South Chesapeake Psychiatry

03/23/2026

Psychiatry may be quietly shifting away from monoamines and toward something much deeper: neuroplasticity.

For decades psychiatry framed depression primarily through the lens of monoamines. SSRIs, SNRIs, and dopamine modulation dominated the conversation, and for many people those medications still work well. But the past decade has forced the field to reconsider whether we have been focusing on the wrong level of the system.

Increasingly, the evidence suggests that many effective treatments converge on something deeper: neuroplasticity.

Ketamine and esketamine accelerated this conversation by demonstrating that meaningful antidepressant effects could occur within hours rather than weeks. The emerging psychoplastogen literature raised an even more provocative question: if structural and functional plasticity is the true therapeutic driver, do we actually need the psychedelic experience to achieve it?

That question led me to a molecule I have been watching for quite some time: osavampator.

Unlike ketamine, which indirectly increases AMPA signaling through NMDA antagonism, osavampator works directly as a positive allosteric modulator of the AMPA receptor. In other words, it attempts to engage the same plasticity cascade from a different entry point.

What makes this particularly interesting from a clinical standpoint is the potential practicality. Running a Spravato treatment center reinforces every day that while these treatments can be extremely effective, they also require infrastructure. Monitoring, chair time, scheduling, staff, and a controlled clinical environment all become part of the therapeutic equation.

An orally administered AMPA modulator that engages plasticity pathways without dissociation or sedation would represent a very different implementation model if the signal holds.

Early Phase 2 data from the SAVITRI trial have generated attention, with effect sizes approaching 0.7 and remission rates nearing 50 percent by eight weeks in adjunctive treatment resistant depression. Whether those results replicate in Phase 3 remains to be seen, but mechanistically the compound sits directly in the middle of the broader shift psychiatry appears to be undergoing.

We may be moving away from receptor occupancy as our dominant framework and toward something more fundamental: circuit modulation and network plasticity.

Edition 10 of The Neuropsychiatry Brief explores this emerging AMPA story and why it may represent another piece of the larger plasticity puzzle.

If the future of antidepressant treatment is about helping the brain reorganize itself rather than simply nudging neurotransmitters, this is a development worth watching.

If you enjoy these discussions, you can subscribe to The Neuropsychiatry Brief directly on LinkedIn.

If you have followed this newsletter over the past several editions, you have probably noticed that a recurring theme keeps appearing beneath many of the mechanisms we discuss. Whether we are talking about ketamine, psychoplastogens, neuromodulation, or emerging serotonergic compounds, the conversat

03/18/2026

There are usually three people in the room during a psychiatric appointment. The client. The clinician. And the insurance company.

As clinicians we spend a great deal of time staying current with research, new treatments, and evolving models of care so that we can give our clients the best options available. In recent years psychiatry has begun moving beyond a purely neurotransmitter-focused model toward a deeper understanding of neural circuits, plasticity, and how the brain adapts over time. Treatments like ketamine and esketamine are part of that shift and have created new opportunities for individuals with treatment-resistant depression who simply do not respond to traditional antidepressants.

But being a good clinician means more than understanding the science. It also means understanding the system we practice within and learning how to navigate that system on behalf of the people we treat.

This Special Edition of The Neuropsychiatry Brief is about that reality.

Sometime ago, I temporarily took over a client’s Spravato treatment while a colleague was away. The client had been in treatment for roughly a year and was on weekly maintenance dosing. Her PHQ-9 suggested she was not doing well, and after discussing her symptoms we decided to return to twice-weekly dosing. Clinically the reasoning was straightforward. Administratively, it became a battle.

When I went looking for literature supporting a return to twice-weekly dosing during maintenance treatment, I was surprised at how little existed addressing that exact scenario. Ultimately I was able to obtain approval and the client improved significantly once treatment frequency increased.

Because of that experience I wrote up the case.

It was declined for an APNA poster and by a couple of journals. That happens. But rejection by a conference or journal does not mean the observation lacks clinical value. Instead of letting it disappear into a folder, I decided to share it here with colleagues.

The Special Edition of The Neuropsychiatry Brief discusses the clinical reasoning behind the decision and the realities of navigating treatment within an insurance-driven system.

I have also attached the full case study so that other clinicians may be able to use it when advocating for their own clients (link within the brief).

If it helps even one person get better care, it was worth writing.

Modern psychiatry is advancing rapidly, from neurotransmitters to neural circuits and plasticity. Yet in everyday clinical practice there is often an unspoken participant shaping treatment decisions — the insurance company sitting quietly in the room.

02/20/2026

The world feels heavy right now.

ICE raids tearing families apart at school drop-offs. Protests and unrest in Iran. A halftime show that somehow became a political flashpoint. The news cycle is relentless, and it is asking something of all of us, especially those of us who work in mental health, where the weight of the world lands in the room with every client.

And then, in the middle of all of it, Alysa Liu stood on top of an Olympic podium with a gold medal around her neck, her hair down and natural, and waved the other medalists up to share the top step with her.

I needed that. I think a lot of us did.

She walked away from figure skating at 16. Not because she failed. At the height of her career, she stepped away to protect her mental health and figure out who she was outside of the sport that had consumed her childhood.

Then she came back. On her own timeline. Because she missed it. Because it felt joyful again.

She said it herself:
"Quitting was the best decision I ever made. Coming back was the best decision I ever made."

That right there is a clinical story.

As a psychiatric nurse practitioner, I could not let this moment pass without unpacking it properly. So I wrote a Special Edition of The Neuropsychiatry Brief on exactly this — burnout, autonomy, identity, and what genuine recovery actually looks like when it plays out in full.

Because in a week this heavy, this is the kind of story that deserves more than a caption.

The full edition covers:
Why stepping away is not the same as giving up, and why that belief is clinically dangerous

Why autonomy is not a motivational concept. It is neurologically meaningful medicine.

Why her hair down on that podium was not a minor detail. It was integration.

Why that podium moment, waving competitors up to share the top step, is one of the clearest behavioral signals that something has genuinely healed.

And what this arc looks like for the clients sitting across from us right now.
This is the mental health story we rarely get to see play out publicly and completely. Not the struggle framed as inspirational suffering, but the full sequence, the stopping, the uncertainty, and the return on different terms.
The world is loud.

This is what quiet healing looks like when it finishes.

By now you may have seen the moment. Alysa Liu, standing at the top of the Olympic podium, gold medal around her neck, hair down and natural, waving the silver and bronze medalists up to share the top step with her.

01/26/2026

A thoughtful surprise on this gloomy Monday. Flowers for Sarah, Lauren, and Amanda as a thank you for the care and support they provide every day. Grateful for a team that makes people feel seen and supported - and for the patients who take the time to share their appreciation.

01/12/2026

We really do want the best for all our patients! Call us today to schedule an appointment! 📲757-908-2124

01/09/2026

We’re honored to share that Global Healthcare Magazine featured our founder, Justin Ray, on the cover in a January 2026 article highlighting his work in community and interventional psychiatry.

The piece reflects the values that guide South Chesapeake Psychiatry every day: depth over volume, accountability over convenience, and care that prioritizes real-world outcomes. From comprehensive evaluations to thoughtful, evidence-based treatment planning, our focus remains on practicing psychiatry with integrity and intention.

We’re grateful to our clients, our team, and our community for the trust you place in us. This recognition is a reminder of why we do the work—and why quality, ethical psychiatric care still matters.

Read the full article here:

For more than a decade, Justin Ray’s professional life unfolded in spaces like these. Long before advanced degrees, leadership roles

12/10/2025

HAPPY BIRTHDAY LAUREN!!! You bring so much joy to all of us here at SCP everyday! Thank you for all the extremely hard work you do for the providers and our clients, your positivity and for making us laugh everyday!! We love you meatball!!!! 🎉🎉🎉🎂🎂🎂🥳🥳🥳

12/05/2025

There are few moments more rewarding in this field than watching a former student grow into a colleague, a leader, and now a teacher in her own right.

When I first met Alysha Cunningham, MSN, PMHNP-BC, she was my student. Even then, it was obvious she had something rare. Not just intelligence or work ethic, plenty of people have that. She had instinct. She had depth. She had the kind of clinical presence you can’t teach, only refine.

I remember thinking, even back then: if I ever get the chance, I’m bringing her into the practice.

And I did.

Today, seeing her published in The Virginian-Pilot, writing about the stress and pressure facing today’s teens, and the real skills they need to cope, was one of those full circle moments that stops you for a second. The student becoming the teacher. The learner becoming the voice others now look to.

Alysha trained at Duke University’s number one ranked PMHNP program and is now pursuing her Doctor of Nursing Practice at Duke while caring for clients across the lifespan at South Chesapeake Psychiatry. Her article is thoughtful, timely, and rooted in exactly the kind of evidence-based compassion our community needs.

Watching someone you once taught step into their own influence is one of the greatest honors in this profession. It’s why we invest in people. It’s why mentorship matters. And it’s why I’m so proud to have her on our team.

Here is her article. It’s worth your time:
https://www.pilotonline.com/2025/12/03/column-give-teenagers-the-tools-they-need-to-manage-stress/?fbclid=IwY2xjawOfpMdleHRuA2FlbQIxMQBzcnRjBmFwcF9pZBAyMjIwMzkxNzg4MjAwODkyAAEeG33Ixvt-JtxMT7wxR_cVxoVEmeuV3sVCuXpMuKifBCGFRx0pqfYl1jm30ks_aem_m24qCe5uuYFJOZ-oxP4n7w

Why are we sending teens into daily life unprepared to cope with stress, psychiatric mental health nurse practitioner Alysha Cunningham asks in a guest column.

11/27/2025

Happy Thanksgiving, everyone!

This week is always one of reflection for me, a chance to slow down, take stock of what matters, and appreciate the people who make the work we do possible. Last night, I had the opportunity to take our staff and our two providers out to dinner, and it reminded me once again just how blessed I am to work with the team I have.

As we head into the holiday, I shared this message with my team, and I think it captures exactly how I feel:
“Sarah and Lauren are the heartbeat of our practice. Their skill, determination, and ability to problem-solve at a moment’s notice allow us to operate at the highest level. When something goes wrong, they don’t shrug, they fix it. Yesterday was a perfect example: multiple Spravato shipments were delayed, and in true fashion, they brainstormed, adapted, and made sure every client, but one, still received care. That level of commitment isn’t common. It’s a gift.”

And it extends beyond operations.
It’s in the compassion Lauren shows to an elderly client who needed help that isn’t even a client at out practice.
It’s in the passion Sarah pours into her work, even on tough days solving problems so that the rest of us don’t have to.
It’s in my wife simply saying yes to every time we have a need or my daughter/son staying up late nights to get some admin work done.
It’s in all the humor, the grit, the problem-solving, and yes, even the moments where we all drive each other a little crazy. That’s what a real team looks like.

We don’t have a 4.8 Google rating by chance.
We don’t win “Best of Coastal Virginia” by luck.
We earn those things because this team works hard, cares deeply, and treats our clients, and each other, like people who matter.

The truth is, we may not be related, but they are my people. My family. I’m grateful for every hurdle, every laugh, every late-night text, every “we’ll figure it out” moment, and every win we’ve had together this year.

As we close out 2025, I just want to say:
Thank you for making this year a meaningful, successful, and genuinely enjoyable one. I can’t wait to see what 2026 brings.

Wishing all of you - colleagues, friends, clients, partners, and everyone in between, a warm, restful, and Happy Thanksgiving!

(Sharing a few photos from some of our past gatherings — because gratitude is always better with good company.)

11/23/2025

At TRIP, we believe healing should happen in a space that feels comforting, human… and occasionally delicious. 😄🍭

Our Sunday Spravato treatment days have become known for cozy recliners, blankets, calm lighting. and yes, an impressively stocked lollipop situation. So when we found the holiday edition Triple Power Push Pop (“3 pops in 1”), we had no choice but to level up. 🎄✨

It’s a small gesture, but we hope it brings our clients a smile, a moment of joy, and a reminder that they’re cared for.

Because mental health treatment should feel supportive, not sterile.

Hope everyone enjoys the sugar-powered holiday spirit as much as we do. 💗

11/18/2025

Every so often, I write something that feels less like a blog and more like a piece of my professional DNA. This one is exactly that.

In community mental health, psychiatry, ACT work, corrections, and interventional treatment, you don’t get to choose comfort. You choose the work. You choose the people. And you choose to walk straight into situations most clinicians only read about.

Over the years, I’ve learned that the only way to do this work well, and to build practices that truly serve people, is to become comfortable being uncomfortable. To embrace the hard moments, lean into the unknown, say yes to opportunities that stretch you, and trust that growth will follow.

In this new blog, I talk about:

• The realities of ACT work, corrections, and walking into the parts of the community most people never see
• Why “embrace the suck” isn’t negativity, it’s strategy
• How three psychiatrists shaped the philosophy that guides my practice
• Why fear almost always signals a training gap, not a clinical limit
• And how the five pillars of SCP and TRIP, Availability, Accountability, Expertise, Quality, and Excellence, came directly from this mindset

If you work in mental health, leadership, medicine, community care, or any field that demands resilience, I hope this resonates.

Here’s the blog:
https://www.southchesapeakepsychiatry.com/article/comfortable-being-uncomfortable-a-philosophy-forged-in-the-real-world

Let me know your thoughts—I always appreciate the conversation.

Comfortable Being Uncomfortable: A Philosophy Forged in the Real World

11/16/2025

Another Sunday at South Chesapeake Psychiatry and Transforming Minds Interventional Psychiatry (TRIP), getting everything ready for our Spravato clients.

If you know us, you already know we take the environment seriously—comfort items, calm spaces, and yes… the candy game. You’d be surprised how much thought goes into picking the right treats, but our clients notice the little things, and that matters to us.

At TRIP, clients get to “take a trip without ever leaving their chairs,” but behind that fun line is real, intentional work. Creating a space where people feel safe, supported, and cared for is at the heart of what we do.

Grateful for this team, this community, and the chance to make Sundays count.