Why We Should Take Our Time on Psychedelic Therapy

Though psychedelic therapy is not yet available to the wider public, and the psychedelics themselves are illegal for recreational purposes, there’s a lot of research being done on this type of therapy.

A big reason is why is that in many completed studies, the treatment results look promising for depression, anxiety, PTSD, substance use disorder, and other mental illnesses.

In my opinion, however, it is vital that we take the time to fully research these potent substances and not fast-track them into the drug treatment marketplace.

What psychedelic therapy is, and how it’s purported to work

Psychedelic therapy uses psychedelic plant compounds that induce hallucinations. These compounds include LSD, psilocybin (mushrooms), mescaline, MDMA (Ecstasy), and others. The way the therapy is normally done, and the method that has proven to be most successful to date, is for a trained therapist to guide the patient verbally while they’re in a hallucinogenic state.

Doctors and researchers sometimes resort to psychedelic therapy with patients who have not responded well to more traditional drugs or therapies. This is often done via clinical trials.

Many researchers believe the real value of psychedelic therapy is not in the drugs themselves, but rather in the assisted therapy that happens during the heightened state. They believe the drug creates the “space” for the therapy to do its thing more thoroughly and profoundly than is normally possible in a therapy-only session. The psychedelic drug acts as a catalyst for a more enhanced therapy experience.

Afterward a psychedelic-assisted therapy session, patients receive what’s called “integration,” which is when the patient discusses with the therapist what they experienced.

One aspect that is most exciting about many of these study results is that patients often see an immediate improvement in their symptoms. Traditional medications for mental health conditions often take weeks to begin working.

The mechanism behind the results

The drug-as-catalyst model is the most likely scenario, but other factors may be playing a role as well. When psychedelic therapy works—and it doesn’t for everyone—one or more of these factors is the likely reason:

• Brain chemical changes: Neurotransmitters are chemical messengers in the brain. Psychedelic drugs may act to promote these neurotransmitters, which may change the brain’s behavior and improve mood.
• Mystical or psychedelic experiences: These drugs can bring about intense and meaningful thoughts that may shift a person’s belief system. This can cause people to think and act differently.
• Increased suggestibility: This is where the guided, or assisted, therapy comes in. A psychedelic drug can make a person more open to suggestions from a therapist—thus more open to what they’re experiencing during the session.

Three recent psychedelic studies of note

Researchers have used psychedelic therapy for people with terminal illnesses, eating disorders, depression, anxiety, addiction, and other conditions. Results have been promising in general, possibly most so with anxiety and depression. Some highlights:

• Treatment-resistant depression: In a 2017 study, researchers gave 20 people with severe depression two doses of psilocybin seven days apart, then tracked their symptoms for six months. After just five weeks, nine of the 20 subjects responded positively to the treatment, with four being in full remission from their depression.
• Depression, anxiety, and stress (DAS): In a 2021 study, after one psychedelic experience, study subjects reported significantly less self-obsession with negative thoughts and more self-compassion. Overall, subjects reported significant decreases in DAS symptoms.
• Anxiety disorder: A 2020 review of 24 previous studies on psychedelic therapy found that in two-thirds of those studies, people reported a reduction in their anxiety levels. Caveat: The review noted that the studies were small, and some had methodological flaws.

A cautionary tale about marijuana

Yes, many of the studies on psychedelic therapy have been promising. Yes, psychedelic therapy may work at certain times when traditional medications and therapies do not. And most of all, yes, I understand how desperate many long-suffering patients and their loved ones are to find relief and get their lives back.

However, it is urgent that we proceed with caution because, in my opinion, we didn’t do that with marijuana research over the last 10 to 20 years. The result of that haste is that marijuana is everywhere, and based on the overly positive hype around it, you would think it cures every ill under the sun. Also, you rarely hear about the potential risks—of which there are many.

For one, marijuana is a lot more powerful than it used to be. (Could psychedelics go down the same route?) A 2018 survey found that the average potency of weed was nearly four times what it was in the 1990s.

Also, marijuana is especially risky for adolescents and young adults, whose brains are still developing. Research has shown that people who begin using marijuana before age 18 are four to seven times more likely to develop cannabis use disorder than people who start using as adults.

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My point here is that we’re finding out about some of these serious marijuana risks after the fact. After the horse had already left the barn. Now that marijuana is everywhere and is marketed as the be-all and end-all for everything that ails you, it’s too late to pump the brakes while we do more research.

We need to maximize the therapies we already know about

It’s important to remember we have a lot of proven treatments in the mental health field. That’s certainly true in my area of addiction treatment.

Unfortunately, many treatments and therapies aren’t used as much as they should be. We need to be a lot better about that. Medication-assisted treatment (MAT) is a great example of a proven, evidence-based therapy that is underutilized, especially for opioid use disorder, but for other substance use disorders as well.

My bottom line: While we’re waiting for psychedelic therapy to get the proper signoff by the research community, let’s make the best use of the mental health drugs and therapies we currently have.