The Promise of Psychedelic-Assisted Psychotherapy

Psychedelic-assisted psychotherapy (PAP) involves ingesting a psychedelic substance as part of a psychotherapeutic process – that is, the professionally supervised use of ketamine, MDMA, psilocybin, LSD, and ibogaine as part of talk therapy.

Entheogens

Lesser known psychedelic drugs include Ololiuqui (found in the seeds of the morning glory flower), Khat (found in the leaves of the East African shrub Catha edulis), peyote (a small, spineless cactus native to Mexico and Texas which contains the psychoactive alkaloid mescaline), DMT (found in certain plants from South America), harmine (from a South American Vine) and 5-MeO-DMT and bufotenine (from the venom of certain toads).

Ketamine and MDMA

While traditional antidepressants can take weeks to work, the therapeutic antidepressant effect of ketamine - an antagonist of the NMDA (N-methyl-D-aspartate) receptor and one type of receptor for glutamate - is both immediate and long lasting. MDMA is being researched as a revolutionary therapeutic modality for posttraumatic stress disorder (PTSD). Ibogaine is said to have therapeutic effects for opiate addiction.

Besides its profound antidepressant and anti-suicidal effects, ketamine is also being explored with promising preliminary results for the treatment of alcoholism. DMT’s traditional use has been in South America in ancient religious ceremonies. Psychedelics have shown benefit in the reframing of purpose and reduction of anxiety in end- of-life and hospice care settings. A large-scale study showed that words used to describe near death experiences (NDEs) were closely correlated with words used by persons describing their ketamine experience.

How Psychedelics Work

A recent survey showed that 65% of affected Americans want access to psychedelics for the treatment of mental health conditions, including treatment-resistant anxiety, depression, and posttraumatic stress disorder (PTSD). Researchers now better understand precisely how psychedelics work. The perception-altering effects are thought to be caused by action on neural circuits in the brain that use the neurotransmitter serotonin.

Specifically, many of the effects occur in the prefrontal cortex, which is involved in mood, cognition, and perception. Psychedelics significantly reduce the activity in the brain’s default mode network (DMN). The DMN refers to a set of brain regions more active during rest than the execution of a goal-directed task. DMN activity is correlated with the experience of our mind wandering, the capacity to imagine mental states of others, and our ability to project ourselves into the past or the future. A reduction in the DMN activity functions as a “rebooting” of the brain, which is thought to be essential to the enduring therapeutic effects of psychedelics.

Psychedelics re-route neural traffic to free up the overloaded pathways - preventing a continuous loop of negative focus. Furthermore, psychedelics can also elevate feelings of empathy and allow people to more freely contemplate mental pain and ego loss. Thus, the benefits of psychedelics are as far reaching as enhancing creativity and problem solving, reducing mental anguish, to confronting and embracing our mortality.

Nature recently published startling results of a Phase-III clinical trial of MDMA-assisted psychotherapy. After three sessions, more than two-thirds of patients with severe PTSD saw their symptoms reduced to the point that their condition no longer met PTSD diagnostic criteria. Another study showed that the antidepressant effects of psilocybin-assisted supportive psychotherapy last at least a year for many patients.

Psychedelics may also have protective mental health effects. Pooling over 190,000 adults, researchers evaluated the relationship of classic psychedelic use, psychological distress, and suicidality. According to a 2015 Journal of Psychopharmacology study, lifetime psychedelic use was associated with significantly reduced odds of past-month psychological distress and past-year suicidal thinking, planning, and attempts. This offers new and promising insights into the potential of psychedelics in suicide prevention and treatment.

Obstacles to Therapeutic Use

1. FDA Approval: The use of psychedelics and research studies on them were made illegal in the ’60s. Laws were passed and psychedelics were classified as a Schedule 1 drug - the highest, most-restricted, and regulated drug of the U.S. Controlled Substances Act of 1970.

Similar laws were passed internationally and research into psychedelics as a mental health treatment option came to a grinding halt. But, fast forward 60 years, and evidence from the Multidisciplinary 11 Association for Psychedelic Studies could lead to FDA approval as early as 2023. Such approval would be groundbreaking. The US Food and Drug Administration (FDA) has also shown interest in prioritizing the approval of certain psychedelic drugs. Both psilocybin-assisted psychotherapy for major depressive disorder and MDMA-assisted psychotherapy for PTSD have already received breakthrough therapy designation from the FDA to fast-track the approval process. This stems from the mounting clinical evidence demonstrating substantial benefits from psychedelics.

Ketamine Essential Reads

What to Know About Ketamine-Assisted Psychotherapy

Rediscovering Ketamine

Clinician Embrace and Stigma: The use of psychedelics is stigmatized because of the association with a counterculture and its illegal status. Even after FDA approval, there will inevitably be some residual resistance among some psychiatrists and therapists to fully embrace their use.

However, the fact that conventional medications are ineffective for nearly 30% of patients and patients are increasingly seeking treatment alternatives - including psychedelics - openness is likely to significantly increase over time. And for the millions of people mentally suffering each day who have already tried yet found inadequate relief from other mental health interventions, this renewed hope and potential for treatment cannot come a day too soon.