Julian Macias, PMHNP-BC

My Story

I became a psychiatric nurse practitioner because I believed that mental health care in this country could do better — and I wanted to be part of making it better.

I came to interventional psychiatry specifically because of the patients nobody was helping. The person who had tried six antidepressants. The veteran who couldn’t get through a single session of trauma therapy without shutting down. The mother of three who had been depressed for so long she had forgotten what it felt like not to be. These are the people who brought me to ketamine and TMS, and they are the people I wake up thinking about.

I grew up in Los Angeles. This city is a part of who I am — its complexity, its diversity, the full range of human experience it holds. I came back here to practice because this is where I want to serve. This is my community.

My path into interventional psychiatry wasn’t the conventional route. I trained as a registered nurse first, and then pursued my graduate education in psychiatric mental health nursing, earning my board certification through the American Nurses Credentialing Center (ANCC). Along the way, I became increasingly drawn to the treatments that were changing outcomes for people who had fallen through the cracks of conventional psychiatry — and I committed to learning them as deeply as I could.

Training Under Dr. Steven Mandel at KCLA

The most formative chapter of my clinical development was my time at Ketamine Clinics Los Angeles, where I trained under Dr. Steven Mandel.

KCLA is not a typical ketamine practice. It is the highest-volume, most established ketamine clinic in Los Angeles — over 35,000 treatments administered, with an 83% reported success rate. Patients come from across the country. The clinical staff sees presentations that most providers encounter only rarely, if ever. And the clinical culture Dr. Mandel built there is defined by precision, patient safety, and a genuine belief in the potential of this treatment.

Training at KCLA meant learning to supervise up to ten infusions in a single day. It meant developing the clinical reflexes that come only from volume and repetition — knowing how to read a patient’s response during an infusion, how to adjust in real time, how to support someone through a difficult experience without panic and without dismissal. It meant learning from a physician who has thought longer and harder about ketamine therapy than almost anyone in the field.

I am not the only PMHNP offering ketamine in Los Angeles. I am one of very few who trained in that environment, at that volume, under that mentorship. That distinction is not something I take lightly, and it is something I bring into every infusion I administer.

My Philosophy: The Whole Person, Not Just the Diagnosis

I practice within a framework I think of as five-dimension transformation: biological, psychological, behavioral, relational, and existential.

Most psychiatric treatment addresses the biological dimension — medication, brain stimulation — and stops there. I believe that is necessary but insufficient, particularly for the patients I see. People with treatment-resistant depression, PTSD, and complex mood disorders are not suffering only at the cellular or synaptic level. They are suffering in their sense of self, in their relationships, in the way they move through the world and make meaning of it.

Ketamine creates a neuroplasticity window — a period of unusual openness in which the brain can build new connections. That window is biological. But what you build through it is human. It is shaped by what you practice, what you reflect on, what you choose to do differently. The 12-Week Integration Program I developed is my attempt to honor that reality — to create a structure in which the biological opportunity that ketamine provides can become genuine, lasting transformation.

TMS works more slowly but sustains what ketamine opens. Medication management, when indicated, supports the underlying biology. And throughout all of it, my relationship with each patient is the constant: attentive, honest, and directed toward their long-term flourishing rather than the management of acute symptoms.

Commitment to Los Angeles

I am committed to serving the full diversity of Los Angeles — a city with no shortage of people who have struggled to access quality mental health care. I am actively developing my clinical capacity in Spanish to better serve Spanish-speaking patients and their families, and I welcome patients from all backgrounds, communities, and circumstances.

Mental health care at this level — interventional, integrative, precision-oriented — has historically been available mainly to people with significant financial resources. I am aware of that. I aim to practice transparently, communicate honestly about cost and access, and find ways to work with patients for whom these barriers are real.

Who I See — and What I Offer

I see adults who are done waiting for something to get better on its own. I see people who have done the work — therapy, medication, self-improvement — and who still aren’t well. I see people who have been told they are treatment-resistant and who are ready to find out if that is actually true when better tools are brought to bear.

What I offer is not a cure or a promise. What I offer is a clinical partner who brings his full attention, his full training, and genuine care to your situation. I will tell you what I think. I will tell you what the evidence shows. I will tell you when I don’t know something. And I will not stop looking for what might help you.

If that sounds like the kind of care you’ve been looking for, I’d like to talk.

— Julian Macias, PMHNP-BC
Los Angeles, CA