Can psychedelics treat mental health conditions?

WHAT THE SCIENCE SAYS ABOUT PSYCHEDELIC-ASSISTED THERAPY

By Jackie Menjivar

(Milad Fakurian / Unsplash)

This article is based on Mental Health America’s October 2022 Regional Policy Council Meeting: Taking a Look at Psychedelic Therapies.

Psychedelic medicine isn’t a new thing. There’s a long history of humans using consciousness-altering plants and fungi for mental and spiritual wellness. It’s been a part of traditional Indigenous healing practices for centuries — waaay before lab-made drugs hit the psychedelic research scene in the 1950s and ‘60s. 

Today, clinical trials are exploring the ways natural and synthetic psychedelics can help people improve their mental health. If you’re wondering what that actually looks like (including the methods, benefits, and risks), here’s what the science says. 

How does psychedelic therapy work in the brain?

“Classic” psychedelics (psilocybin, LSD, ayahuasca, DMT) stimulate a brain receptor called serotonin 5-HT2A.

“By stimulating it, the brain’s network connectivity is vastly enhanced, which then reduces this continuous chatter we have in the head that says, ‘Don’t do this, or don’t think that, or think this,’” says Dr. Rakesh Jain, MD, MPH, and co-founder of Jain Uplift. “That constant brain chatter over our emotional life is reduced, which then leads to a freeing of the mind, so to speak — reorganization with new patterns, alleviation of symptoms, and neuroplasticity.”

So…what does that actually mean? Here’s an example: you’re hanging out with friends, and you’re feeling really cared for and connected to them. But if you have depression, you might have these looming thoughts that hold you back — this voice in the back of your head that tells you you’re not worthy of their friendship or that they’ll eventually leave you. The top-down control (negative thoughts about abandonment and self-worth) keeps you from experiencing the bottom-up information (a good time with your friends). 

DMT quiets the negative brain chatter, which lets you fully experience the positive things. That also makes you more open to new ideas — like the belief that you are loveable and deserving of care.

“We all believe in muscle memory, but for some reason, we always put the ‘muscle memory’ terminology into only physical memory. We’ve never really put it into behavioral memory,” says Kathryn Walker, APRN, CRNA, PMHNPS, and founder of Revitalist. “Psychedelics help take the brain to a neutral space, and they help the default mode network to kind of reset itself.”

“Psychedelics can change rigid thinking into a more flexible, more positive way that a person can live their life,” says Dr. Rakesh Jain. “It’s almost as if their way of thinking has changed. Their way of interacting with themselves has changed. Their way of interacting with stress has changed.”

How does psychedelic-assisted therapy work?

“For these different mental health challenges, it’s almost like we become a bit rigid. We become like a trap that’s just rusted shut,” says Dr. Saundra Jain, MA, PsyD, LPC and co-founder of Jain Uplift. “So we behave in the same way, we have the same thoughts, and our brain is not communicating in a way that allows for psychological flexibility. Psychedelics disrupt that rigidity.”

That’s the key concept behind psychedelic-assisted therapy (PAT) — where a person takes psychedelic medication along with highly-skilled therapeutic support. This is still a relatively new field of study, so there’s a lot of different ways that it’s been conducted in clinical settings. But here’s (generally) what PAT might look like. 

A client will go to their psychedelic therapy provider for an initial screening and consultation. The provider will make sure the person is a good candidate for PAT and figure out the right treatment plan based on their goals and needs. Then, under the supervision of the provider, the client takes the medication and is guided through their psychedelic experience. This can happen over the course of multiple sessions. 

“During a psychedelic experience, little bits and pieces may be revealed to people — learnings, messages, and things they may see while in that non-ordinary state of consciousness,” says Dr. Saundra Jain. “The process of integration is taking those pieces of the puzzle and creating the whole. It’s what we refer to as ‘meaning-making’.”

Integration happens after the psychedelic experience. Therapists help clients take the new thoughts, feelings, and learnings that came up during the experience, and translate it into positive changes in their daily lives. 

“Psychedelics help take the brain to a neutral space, and they help the default mode network to kind of reset itself. That’s where that therapy piece is so important,” says Kathryn Walker. “If you’re able to reset your typical mode of thinking with memory, you really need someone there who’s an objective party, who’s there to guide you, lead you, or to process.” 

Which psychedelics are used for mental health treatment? 

There are lots of psychedelics being researched for their mental health benefits, but these are the ones that are usually in the spotlight: 

Ketamine: This is a lab-made psychedelic and FDA-approved anesthetic with dissociative properties. It’s also being researched as an antidepressant (both with and without psychotherapy). Multiple studies have shown that a single dosage can rapidly reduce suicidal thoughts and depressive symptoms in as fast as a few hours. This makes it a promising treatment for acute mental health crises. 

Psilocybin: This is a naturally-occurring chemical found in certain fungi (AKA “magic mushrooms”). One study found that psilocybin worked just as well as the antidepressant escitalopram (Lexapro) for improving symptoms of depression, and it worked better at improving overall wellness. It’s also been successfully used in PAT to reduce symptoms of both anxiety and depression.

MDMA: This is a lab-made drug with stimulant properties that’s best known for its ability to help people heal from traumatic experiences. MDMA-assisted psychotherapy has been shown to be effective for improving PTSD symptoms. 

This really is just scratching the surface. There have been studies that involve other substances and their impact on a huge range of mental health conditions (including substance use, eating disorders, and OCD). For more in-depth clinical evidence for psychedelic-assisted therapy, check out Psychedelic Medicine: A Review of Clinical Research for a Class of Rapidly-Emerging Behavioral Health Interventions, from BrainFutures.

What are the risks of psychedelic-assisted treatment?  

“We should not take the approach that psychedelics are good for everybody, or psychedelics are bad for everybody,” says Dr. Rakesh Jain. “It’s more nuanced. It appears they are, on the whole, better for most, but they can be harmful for some.”

One study surveyed people who had at least one psychedelic experience in their lifetime. About 13% of those people reported negative outcomes of their psychedelic use — the most common harms were increased cannabis and tobacco use. 

“The beautiful thing that we’re seeing with psychedelics right now is that the benefits greatly outweigh the risks. Some of those risks that we do want to mention — which are very theoretical, but they should be considered — are serotonin syndrome…as well as glutaminergic storm, “ says Kathryn Walker. 

According to Dr. Rakesh Jain, psychedelic use could be especially problematic for people with a family history of psychotic disorders or who severely struggle with suicidal thoughts. That’s why a thorough screening is so important for supervised psychedelic use. 

Are psychedelics legal for psychiatric use?  

As of right now, people in the US can legally consume psychedelics pretty much only in the context of clinical trials. As psychedelic research grows, more and more trials are being conducted to test the effectiveness of psychedelics as medications and therapy tools. 

You can find and join clinical trials conducted by:

Oregon is the first state to vote to legalize psilocybin for personal use — this includes (but isn’t limited to) mental health treatment. The measure goes into effect in 2023, and the state is still ironing out their plan for state-certified, supervised psychedelic centers. 

Although psychedelic use still isn’t legal in most places, we know that that won’t stop people from seeking these substances out through other, illegal methods. Harm reduction resources are helpful in situations where people aren’t under professional supervision and need help with difficult psychedelic experiences. Here are a few: 

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There’s still a lot we don’t know about psychedelic therapy — and there’s a lot that we do. From scientific papers to Netflix documentaries, it feels like psychedelics just keep making headlines. And you can expect to see a lot more of it as the science continues to grow. 

“It’s quite remarkable. Five years ago, I just didn’t have these kinds of conversations with my patients. People are more aware and very interested in [psychedelic therapy].” says Dr. Saundra Jain. “We want the research to guide our steps forward. If we can just hold tight, I do believe that these will be available in a medicalized setting.” 

MedicationKristina Benoist