Psychedelic Therapy — Here’s What You Need to Know

Psychedelic therapy, also dubbed psychedelic-assisted psychotherapy or PAP, is a mental health practice that ropes in psychedelic substances into the therapeutic mix.

This approach marries the ingestion of psychedelics with traditional talk therapy sessions.

A slew of mind-bending psychedelics are on the table for therapeutic use or study in both formal clinical settings and more laid-back scenarios.

Some of these trippy compounds come from nature—like psilocybin (magic mushrooms), DMT, peyote, ayahuasca, and ibogaine. Then there are the lab-created ones, such as ketamine, MDMA, and LSD.

While native populations have long harnessed psychedelics for healing and spiritual purposes, this practice is a fresher face in Western medicine.

Its growing traction stems from more relaxed laws around certain psychedelics, a spike in mental health issues, and a stagnant phase in psychopharmacological advancements.

Psychedelics and Psychedelic Therapy Overview

In the U.S., there’s yet to be a concrete, universally accepted definition of psychedelic therapy, though it’s currently under scrutiny at the federal level.

Per insights from a 2022 workshop by the National Institutes of Health (NIH), these mind-altering substances might reshape our perceptions of the world and our place in it, potentially tweaking mood, stress response, memory, and how we interact socially.

A 2020 study featured in *Frontiers in Psychiatry* characterizes psychedelic therapy as a treatment modality for mental disorders where patients are administered psychedelics in a controlled clinical setting, surrounded by preparatory and integrative counseling. This study highlights “classic serotonergic psychedelics”—drugs that poke at specific serotonin receptors in the brain to warp perception and kickstart hallucinogenic experiences.

(Note: It’s critical to distinguish that recreational and illegal use of psychedelics without clinical oversight isn’t considered therapeutic and is advised against by healthcare professionals.)

**Breaking Down Classic vs. Non-Classic Psychedelics**

“Classic” psychedelics form a group of psychoactive substances, including psilocybin (from certain mushrooms), LSD (crafted from another fungus), and ayahuasca (a plant-based psychoactive concoction). Meanwhile, substances like ketamine and MDMA fall into the “hallucinogenic agents” or non-classic psychedelics category due to their similar brain pathways and effects. This classification emerged from a consensus statement proposed in March 2023, published in *Psychedelic Medicine*.

Despite their differences, both classic and non-classic psychedelics often merge under the umbrella term “psychedelics” in discussions about psychedelic medicine and therapy. For instance, the NIH broadly uses “psychedelics” to refer to all such hallucinogenic substances, covering a spectrum from DMT and ayahuasca to ketamine, LSD, MDMA, and psilocybin, as recognized by the Psychedelic Medical Association.

Working With a Licensed Therapist

Often, psychedelic therapy can serve as an additional tool alongside established mental health therapy objectives. If you’re considering psychedelic-assisted therapy—currently limited to ketamine and, in select states, psilocybin—it’s crucial to pursue this under the guidance of a licensed therapist, an integrative doctor, or a psychiatrist who is well-informed about these substances to minimize health risks.

Psychedelic-assisted therapy involves a competent, experienced facilitator who initially screens individuals to confirm their suitability for the treatment. Once deemed appropriate, the patient will be prepared for the psychedelic experience over several sessions. This structured approach ensures that the therapy is both safe and effective, aligning with the patient’s overall mental health strategy.

Exploring the Therapeutic Advantages of Psychedelic Drugs

While many psychedelic substances are still in the experimental stages and haven’t been extensively researched across various demographics or uses, current studies suggest potential applications in mental health care along with certain limitations.

1. Potential Aid for Persistent Depression
The FDA has sanctioned the use of a nasal spray containing esketamine, known commercially as Spravato, for battling treatment-resistant depression. This approval has spurred the rise of clinics offering ketamine treatments. Although ketamine can be administered alone, it is frequently paired with traditional psychotherapy or additional medications. According to a comprehensive meta-analysis featured in Lancet Psychiatry in 2018, approximately half of individuals do not respond to conventional antidepressant treatments, which can take a prolonged period to become effective. In contrast, ketamine’s effects are almost immediate. A study published in Psychiatry Investigation in March 2020 found that patients with major depressive disorder might experience ketamine’s antidepressant benefits within hours of an infusion and even faster with intranasal esketamine. The drug is also noted for its potential to reduce suicidal thoughts among those with severe depression.

While ketamine therapy has its benefits, it is not without side effects, such as elevated blood pressure, which necessitates medical clearance before treatment. However, these side effects are generally well-tolerated and confined to the duration of treatment, as noted in a 2022 review in Discover Mental Health. The long-term effects of ketamine, including potential dependency, remain under-studied.

In conjunction with other established psychotherapies, ketamine therapy may offer additional advantages. For instance, its use has been associated with increased neuroplasticity, fostering new neural connections and counteracting damage caused by chronic stress and anxiety, as per a June 2021 study in Biological Psychiatry. This enhancement in neuroplasticity may facilitate quicker learning and recovery processes, and integrating traditional therapy can help patients leverage insights gained during psychedelic sessions, as noted by Mailae Halstead, a licensed therapist specializing in ketamine-assisted therapy. Increased neuroplasticity might also support more effective conventional therapeutic efforts, such as improving relationship skills or rediscovering enjoyment in hobbies, crucial for enhancing life quality. A small April 2021 study in the Journal of Affective Disorders Reports involving individuals with treatment-resistant depression observed significant improvements in mood and a reduction in suicidal thoughts, enhancing overall life quality.

2. Potential Efficacy for PTSD
Beyond ketamine, other psychedelic substances like MDMA, commonly known as ecstasy, are nearing the end of clinical trials and may soon seek FDA approval, particularly for treating PTSD. A notable phase 3 trial published in May 2021 in Nature Medicine compared MDMA-assisted therapy to placebo treatments over three sessions. By the study’s primary endpoint, 67% of the MDMA group no longer met PTSD diagnostic criteria, significantly higher than the 32% in the placebo group. Furthermore, 33% of the MDMA group achieved remission status. MDMA has been found to decrease symptoms of depression and is generally well-tolerated, even in individuals with complex comorbidities. This substance may facilitate an emotional state where patients can process trauma with reduced shame and increased self-compassion, suggesting a promising therapeutic tool for severe PTSD. A separate analysis from June 2020 in Psychopharmacology, examining six phase 2 trials, showed that MDMA-assisted psychotherapy could significantly reduce PTSD symptoms within a few months and maintain these improvements for at least a year. However, further extensive trials are necessary to fully ascertain MDMA’s therapeutic benefits and advance towards FDA approval.

Exploring the Role of Psychedelic-Assisted Therapy in Treating Addictions and Other Conditions

While success rates for quitting substances like smoking and alcohol are generally low, with less than one in ten smokers quitting annually according to the Centers for Disease Control and Prevention, and fewer than 10 percent of those with alcohol use disorder receiving treatment per the National Institute on Alcohol Abuse and Alcoholism, research suggests psychedelics like psilocybin may offer new hope.

A June 2022 study in Disruptive Psychopharmacology led by Dr. Johnson and an October 2022 study in JAMA Psychiatry show promising results for psilocybin in reducing heavy drinking days and overall alcohol consumption. These findings, while preliminary, indicate that psilocybin could reshape traditional approaches to addiction treatment.

Further, a study involving smokers who received psilocybin alongside cognitive behavioral therapy found a significant cessation rate at a 12-month follow-up, with many participants describing the experience as profoundly meaningful. This suggests potential for psilocybin in addressing nicotine addiction, although larger studies are needed to confirm these effects.

Johnson theorizes that psilocybin may enhance traditional therapies and promote significant behavioral changes by disrupting entrenched patterns of thought.

Additional research highlights other psychedelics like ibogaine and 5-MeO-DMT as potential treatments for alcohol use disorder, with studies pointing to their efficacy in reducing dependency on alcohol, cocaine, and tobacco.

Addressing Psychological Distress in Terminal Illness

Psychedelic-assisted therapy might also alleviate the psychological burden in terminally ill patients, particularly those with cancer. Research indicates that one-third of such patients experience increased anxiety and depression, heightening risks of mortality and suicide. Studies, such as one published in the February 2020 Journal of Psychopharmacology, demonstrate that psilocybin therapy can significantly reduce anxiety, depression, and existential distress in cancer patients, with effects lasting several years.

Aiding Recovery from Eating Disorders

The treatment of eating disorders, often complicated by co-occurring conditions like severe PTSD, may also benefit from psychedelic therapy. A May 2022 study in the Journal of Psychiatric Research found that MDMA-assisted psychotherapy reduced eating disorder symptoms more effectively than placebo. The treatment appears to lessen anxiety and foster a sense of connection with others, which could be key in overcoming the psychological factors underlying eating disorders.

However, experts urge caution and highlight the need for further research to optimize dosages and ensure the safety of long-term psychedelic use, especially considering the cardiovascular risks and the necessity for tailored psychotherapeutic approaches in treating eating disorders.

Summary of Psychedelic Therapy

Psychedelic therapy utilizes classic psychedelics like psilocybin and non-classic substances such as ketamine and MDMA to treat a variety of mental health issues, from depression and PTSD to eating disorders and substance abuse. This emerging treatment is currently under extensive research to determine its benefits and risks. While most psychedelic drugs are illegal under federal law, exceptions include ketamine and esketamine, and some states are considering the legalization of psilocybin. Those interested in exploring psychedelic-assisted therapy should consult with healthcare professionals to assess their eligibility for treatment or participation in clinical trials.

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