When it comes to mental health treatment, there have been two basic, and often opposing, views as to the best approach: pharmaceutical or psychotherapeutic. Psychedelic therapy is a treatment option that unites both, Robin Carhart-Harris, PhD, explained at the 2020 virtual Psych Congress Elevate conference.
“You have the drug camp, and then you have the psychotherapy camp, and they don’t really get on. In fact, they often fight,” said Dr. Carhart-Harris, head of the Centre of Psychedelic Research at Imperial College London in England. “Wouldn’t it be wonderful if we had an intervention that was biological, that truly affected the brain on a direct level and also opened things up for therapeutic work? The argument is that psychedelic therapy really does that well in a synergistic way.”
During his session, Dr. Carhart-Harris characterized psychedelic therapy as “quintessentially biopsychosocial.” When used in the appropriate context with professional support, psychedelics such as psilocybin, DMT, and LSD offer promise for helping people undo negative habits or biases associated with a range of mental health disorders to achieve improved well-being, according to the presentation.
Inducing Pivotal Mental States of Plasticity
Coined in the 1950s, the term psychedelic means to reveal the mind or soul. Molecularly, psilocybin, DMT, and LSD are similar to serotonin, which modulates a number of key functions in the brain, Dr. Carhart-Harris explained. The mechanism of action of psychedelic drugs appears to involve serotonin 2A receptors in the cortex. Serotonin 2A receptor agonism via psychedelic compounds stimulates plasticity and adaptability in the brain, and can create what Dr. Carhart-Harris termed “pivotal mental states” of pure plasticity.
“The key question is, what do you do with that plasticity?” he said. “If someone spiked your drink at Burning Man, you might trip out and have a psychotic episode, and things aren’t going to go well. But if you take a psychedelic with a perfectly nurturing, supportive pair of therapists or guides, it could be really beneficial.
“You could explore the furthest reaches of your mind and release a lot of trauma and repressed material, work through it, and come upon insights that are healthy and useful to improving mental health.”
Growing Evidence Base Offers Promise
Psilocybin shows promise for improving well-being and easing symptoms of depression, addiction, end-of-life distress, and obsessive-compulsive disorder. The environment a psychedelic drug is administered in, however, is important. In an optimal context, therapeutic guides prepare patients, sit with them during the experience, and talk with them afterward to help glean insights and integrate lessons. Trait absorption, therapeutic intentions, and listening to music all appear to affect emotional breakthrough and long-term outcomes.
“I saw negative patterns in my life where if something bad happens, I used to just put it to the back of my mind,” recalled a patient with treatment-resistant depression who received psilocybin therapy in a trial. “Afterwards, I allowed myself to experience everything—even if it is sadness. Now I know how to deal with my feelings rather than repress them.”
One participant described openly crying during psilocybin therapy—not in pain, but “like a washing, a washing out.” Another described a renewed ability to experience beauty after receiving psilocybin therapy. Although that study was open-label, the effect sizes of psilocybin in patients with treatment-resistant depression were huge, Dr. Carhart-Harris said.
More recently, he and colleagues performed a double-blind randomized controlled trial comparing two session of psilocybin therapy with 6 weeks of the antidepressant escitalopram. He urged conference attendees to watch for published findings.
“The results are really exciting…Psilocybin therapy comes out very well in this trial,” Dr. Carhart-Harris said with a quick smile. “I wish I could say more, but I can’t. But the safety and efficacy outcomes are really, really promising.”
— Jolynn Tumolo
“Therapeutic Mechanisms of Psychedelics: Changing the Landscape of Psychiatric Treatment?” Presented at Psych Congress Elevate: Virtual; July 26, 2020.