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Will Psychedelic Therapy Transform Mental Health Care?

Therapeutic ‘trips’ may someday bring relief from addiction, anxiety, depression — and even the fear of death.

by Joseph Bennington-Castro /
Flower powerImages Etc Ltd / Getty Images

In the mid-1950s, LSD and other psychedelic drugs took the medical world by storm — and no wonder. Studies at the time suggested that the hallucinogens were effective against a variety of difficult-to-treat mental health problems, including alcoholism.

The research stalled in the early 1970s, however, in large part because psychedelics had developed a reputation as dangerous recreational drugs and had been reclassified by the federal government as "drugs of abuse" with no medical value.

But research is picking up again, with new trials not just of LSD but also of psilocybin (the active compound in magic mushrooms), MDMA (street name "ecstasy"), and ayahuasca (a South American brew containing a hallucinogen known as DMT). If the drugs prove to be as safe and effective as recent research suggests, we may be on the brink of what some are calling a revolution in mental health care.

"Psychedelics, under carefully controlled conditions, can create experiences of wonder and awe and a connection to a 'divine realm' that leads to significant behavioral changes," says ayahuasca expert Kenneth Tupper, director of implementation and partnerships at the British Columbia Centre on Substance Use. "Psychedelic drugs are not a panacea, but the research is showing a lot of promise."

MULTIPLE DRUGS, MULTIPLE BENEFITS

Just what can the drugs do? A single treatment with psilocybin has been shown to relieve crippling anxiety in people with terminal cancer. The drug has also been shown to be an effective therapy for substance use disorders. MDMA can provide valuable help to people suffering from post-traumatic stress disorder (PTSD).

And there’s more. Preliminary evidence suggests that psychedelic drugs can be effective for eating disorders, obsessive-compulsive disorder, and major depression — including cases that don't respond to conventional antidepressants.

The drugs may also be good for helping smokers kick the habit, a process that's often notoriously difficult via conventional means.

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 Psilocybin mushrooms are cultivated at a farm in the Netherlands in 2007. Peter Dejong / AP file

If the research pans out, the world of mental health care may look very different in the coming decades. Psychedelic treatment won't be available for just anyone, and recreational psychedelic use may still be banned. But those with certain illnesses could seek treatment from a psychiatrist specially certified in psychedelic therapy. Just a few treatment sessions a year might be enough to provide lasting relief from their issues.

People with mood disorders, including those who are unresponsive to conventional therapies, might be able to ditch their antidepressants and antianxiety medications. Those with terminal illness could enjoy their remaining days without the fear of death looming over them, while people with PTSD could return to a normal life unobstructed by paralyzing flashbacks. And rehab centers for substance use and eating disorders could empty out as more people turn to psychedelics.

Again, we’re not at this point yet. But such is the promise of psychedelic medicine.

SAFETY FIRST

Psychedelic drugs fall into one of two categories depending on how they affect the brain.

Classic psychedelics include LSD, psilocybin, and ayahuasca. They work by binding to the same receptors in the brain as serotonin, a neurotransmitter associated with feelings of wellbeing. MDMA, on the other hand, causes the release of another neurotransmitter, serotonin, in the brain.

At this point, the star players in psychedelic research are psilocybin and MDMA. (LSD's hallucinogenic effects last too long, thus limiting its therapeutic value; ayahuasca is hard to standardize because it’s a brew made from two plants.)

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Given psychedelics’ potential for abuse — and the possibility of unpleasant hallucinations — clinical trials of the drugs follow rigid protocols. Patients for the clinical trials are screened for schizophrenia and related disorders that preclude psychedelic therapy; those who are selected undergo preliminary sessions during which they learn about the goals and nature of the treatment, as well as the particulars of the drug they’ll be trying.

During treatment, patients typically don headphones for music and eyeshades and then lie down. They’re encouraged to go as "deep" as possible into the experience, says Charles Grob, a UCLA psychiatry professor who has done research on MDMA, psilocybin, and ayahuasca. As the session ends and the hallucinogenic effects wear off, patient and therapist discuss the experience. Follow-up psychotherapy sessions facilitate lasting results, Grob says.

As experimental therapies, the sessions are conducted in research labs under medical supervision. Psychedelic therapy is not yet available in therapists’ office or other ordinary therapeutic settings.

WHAT THE RESEARCH SHOWS

Just what do the studies show? In 2010, Grob and his colleagues published a tiny pilot study showing that psilocybin reduced anxiety and depression in patients with advanced-stage cancer, helping them better cope with the fear of death.

Recent studies conducted by other research groups have shown similarly promising results. In 2016, for instance, a Johns Hopkins study and a concurrent New York University study found that about 80 percent of cancer patients showed clinically significant decreases in depressed mood and anxiety even six months after receiving one to two psilocybin treatments.

Psilocybin also appears to be an effective treatment for addiction. Echoing past research with LSD, scientists recently showed decreased cravings for and increased abstinence from alcohol after psilocybin treatment in a proof-of-concept study — and the benefits were still in evidence nine months later.

Psilocybin seems especially promising as a tool for smoking cessation.

In a preliminary study of smokers conducted in 2014, 80 percent of participants remained nicotine-free six months after receiving three psilocybin sessions. And 60 percent of the participants remained nicotine-free an average of 30 months after treatment.

Compared with the classic psychedelics, MDMA doesn't encourage deep introspection, so psychotherapy sessions with the drug often involve much more discussion between doctor and patient. That makes it a good fit for PTSD treatment.

"Normally, when someone [with PTSD] would be instructed to relive the traumatic experience, they would be overwhelmed with fear, anxiety, and despair," Grob says. "But while under the influence of the MDMA, it's as if they can navigate the experience more safely."

In recent clinical trials, 61 percent of 107 participants no longer had PTSD symptoms two months after MDMA-assisted psychotherapy. Sixty-eight percent were still PTSD-free a year later. In light of findings like these, the FDA recently deemed MDMA a "breakthrough therapy," putting it on the fast track for approval.

MYSTICISM AND HEALTH

What makes psychedelic therapy so powerful? Experts say it may be because the drugs work on a deep emotional as well as biological level, with patients experiencing a transformative sense of positivity, benevolence, and unity during “trips” that many describe as mystical.

"Unlike almost all other psychiatric medications that have a direct biological effect, these drugs seem to work through biology to open up a psychological opportunity," says Matthew Johnson, a Johns Hopkins University psychiatrist who heads the university’s Psilocybin Research Project and has conducted psilocybin research.

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And the drugs’ benefits may go beyond simply treating specific disorders. In 2011, Johnson and his colleagues showed that a single psilocybin session can give people a more "open" personality, as well as a greater appreciation of new experiences and enhanced curiosity and imagination. Follow-up research showed that these effects persisted for at least 14 months — and may even be permanent.

If that makes you eager to give psycheledic therapy a try, you'll have to wait awhile. The only psychedelic that seems close to clinical use is MDMA (for PTSD), and it needs to go through final trials that are expected to take several years.

"We're still at the beginning of this field and the questions are wide open," Johnson says. "There are hundreds of careers worth of study left to do."

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