At Maryville Psychiatry all new patients are evaluated by our Medical Director/Psychiatrist, Dr. Lapollo. We operate on a tier based system of care where patients are placed in either two tiers based on level of care needed. Tier 1 patients are seen for follow-up appointments by Dr. Lapollo. These patients are usually significantly clinically complex and often requiring interventional techniques like TMS or Ketamine as well as traditional medication management and individual therapy. All other patients fall into Tier 2 and are seen by our Psychiatric Nurse Practitioners. During their care patients are constantly being evaluated and if need arises to change to tier 1 care that will be made by treating provider in collaboration with the patient and Dr. Lapollo. This model allows us to adequately triage patients and get them the best care possible based on individual need. This tier system also sets us apart from other clinics which often have one level of care for all patients and have no system in place to adequately triage patients who require more intensive interventions.

Transcranial Magnetic Stimulation (TMS) is a non-invasive, drug-free treatment designed to alleviate symptoms of depression and anxiety by using electromagnetic pulses to stimulate areas of the brain that may be over or underactive. The treatment involves a commitment of 36 sessions, with one session administered daily, Monday through Friday. The initial appointment, which includes mapping and the first treatment, lasts about an hour, while subsequent treatments are approximately 20 minutes each.

TMS is FDA-approved and covered by most insurance companies, and a benefits investigation is conducted to determine any potential out-of-pocket costs for the patient. The therapy is generally well-tolerated, with no significant side effects, and is considered painless. During treatment, the patient remains awake and comfortably reclined in a spa chair, experiencing a mild tapping sensation as the electromagnet is placed in the targeted treatment area. After the session, there are no restrictions on driving or working.

TMS has proven to be highly effective, with collective data indicating that it improves symptoms of depression in 83% of patients and induces full remission in 62% of patients.

The SAINT (stands for Stanford Accelerated Intelligent Neuromodulation Therapy) protocol is a newly developed condensed TMS treatment that has been cleared by the FDA for treatment-resistant depression. It consists of 1800 pulses of theta burst TMS every hour, 10 sessions a day, for five straight days. We also offer an abbreviated “mini SAINT” treatment which consists of 5 sessions a day over the same time period. Dr. Lapollo can help in deciding which treatment is best for you. Learn more about the SAINT Protocol Here. 

Ketamine is an anesthetic medication that has been extensively studied for its potential in improving treatment-resistant depression. The recommended treatment plan includes a 4-week loading phase, during which patients receive treatment twice a week, followed by a 4-week stabilization phase with weekly treatments. After this, maintenance boosters are suggested monthly, typically every 3 to 5 weeks.

Currently, Ketamine treatments are not covered by insurance, and the cash pay rate is $175 per treatment. Side effects are generally mild and tend to wear off within an hour or two after administration, including feelings of dissociation, nausea, or elevated blood pressure. The treatment involves an intramuscular injection in the deltoid, similar to a flu shot, and is generally well-tolerated. While Ketamine has shown promise as a safe and effective treatment for depression, it is still being studied for its broader clinical utility and is recommended as an adjunctive treatment for resistant depressive symptoms. We offer payment plans for this treatment.

Tirzepatide is a medication that functions as both a GIP (Gastric Inhibitory Polypeptide) receptor agonist and a GLP-1 (Glucagon-Like Peptide-1) receptor agonist. By stimulating the GIP receptor, Tirzepatide enhances insulin release from the pancreas in response to food intake, which helps lower blood sugar levels by facilitating glucose uptake into cells. Additionally, as a GLP-1 receptor agonist, Tirzepatide has several beneficial effects: it stimulates insulin secretion, inhibits glucagon secretion to reduce liver glucose production, slows gastric emptying to help control post-meal blood sugar levels, and promotes a feeling of fullness, which can aid in weight management.

By targeting both GIP and GLP-1 receptors, Tirzepatide offers a comprehensive approach to glycemic control in individuals with type 2 diabetes. This dual mechanism may lead to improved blood sugar control, weight loss, and potentially other cardiovascular benefits.

Regarding commitment, each patient's plan varies based on their weight loss goals. Currently, Tirzepatide treatments are not covered by insurance, and the cash pay rate is as low as $100 per treatment. The medication has proven to be highly effective in managing blood sugar levels and supporting weight loss.