Brain-based care, alongside therapy

FHE Health's NeuroRehab services include qEEG brain mapping, neurofeedback and neurostimulation. FHE Health also offers TMS and ketamine infusions for depression.

These services are added to a treatment plan when clinically appropriate. They do not replace psychiatric care or therapy.

Licensed clinicians decide whether a service fits you. FHE Health's care teams include medical doctors, board-certified psychiatrists, nurse practitioners, licensed therapists and neuro-rehabilitation specialists. Everyone has a psychiatric evaluation before TMS, and ketamine treatment includes a full psychiatric evaluation.

No one can promise how you will respond to any of these services. Some uses are FDA cleared or approved, such as TMS for depression. Others are off-label or still being studied. The sections below explain each one.

A qEEG starts with an EEG. Sensors placed on your scalp record the brain's electrical activity. A computer then analyzes the recording and shows how much activity occurs at different frequencies. The results can be shown as maps of the head, which is why it is often called brain mapping.

At FHE Health, NeuroRehab care starts with a qEEG, and the team uses it to plan neurofeedback and neurostimulation.

A qEEG is not a diagnosis. It does not tell anyone whether you have an addiction, PTSD or depression. Diagnoses come from an evaluation by licensed clinicians. A 2019 review of studies in depression also found qEEG was not reliable for predicting whether a treatment would work.

Neurofeedback is a type of biofeedback. During a session, sensors read your brain activity while you watch a screen or listen to sounds. The image or sound changes as your brain activity changes, which helps you learn to shift that activity over time.

It is used alongside therapy, not instead of it. Research reviews describe neurofeedback as a promising add-on to substance use treatment, but the studies are small and use many different methods, so the evidence is still developing. For PTSD, the VA/DoD guideline found there is not enough evidence to recommend for or against it.

For more detail, read Brain mapping and neurofeedback: what the evidence says.

Neurostimulation is a broad term for treatments that use electrical or magnetic energy to stimulate the brain or nerves. Some forms send a small current through pads placed on the scalp or skin. Others use magnetic fields, like TMS.

The evidence and FDA status depend on the method and what it is used for. Some devices are FDA cleared or approved for specific conditions. Many other noninvasive methods are still being studied. For PTSD, the VA/DoD guideline found not enough evidence to recommend for or against transcranial direct current stimulation (tDCS), and it suggests against vagus nerve stimulation.

If neurostimulation is suggested for you, ask which method it is, what it is cleared for, and what the research shows for your condition.

TMS uses an electromagnetic coil held against your head. The coil sends short magnetic pulses that stimulate a targeted brain area. No anesthesia is needed.

FHE Health offers TMS with the BrainsWay Deep TMS system for adults with major depressive disorder whose symptoms have not improved enough with standard treatment. Everyone has a psychiatric evaluation first. Sessions last about 30 minutes, five days a week, for several weeks.

Under FDA rules, TMS devices are used to treat major depression in people who have not improved with at least one antidepressant. The FDA first allowed TMS for depression in 2008. It has also cleared the BrainsWay system for OCD (2018), as an aid to quit smoking (2020), and for anxiety symptoms in adults with depression (2021). FHE Health's program information describes TMS for depression.

TMS is not for everyone. The FDA says this device should not be used by people with metal objects or implanted stimulator devices in or near the head, and people with a history of seizures should talk with their provider first. Side effects can include headache and discomfort where the coil sits.

Ketamine is a medicine the FDA has approved for anesthesia. FHE Health offers IV ketamine infusions for depression as part of a treatment plan that includes a full psychiatric evaluation.

Using ketamine for depression is off-label. Ketamine is not FDA approved to treat any psychiatric disorder, and FHE Health describes ketamine treatment as experimental. A related medicine, esketamine nasal spray (Spravato), is FDA approved for adults with treatment-resistant depression. It is given only in certified health care settings, with monitoring for at least 2 hours after each dose.

The FDA lists known safety concerns with ketamine. They include sedation, dissociation (feeling disconnected from your thoughts, feelings or surroundings), psychiatric events or worsening psychiatric symptoms, higher blood pressure, slowed breathing, misuse, and bladder symptoms. The FDA also says it has not established a safe or effective dose of ketamine for any psychiatric use.

The VA/DoD guideline suggests against ketamine for PTSD.

Coverage varies by plan and by service. Some brain-based services may be covered by insurance, and others are self-pay. FHE Health describes ketamine as not covered by insurance. Admissions reviews this with you based on your coverage and clinical need.

TRICARE covers services that are medically necessary and proven, and it does not cover unproven treatments. Ask admissions to check before any service starts. See insurance and TRICARE.

FHE Health does not accept Medicaid or Medicare. If you have Medicaid, Medicare or no insurance, SAMHSA's National Helpline at 1-800-662-4357 is confidential and open 24/7. It can point you to your state's office for state-funded treatment, and often to programs that accept Medicaid or Medicare. You can also search FindTreatment.gov.