Some 23.8% of Oregon residents, or 783,000 people, suffer from a mental health illness according to Mental Health America. This is the third highest amongst all states and the District of Columbia. The American Psychological Association reported in October 2021 that 84% of psychologists who treat anxiety reported an increase in demand across the country.
With this demand comes a diverse set of needs. One alternative therapeutic modality gaining popularity is the medicinal use of ketamine.
"Ketamine is different [from] any of our other antidepressants in that it targets the neurotransmitter glutamate... Selective serotonin reuptake inhibitors [SSRI's], like Prozac, are working with serotonin, norepinephrine and dopamine. A lot of people have never worked with an antidepressant that targets glutamate, and that can be game changing," said Amy Erber, owner and psychiatric nurse practitioner at Bright Mind Integrative Psychiatry + TMS—a term short for Trans Magnetic Stimulation. "Glutamate targets the default mode network."
Patients suffering from anxiety, depression or Obsessive-Compulsive Disorder may experience an overactive Default Mode Network, the network of interacting brain regions that are active when not focused on a task or activity. The regions become less active the more engaged an individual is to a task or their surroundings. Studies have shown that after taking ketamine the areas of the brain that were highly active prior to ingestion become less active.
"When people start ruminating, that's a sign of having this overactive DMN. Ketamine does a great job of interrupting and dampening that DMN," Erber said.
Ketamine was first synthesized in 1962, and gained approval by the Food and Drug Administration for use as an anesthetic in 1970. Its use as a popular rave and party drug led to its designation as a Schedule III substance by the FDA in 1999, which limits legal administration through a prescription. This allows clinics to administer ketamine in a safe and secure environment.
Eber's clinic offers the only psychedelic assisted therapy service in Central Oregon. Erber is a licensed psychiatric nurse having obtained her Psychiatric Mental Health Practitioner certificate from Johns Hopkins University. She has completed numerous psychoactive substance training programs and fellowships in popular integrative clinics.
If you don't have support or people to help you integrate [insights] and embody them, then we're just kind of going from one thing to the next, without getting the most out of it and really optimizing the gains from the treatment—Amy Erbertweet this
"We spend two hours with a [patient]. And it just kind of opens up that space to not only deliver those neurological bias benefits, but also target some of the psychotherapeutic modalities."
Erber starts a typical session by asking a patient to set an intention before administration. The patient is in a big relaxing recliner, usually with an eye mask on, listening to music designed to evoke emotions. For around 40 minutes the patient will experience an altered mind-state. After this state Erber engages in conversation, taking notes for the patient's therapist.
"We have about 45 minutes to an hour for people who are in this, you know, very open state and have more access to their emotions." Erber describes this state as having more space in the brain for contemplation because the rumination sectors of the brain are dampened. Some people come only once, while others may meet multiple times a week for an extended period of time.
A last essential element to Erber's practice is integration.
"Integration is...embody[ing] some of these insights and feelings [patients] experience in the session." Erber explains further it is also about finding a support system. "If you don't have support or people to help you integrate [insights] and embody them, then we're just kind of going from one thing to the next, without getting the most out of it and really optimizing the gains from the treatment...The goal is honestly not to be big, but that people won't need us anymore."