Frequently Asked Questions About Stella
See answers to the most frequently asked questions about Stella and its innovative treatments, including ketamine and SGB treatments.
What's included with Treatment by Stella?
Treatment by Stella is a commitment to your recovery, from first contact to the moment you feel like yourself again. The Stella Standard of Care was created to meet your needs before, during, and after treatment. This is the new model of trauma treatment.
Getting To Know You:
The first step is to speak with a licensed Advanced Practice Provider (APP). The APP will conduct a bio-psycho-social assessment which includes a review of your symptoms and health history. Using this information, the APP will create a custom treatment recommendation for you.
Our APPs use validated measures to gauge your symptoms. These measures include the Post-traumatic Stress Disorder Checklist (PCL-5) for symptoms of PTSD/ emotional trauma, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, the Patient Health Questionnaire-9 (PHQ-9) for depression, and the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) for Traumatic Brain Injury.
Throughout the journey, you will work with a dedicated Care Coordinator who will coordinate your care and help answer any questions along the way.
If receiving the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment, the entire procedure takes less than 20 minutes, but please plan on being at the facility for one to two hours. The positive effects of SGB are often immediate.
If receiving ketamine, each infusion session typically takes 45 minutes. Please plan on being at the facility for one to two hours. Most have relief from symptoms within hours of treatment.
Those on Care Plans will work with Stella's APPs over 6 months and receive an individualized treatment plan that combines biological and psychological interventions to provide the best outcomes possible.
Following treatment, your APP will call to review the effectiveness of the procedure(s) you had and ask about any symptoms that you may be experiencing. Each patient will also have a 30-minute follow-up to continue that review and discuss how to maximize the positive effects of treatment. APPs are there to physically, mentally, and emotionally support a patient, as uniquely required, during this session.
Those on Care Plans will have additional follow-up sessions with Stella's APPs, which include completing standard mental health assessments, determining whether additional treatment is warranted, and discussing trauma-informed, healing-related topics such as getting better sleep, approaching grief, or mindfulness techniques.
How do I determine which treatment is right for me?
A licensed Advanced Practice Provider (APP) will review your symptoms and health history to determine if you are a good candidate for the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment, and/or ketamine infusion therapy.
We will discuss any health conditions that you have to ensure that they do not interfere with the treatment's ability to relieve your symptoms. Call 908-928-4086 to schedule your initial consultation with an APP.
Do I need to have a mental health provider to receive Treatment by Stella?
At Stella, we have seen that patients who receive comprehensive care that includes biological treatments and insight-oriented talk therapy receive optimal benefits. For this reason, we strongly recommend a treatment plan that combines both biological and psychological care.
For patients receiving Treatment by Stella, whether ketamine or the dual sympathetic reset, Stella's stellate ganglion block (SGB) treatment, co-occurring mental health support is highly encouraged.
Stella integration sessions are included in all of our Gold Standard Care Plans, and this series can be purchased as part of any Stella treatment plan. We also partner with the therapy provider All Points North (APN), who offers a series of individual therapy sessions tailored to DSR.
How soon can I receive treatment?
The first step is to speak with a licensed Advanced Practice Provider (APP). The APP will conduct an assessment which includes a review of your symptoms and health history. Using this information, the APP will create a custom treatment recommendation for you.
On average, our patients schedule their treatment within a few weeks of their PMHNP appointment, depending on their location and treatment.
How do I schedule a procedure?
Stella offers concierge-level access to care and will help guide you through your care experience. After meeting with one of Stella's Advanced Practice Providers (APP), our care team will work directly with you to schedule your treatments at one of our +30 locations around the US.
We will be with you every step of the way and can help answer any questions about the day of treatment, what to expect, financing options, and more.
Is Treatment by Stella covered by insurance?
Stella's Advanced Practice Provider assessments, follow-up appointments, and psychoeducational sessions may be eligible for insurance reimbursement. Stella provides patients in certain states with a Superbill for each visit to submit for reimbursement. Superbills are available for residents of CA, CO, FL, IL, IN, NC, NJ, NY, VA, and WA. Please note that the actual amount reimbursed may vary depending on your health insurance coverage and deductible.
Biological interventions for mental health care – including the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment, and ketamine infusion therapy – are not currently covered by insurance. At this time, insurance companies only cover the SGB when it's used for pain management and, unfortunately, insurance does not cover ketamine infusions.
All of our patients are considered self-pay. To help make treatment affordable, Stella accepts Health Savings Account (HSA) and Flexible Spending Accounts (FSA) as payment options. We also provide financing plans through Rectangle Health with flexible and affordable custom payment plans that fit any budget.
Is financing available?
Yes. We offer flexible and affordable financing through Rectangle so you can get access to the treatment you need with a custom payment plan that fits any budget. Our Care Team can assist you with the application if needed.
We also accept Health Savings Accounts and Flexible Spending Accounts. Stella's PMHNP assessments, follow-up appointments, and integration sessions may be eligible for insurance reimbursement. Superbills are available for residents of CA, CO, FL, IL, IN, NC, NJ, NY, VA, and WA. Please note that the actual amount reimbursed may vary depending on your health insurance coverage and deductible.
Is Treatment by Stella FDA-approved?
Is the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment, FDA-approved?
SGB has long been approved by the FDA as a pain management treatment. When used for trauma symptoms, licensed professionals can legally perform SGB as an off-label procedure for symptom relief based on the body of supporting medical evidence for this application in peer-reviewed literature.
Stella's SGB treatment uses the dual sympathetic reset (DSR) protocol developed by Dr. Eugene Lipov, Stella's Chief Medical Officer. The DSR is two injections of local anesthetic on the same side of the neck. The local anesthetics Stella Providers use are Bupivacaine or Ropivacaine, both of which are FDA-approved.
Is Ketamine Infusion Therapy FDA-approved?
Ketamine has long been FDA-approved as an anesthetic medication. The nasal spray form of ketamine, Esketamine, is FDA-approved for treating suicidal ideation. Just as SGB is used in an off-label way for other symptoms and concerns, ketamine is also legally used by licensed healthcare providers to address symptoms of depression and anxiety.
Off-label use of medications long known to have strong safety profiles is common within the practice of medicine. Across the field of practice, an estimated 30% of all medications are prescribed off-label, including many cancer drugs, and are frequently used by physicians even though they are not FDA-approved for that particular purpose.
A classic example is that aspirin is often prescribed to reduce cardiac risk factors, an application for which it is not "FDA approved" to address. In the same way, Stella's innovative treatments are used to address a range of symptoms that have shown promise within the body of peer-reviewed medical literature.
Wittich CM, Burkle CM, Lanier WL. Ten common questions (and their answers) about off-label drug use. Mayo Clin Proc. 2012 Oct;87(10):982-90. doi: 10.1016/j.mayocp.2012.04.017. Epub 2012 Aug 6. PMID: 22877654; PMCID: PMC3538391.
What is Stella's Gold Standard Care Plan?
Leveraging a multi-care approach provides our patients with an optimal pathway to a seamless, comprehensive, integrated treatment plan using a variety of innovative treatments in combination with each other.
This comprehensive approach to care combines highly effective biological treatments with psychological support to lead to long-lasting results.
For example, the dual sympathetic reset, Stella's stellate ganglion block (SGB) treatment, can work well in combination with Stella's integration sessions or therapy from an outside provider. After DSR, many Stella patients feel a new sense of calm that can accelerate the positive impact of existing therapies (e.g., talk therapy, EMDR, CBT, DBT, etc.). Patients may find that they can recall their past and discuss it with their mental health provider without feeling as though they're reliving it.
The Gold Standard Care Plans offers a full range of treatments over a 6-month period with the flexibility to adapt the treatment as needed. Possible treatment options are determined collaboratively by the APP team and the patient.
Find out more on our Care Approach page.
What is the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment?
The body's fight-or-flight response turns on when we experience trauma. And sometimes it stays on long after the traumatic event, which can cause debilitating symptoms. This over-activation of the fight-or-flight response causes nerve growth in the amygdala (also known as the brain's "fear center"). This nerve growth can prevent the fight-or-flight response from returning to a normal level.
The dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment is two injections of local anesthetic into the stellate ganglion – a bundle of nerves in the neck – that helps restore normal biological function and can efficiently relieve even the most severe trauma symptoms.
After researching and testing many ways of administering SGB, Dr. Eugene Lipov, Stella's Chief Medical Officer, found that this protocol yields the best results.
Each Stella doctor is board certified and uses Dr. Lipov proprietary DSR methodology. We also require that our doctors use image guidance for correct needle placement.
The local anesthetics we use are Bupivacaine or Ropivacaine, both of which are FDA-approved anesthetic medications.
The local anesthetic temporarily "turns off" the stellate ganglion, which has been sending signals via nerve pathways to the amygdala, causing nerve growth. DSR can stop the nerve growth that is occurring as well as eliminate or prune the extra nerve fibers that have been created, thereby "resetting" the amygdala to its pre-trauma state. The entire procedure takes less than 20 minutes.
On the day of your procedure, you may spend a few hours at the location to allow time for check-in, twilight sedation (if desired), treatment, and follow-up observation.
Over 81% of Stella patients experience lasting relief from their trauma symptoms after one dual injection.
The duration of the DSR's positive effects varies from patient to patient, lasting months or years.
While the longevity of DSR's effectiveness is still being researched. In a 2014 study, 70% of participants were clinical successes at a follow-up administered between 3 and 6 months after treatment.
Is DSR proven to work?
Stella's approach of responsible innovation means transparency in sharing our outcomes. While no medical procedure is guaranteed to work for everyone, the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment, has helped thousands of patients find lasting relief from their trauma-related symptoms.
While studies show that 70% - 75% of SGB treatment participants experienced high rates of rapid clinical improvement in PTSD symptoms, Stella's advanced DSR protocol results in 81% of clients finding relief from their PTSD symptoms
In a study of 327 Stella patients who received DSR between December 2016 and February 2020, on average, over 83% reported a 28.9-point decrease in their PCL score. The PTSD Checklist (PCL) is a self-report survey used to measure PTSD symptoms. According to the National Center for PTSD Guidance, a 10-point decrease in PCL score is a clinically significant improvement.
The neck has up to 3 ganglia in the sympathetic chain. The superior cervical ganglion, the middle cervical ganglion, and the inferior cervical ganglion. Although 20% of people do not have ganglia in their neck, they still have nerves that can be affected by an injection of local anesthetic.
- 100% of people have C3 ganglia
- 56% of people have C6 ganglia
- 87% of people have C7 ganglia
- Injecting C6 hits the C7
- Injecting C4 hits the C3
What is Stella's ketamine therapy treatment?
Ketamine is a safe, effective anesthetic that has been in use worldwide since 1970 and listed on the World Health Organization's Essential Medicines list since 1985. Unlike standard antidepressants like SSRIs and SNRIs, which generally take 4 to 8 weeks to work (if they work at all), ketamine is fast-acting and can sometimes show immediate efficacy after a single intravenous dose.
Because of its fast-acting nature, ketamine can be an extremely valuable tool in preventing suicide and immediately alleviating the suffering caused by major depressive disorder (MDD). More recently, it has been used to treat PTSD symptoms and neuropathic pain.
Stella's ketamine infusion therapy involves ketamine being administered intravenously very slowly over 45 minutes by trained personnel under the direction of a board-certified doctor.
You will be monitored throughout the infusion, and we are prepared to increase or decrease dosage in real time and treat any unpleasant side effects during the procedure.
Generally, within 15 minutes of completing the infusion, you will start to regain your senses, and your thinking will return to normal. Results are fast and effective – most people have relief from symptoms in hours of treatment. You can expect to be at the facility for about 1-2 hours from start to finish.
Are ketamine infusions addictive?
No, there is no evidence that ketamine infusions at low doses and frequencies used to treat mood disorders lead to dependence or addiction. (In fact, research suggests that ketamine can be an effective treatment for overcoming addiction. If you have a history of substance abuse, it does not exclude you from receiving ketamine infusions but it is important to disclose this information during your assessment.
Are there any side effects from the treatments offered?
A Stella Advanced Practice Provider (APP) will perform a check-in call the day after treatment to discuss any concerns or side effects and escalate as needed. They will ask questions that analyze the effects of the treatment and ensure your safety after treatment.
Continued follow-ups aimed at integration and growth will then occur monthly to continue watching the effects of the treatment and help you learn how to sustain the positive effects.
The dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment
Serious side effects of DSR are extremely rare (1 in 10,000) because we hire seasoned, board-certified MDs, train them in our field-leading protocol and require that image guidance techniques are used for correct needle placement.
Directly after DSR, you may temporarily experience various symptoms such as a droopy, bloodshot eye, warmth in your face and arm, and congestion. Nearly half of Stella's patients experience hoarseness or trouble swallowing that resolves within 24 hours of the procedure.
Ketamine infusion therapy
The side effects directly after a ketamine session are minimal and usually only last an hour or two. Side effects may include mild drowsiness, nausea, and increased blood pressure.
We monitor your vital signs throughout the infusion session and will routinely administer medication to prevent nausea. Less common side effects include vivid dreams or agitation, which can be controlled by adjusting the dosage.
Many patients do not mind the relaxed and free feeling they experience during the infusion, and this feeling has been postulated to be beneficial.
Symptoms & Conditions
Can Stella treat depression and anxiety?
Yes, Stella has treated many patients who experience anxiety and depression along with traumatic brain injury, stress, and PTSD.
For example, the dual sympathetic reset (DSR), Stella's stellate ganglion block (SGB) treatment, can help reduce nervousness, hypervigilance, trouble sleeping, and trouble concentrating.
SGB is not recognized as a treatment for psychotic disorders (e.g., schizophrenia), personality disorders (e.g., borderline personality disorder), or bipolar disorder.
Because of ketamine's fast-acting nature, it can be an extremely valuable tool in immediately alleviating the suffering caused by major depressive disorder (MDD) and preventing suicide. More recently, it has been used to treat PTSD symptoms and neuropathic pain.
Can Stella treat Complex PTSD (C-PTSD)?
DSR, Stella's SGB procedure has shown efficacy for a wide range of traumas. Many of our patients have experienced multiple traumas over their life, including early childhood trauma. In fact, it is more rare to treat a patient with a single traumatic exposure, as opposed to an individual who has suffered from two or more different forms of trauma.
Because Stella treats a large number of veterans and first responders, a significant number of our patients have had high levels of cumulative, multi-layered trauma. Our research on the biggest sample to date of patients treated with SGB for trauma shows that regardless of the source of trauma, Stella's DSR procedure shows good outcomes for most patients regardless of the type of trauma and when it occurred.
In other words, we have seen great outcomes both with patients whose trauma was sustained during their early childhood and patients with more recent forms of trauma. While individual outcomes vary, there is reason to hope that Treatment by Stella can bring relief to suffering.