Unlocking the Mind: An Introduction to Psychedelic-Assisted Psychotherapy

Trends are fascinating, aren’t they? Sometimes, they move slowly, predictably, forward. Other times, quantum shifts and disruptions occur. Perhaps most intriguingly, sometimes a trend involves rewinding the clock, re-popularising something of the past. Let’s explore one such trend today.

Today, we’ll explore an emerging trend that has re-ignited ancient wisdom. From the Aztec tribes of South America to the modern-day psychiatrist’s office, psychedelics are experiencing a resurgence.

From my own experience, my mental health drastically changed after a few eye-opening experiences. Depression, anxiety and my view on life changed in an instant, almost like a switch had been flicked in my head. But beware: this is not an endorsement, and these powerful substances should be treated with the respect they deserve.

What is Psychedelic Assisted Therapy?

Psychedelic-assisted therapy (PAP) is an exciting area of therapeutic potential. Research on drugs like psilocybin, MDMA, LSD and ketamine has arguably been held back for years by illicit drug classifications. But times are changing. Evidence is mounting. And legal frameworks are evolving.

The modern scientific method is finally catching up with the long-held wisdom of specific indigenous communities. Early evidence is showing ground-breaking use cases for psychedelics for treating mental health issues, from addiction to depression and anxiety to post-traumatic stress disorder (PTSD)¹.

Leading the charge in this innovative field are the Johns Hopkins Center for Psychedelic and Consciousness Research and MAPs (the multidisciplinary association for psychedelic studies²), among other institutions dedicated to unlocking the therapeutic benefits of psychedelics through rigorous scientific exploration.

Which Substances Are Used in Psychedelic Therapy?

In the world of psychedelic therapy, several substances have emerged as frontrunners aiming to alleviate various mental health conditions. These include:

Psilocybin: This compound, naturally occurring in certain mushroom species, has garnered attention for its efficacy in addressing depression, anxiety, and addiction. Its ability to catalyse profound psychological insights and emotional processing is central to its therapeutic potential³ ⁴.

MDMA: Commonly known as ecstasy, MDMA has been explored for its unique effectiveness in treating post-traumatic stress disorder (PTSD) and enhancing social interaction and empathy in adults on the autism spectrum. Its empathogenic effects make it a valuable tool in psychotherapy⁵.

LSD: This synthetic psychedelic has been studied for its potential benefits in managing anxiety and depression. Its long-lasting psychoactive effects can facilitate deep introspection and psychological flexibility⁶ ⁷.

Ketamine: Unlike the other substances listed, ketamine is primarily known for its rapid antidepressant and analgesic effects, offering a novel approach to treatment-resistant depression. Its relatively short-lived effects and unique mechanism of action distinguish it from classic psychedelics⁸.

These substances are administered in controlled clinical environments, ensuring safety and maximising therapeutic outcomes. Under the watchful eye of trained therapists, patients embark on guided psychological explorations, leveraging the unique properties of these psychedelics within a structured psychotherapeutic framework.

How Do Psychedelic Drugs Work?

Understanding the mechanism by which psychedelic drugs exert their effects is crucial to appreciating their therapeutic potential.

Research indicates that psychedelics such as LSD facilitate significant neuroplastic changes, promoting neurogenesis and the fortification of dendritic spines. They have been observed to enhance the complexity of dendritic arbors, increase dendritic spine growth, and stimulate both spinogenesis and synaptogenesis in cortical neurons. This leads to increased dendritic spine density on cortical neurons, effectuating structural and functional transformations within the brain.

Additionally, psychedelics are known to significantly influence the production of brain-derived neurotrophic factor (BDNF). This critical protein supports neuron survival and facilitates the growth and differentiation of new neurons and synapses.

What does this all mean? Well, in the most basic terms, psychedelics can help the brain grow and form new connections, making it more flexible and capable of change. Psychedelics boost a particular protein in the brain that allows neurons to live longer, develop, and connect, enhancing the brain’s ability to adapt and repair.

The alterations precipitated by psychedelics and the enhanced neuroplasticity typically manifest within hours of psychedelic exposure. They can persist for several days, impacting brain structure and function profoundly.

The anti-inflammatory effects of psychedelics represent another vital aspect of their action, contributing to their therapeutic efficacy in conditions associated with neuroinflammation. By promoting neuroplasticity and exerting anti-inflammatory effects, psychedelics offer a promising avenue for treating a variety of mental health conditions.

Psilocybin: An Overview

Psilocybin, the active ingredient in “magic mushrooms,” is like a key that fits into special locks in our brain called serotonin receptors, particularly one subtype known as the 5-HT2A receptor⁹.

This interaction causes changes in perception, thought, and feeling, leading to experiences that can vary widely. These can include shifts in how we see the world, deep emotional insights, and even feelings of merging with the universe. These effects typically start within 30 to 60 minutes of taking psilocybin and can last between three and six hours.

Research into psilocybin’s effects has revealed its potential for treating mood disorders and addiction, suggesting it could help people see and experience the world in new ways that reduce feelings of sadness or the need for addictive substances. When given in a safe, controlled environment, psilocybin is considered safe, with a low risk of addiction or lasting adverse effects.

The science behind why psilocybin can help is still being unravelled. It appears to change how different parts of the brain talk to each other, affecting areas involved in deep thought, mood regulation, and our response to emotional events. This might explain its ability to lessen symptoms of depression, including in those who haven’t found relief with traditional treatments, and its potential benefits for anxiety and addiction.

Essentially, psilocybin might help ‘reset’ brain circuits stuck in unhelpful patterns, offering new perspectives and mental flexibility that can lead to lasting positive changes.

MDMA: An Overview

MDMA, commonly recognised by its street names Ecstasy or Molly, acts like a volume knob for certain chemicals in the brain—serotonin, norepinephrine, and dopamine¹⁰. Turning up these chemicals enhances joy, emotional bonding, and understanding towards others while simultaneously dialling down fear and defensiveness.

In therapy settings, MDMA has shown promise in helping people with PTSD open up more quickly and process difficult memories during talk therapy sessions. Studies have found that this approach can significantly lessen PTSD symptoms to the point where some individuals no longer meet the criteria for PTSD after treatment¹¹.

By combining MDMA with guided therapy, there’s potential for a breakthrough treatment method for those who haven’t found relief through traditional therapies. Essentially, MDMA could help rewrite the emotional responses tied to traumatic memories, offering hope and a new path forward for individuals struggling with PTSD.

LSD: An Overview

LSD, short for lysergic acid diethylamide, is a bit like a universal remote for the brain’s chemical receptors, especially those for serotonin and dopamine. This interaction can significantly alter a person’s outlook, reduce fears and anxieties, and even encourage the growth of new neurons.

Within psychedelic-assisted therapy, LSD is predominantly under study for its ability to help with depression, PTSD, and anxiety. When LSD is used in a safe, controlled environment, like a therapist’s office, and combined with professional guidance, it has shown potential to aid in mental health improvement.

The clinical use of LSD can allow individuals to step back and see their lives and challenges from a broader perspective, often leading to profound insights and emotional breakthroughs. The scientific literature is currently most robust for treating alcoholism, but studies for many other mental health conditions are ongoing, indicating a promising future for LSD in therapeutic settings¹².

What Does the Law Say?

¹³The legal landscape is as complex as the substances themselves. In the United States, most psychedelics fall under Schedule I of the Controlled Substances Act (CSA), marking them as substances with a high potential for abuse and no recognised medical value, thus making their use illegal. Despite this, a wave of reform at the state and local levels is challenging these federal restrictions, creating a patchwork of laws that vary significantly across the country.

Across the pond in the United Kingdom, the legal stance is similarly restrictive. Magic mushrooms and LSD are categorised as Class A drugs, the classification reserved for the most severe substances in terms of legal penalties. MDMA joins them in this highest category, underlining its prohibited status. Ketamine, while also illegal for recreational use, is classified as a Class B drug, indicating a slightly lesser degree of legal severity but still significant penalties for unauthorised possession and use¹⁴.

Both the US and UK positions underscore the complexities surrounding the legal and social acceptance of psychedelics despite growing interest and evidence in their potential therapeutic benefits¹⁵. This legal landscape is in flux, with ongoing research and changing public opinion potentially influencing future legislation.

What Is The Current Status of Psychedelic-Assisted Therapy (PAP)?

Psychedelic-assisted psychotherapy (PAP) is at the forefront of a mental health revolution in both the UK and the US, targeting conditions that have long challenged traditional treatments. Key areas of focus include:

Treatment-Resistant Depression (TRD): Psychedelics like psilocybin and MDMA are under research for their potential to break through where other treatments have failed. Recognising their promise, the US FDA has labelled MDMA and psilocybin as “breakthrough therapies.”
Post-Traumatic Stress Disorder (PTSD): Studies are showing that MDMA-assisted therapy, in particular, can significantly reduce PTSD symptoms, offering new hope to sufferers.
Anxiety Disorders: Ketamine is being explored for its ability to ease anxiety symptoms, with promising results that could redefine anxiety treatment.
Addiction: The potential of psychedelics to treat various addictions is also under investigation, with ketamine leading the way in some of these studies.

In terms of regulatory progress, both the UK and the US are cautiously but progressively moving forward. In the UK, the Medicines and Healthcare Products Regulatory Agency (MHRA) has greenlit pioneering human trials for psilocybin, marking a significant step towards embracing psychedelic research¹⁶. Similarly, in the US, the FDA’s “breakthrough therapy” designation for certain psychedelics aims to expedite their journey from research to clinical application.

Despite these advancements, widespread regulatory approval for therapeutic use remains elusive, with psychedelics mainly in the clinical trial phase. However, the expedited regulatory processes in the UK for psychedelic trials and the FDA’s acknowledgement of their therapeutic potential in the US signal a burgeoning recognition of PAP’s value in mental health treatment. This evolving landscape indicates cause for cautious optimism for the future of psychedelics in therapy, balancing scientific exploration with regulatory prudence¹⁷ ¹⁸.

TLDR;

We are standing at the threshold of a new era in mental health treatment. PAP offers a glimmer of hope for those grappling with some of the most intractable mental health challenges. This introduction to PAP, from its innovative approaches and the substances it employs to its profound impact on brain function and therapeutic potential, highlights a pivotal shift in our understanding and treatment of mental health.

The exploration of psilocybin, MDMA, LSD, and ketamine within therapeutic contexts not only illustrates the vast potential of these substances but also highlights the complexity of their integration into mainstream medical practice. Research continues to unravel the intricate mechanisms through which these psychedelics operate. Their ability to remodel the neural landscape and foster emotional and cognitive flexibility promises a revolutionary approach to healing.

However, this journey is not without its challenges. The legal and regulatory landscapes in the UK and the US reflect the tension between historical scepticism and emerging scientific evidence. This necessitates a nuanced dialogue to balance safety, ethics, and accessibility. The designation of certain psychedelics as “breakthrough therapies” by regulatory bodies marks a significant, though initial, step towards reconciling these complexities, paving the way for more inclusive and scientifically grounded policies.

The promise of PAP encapsulated within this article invites us to reimagine the possibilities of psychiatric care. We should all advocate for a world where mental well-being is accessible, compassionate, and deeply attuned to the intricacies of the human psyche. Of course, it should go without saying that you should not try any of these substances in an uncontrolled environment without the expertise and guidance of a qualified medical professional.

References

[NB. All images created using MidJourney]

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