Dismissed and criminalized for decades, psychedelics were thought to offer nothing beyond mind-bending hallucinations. However, as times change, scientists are beginning to re-explore the medicinal benefits of psychedelics for treatment-resistant mental health conditions. Research has shown that drugs such as psilocybin and MDMA can be effective for treating a range of psychiatric conditions, including depression, anxiety disorders, PTSD, and alcohol and substance use disorders.
Medical reports on psychedelics date back to the 1890s, noting their profound effects on perception and cognition, and their potential value for psychology. However, increased recreational use, concerns about safety and abuse, and shifting political attitudes led to the prohibition of psychedelics by the early 1970s. It is only in the last couple years that scientists have begun to revisit the implications of psychedelics for mental health disorders.
40%–60% of people with PTSD do not respond to the selective serotonin reuptake inhibitors (SSRIs) that are first-line medications for the condition, and many also do not respond to trauma-focused psychotherapies. Additionally, about a third of people diagnosed with major depressive disorder experience treatment-resistant depression. When symptoms are not solved with therapy and medication, there is often no next step for patients. Psychedelic treatment provides a potential alternative in these cases.
“40%–60% of people with PTSD do not respond to the selective serotonin reuptake inhibitors (SSRIs) that are first-line medications for the condition.”
Chronic stress, PTSD, and depression can damage brain circuits, particularly in the prefrontal cortex. Psychedelics, such as psilocybin and methylenedioxy-methamphetamine (MDMA), repair damaged brain circuitry faster than SSRIs and promote structural neuroplasticity required for recovery and improvement. Clinical trials found that psychedelics seemed to open a window of flexibility, relax higher level processes, and increase sensitivity to bottom-up information. This allows patients to deconstruct patterns, behaviors, thoughts, and emotions that exacerbate their condition.
These benefits seem promising, but the procedures behind psychedelic treatment are incredibly important to ensure safety and minimize risk. In most studies, a preparation phase is included to discuss the aims of the individual and the supposed therapeutic outcomes. Subsequently, drug sessions are conducted that last between 45 minutes and eight hours. These are always supervised by at least one clinician and are often held in comforting, living-style rooms rather than a medical office. Therapists aim to direct the participants’ attention inward and provide verbal and non-verbal support during challenging moments. Following the trial, there is usually an integration phase, in which patients are encouraged to discuss or write about their experience to consolidate memories and promote positive change.
Medicinal use of psychedelics differs greatly from recreational use in that the substances and amounts are regulated, only used when other treatments are ineffective, and supervised by clinicians. However, there are dangers and risks associated with the use of psychedelics in any setting. Patients undergoing treatment can uncover dark or traumatic memories and experience profound emotion in an unfamiliar and uncomfortable way. Therefore, proper therapeutic support is a key aspect of success in psychedelic therapy. Jennifer Mitchell, PhD, is a professor in the Departments of Neurology and Psychiatry and Behavioral Sciences at UC San Francisco who led an MDMA therapy study in 2023. Mitchell explained that “the partnership between the patient and a savvy care team was a critical aspect of the experience in the clinical trial.”
The preliminary evidence collected from completed studies is encouraging for the medicinal benefits of psychedelics; however, further placebo-controlled clinical trials need to be conducted before this treatment can reach the general public. With adequate preparation and medical support, scientists are optimistic that psychedelic therapy can provide hope for mental health patients who have run out of other options. There is more to psychedelics and the human mind than we are aware. The shift to open-mindedness when approaching mental health issues and treatments can potentially lead to other creative solutions, and shape a more accepting medical environment for patients.
“With adequate preparation and medical support, scientists are optimistic that psychedelic therapy can provide hope for mental health patients who have run out of other options.”