Psychedelics are, once again, being investigated as potential healing tools. But what is this based on? And who or what can they heal?
Introduction to psychedelic medicine
Psychedelic medicine refers to the controlled use of psychedelic drugs for the treatment of physical and mental disorders.
One of the reasons why psychedelic medicine is on the rise is the dissatisfaction many people feel regarding current tools, such as traditional antidepressants – which bring with them several disadvantages. They usually only reduce the symptoms without tackling the underlying causes. They must often be taken for several years, if not an entire lifetime. And most importantly, they tend to have numerous unwanted side effects, such as sexual dysfunction, weight gain, and sleep problems, to name just a few.
Psychedelic medicine works on a different model. Instead of taking a drug that doesn’t cure you for the rest of your life, it involves administering an experience that aims to change and heal you. In addition, they tend to work fast, with sometimes one single administration or session being sufficient to elicit long-lasting change.
Breakthrough therapy designated drugs
While a lot of research still needs to be done, preliminary clinical trials have shown promise in treating conditions where existing treatments are not especially effective, such as PTSD and major depression.
Because of the high potential, various non-profit organizations and start-ups have been permitted by the U.S. Food and Drug Administration (FDA) to continue conducting research, and both MDMA and psilocybin have been designated as breakthrough therapy drugs.
For a drug to be given this designation, it must treat a severe or life-threatening condition, and preliminary clinical evidence must indicate that the substance demonstrates substantial improvement over other available forms of treatment.
In the case of MDMA and psilocybin, this designation refers to MDMA-assisted psychotherapy for PTSD and psilocybin-assisted therapy for treatment-resistant depression.
While this interest by the FDA is encouraging, FDA approval is just one step in a complex process to turn these substances into accepted therapies.
Psychedelic therapy has a long history, dating back to the 1950s. As therapists realized that psychedelics improved the therapist-patient bond and lowered patients’ ego defenses, thus facilitating the discussion of difficult or repressed topics, it was soon used as an aid to talk therapy.
It has been proposed that psychedelic therapy enables the brain to change more dramatically than it normally would. A kind of reset can take place, and previously rigid ways of feeling and thinking can be viewed with a little more distance, thus granting insight into their harmful effects.
Psychedelics are also known to shift one’s sense of self. While this may sound daunting, it can be incredibly useful – particularly for people diagnosed with anxiety and depression, as these tend to be characterized by fixed, negative self-narratives that limit one’s relationship with oneself and the world.4
Psychedelic therapy versus psycholytic therapy
If you could choose between several light-to-moderate psychedelic doses to unlock more impactful therapy sessions or one strong psychedelic experience with your therapist as a guide, which one would you pick?
This is the key difference between psycholytic therapy and psychedelic therapy.
Psycholytic, which means ‘to dissolve the soul’, was a term coined by British psychiatrist Dr. Ronald Sandison. Psycholytic therapists see the psychedelic substance as a tool for deepening ongoing psychotherapeutic sessions by allowing patients easier access to their subconscious. The focal point is on the therapeutic process, not the mind-altering experience.
On the other hand, psychedelic-assisted therapy mainly focuses on the psychedelic journey and its profound effects. By utilizing large doses – often limited to one to three sessions – the aim is to provide insight and bring about behavioral change through a mystical experience. This is then followed up by aftercare and integration support.
The Al Hubbard method – all about set and setting
While early studies on psychedelic therapy often took place in typical hospital rooms with white walls and harsh bright lighting, today, more and more researchers know this is not the best way to go.
This is in part thanks to Al Hubbard.
Nicknamed the ‘Johnny Appleseed of LSD’, Hubbard was an early LSD proponent during the 1950s and one of the first researchers to understand the importance of ‘set’ and ‘setting’ – years before Timothy Leary would end up popularizing the terms.
This knowledge would come as no surprise to shamans who long knew the importance of one’s mindset and the surrounding environment while undergoing an altered state of consciousness.
Realizing the sterile rooms were all wrong, Hubbard created a Westernized version of shamans’ established practices by introducing things such as pictures, music, and flowers, with the idea of creating a fertile ground for a comfortable experience.3
Difficulties in researching psychedelics
Psychedelic therapy poses some problems for modern medicine, which tends to stick to tried-and-proven scientific practices.
For example, the placebo-controlled double-blind trial is seen as the gold standard.
This refers to a study in which neither the participants nor the researchers know who’s receiving what – the real treatment or just a placebo.
How do you conduct such an experiment with a psychedelic? Most people – both participants and researchers – will be able to tell if someone is tripping.
Modern drug testing’s desire to rule out any placebo effects and get to the bottom of what causes what by isolating a single variable also further complicates things. How can a psychedelic’s chemical effects be isolated from the critically important set and setting?3
In addition, while there is clear value in scientific exploration of these substances, it has often been done in a way that ignores the cultural practices that have contributed to their therapeutic value in the past. Psychedelic plants and fungi are treated as an object of study, while ceremonial traditions that surround their use are ignored.
Non-hallucinogenic psychoplastogens: benefits without subjective effects?
Can psychedelics still benefit one’s well-being without their mind-altering effects?
This question is on the minds of researchers investigating non-hallucinogenic psychoplastogens – a class of drugs that carry psychedelics’ plasticity-promoting effects without producing profound changes to cognition, like hallucinations or mystical experiences.
Some believe these drugs have great potential and can make the medicinal properties of psychedelics even more accessible. They can be taken by individuals who are not mentally prepared for a psychedelic trip and can be administered outside the clinic.
Others are doubtful that such drugs would be effective and argue that the transformative mind-altering insights experienced during a psychedelic trip ultimately makes the difference.
While the jury is still out on how effective non-hallucinogenic psychoplastogens will be, research into these drugs can help us understand the role that the psychedelic experience itself plays in improving mental health.
Psychedelics and addiction
The idea of using one drug to get people off another might seem strange, but it is not a new strategy. Peyote has long been used as a treatment for alcohol addiction by Native Americans. And Selective Serotonin Reuptake Inhibitors or SSRIs, better known by trade names such as Prozac and Zoloft, have been used for smoking cessation treatment for years.
In the 1960s, LSD was considered a miracle cure for alcohol addiction. Now, after a long hiatus, new clinical trials once again support the use of psychedelics in addiction treatment.
Most addicts are well aware that their habit is damaging, but through psychedelic-therapy, that knowledge can transform into a more concrete understanding of the necessity to make that change.
After participating in clinical trials, many volunteers report feelings of disgust toward their former habits. This, combined with a renewed sense of connection and responsibility, can greatly reduce one’s cravings, a symptom that underlies all addiction.
Psychedelics and depression
Traditional antidepressants, like SSRIs, are still the most prescribed medicine for people dealing with depression. Unfortunately, these do not always have positive results. Some patients may stop treatment prematurely due to the unwanted side-effects, and others are lumped into the treatment-resistant category, meaning that no form of treatment has worked for them.
Studies have now shown that psychedelic medicines can be effective in both these cases due to their rapid onset of antidepressant effects and ability to improve even the most resistant of cases.
Similar to electroconvulsive therapy, which is still often prescribed for severe, chronic depression, a psychedelic trip can be seen as a shock to the system – with many patients reporting that their trip helped them feel more connected to both themselves and others.
However, as with many other treatments, some patients eventually see their depression return – indicating that psychedelic therapy for depression might not always be a once-off intervention.4
Psychedelics and anxiety
While a bad trip often involves high amounts of fear and panic, recent studies have demonstrated that psychedelic substances may actually reduce anxiety symptoms.
One way this is believed to happen is by modulating systems in the amygdala – a key player in detecting threats and subsequent processing of fear that appears to be overactive in people with anxiety disorders. Studies have shown that psychedelics reduce amygdala reactivity, which correlates with positive mood increases.
So, besides their antidepressant effects, serotonergic psychedelics also have anxiolytic, or anxiety-reducing, effects. This is not entirely surprising, seeing as psychedelics work via modulating serotonin. After all, antidepressants that affect serotonin are also frequently prescribed for depression and anxiety, indicating that these two conditions may share more similarities than we might think.
Psychedelics and PTSD
The treatment of Posttraumatic Stress Disorder, or PTSD, is one of the big areas in which psychedelics have been applied – with MDMA-assisted therapy emerging as one of the most promising treatments.
To facilitate recovery from PTSD, most therapeutic approaches require patients to recall scenes around the trauma and relive the emotions they then felt. But as returning to traumatic memories often elicits severe stress and anxiety, this healing process can be incredibly hard.
In combination with psychotherapy, psychedelics, such as MDMA and psilocybin, have been shown to dampen that automatic stress-and-anxiety-inducing response, in turn helping patients to be more at ease with thoughts and memories around the traumatic event.
MDMA’s ability to treat PTSD may come as a surprise to people who mostly associate it with the rave scene – where severe reactions and even death related to MDMA consumption have occurred, sometimes due to the substance being tainted with more dangerous drugs, such as methamphetamine.
Psychedelics and terminal illness
Some of the most profound work with anxiety and psilocybin is the work around end-of-life-anxiety – the type of existential distress one experiences around the impending death from a terminal disease, like cancer.
There are currently very limited psychiatric tools at our disposal to help terminally ill people, who often develop chronic symptoms of depression and anxiety due to their predicament. Morphine might offer pain relief but does not reduce mental suffering.
This is where psychedelics can be handy by offering something more experiential in nature than purely pharmacological – not directly curing the disease, but instead helping patients find more meaning in their lives again. As studies have shown that a single guided psilocybin session can do just that, it has been proposed that this type of treatment may be especially useful to help curb the anxiety and depression that many dying people deal with.
Psychedelics and schizophrenia
Before LSD was given the name ‘psychedelic’ in the late 1960s, it was seen as a ‘psychotomimetic’ – a drug that temporarily induces or mimics the effects of a psychotic state.
This interested psychiatrists as they believed that consuming psychedelics themselves would help them better understand what their patients experienced during a psychotic episode, thus gaining ‘inside’ insights into how to best treat the condition.
But, after some time, some important differences emerged, and the psychomimetic model fell out of favor. Psychosis is anything but an enjoyable state, and psychedelics often evoke pleasurable experiences. In other words, the effects were just too pleasant for these to be true psychotomimetics.
In parallel, a series of studies in the 1950s aimed to investigate whether psychedelics could be used to treat schizophrenia. These, too, were abandoned after they found that psychedelics often only worsened psychotic symptoms.
A sobering afterthought
Psychedelic medicine currently holds a lot of promise. And despite its long history, it is still seen as a rather novel option. This may, in fact, be one of the reasons why so many clinical trials are seeing such positive results.
Treatments have a tendency to outperform when they first appear.
For one, the hype and hope enhances the placebo effect as both patients and therapists have high expectations. When antidepressants first emerged in the 1980s, for example, their positive portrayal made them seem much more effective than they are today.4
In addition, early studies usually work with small, self-selected samples. Treatments may, therefore, not necessarily be as effective in the larger population. Financial interests and biased researchers may also be inclined to highlight positive results.
While there is definitely a lot to be excited about, we still have a long way to go before we can know for sure whether psychedelics will continue to be as healing as these early signs suggest.