Sandhya Prashad, MD Practice Overview

HOUSTON CENTER FOR ADVANCED PSYCHIATRIC TREATMENT SANDHYA

P R A S H A D, M D

A Modern Approach to Treatment We offer an expertise in cutting edge treatment options when conventional treatments fall short.

For many patients struggling with depression, bipolar disorder, PTSD or anxiety, oral medications can play a big role in alleviating symptoms but may not be enough. One-third of patients with major depressive disorder will not respond even after multiple attempts at treatment.

Newer treatment options, when expertly administered, can be incredibly beneficial, even when past treatments have failed.

Many practices offer only one of the innovative treatments. We know that any one treatment, no matter how cutting edge it is, can’t be the right solution for everyone, and that treatments must be customized for each patient. In addition, these treatments often work well in combination, thus enhancing the effects to give each patient the best chance at reaching remission from their symptoms.

INTRAVENOUS KETAMINE DEPRESSION - ANXIETY- BIPOLAR DEPRESSION - OCD - PTSD - SUICIDALITY

INTRANASAL ESKETAMINE SPRAVATO DEPRESSION - SUICIDALITY

BRAINSWAY DEEP TMS MAGSTIM ACCELERATED TMS DEPRESSION - ANXIETY- BIPOLAR DEPRESSION - OCD - ADHD SUICIDALITY - SMOKING CESSATION

KETAMINE ASSISTED PSYCHOTHERAPY DEPRESSION - ANXIETY- BIPOLAR DEPRESSION - OCD - PTSD

COMBINATION TREATMENTS IV KETAMINE + TMS DEPRESSION - ANXIETY- BIPOLAR DEPRESSION - OCD - PTSD - SUICIDALITY

INTRAVENOUS KETAMINE For some patients, ketamine infusion therapy is quite simply life changing and unlike any other treatment currently available given its rapid, robust effects and lack of side effects between treatments. It works on glutamate instead of serotonin, and is effective even in patients that have failed multiple other treatments. It is thought to help restore nerve synaptic connections in patients with major depressive disorder.

In the last decade, a great deal of clinical research has been conducted by leading institutions proving intravenous ketamine’s efficacy and safety in the treatment of major depression, bipolar depression, PTSD, OCD and severe anxiety as well as certain pain disorders.

Dr. Prashad specifically tailors each infusion to each patient. There is no pre-determined set time limit or dosage; we customize each treatment. Dr. Prashad has extensive experience with using ketamine and is one of the most experienced ketamine psychiatrists in the country.

6 infusions over 2-3 weeks followed by booster infusions approximately once monthly Studies report a 70% success rate or higher, the success rate at our clinic is over 80% No side effects between treatments Improvement can occur as quickly as after one infusion Suicidal thoughts may immediately improve

"It’s like you have 50 pounds on your shoulders, and the ketamine takes off 40 pounds off”

Recent data suggest that ketamine, given intravenously, might be the most important breakthrough in antidepressant treatment in decades.

–Thomas Insel, MD, Former Director of National Institute of Mental Health PAGE TWO| WWW.SPRASHADMD.COM

NASAL ESKETAMINE (SPRAVATO) INSURANCE COVERAGE OF ESKETAMINE WILL ALLOW THIS LIFE-SAVING TREATMENT TO BE ACCESSIBLE TO PATIENTS THAT NEED IT Spravato, or nasal esketamine, is chemically similar to ketamine and is offered in a nasal spray version as an in office treatment. It is FDA approved and covered by insurance. We are excited to offer this treatment as an in network provider. It is often an affordable option for those who might not otherwise be able to receive ketamine.

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Initial treatment consists of twice weekly treatments for four weeks and then treatment once weekly in the office Less frequent ongoing treatment is usually required.

Studies report a 50-60% response rate No side effects between treatments Improves suicidal thoughts Works faster than other antidepressants

Setting The setting in which ketamine is administered is extremely important not only to the patient’s comfort but also to achieving the best possible results. Dr. Prashad’s clinic was built specifically with this in mind. Every aspect of the environment has been tailored for the best possible experience. Great attention was given to curate a peaceful, beautiful, warm and professional environment.

We have comfortable seating and each infusion room serves only one patient at a time. The infusion chair reclines back so you can fully relax.

Furthermore, we have headphones, eyeshades, music, and aromatherapy inside of the clinic to target all senses to make the ideal environment for your treatment. .

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KETAMINE ASSISTED PSYCHOTHERAPY

KETAMINE ASSISTED PSYCHOTHERAPY IS AN INTENSIVE PSYCHOTHERAPEUTIC EXPERIENCE THAT CAN RESULT IN RAPID IMPROVEMENT IN DEPRESSION, ANXIETY, SUICIDALITY AND OTHER PSYCHIATRIC CONDITIONS. KETAMINE CAN HELP TO ENHANCE AND DEEPEN THE THERAPEUTIC PROCESS. IT CAN PROVIDE AN OPPORTUNITY FOR THE TEMPORARY SOFTENING OF DEFENSES TO ALLOW FOR DEEPER PROCESSING THROUGH PSYCHOTHERAPY. PATIENTS CAN ALSO EXPERIENCE PROFOUND TRANSPERSONAL EXPERIENCES THAT CAN OFFER IMPORTANT INSIGHTS. THIS IS AN ESPECIALLY HELPFUL APPROACH FOR PATIENTS WITH A HISTORY OF TRAUMA. DURING THIS TREATMENT, A THERAPIST TRAINED IN KETAMINE ASSISTED PSYCHOTHERAPY WILL PREPARE, GUIDE AND INTEGRATE THE EXPERIENCE.

WU . SR PR PP AGGEE F FI VI EV E| W | WJ O NAESYH A D M D . C O M

DEPRESSION ANXIETY OCD ADHD SMOKING CESSATION

TRANSCRANIAL MAGNETIC STIMULATION (TMS) BRAINSWAY DEEP TMS

DEEP TRANSCRANIAL MAGNETIC STIMULATION (DTMS) IS A REVOLUTIONARY APPROACH TO TREATING PSYCHIATRIC CONDITIONS WITHOUT MEDICATION. TREATMENT INVOLVES 20 MINUTE OUTPATIENT SESSIONS OVER A COURSE OF 6-8 WEEKS. WE ARE ABLE TO ADDRESS DEPRESSION, ANXIETY, OCD, ADHD, AND SMOKING CESSATION WITH THE DEEP TMS SYSTEM SAFE – NO LONG-TERM SIDE EFFECTS THE PATIENT REMAINS AWAKE AND ALERT DURING THE TREATMENT NON-SYSTEMIC, MEANING NOTHING CIRCULATES IN THE BLOODSTREAM THROUGHOUT THE BODY FDA CLEARED WHEN DTMS IS USED WITH ANTIDEPRESSANTS, 70% OF DEPRESSED PATIENTS WERE SHOWN TO RESPOND ACTIVITY IN THE LEFT FRONTAL AREA OF THE BRAIN, IN THE DORSOLATERAL PREFRONTAL CORTEX, IS REDUCED IN PATIENTS WITH DEPRESSION. HIGH FREQUENCY TMS AIMED AT THIS AREA IS USED TO RETURN NORMAL ACTIVITY TO THAT PART OF THE BRAIN AND ELIMINATE OR REDUCE THE SYMPTOMS OF DEPRESSION. PAGE SIX | WWW.SPRASHADMD.COM

DEPRESSION ANXIETY SUICIDAL IDEATION ACCELERATED THETA BURST INTENSIVE TMS (1 WEEK)

TRANSCRANIAL MAGNETIC STIMULATION (TMS) MAGSTIM TMS WITH NEURONAVIGATION INTERMITTENT THETA BURST (ITBS)

A NEW APPROACH TO TMS THERAPY, HAVING A HIGHER FREQUENCY AND SHORTENING THE TREATMENT LENGTH FROM THE TRADITIONAL 20-40 MINUTES TO 3 MINUTES.MULTIPLE TREATMENTS CAN BE DONE PER DAY WHICH LEADS TO RAPID IMPROVEMENT.

INTENSIVE TMS - 1 WEEK

AN INNOVATIVE TREATMENT THAT OPTIMIZES STIMULATION BY DELIVERING MULTIPLE THETA BURST TREATMENTS THROUGHOUT THE DAY, SIGNIFICANTLY SHORTENING THE TREATMENT PLAN FROM SEVERAL WEEKS TO ONE WEEK. INTENSIVE TMS FOR DEPRESSION TARGETS THE SAME PART OF THE BRAIN AS OTHER DEPRESSION PROTOCOLS WITH A FIGURE 8 COIL ATTACHED TO A MAGSTIM MACHINE, FOCALIZING THE TREATMENT BY USING THE NEWLY ADDED STIMGUIDE NEURONAVIGATION SYSTEM TO INCREASE ACCURACY. THE INTENSIVE TMS TREATMENT PACKAGE IS BASED OFF A CLINICAL STUDY AT STANFORD UNIVERSITY WHERE ABOUT 90% OF PARTICIPANTS ACHIEVED REMISSION AND ALL HAD A RESOLUTION OF SUICIDAL IDEATION (SI) BY THE END OF THE WEEK. THIS RAPID PROTOCOL REQUIRES THE PARTICIPANT TO RECEIVE 10 THETA BURST (ITBS) TREATMENTS, WITH 1 HOURS BREAKS IN-BETWEEN, FOR 5 DAYS, REACHING REMISSION AFTER ONE WEEK. PAGE SEVEN |WWW.SPRASHADMD.COM

IV KETAMINE + TMS For some patients, the combination of IV ketamine with TMS may be especially useful.

It is a very useful combination for patients who struggle with significant anxiety in addition to their depression. This combination often leads to longer lasting effects from ketamine as well.

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“Ketamine therapy was life changing for me and helped lift the fog of depression that had for so long weighed me down and made arduous even the most basic of tasks. As my depression began to feel more manageable, Dr. Prashad suggested that adding Deep TMS to my treatment plan could reap benefits in helping to tame my anxiety and, perhaps, even make my ketamine infusions more effective. Boy was she right. After the first week of TMS treatment, my anxiety started to noticeably decrease and those hypnotic and seemingly ever-present feelings of sadness/despair began to hold less and less sway over me.

Flashforward three months, and I’m thrilled with the results of combining Deep TMS and Ketamine therapy. The two seem to have a symbiotic relationship that has “supercharged” my treatment, helps me better tackle risks and embrace failure and, quite frankly, feel like the best version of myself in years. Finally, I can’t say enough kind words about Dr. Prashad. How do you sufficiently thank someone who has helped you climb out of a pit of depression and anxiety that at times can seem so dark, so deep and so lonely? Dr. Prashad is the kind of physician that we as patients so often seek, but rarely find. A provider who is patient, enthusiastic, present, compassionate, and committed to helping you find your path to mental health wellbeing.”

Why Choose Us? EXPERTISE MATTERS Dr. Prashad is one of the most experienced ketamine psychiatrists in the country. She has been administering ketamine in her practice since 2016, and has administered over 6,000 treatments with ketamine or esketamine. The focus of her practice is treatment resistant disorders, and this is her area of expertise. She is also the current president of the American Society of Ketamine Physicians, Psychotherapists, and Practitioners where her focus is to promote a standard for ketamine treatment as well as furthering awareness and education. Dr. Prashad is also a clinical assistant professor at Baylor College of Medicine Department of Psychiatry where she assists in education regarding the use of ketamine, esketamine and TMS in clinical practice.

OUR GOAL IS REMISSION With advanced treatment modalities, remission from depression is a possibility, and it is our goal for treatment. In treatment resistant patients, any one intervention may not be enough to achieve remission. We address treatment from numerous angles to maximize results and give patients the best chance to respond.

SET AND SETTING The setting in which ketamine is administered is extremely important not only to the patient’s comfort but also to achieving the best possible results. Dr. Prashad’s clinic was built specifically with this in mind. Every aspect of the environment has been tailored for the best possible experience.

TREATMENT RESISTANT CONDITIONS ARE COMPLEX ,Unfortunately, not all patients will achieve remission with an interventional treatment alone. Optimizing the current medication regimen is an important part of treatment in order to complement the interventional treatments that we offer. Dr. Prashad is a board certified Psychiatrist that understands how psychiatric medications may interfere or augment TMS and ketamine therapy.

She will also address multiple aspects of care including making referrals when needed.

TREATMENT IS PERSONALIZED In order to achieve the best results, treatment must be tailored to each patient. Dr. Prashad personally puts together a treatment plan for each patient. She will also meticulously customize the dosing for each individual infusion. This is imperative to maximize the response to ketamine. The response rate to IV ketamine in our practice is over 80%, well over that of many other practices.

OPTIONS OTHER THAN KETAMINE There is a subset of patients that may not respond to ketamine, esketamine or TMS alone. We have had success with helping these patients improve by optimizing and combining treatment with other modalities. Many patients worry that ketamine or TMS may be a last resort, but there are often additional options. Dr. Prashad understands all the options available to patients with treatment resistance and can continue to provide guidance even when a patient has not received a complete response. Our clinic has had success with patients that achieved a partial response to TMS, ketamine or esketamine previously.

ADVANCED TMS OPTIONS AND PROTOCOLS Many practices offer one standard protocol for TMS, which may not be the right option for each patient. Dr. Prashad utilizes many different evidence-based protocols in order to optimize response to treatment. We offer several different treatments utilizing two different TMS machines and multiple treatment helmets.

ABILITY TO COMBINE KETAMINE AND TMS Some of the most impressive results are achieved by combining ketamine with TMS treatment concurrently. Most practices do not have the ability to coordinate this care. This method has even been helpful to patients who have previously failed treatment with TMS, ketamine or esketamine alone.

THERAPISTS TRAINED IN WORKING WITH KETAMINE Some patients, especially those with trauma, benefit tremendously from support and processing with a trained therapist during treatment. The therapists in our clinic are trained to work with ketamine and psychedelics, and understand how to best help patients throughout their treatment.

INSURANCE We are in network with several commercial insurance plans, and many of our treatments are covered. We can discuss covered services in detail at the time of consult

Dr. Sandhya Prashad is a board certified psychiatrist specializing in interventional modalities for treatment resistant disorders with a particular expertise in ketamine therapy. She completed both medical school and psychiatry residency at Baylor College of Medicine. She has been in private practice in the Houston area since 2011 and has been utilizing intravenous ketamine since 2016. She has personally administered over 6,000 treatments with ketamine or esketamine. She is the founder and medical director of Sandhya J. Prashad, MD, Houston Ketamine Therapeutics, and Houston TMS Therapeutics. Dr. Prashad is involved on an international level with furthering awareness and education regarding the safe and effective use of ketamine. She is a founder, the former secretary and the current president of the American Society of Ketamine Physicians, Psychotherapists and Practitioners (www.askp.org,) a non-profit dedicated to education and awareness of the safe and effective clinical use of ketamine.

Under her leadership as president, the organization published standards of practice and ethics for the therapeutic use of subanesthetic ketamine. Dr. Prashad presents frequently on a national level both to the public and to other physicians regarding the use of ketamine for psychiatric disorders. She also serves on several advisory panels for ketamine related research. Dr. Prashad has been appointed as a clinical assistant professor at Baylor College of Medicine in the Menninger Department of Psychiatry and Behavioral Sciences where she assists in education of residents and medical students regarding the use of ketamine, esketamine and TMS in clinical practice. She continues to work to expand her practice to include evidence based interventional treatments as they become available, and has a particular interest in expanding access to these treatments.

SANDHYA PRASHAD, MD 6565 W. Loop South #500 & 530 Bellaire, Tx 77401 832.436.4055 www.sprashadmd.com