LAUREN BIERMAN, NURSE Practitioner, started her own practice in hopes of providing the community with holistic, compassionate care. She runs Long Trail Psychiatry in Middlebury.

MIDDLEBURY — Lauren Bierman spent over a decade working in geriatrics and has worked as a hospice nurse and hospice nurse practitioner since 2016. 

When she saw how huge the need was for mental health care providers, a few years ago, she left primary care to go back to school for earn her psychiatric-mental health certificate.  

She is now a psychiatric-mental health nurse practitioner with a doctorate in nursing practice. She is double board certified in adult geriatrics and psychiatry.

“I started this business because of my own journey with mental health,” Bierman said. “There were times where I had to wait a really long time to see people. My resources and supports didn’t match my values, and providers didn’t see me as human.” 

Bierman opened Long Trail Psychiatry in Vergennes in 2019, and in 2023 moved the business to Middlebury at 88 Main St. 

Long Trail Psychiatry provides mental health and psychiatric services of all sorts, such as mental health evaluations, consults, medication management and psychotherapy, among other things.  

Bierman also has training in yoga, ayurveda (a traditional medicine system from India), and other meditation practices, which she uses in her sessions.

The practice specializes in holistic healing. Notably, it has entered the practice of ketamine assisted psychotherapy, or KAP. Ketamine is a dissociative anesthetic drug that is used for a variety of purposes in medicine. In this case, it is used for therapeutic purposes. 

Bierman’s practice uses both Spravato, an FDA-approved nasal treatment that uses a slightly altered form of ketamine, and ketamine lozenges for KAP. Unlike other mental health remedies like antidepressants, Spravato does not need to be taken every day. Bierman is present during all KAP sessions, in which the substance is used to complement the space for therapeutic practices, including meditation, talk therapy, etc. 

“I took ketamine myself at first because I had seen and read all these things about it. And it was remarkable how easy it became for me to talk about things in my life that were notoriously difficult for me to talk about before,” Bierman said.

Prior to being given ketamine in any capacity, people seeking treatment are screened to ensure they are a candidate for this treatment. Ketamine is most commonly used to treat depression, Post Traumatic Stress Disorder, and other mental health issues.

“Having reservations is valid. I had reservations taking ketamine … at first,” Bierman said. Clients “ask me any questions that they have and voice any concerns that they have. You don’t have to take it every day and the side effects are usually occurring while you’re here getting treatment. 

“I think it’s good for people to have reservations. That’s why we have such open and honest conversations about it. Ketamine is just one option, we work with all medications and different modalities,” Bierman said. 

Long Trail Psychiatry prides itself on its practice of holistic treatment and commitment to putting the patient first. The practice collaborates with other primary care providers, emergency rooms and psychiatrists to provide treatments for their patients. However, Bierman emphasized that the patient’s own needs and desires are the priority. 

“The patient comes first, always. We don’t have any agendas here. It’s really about keeping and building trust with someone,” Bierman said. “We are very honored to come on these healing journeys with them. It’s really about what works for them. There is no one size fits all with psychiatry. We have to be innovative and think about every aspect of a person’s life.”

Above all, Bierman hopes her practice is known as one that thoroughly nurtures and cares for its patients. They offer flexibility, with the staff being available on the evenings and weekends as patients require. Long Trail is a teaching practice, with students being trained to aid in Spravato and other treatments. Bierman is present in all KAP sessions, and sometimes a student will be accompanying her. The practice currently sees around 300 patients and takes patients through referrals, website inquiries, and various other manners. 

Long Trail Psychiatric recently hired another psychiatric-mental health nurse practitioner, and they plan to have two more join the practice. As she looks to the future, Bierman hopes to hire more providers and expand her efforts in mental health and wellness. She will be hosting a ketamine retreat in October and an ADHD workshop later this year. 

“I want to be a safe space and want the community to know that we have wonderful providers,” she said. 

Why I treat patients with ketamine

Bierman offers treatment with ketamine. The Addison Independent asked her about how Long Trail uses the dissociative anesthetic drug in its holistic healing practice. Here are the questions and her answers:

Q: How did you become interested in prescribing ketamine?

Bierman: I grew interested in ketamine after seeing many published studies that were showing huge reductions in people’s depressive symptoms and suicidal thoughts. I had a lot of patients asking me about it, so I figured I should try it on my own so I could better educate people.  I did a series of ketamine-assisted psychotherapy sessions, and I was blown away with the effects.  Not only did I feel antidepressant effects rather quickly after a session, but the medicine also allowed me to access places and times from my past that had been too difficult to talk about.  Finally, after over 30 years of different types of medications and therapies, I was actually able to talk about the trauma I experienced in childhood, and I was able to see it from a different lens. It became easier to find grace and compassion for myself, whereas I have generally lived my life feeling like I was at fault for everything that had happened when I was just a child. After seeing the benefits in my own life with my depression symptoms and PTSD symptoms, I knew that I wanted to be able to offer this to my patients.

Q: How is this drug taken (oral pill, injection, daily, monthly…?)

Ketamine is taken in several different ways.  It can be administered in the muscle, under the skin, directly into the vein, in the nose, and orally with a lozenge.  Currently I offer Spravato (esketamine) which is administered into the nostrils, and a special oral lozenge called a “troche” for ketamine-assisted psychotherapy (KAP) sessions.

Spravato is FDA approved for treatment-resistant depression and depression with active suicidal ideation.  It has been shown to be most effective when used according to a treatment protocol, so people can expect two treatments per week for one month, and then one treatment per week for one month.  Maintenance doses are recommended, and they differ according to the individual.

Ketamine, when used for ketamine-assisted psychotherapy, is dosed based on the patient. I recommend that people aim to start with three sessions, because each session is going to be different, and our goal is to work through and process trauma and depression. During this therapy, people are better able to access different perspectives, and change some of their cognitive blocks.

Q: What are the benefits of ketamine?

One of the best benefits of ketamine is that it works quickly.  Antidepressants can take at least 4-6 weeks before we know if they’re even minimally effective, and then we often have to adjust the doses multiple times.  Ketamine can show benefits after just a few sessions.

Ketamine is also a very safe medication and generally comes with minimal side effects.  Other medications, such as antidepressants and antipsychotics, have a myriad of side effects that can really affect someone’s quality of life.  The most common side effects of ketamine are a slight elevation in blood pressure (which usually resolves very quickly), nausea (which we can premedicate for), dissociation and sedation.  These side effects have resolved before someone leaves my office, whereas side effects with daily medications can last as long as someone takes the medication.

Ketamine also helps to create new neural pathways in the brain. It increases neuroplasticity, which means it actually makes new connections between neurons, which is incredible! This is, in part, what helps patients create new ways of thinking and relating.  Ketamine enhances the mind’s capacity for deeper thinking and change, which then provides opportunities for rapid progress.

Q: How long is the course of treatment?

I recommend that people stick with the protocol for Spravato, because that’s what’s been proven to work.  With KAP, it’s really based on the person and if they are finding benefit from the treatment.  Most people will need maintenance dosing on a long-term basis.

Q: Who should avoid ketamine?

People should disclose to their provider if they have a history (or risk factors) for hypertension, stroke, seizures, aneurysms, urinary problems, intracranial pressure issues and psychosis.  This doesn’t mean they aren’t a candidate for the treatment, it just means we may need to do a little more digging to fully understand their risk for adverse effects, and then we would review risks versus benefits before determining to treat with ketamine or Spravato.

Q: How do you respond to patients who are worried that ketamine is known as an illegal party drug?

Ketamine may be an illegal party drug, but it is not an illegal medication when prescribed by a provider for a patient, and it is taken by that patient.  Ketamine is a Schedule 3 drug.  For context, Schedule 1 drugs have the highest risk for abuse, and that list includes heroin, mescaline and LSD (among others). Medications that treat ADHD, like Adderall and Ritalin, are Schedule 2 drugs, as are pain medications like Percocet and Morphine.  Ketamine is an anesthetic (used in surgery for anesthesia), and it’s used more and more in the emergency room and ambulance for anxiety.  It’s in the same class as aspirin with codeine and testosterone.  It works quickly, has minimal side effects, and leaves the body quickly.

Patients sign a controlled substance contract any time they receive a medication that has potential for abuse, and we spend a lot of time assessing the person for any comorbidities that might increase their risk for abuse.  In a safely monitored and controlled environment, studies show that ketamine does not exhibit addictive potential and may be administered consistently to sustain mental well-being.  

Q: Is ketamine therapy covered by insurance, and how much can a patient expect to pay?

Spravato is covered by insurance, and there are Care Navigators who can help patients determine their cost of treatment, and whether they qualify for financial assistance… which at times can cover the entire cost of treatment.

Ketamine-assisted psychotherapy (KAP) is not covered by insurance.  These sessions can be three to four hours long and can range in cost, depending on the patient’s financial situation.