Psychiatry Might Need Some Psychedelic Therapy

Treatment with psychedelic drugs provides a level of relief from suffering no amount of talk therapy or SSRI regimen has reached.

Nine years ago, I had my first psychedelic trip as part of a clinical trial at Johns Hopkins University School of Medicine’s Behavioral Pharmacology Research Unit. I was given two doses of psilocybin spaced a month apart to treat my cancer-related depression. The goal of the study was to determine whether psilocybin was effective in treating reactive depression. Prior to their 1971 prohibition, psilocybin and LSD were administered to approximately 40,000 patients, among them people with terminal cancer, alcoholics, and those suffering from depression and obsessive-compulsive disorders. The results of the early clinical studies were consistent: the drugs showed great promise in treating emotional maladies which had proven unresponsive to psychotherapy and psychiatric drug interventions.

Trial after clinical trial has been carried out with psilocybin since then, proving safety and efficacy. All of the studies echoed the early findings: psilocybin is far more effective in treating depression than SSRIs and talking therapy.

Dr Robin Carhart-Harris, Director of the Psychedelic Research Group, Neuropsychopharmacology Unit, Imperial College London, who has conducted numerous studies on the mechanism, safety and effectiveness of psilocybin to treat depression questioned the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in a 2018 paper, published in the journal World Psychiatry:

“Medication [with SSRIs] remains the dominant treatment for unipolar depression, and SSRI prescription rates have been increasing year-on-year at record levels. Such widespread SSRI use has not noticeably impacted on depression prevalence, however, and questions continue to be asked about the safety, efficacy and general philosophy of chronic pharmacotherapy.”

By contrast, the studies carried out over the last decade-plus show psychedelic treatment to be effective and long-lasting. Promising outcomes have been observed, studied and measured in addiction as well as other disorders.

These include obsessive-compulsive disorders, anxiety disorders, and demoralization syndrome, the distress people experience when facing terminal diagnoses or having undergone unmanageable, unchangeable life circumstances, such as the traumatic moral injuries brought on by simply doing one’s job: veterans following active combat; doctors and medical workers treating patients during the Covid-19 pandemic.

“That just one or two treatment sessions can yield therapeutic effects lasting for several months is unprecedented in modern psychiatry,” wrote Carhart-Harris.

Why then, is psilocybin treatment not available worldwide for treating mental illness and emotional disorders?

Dr Matthew Johnson, Professor of Psychiatry and Behavioral Sciences at Johns Hopkins, who has done seminal research on psychedelic treatment for tobacco addiction wrote of the stagnation in the psychiatric field in an article in the International Review of Psychiatry. “Psychiatry needs help,” he pointed out bluntly.

The US faces epidemic rates of suicide and opioid addiction fatalities.

“Bucking a decades-long trend in the opposite direction, between 1999 and 2013, mortality among middle-aged white, non-Hispanic adults in the US (i.e. a relatively advantaged demographic) showed a marked increase, primarily due to substance use and suicide,” wrote Dr Johnson. All of these are preventable and treatable behavioral disorders “the turf of psychiatry,” wrote Dr Johnson.

Psychiatry, he wrote, is in desperate need of fundamental mechanistic advances. The absence of any scientific argument for the efficacy of traditional talking-based psychotherapeutic treatment is so evident that the US National Institute of Mental Health (NIMH) no longer ties its funding decisions to the words written in psychiatry’s diagnostic Bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM). This is a huge change.

“Several years ago, the NIMH made the decision to no longer fund research that only uses [the DSM] to describe psychiatric illness, due to the framework’s relative lack of scientific rigor. Unlike other areas of medicine, psychiatry relies on a largely superficially descriptive, rather than mechanistic, understanding of its various disorders.” The absence of any scientific underpinning accounts for much of “psychiatry’s slow and modest advances in treatments, and resulting unmet clinical needs,” wrote Dr Johnson.

Now the scientific basis for the effectiveness of psychedelics is being demonstrated. In his paper in World Psychiatry, Dr Carhart-Harris describes how the neurotransmitter serotonin encodes—changes at the cellular level— behavioral and physiological responses to uncertainty in different ways in the brain, depending upon the conditions, such as an external threat, or crisis, or a person’s internal emotional state.

Serotonin works on the brain by attaching to brain cell receptors. One type of brain cell receptor—the 5-HT1A receptor— is more engaged during normal, relatively low-stress conditions, moderating anxiety and promoting general well-being. At times of crisis, however, the 5-HT2A receptor is more activated. During a psychedelic session, psilocybin molecules attach to 5-HT2A cell receptors, which promote a different response in the neuron downstream. The experience allows the suffering person to “relax prior assumptions or beliefs, held at multiple levels of the brain’s functional hierarchy: perceptually, emotionally, cognitively and philosophically (e.g., in terms of biases). In so doing, it opens a door to heightened sensitivity to context, an ideal pre-condition for effective change.”

Psychedelic treatment allows patients to become less rigid in their thinking patterns. Their emotional state is altered following the session. It is this result—changing rigid patterns of thought and belief about oneself and the relationship to the outside world—which psychotherapy has aimed for and mostly failed to achieve over the course of 160 years of practice, and which, in a matter of a few sessions, psychedelic therapy attains.