“There is a growing recognition that there is no health without mental health, that the body and mind are integrally connected,” says Danovitch. “Our culture’s current gravitation to natural substances probably also contributes to the current wave of openness to rediscovering agents that have long existed on the periphery of society and have powerful effects promoting self-reflection, empathic connectedness, and sometimes adaptive change.”
Psilocybin (4-Phosphoryloxy-N,N-Dimethyltryptamine)
LSD (D-Lysergic Acid Diethylamide)
MDMA (3,4-Methylenedioxymethamphetamine)
Ketamine
Peyote (Mescaline)
“There is evidence that the brain becomes more flexible or ‘plastic’ after a psychedelic,” says Johnson. Kelley O’Donnell, MD, PhD, an assistant professor of psychiatry at the New York University (NYU) Grossman School of Medicine and a researcher at the NYU Langone Center for Psychedelic Medicine, puts it this way: Psychedelic drugs allow patients to access parts of themselves that are ordinarily inaccessible. As Dr. O’Donnell explains, “The human brain is fundamentally a learning machine, and it derives its power from its ability to learn and recognize patterns and use those patterns to predict the future. It seems that psychedelics make that pattern much more flexible, so you have a window of opportunity to reopen a period of development, so even after the psychedelic experience, you can make choices and establish new patterns.” How each psychedelic drug affects the brain and body depends on the drug class to which it belongs. MDMA is an entactogen, which works by flooding the spaces between brain cells with serotonin, Johnson explains.
Psilocybin
LSD
Ketamine and Esketamine
MDMA
Some of the most compelling results for MDMA as a treatment for mental illness have come from clinical trials involving people with PTSD. In a study with 90 participants, investigators found that 67 percent of people treated with MDMA-assisted therapy no longer met the diagnostic criteria for PTSD 18 weeks after starting treatment.
Supportive Therapy Is Essential, Too
Although the research on psychedelic medicine is promising, it’s important to note that these studies involved very careful administration of these drugs in a clinical setting under the supervision of doctors. Currently available research consists of very small, short-term studies, many of which are performed in specific groups of patients (such as people with life-threatening illnesses, for instance). This means that the findings from these studies may not be applicable to everyone being considered for psychedelic therapies. In addition, many studies also included supportive care in the form of psychotherapy. “For clinical indications, psychotherapy appears to be necessary to support and facilitate change,” says Danovitch. He adds that therapy protocols typically involve the following phases:
Assessment phase During this phase, a mental health professional and the patient set goals for therapy.Preparation phase This phase is intended to get patients physically and emotionally ready for treatment.Experience phase During this phase, health professionals monitor patients carefully as they take the medication.Integration phase This phase focuses on helping patients reflect and learn from the experience after treatment with the psychedelic has ended.
O’Donnell says this type of support, including preparing the patient for what will happen when taking the medication, is vital for successful treatment. “If someone has no idea what they’re in for and someone gives them a psychedelic, that can be a really traumatic experience,” O’Donnell says. “A lot of people have the idea that it’s a one-and-done and your life is transformed forever, and that’s really not the case. That takes it out of the context of a therapeutic relationship, which is so important.”
Individuals prescribed psychedelic therapies should always be clinically monitored and should never try to take the drugs on their own. “It is important to have supervision anytime someone consumes anything that dramatically alters perceptions of reality,” says Danovitch. “It’s receiving attention because of very large effects for very difficult to treat disorders — effects that often dwarf our best existing medications,” Johnson says. “That, combined with the fact that we are at peak levels of mental health trouble as a society and we’re pretty desperate for breakthrough changes. This shows good promise of being a game-changer,” he adds. Still, Johnson and others say more extensive, rigorous studies need to be done before psychedelic drugs can be considered a mainstream therapy. And although studies are showing positive results, there are still many unknowns, such as the ways these drugs will be administered if they become FDA-approved. “There are so many questions we have to study that we don’t know the answers to,” O’Donnell notes. O’Donnell says she envisions specialized psychedelic clinics popping up in areas around the country where patients will receive guidance, support, and psychotherapy along with psychedelic treatment. While the future of psychedelic therapy offers exciting possibilities, O’Donnell emphasizes that overcoming mental health disorders is a process that often takes time and hard work. “Changing one’s life isn’t something that happens in an instant. It’s something we have to commit to and live out,” O’Donnell says. “Psychedelics give us an opportunity to settle into a new pattern, but we still have to choose that pattern and establish it consciously. There’s a real responsibility, and it can be a lifelong journey.”
