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Dr. Kristen Gialo

Medical Director

Dr. Gialo joined Greenbrook in 2023 offering TMS and Spravato treatments. She completed medical school at Philadelphia College of Osteopathic Medicine and pursued Psychiatry residency at the University of Maryland Medical Center and Sheppard Pratt Hospital, where she also served as Executive Chief Resident. She specializes in treating patients with psychotic disorders, bipolar disorders, depressive disorders, and anxiety disorders. She was previously a faculty member at the University of Maryland Medical Center, and continues to teach residents and medical students as well as can be heard on a variety of podcasts providing educational topics of the impact of lifestyle on cognitive health. In addition to providing services at Greenbrook, she has a private practice that serves patients in Maryland, North Carolina and South Carolina.

Her approach to healthcare emphasizes the vital connection between mental and physical well-being. As a Certified Lifestyle Medicine Physician, she addresses lifestyle factors like nutrition, exercise, stress, social connections, sleep, and substance use in treating chronic medical conditions. Additionally, she has specialized training in Perinatal Mental Health through Postpartum Support International and Massachusetts General Hospital.

When she is not in the office, she enjoys yoga, kayaking, biking, baking, gardening, crocheting, singing and playing the flute.

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(855) 940-4867 or info@greenbrooktms.com.

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NeuroStar® TMS Therapy

NeuroStar Adult Indications for Use

The NeuroStar Advanced Therapy System is indicated for the treatment of depressive episodes and for decreasing anxiety symptoms for those who may exhibit comorbid anxiety symptoms in adult patients suffering from Major Depressive Disorder (MDD) and who failed to achieve satisfactory improvement from previous antidepressant medication treatment in the current episode.

The NeuroStar Advanced Therapy System is intended to be used as an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder (OCD).

NeuroStar Adolescent Indications for Use

NeuroStar Advanced Therapy is indicated as an adjunct for the treatment of Major Depressive Disorder (MDD) in adolescent patients (15-21).

Important Safety Information

NeuroStar Advanced Therapy is only available by prescription. A doctor can help decide if NeuroStar Advanced Therapy is right for you. Patients’ results may vary.

The most common side effect is pain or discomfort at or near the treatment site. These events are transient; they occur during the TMS treatment course and do not occur for most patients after the first week of treatment. There is a rare risk of seizure associated with the use of TMS therapy (<0.1% per patient).

Visit neurostar.com for full safety and prescribing information.

SPRAVATO® (Esketamine) Nasal Spray

Important Safety Information

What is the most important information I should know about SPRAVATO®?

SPRAVATO® can cause serious side effects, including:

Sedation, dissociation, and respiratory depression. SPRAVATO® may cause sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation), and breathing problems (respiratory depression and respiratory arrest).
Tell your healthcare provider right away if you feel like you cannot stay awake or if you feel like you are going to pass out.
Your healthcare provider must monitor you for serious side effects for at least 2 hours after taking SPRAVATO®. Your healthcare provider will decide when you are ready to leave the healthcare setting.
Abuse and misuse. There is a risk for abuse and misuse with SPRAVATO®, which may lead to physical and psychological dependence. Your healthcare provider should check you for signs of abuse, misuse, and dependence before and during treatment.
Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
Your healthcare provider can tell you more about the differences between physical and psychological dependence in drug addiction.
SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, respiratory depression, and abuse and misuse, SPRAVATO® is only available through a restricted program called the SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS) Program. SPRAVATO® can only be administered at healthcare settings certified in the SPRAVATO® REMS Program. Patients treated in outpatient healthcare settings (such as medical offices and clinics) must be enrolled in the program.
Increased risk of suicidal thoughts and actions. Antidepressant medicines may increase suicidal thoughts and actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed. SPRAVATO® is not for use in children.
Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a higher risk of having suicidal thoughts or actions. These include people who have (or have a family history of) depression or a history of suicidal thoughts or actions.
How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?
Pay close attention to any changes, especially sudden changes, in mood, behavior, thoughts, or feelings, or if you develop suicidal thoughts or actions.
Tell your healthcare provider right away if you have any new or sudden changes in mood, behavior, thoughts, or feelings, or if you develop suicidal thoughts or actions.
Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you have concerns about symptoms.
Tell your healthcare provider or get emergency help right away if you or your family member have any of the following symptoms, especially if they are new, worse, or worry you:
thoughts about suicide or dying
new or worse depression
feeling very agitated or restless
trouble sleeping (insomnia)
acting aggressive, being angry or violent
an extreme increase in activity and talking (mania)
suicide attempts
new or worse anxiety
panic attacks
new or worse irritability
acting on dangerous impulses
other unusual changes in behavior or mood

Do not take SPRAVATO® if you:

have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal aorta, arms and legs)
have an abnormal connection between your veins and arteries (arteriovenous malformation)
have a history of bleeding in the brain
are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO®.

If you are not sure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO®.

Before you take SPRAVATO®, tell your healthcare provider about all of your medical conditions, including if you:

have heart or brain problems, including:
high blood pressure (hypertension)
slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness, or fainting
history of heart attack
history of stroke
heart valve disease or heart failure
history of brain injury or any condition where there is increased pressure in the brain
have liver problems
have ever had a condition called “psychosis” (see, feel, or hear things that are not there, or believe in things that are not true).
are pregnant or plan to become pregnant. SPRAVATO® may harm your unborn baby. You should not take SPRAVATO® if you are pregnant.
Tell your healthcare provider right away if you become pregnant during treatment with SPRAVATO®.
If you are able to become pregnant, talk to your healthcare provider about methods to prevent pregnancy during treatment with SPRAVATO®.
There is a pregnancy registry for women who are exposed to SPRAVATO® during pregnancy. The purpose of the registry is to collect information about the health of women exposed to SPRAVATO® and their baby. If you become pregnant during treatment with SPRAVATO®, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/.
are breastfeeding or plan to breastfeed. SPRAVATO® passes into your breast milk. You should not breastfeed during treatment with SPRAVATO®.

Tell your healthcare provider about all the medicines that you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Taking SPRAVATO® with certain medicine may cause side effects.

Especially tell your healthcare provider if you take central nervous system (CNS) depressants, psychostimulants, or monoamine oxidase inhibitors (MAOIs) medicine. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine.

How will I take SPRAVATO®?

You will take SPRAVATO® nasal spray yourself, under the supervision of a healthcare provider in a healthcare setting. Your healthcare provider will show you how to use the SPRAVATO® nasal spray device.
Your healthcare provider will tell you how much SPRAVATO® you will take and when you will take it.
Follow your SPRAVATO® treatment schedule exactly as your healthcare provider tells you to.
During and after each use of the SPRAVATO® nasal spray device, you will be checked by a healthcare provider who will decide when you are ready to leave the healthcare setting.
You will need to plan for a caregiver or family member to drive you home after taking SPRAVATO®.
If you miss a SPRAVATO® treatment, your healthcare provider may change your dose and treatment schedule.
Some people taking SPRAVATO® get nausea and vomiting. You should not eat for at least 2 hours before taking SPRAVATO® and not drink liquids at least 30 minutes before taking SPRAVATO®.
If you take a nasal corticosteroid or nasal decongestant medicine take these medicines at least 1 hour before taking SPRAVATO®.

What should I avoid while taking SPRAVATO®?

Do not drive, operate machinery, or do anything where you need to be completely alert after taking SPRAVATO®. Do not take part in these activities until the next day following a restful sleep. See “What is the most important information I should know about SPRAVATO®?”

What are the possible side effects of SPRAVATO®?

SPRAVATO® may cause serious side effects including:

See “What is the most important information I should know about SPRAVATO®?”

Increased blood pressure. SPRAVATO® can cause a temporary increase in your blood pressure that may last for about 4 hours after taking a dose. Your healthcare provider will check your blood pressure before taking SPRAVATO® and for at least 2 hours after you take SPRAVATO®. Tell your healthcare provider right away if you get chest pain, shortness of breath, sudden severe headache, change in vision, or seizures after taking SPRAVATO®.

Problems with thinking clearly. Tell your healthcare provider if you have problems thinking or remembering.

Bladder problems. Tell your healthcare provider if you develop trouble urinating, such as a frequent or urgent need to urinate, pain when urinating, or urinating frequently at night.

The most common side effects of SPRAVATO® include:

feeling disconnected from yourself, your thoughts, feelings and things around you
dizziness
nausea
feeling sleepy
spinning sensation
decreased feeling of sensitivity (numbness)
feeling anxious
lack of energy
increased blood pressure
vomiting
feeling drunk
headache
feeling very happy or excited

If these common side effects occur, they usually happen right after taking SPRAVATO® and go away the same day.

These are not all the possible side effects of SPRAVATO®.

Call your doctor for medical advice about side effects. You may report side effects to Johnson & Johnson at 1-800-526-7736, or to the FDA at 1-800-FDA-1088.

What is SPRAVATO® (esketamine) CIII nasal spray?

SPRAVATO® is a prescription medicine used:

with or without an antidepressant taken by mouth, to treat adults with treatment-resistant depression (TRD)
with an antidepressant taken by mouth, to treat depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions

SPRAVATO® is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if SPRAVATO® is safe or effective as an anesthetic medicine.

It is not known if SPRAVATO® is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions. SPRAVATO® is not for use in place of hospitalization if your healthcare provider determines that hospitalization is needed, even if improvement is experienced after the first dose of SPRAVATO®.

It is not known if SPRAVATO® is safe and effective in children.

Please see full Prescribing Information, including Boxed WARNINGS, and Medication Guide for SPRAVATO® and discuss any questions you may have with your healthcare provider.

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