is not dispensed for home use. Patients are monitored for at least two hours after each treatment.

What should I expect during an esketamine treatment visit?

Esketamine treatment takes place in our clinic. Patients self-administer the nasal spray under clinical supervision, then remain under observation for at least two hours. Because esketamine can cause sedation, dissociation, impaired coordination, and blood pressure changes, patients cannot drive themselves home after treatment. A responsible adult or transportation plan is required.

How are esketamine and ketamine different?

Esketamine is the S-enantiomer of ketamine and is FDA-approved as Spravato for specific psychiatric indications under a REMS program. Ketamine contains both R- and S-ketamine and may be used off-label for depression depending on route and clinical context. Both require careful screening and monitoring. Neither is appropriate for every patient.

OCD and OCD TMS

What is TMS for OCD?

TMS for OCD is a noninvasive neuromodulation treatment used as an adjunct treatment for adults with obsessive-compulsive disorder. McLean NTC offers OCD TMS using MagVenture B80 technology. The B80 coil is FDA-cleared as an adjunct treatment for adult OCD, targeting the bilateral dorsomedial prefrontal cortex. OCD TMS does not replace exposure and response prevention therapy or medication. It is an adjunctive option for patients with persistent symptoms.

Who may be a candidate for OCD TMS?

A patient may be considered for OCD TMS evaluation if they are an adult with OCD, have persistent symptoms despite appropriate treatment including ERP and medication, and can safely participate in outpatient TMS. Candidacy depends on the full clinical picture including diagnosis, severity (Y-BOCS), prior treatment history, safety factors, contraindications, and insurance coverage.

Vagus Nerve Stimulation

What is VNS for depression?

Vagus nerve stimulation, or VNS, is a neuromodulation treatment that uses an implanted device to stimulate the vagus nerve. The VNS Therapy System is FDA-approved for adjunctive long-term treatment of chronic or recurrent depression in adults 18 or older who have not had adequate response to four or more adequate antidepressant treatments. VNS is not a first-line depression treatment. It is generally considered for highly treatment-resistant, chronic, or recurrent illness.

What VNS services does McLean NTC provide?

McLean NTC provides psychiatric evaluation for VNS candidacy. When VNS may be appropriate, we coordinate with LivaNova, the VNS device company, to help navigate prior authorization, identify a neurosurgical partner, and coordinate device implantation. The implantation is performed by a neurosurgeon in a hospital operating room, not at our clinic. After implantation, McLean NTC follows the patient psychiatrically, monitors response over time, and performs routine VNS stimulator adjustments.

Is VNS covered by insurance?

VNS coverage for depression is reviewed on a case-by-case basis. Coverage is improving but often requires careful documentation, prior authorization, and coordination among the clinic, device company, insurer, patient, and neurosurgical team. Our insurance coordinators work closely with patients, insurers, and LivaNova to help pursue coverage when VNS appears clinically appropriate.

Older Adults and Geriatric Psychiatry

Do you treat older adults with depression?

Yes. Dr. Haq is a geriatric psychiatrist by training with particular expertise in evaluating and treating older adults with depression, cognitive symptoms, medical complexity, and medication sensitivity. Depression is not a normal part of aging. It is a treatable medical condition. Careful evaluation is especially important in older adults because depression, cognitive impairment, delirium, medication side effects, substance-related symptoms, sleep disorders, grief, and medical illness can overlap.

Why is geriatric psychiatric evaluation important?

In older adults, the first question is not simply which antidepressant or procedure to use. The first question is what condition is actually driving the symptoms. An older adult with low mood, apathy, memory complaints, poor sleep, weight change, or functional decline may have major depressive disorder, a neurocognitive disorder, delirium, medication side effects, or a medical contributor. A geriatric psychiatric evaluation helps clarify the diagnosis and build a treatment plan that accounts for medical comorbidity, cognition, fall risk, drug interactions, and patient goals.

Can TMS, esketamine, or ECT be considered for older adults?

Yes, selected interventional psychiatric treatments can be considered for older adults when clinically appropriate. Older adults may be more vulnerable to medication side effects, drug interactions, falls, sedation, and anticholinergic burden. This can make noninvasive or interventional options worth discussing in carefully selected cases. TMS, esketamine, and ECT have evidence supporting use in older adults with treatment-resistant depression. These treatments require individualized evaluation, medical review, and risk-benefit discussion.

Insurance and Access

What insurance plans do you accept?

McLean NTC accepts all major insurances, including Virginia Medicaid and Medicare. Our insurance coordinators work closely with insurance companies and patients to help pursue coverage and prior authorization for appropriate treatments.

Which treatments are typically covered by insurance?

Esketamine, TMS for depression, and medication management are typically covered by insurance when plan criteria are met. Ketamine treatment is very rarely covered by insurance. OCD TMS and VNS for depression are covered on a case-by-case basis, with coverage improving over time. Our team can help review coverage and prior authorization requirements before treatment begins.

Current Patients

What should I do if my symptoms worsen during treatment?

Tell the treatment team promptly. Worsening mood, new suicidal thoughts, manic symptoms, psychotic symptoms, severe anxiety, severe insomnia, substance use relapse, or major functional decline should be reported. If you may harm yourself or someone else, or cannot stay safe, call 988, call 911, or go to the nearest emergency department.

Can I drive after treatment?

It depends on the treatment. Patients generally can drive after TMS unless the clinical team advises otherwise. Patients cannot drive themselves home after esketamine or ketamine treatment because these treatments can cause sedation, dissociation, impaired coordination, and other effects. A transportation plan is required.

Should I continue therapy during treatment?

Often, yes. Many patients benefit from continuing psychotherapy during TMS, esketamine, ketamine treatment, OCD TMS, or medication management. For OCD, exposure and response prevention therapy remains an important evidence-based treatment component for many patients. Do not stop therapy, medication, or other treatment without discussing it with your clinician.

Still Have Questions?

Our team is happy to answer questions before you schedule. Call or text us, or request a consultation online.