22 Feb 2021


Now Accepting Patients By Referral

Dr. Anthony Frasca (MD, MSPH, certified by the American Board of Psychiatry and Neurology) would like to announce the opening of Zen Psychiatric Services, PLLC.

Located at 126 Fiddler’s Run Blvd, in the shopping center off I-40 Exit 104, Zen Psychiatric Services will be offering treatment of refractory affective, anxiety and some substance use disorders with ketamine and esketamine (Spravato). Zen Psychiatric IS NOT accepting patients for ongoing general psychiatric care. (Sorry. We know the need is great, but one physician can’t solve that problem and Dr. Frasca’s other professional commitments make it impossible for him to start and maintain such a practice in a manner consistent with his own standards of care.)

Evaluations are by referral and appointment only. No walk-ins. At this time only Dr. Frasca will be performing intake evaluations. The phone number for referrals is 828-608-0892. Fax number is 828-608-0373. Nearly all insurances, including Medicaid, are accepted.

The evaluation and treatment process is roughly as follows:

The initial psychiatric evaluations are one hour in length and will focus on symptoms and treatment history. We welcome referrals solely for evaluation and are happy to serve as a psychiatric consultation resource for our colleagues in the community. Initial evaluations are billed at $150.

If a client is not considered appropriate for ketamine or esketamine treatment, Zen Psychiatric will discuss other treatment recommendations with the client and will provide a copy of the completed intake evaluation to them and the referring provider within five (5) business days. As noted earlier, Zen Psychiatric WILL NOT accept patients for ongoing general psychiatric care. Referral to Zen Psychiatric does not constitute referral for ongoing general psychiatric care.

If a client is considered appropriate for treatment, and insured, Zen Psychiatric will seek prior authorization to use esketamine (Spravato) nasal spray. Out of pocket cost to the client won’t be known until the prior authorization is completed, at which time the client will be informed and can choose to initiate or decline treatment. The recommended course of treatment is twice weekly for four weeks, followed by once weekly for four more weeks, then either stopping or continuing as clinically indicated. (At time of this writing Zen Psychiatric has one patient on indefinite weekly maintenance treatment. All other clients have graduated off treatment after demonstrating at least moderate improvement.)

If a client is not insured, or wishes to self-pay for purposes of privacy, they can elect to receive either intramuscular ketamine injections or locally compounded nasal spray ketamine. The treatment schedule and protocol are the same – twice weekly for a month, followed by weekly for a month, followed by discontinuation or further maintenance depending on clinical status. Cost for those treatments is $150 for each session; medication is included in that cost.

All Zen Psychiatric Services clients treated with ketamine or esketamine, regardless of means of administration, are required to have a driver to and from treatment. Clients must take no oral food for at least two hours prior to treatment. They remain under close observation of Zen Psychiatric staff for approximately 120 minutes, during which time they have their vital signs checked at least three times: before, once during, and then after treatment. The most common reported (but infrequent) side-effects during treatment are nausea, transient increases in blood pressure, and dissociation. Supportive medications to manage those side-effects are available on site and will be administered as needed by trained staff, without any extra cost to the client. (The need for observation and possible management of side-effects is the primary driver behind the cost of treatment with ketamine, and a very significant factor in the cost of treatment with esketamine. Neither ketamine or esketamine are available for unsupervised self-administration. To maximize benefit, treatments are best administered on a Monday/Thursday or Tuesday/Friday schedule. Wednesday/Saturday schedules may become available to accommodate demand.)

The treatments are administered in recliners stationed in visually private treatment bays. The treatment bays are all equipped with a small nightstand, on which there are cell phone charging cords, white noise machines, and a lamp. Blankets are available on request. There is WiFi guest access. Towards the end of the session clients receive a small snack and something to drink. No last names or identifying information are ever spoken out loud in the clinic. (There is an opportunity for fully private sessions, potentially in the presence of the client’s therapist, in one of two offices on premises. Such inquiries are welcome!)

FULL DISCLOSURE: At this point in time only esketamine (Spravato) has FDA indication for mental health use, and only for refractory depression. Although there is a large and growing body of literature supporting the use of ketamine for mood, anxiety and substance use disorders – and the evidence supporting the safety and efficacy of ketamine was what prompted the Jansen company to produce esketamine in the first place – there have been no definitive clinical trials using original ketamine. Therefore the use of ketamine for those purposes is off-label at this time. Clients are certainly free to seek insurance reimbursement for off-label ketamine use, and Zen Psychiatric Services will gladly provide information to support such efforts, but the burden of such efforts and the costs of off-label ketamine treatment fall completely on the client.

IN THE FUTURE, Zen Psychiatric plans to offer Transcranial Magnetic Stimulation. When medications such as mescaline, psilocybin and MDMA are legalized, Zen Psychiatic Services will seek to offer those treatments as well.


Please feel free to call or fax with inquiries or referrals.


828-608-0892 – Main


828-608-0373 – Fax