What to Expect from Medication Management at Elevium
Ritesha Krishnappa • December 18, 2025
Quick overview
Medication
management at Elevium is a collaborative, medical approach to treating mood, anxiety, and related conditions. It’s not just “getting a prescription” - it’s an ongoing process of assessment, careful medication selection, safety monitoring, and coordination with therapy and other supports. Elevium’s medication management workflow is designed to be evidence-informed, patient-centered, and transparent about costs and logistics.
What’s included in Elevium’s medication management
1. Comprehensive initial psychiatric evaluation
- Length: typically 60–90 minutes.
- Contents: clinical interview, psychiatric history, medication history (what’s worked/hasn’t), family psychiatric history, medical history, current symptoms (standardized rating scales like PHQ-9/GAD-7 as appropriate), suicide risk assessment, substance use screening, and review of labs/medical records.
- Goal: establish a working diagnosis, treatment goals, and an initial medication plan (if indicated).
2. Personalized medication plan
- A tailored plan that explains why a certain medication or strategy is recommended (monotherapy, augmentation, switching, or targeted symptom approach).
- Education about expected benefits, typical timeline for improvement, common side effects, and safety/caution points.
3. Shared decision-making & informed consent
- Discussion of risks vs benefits, alternatives (therapy, neuromodulation like TMS, Spravato, where appropriate), and patient preferences.
- Documentation of consent, particularly for controlled or higher-risk medications.
4. Follow-up visits & monitoring
- Initial follow-up: usually 2–6 weeks after starting a new med to check tolerability and early response.
- Ongoing follow-ups: frequency depends on stability - could be every 4–12 weeks once stable. Visits may be longer if doses change or new symptoms emerge.
- Monitoring includes symptom scales, side-effect checklists, vitals/labs when indicated, and safety checks.
5. Safety & side-effect management
- Counseling about what side effects to expect and what warrants urgent attention.
- Protocols for dose adjustments, cross-tapers, or switching medications.
6. Coordination of care
- Communication with therapists, primary care providers, pediatricians (for teens), schools, or other specialists as needed.
- Referrals for psychotherapeutic care, higher levels of service (IOP/PHP), or specialist consultation.
7. Administrative support
- Assistance with prior authorizations, prior-therapy documentation, and medication prior-authorization appeals when needed.
- Clear instructions for prescription refills and after-hours urgent concerns.
How visits typically work
Before your first visit
- You’ll be asked to complete intake forms, symptom scales, and to bring (or authorize transfer of) records: previous medication lists, pharmacy records, recent labs, and any recent psychiatric evaluations.
The first visit (initial psychiatric evaluation)
- 60–90 minutes. The clinician obtains a detailed history and establishes a plan. At the end of the visit you’ll usually receive: a diagnosis summary, the medication plan (or rationale for not prescribing), expected timeline, and a safety plan if needed.
Follow-up visits
- Shorter (15–45 minutes). Focus on side effects, symptom progress, and any dose adjustments. More complex changes (cross-tapers, combination strategies) may take longer.
- Mode: in-person or telemedicine — Elevium typically offers both, depending on the clinical need. Certain medications or monitoring (e.g., Spravato, injections, labs) require in-person visits.
Between visits
- Refills: request through the clinic portal or phone as specified. Elevium staff generally require a follow-up visit before approving repeated refills for controlled medications.
- Urgent concerns: Elevium should provide instructions for after-hours matters; urgent side effects or suicidal thoughts should be addressed immediately (call emergency services or local crisis resources).
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Clinical monitoring & safety (what we watch for)
Symptom tracking:
standardized scales to measure improvement and side effects over time.
Physical monitoring:
blood pressure, weight, and targeted labs (e.g., metabolic labs for some atypical antipsychotics, lithium levels, or LFTs when indicated).
Medication-specific monitoring:
Some meds require routine labs or EKGs; the clinic will advise and order these when appropriate.
Controlled substances:
Special tracking, limited refills, and closer follow-up.
Common medication categories discussed in management visits
- Antidepressants (SSRIs, SNRIs, bupropion, mirtazapine, etc.)
- Augmentation agents (atypical antipsychotics, lithium, thyroid augmentation)
- Anxiolytics and sedative-hypnotics (cautious use, short trials, or alternatives favored when possible)
- Stimulants and non-stimulants for ADHD (careful coordination with schools/therapists)
- Novel/clinic-administered therapies (Spravato/esketamine — in-clinic administration & monitoring; ketamine protocols discussed case-by-case) — availability depends on clinical indication and clinic policy.
Insurance & billing - what to expect
How medication is billed
- Office visits and medication management are usually billed to the medical benefit as psychiatry/med management visits.
- Prescription drugs may be billed through the pharmacy benefit or medical benefit, depending on how the drug is supplied (clinic-administered drugs like Spravato are typically medical-benefit billed). Elevium staff will help clarify how high-cost clinic-administered treatments are billed.
Learn more: pricing guide
Prior authorization & documentation
- Prior authorization (PA) is common for many psychiatric medications, especially brand-name meds or for Spravato/esketamine. Elevium can assist with PA paperwork.
- What insurers often request: history of prior medication trials, documentation of diagnosis, symptom severity, and a clear medical necessity rationale.
Coverage variations & out-of-pocket costs
- Most standard psychiatric meds (generic SSRIs, SNRIs) are commonly covered under pharmacy benefits with standard copays.
- Spravato/esketamine - typically covered only with prior authorization and when clinic REMS requirements are followed; patient responsibility depends on plan.
- Off-label options (e.g., ketamine infusions) are frequently not covered and may require self-pay; Elevium will provide cost estimates if a service is likely out-of-pocket.
- Tip: always request a benefits estimate before starting a long or expensive course of treatment.
Practical steps to help coverage & smooth care
- Bring or request records of previous meds, dates, doses, and responses. Pharmacy printouts are extremely helpful.
- Ask Elevium for a pre-treatment benefits estimate for complex or out-of-network drugs or clinic-administered therapies.
- Be prepared for prior authorization: allow time (days to weeks) for insurer review. Elevium’s administrative team can submit PAs and assist with appeals when appropriate.
Sample patient checklist (for the first med management visit)
- A full list of current and past medications (including supplements) with doses & dates.
- Recent labs or medical issues (thyroid disease, pregnancy, heart disease).
- Contact information for therapists/other treating clinicians (with patient consent).
- Insurance card & pharmacy information.
- Questions you want addressed (side effects, treatment timeline, alternatives).
How soon will medication help?
Some medications show benefit in 1–2 weeks; most antidepressants are assessed at 6–8 weeks for a full therapeutic effect. Augmentation strategies and switches take additional time; your clinician will set expectations.
Can I do med management by telemedicine?
Many follow-ups can be done by telemedicine. In-person visits may be required for labs, injections, or clinic-administered treatments.
What if I’m worried about side effects?
Yes. Even when the drug is covered, facility fees, monitoring time, and repeated sessions may have patient responsibility. Always request a pre-treatment benefits estimate.
Will Elevium prescribe Spravato/ketamine?
Elevium discusses clinic-administered therapies as options when clinically appropriate; Spravato requires in-clinic administration and monitoring and typically needs prior authorization. Off-label ketamine is addressed case-by-case, and coverage varies.
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Quick takeaway Yes - TMS can be an effective option for some people with obsessive–compulsive disorder (OCD). In particular, deep TMS (dTMS) has received FDA clearance for OCD and is provided using specific, evidence-based protocols. At Elevium, TMS for OCD is offered as part of an integrated care plan that pairs neuromodulation with therapy, medication management, and careful clinical oversight. How TMS treats OCD - the basic idea TMS uses focused magnetic fields to change activity in brain circuits involved in mood and compulsive thinking. For OCD, clinicians target the networks thought to underlie obsessive thoughts and repetitive behaviors. Deep TMS (dTMS) uses a specialized coil to reach deeper brain structures implicated in OCD and is the modality that has been FDA-cleared for this indication. Clinical protocols are standardized so clinicians can safely and reliably deliver therapeutic stimulation. FDA approvals & what they mean The FDA has cleared specific dTMS systems for the treatment of OCD , which means there is a regulatory basis and controlled clinical evidence supporting its safety and effectiveness for eligible patients. FDA clearance also helps establish standardized treatment protocols and safety monitoring that clinics follow. Typical protocols & what a course looks like Intake & screening: A full psychiatric and medical evaluation is performed to confirm the OCD diagnosis, review prior treatments (therapies and medications), and screen for contraindications (for example, certain implants or seizure risk). Treatment schedule: OCD TMS protocols are typically delivered as a course of daily sessions over multiple weeks. The length of each session and the total number of visits depend on the specific dTMS protocol used and the patient’s clinical response. Monitoring & follow-up: Symptoms are tracked with standardized scales; clinicians adjust the plan and recommend complementary therapies (e.g., ERP — exposure and response prevention) as needed. Elevium’s guidance emphasizes standardized protocols and close outcome tracking to optimize results. Success rates & evidence (what research and clinic experience show) Clinical trials and real-world clinic reports show that many patients with OCD experience meaningful symptom reductions after a full course of dTMS, and some achieve remission. Outcomes vary by individual factors (severity, duration of illness, prior treatment response). Elevium’s TMS for OCD materials summarize published evidence and emphasize honest, individualized expectations during the consent process.
Quick overview When evidence-based talk therapy and medication management don’t bring sufficient relief, Elevium offers advanced, clinically proven options that can help many people regain function and hope: TMS (Transcranial Magnetic Stimulation) — a non-invasive, FDA-cleared brain-stimulation therapy for depression and certain other conditions. Spravato (esketamine) — an FDA-approved, rapidly acting medication for treatment-resistant depression given in-clinic under a REMS safety program. Ketamine (IV/IM/compounded intranasal/oral) — an off-label but increasingly used rapid-acting option with a different regulatory and coverage profile than Spravato. Each has different mechanisms, logistics, evidence levels, and cost/coverage patterns. Below, we explain how they work, who they help, what to expect, and how Elevium integrates them into personalized care. First step: careful re-evaluation Before recommending an advanced therapy, Elevium begins with a comprehensive reassessment: review of diagnosis, co-occurring conditions ( anxiety, PTSD, bipolar spectrum, substance use ), medication history, prior psychotherapy responses, safety (including suicidal risk), medical history, and relevant labs or imaging. This ensures that the chosen option is medically appropriate and that reversible contributors (such as sleep, thyroid, substance, and medication interactions) have been addressed. Elevium’s medication-management and intake workflows emphasize this structured evaluation and shared decision-making. TMS: how it helps when meds/therapy aren’t enough How it works TMS uses focused magnetic pulses to stimulate brain regions involved in mood regulation (commonly the left dorsolateral prefrontal cortex). It is a non-invasive procedure performed while the patient is awake. Evidence shows TMS can significantly reduce depressive symptoms in many patients who have not responded to multiple medication trials. Who it’s for People with treatment-resistant depression (failed adequate trials of antidepressants) or those who can’t tolerate medication side effects. Selected patients with OCD or other indications, when supported by the device/protocol and clinical judgment. (Device-specific approvals and local practice guide candidacy.) What the course looks like Intake & screening: psychiatric evaluation, medical history, and motor-threshold titration. Typical course: daily sessions (usually 5×/week) for ~4–6 weeks (about 20–30 sessions). Some accelerated protocols (e.g., iTBS) use much shorter sessions. During sessions, patients are awake, can read or relax, and usually resume normal activities afterward. Side effects are most commonly scalp discomfort or headache; seizures are rare with proper screening. Why does it help when meds fail TMS offers a non-systemic approach that targets neural circuits directly rather than changing neurotransmitter levels systemically. That means patients who did not respond to medication trials sometimes respond to TMS. Pros/cons summary Pros: FDA-cleared, few systemic side effects, durable responses for many. Cons: Time commitment (daily visits), potential for scalp pain/headache, insurance often requires prior authorization and documentation of prior treatment failures.
At Elevium, we believe there’s no one-size-fits-all answer to mental health care. Every treatment has strengths, limitations, and a best-fit patient. Below is a clear, patient-friendly comparison to help readers weigh their options and see how Elevium integrates treatments into individualized plans. At a glance - Quick Comparison Table
What is TMS (Transcranial Magnetic Stimulation)? TMS uses focused magnetic pulses to stimulate targeted areas of the brain (most commonly the left dorsolateral prefrontal cortex for depression). Pulses are delivered with a coil placed on the scalp; treatment is done while awake and does not require anesthesia. Variants: Standard rTMS: sessions ~30–45 minutes. iTBS (intermittent theta burst stimulation): accelerated protocol with much shorter sessions (often 3–10 minutes) that can produce similar clinical results in many patients. Safety & Side Effects: The most common side effects are mild scalp discomfort or headache, which typically resolve. Serious events (seizures) are rare when patients are properly screened and protocols followed. Who is a candidate for TMS? TMS is typically considered when: A patient has major depressive disorder that has not responded adequately to multiple antidepressant trials or therapy. Medication side effects are intolerable, or the patient prefers a non-drug option. The patient can attend frequent sessions and has no contraindications (e.g., certain metal implants near the head, unshielded intracranial hardware, or an active condition that raises seizure risk). For teens: certain devices have adolescent indications — candidacy is determined by device labeling and clinician judgment. Typical pre-treatment evaluation includes: psychiatric assessment, medical history, medication review, seizure risk evaluation, and review for metal implants. A baseline symptom scale (PHQ-9, etc.) is often used to track progress. What to expect during treatment (timeline & session flow) Evaluation & prep Initial consult / intake (60–90 minutes): psychiatric history, prior treatments, informed consent, and screening. Motor threshold titration: first appointments set the stimulation intensity based on each patient’s motor threshold (a quick calibration). Treatment course Frequency: Most standard protocols are 5 sessions per week (Mon–Fri). Duration: Typical acute course is 4–6 weeks (totaling ~20–30 sessions). Some protocols extend to 6 weeks or include additional sessions for partial responders. Session length: Traditional rTMS sessions 20–45 minutes; iTBS sessions about 3–10 minutes. Maintenance: Some patients have periodic maintenance TMS (weekly or monthly) if symptoms recur. During a session You’ll sit comfortably. The technician positions the coil and runs the protocol. You’re awake and alert and can read, use your phone, or relax. Most patients return to normal activities immediately after (unlike treatments that require post-procedure monitoring or sedation).
Quick answer If you’re a parent looking at TMS (transcranial magnetic stimulation) or Spravato (esketamine nasal spray) for a teen with depression, the biggest takeaway is this: TMS has FDA-cleared options for some adolescents (ages 15–21) as an adjunct treatment for major depressive disorder, depending on the specific TMS system and clinical scenario. Spravato is not established for pediatric patients (safety/effectiveness in people under 18 hasn’t been established in labeling). Spravato also requires in-clinic administration and at least 2 hours of monitoring each session due to risks like sedation/dissociation and respiratory depression. Below is a parent-friendly guide: eligibility, safety data, FAQs, and what options a clinic like Elevium may offer for younger patients. What are these treatments? TMS (Transcranial Magnetic Stimulation) TMS uses a magnetic coil placed on the scalp to stimulate brain circuits involved in mood regulation. It’s non-invasive, done awake, and doesn’t require anesthesia. In youth research, the most common side effects are typically headache and scalp discomfort, and serious adverse events are uncommon when safety guidelines are followed. Spravato (Esketamine) Spravato is a controlled substance nasal spray administered under supervision in a certified healthcare setting with monitoring because of risks like sedation/dissociation and respiratory depression. It is not dispensed for home use. Spravato. For pediatric use, labeling states that the safety/effectiveness has not been established. Eligibility: Who might be a candidate? TMS eligibility (typical teen considerations) A teen may be considered when: Depression is moderate to severe and significantly impairing. Symptoms haven’t improved enough with evidence-based first-line care (therapy and/or medication), or there’s a reason meds aren’t a good fit. The teen can attend frequent sessions and cooperate with treatment. No contraindications (for example, certain metal implants near the head). Important age note: Some TMS devices now have FDA-cleared indications for adolescents 15–21 as adjunct treatment for MDD. Spravato eligibility for teens In practice, most reputable programs treat Spravato as an adult-focused option because pediatric safety/effectiveness is not established in the labeling. If a clinic considers ketamine/esketamine-type therapies for youth at all, it’s usually in highly specialized contexts with careful risk/benefit review and parent/guardian involvement.
Quick answer Spravato (esketamine) - more likely to be covered by insurance for treatment-resistant depression or certain labeled indications because it is FDA-approved for those uses and provided under a REMS (safety) program. Coverage usually requires prior authorization and is commonly billed through the medical benefit (clinic/office administration), though specifics vary by insurer. Ketamine (racemic or other formulations) given for depression (IV, IM, oral, compounded intranasal) is generally off-label for psychiatric indications. Most commercial and government payers treat ketamine for depression as experimental/ investigational and do not routinely cover it, so patients commonly pay out-of-pocket. Exceptions can occur on a case-by-case basis. Below is a patient-friendly but practical breakdown to help you understand the differences, benefits, and when each option might be preferred. How insurers think about these two treatments 1. FDA approval & labeling (big insurer signal) Spravato (esketamine): FDA-approved specifically for treatment-resistant depression (and for depressive symptoms in certain cases). Because it’s approved and regulated (REMS), payers have a clear precedent for coverage policies — though they still typically require documentation of prior treatment attempts and a prior authorization. Ketamine (IV/IM/oral/compounded intranasal): Ketamine as an anesthetic is FDA-approved, but not specifically approved for depression except for esketamine. Using ketamine for depression is off-label, so most insurers label it “investigational” and don’t cover it routinely. 2. Delivery setting & billing pathway Spravato: Administered in a certified clinic with monitoring (because of REMS). Charges are generally billed under the medical benefit (clinic visit/drug administration/observation). In some systems, parts may route through the pharmacy/medical split — check your plan. Ketamine: Often given via IV infusion in outpatient infusion clinics/medical offices. Since this use is off-label, some insurers will not cover the drug or the infusion visit; even when they do, coverage is inconsistent. Ketamine given for anesthesia (unrelated uses) is covered in its approved context, but that does not imply coverage for depression treatment. 3. Evidence & guidelines Spravato has randomized trials, an FDA label, and published REMS safety requirements — this strengthens the case for insurer coverage. Ketamine has growing evidence showing rapid antidepressant effects but lacks a universal regulatory approval for depression (outside esketamine), so guidelines and payer policies are uneven. Benefits of each treatment (clinical perspective) Spravato (esketamine) Standardized, FDA-approved formulation and dose. REMS program requires safe administration and monitoring, which some insurers view positively. Good evidence for treatment-resistant depression and a clear pathway for prior authorization. Administered under supervision with structured follow-up — easier to document for insurers. Ketamine (IV/IM/oral/compounded) Flexible routes of administration (IV, IM, oral, intranasal) — IV infusions may produce rapid effects. Often faster & flexible protocols in experienced clinics (some patients respond when other treatments fail). Potentially lower direct drug cost (depending on formulation), but overall cost can still be high because of clinic fees and repeat sessions. Clinical experience: Many providers and clinics report beneficial outcomes, particularly for acute suicidal ideation or rapid symptom relief; however, standardization and long-term data vary.
For many patients, Spravato (esketamine nasal spray) represents a lifeline when traditional antidepressants fall short. However, no treatment is without risk, and you may have stumbled upon online stories that read “Spravato ruined my life.” In this article, we’ll explore: Why some patients have negative experiences Common and rare side effects of Spravato How to minimize risks When to seek help What makes treatment at Elevium different
Transcranial Magnetic Stimulation (TMS) is FDA-approved and widely considered a safe, effective treatment for depression, OCD, and other mood disorders. But, as with any therapy, individual experiences vary - and online, you may have come across forums or articles claiming “TMS made me worse.” At Elevium , we believe in open, honest communication about both the benefits and the potential challenges of treatment. In this article, we’ll cover: Why some patients report negative experiences The most common side effects How Elevium minimizes risk and enhances outcomes What to do if symptoms worsen How to make an informed, confident decision about TMS
When to Expect Results and Side Effects from Spravato
How Much Does Spravato Cost? Understanding Pricing, Insurance, and Treatment Options
