Treating mental health issues with psychedelic drugs such as MDMA, LSD and psilocybin, the compound found in magic mushrooms, is one of current science’s most interesting and dynamic fields. Research into those drugs was impossible for decades after they were criminalised in the mid-1960s, just when studies exploring potential benefits were taking place.
Since the mid-2000s, determined scientists at, for example, Johns Hopkins University in the US and Imperial College, London, have fought to overcome government opposition and carry out clinical trials. The results have been highly promising, rekindling the belief that psychedelics could be beneficial to sufferers of depression, PTSD, addiction and other mental health problems. Investors are backing start-ups and other commercial ventures in the field, and this August, Europe’s first commercial psychedelic research clinic opens in London.
Media reports of ‘magic mushrooms curing depression’ have positively spun research findings and taken the idea of psychedelic treatments mainstream. (More in-depth explorations, such as the documentary Magic Medicine, available on Netflix, and Michael Pollan’s 2018 book How To Change Your Mind, give a more nuanced view.) One of the best sources of information in this area is the free twice-weekly email newsletter The Microdose, published by the UC Berkeley Center for the Science of Psychedelics in California and written by Jane C Hu, who has her finger on the pulse of psychedelics like no one else.
MH: Why is psilocybin the raw material of choice in psychedelic research?
JCH: It’s out front in terms of what people are studying. MDMA is almost neck and neck. Ketamine is also mentioned in the same breath; if you talk with chemists and biologists, they would tell you that ketamine does not operate in the same way in the body as psilocybin and MDMA.
MH: What links the various approaches and types of research?
JCH: People are concerned that current antidepressant drugs tend to have serious side effects and only seem to be effective about half of the time. So a lot of people who have tried those and found they didn’t work for them are eager to find something new. Most of the research so far has focused on treating depression, PTSD and addiction. I’ve also seen trials in place, or proposed, to see if psychedelics can be an effective treatment for eating disorders.
MH: But there are two significant unknowns here: the neuroscience – what psychedelics do to us physically – and the psychological effects.
JCH: Definitely, although I will say that we don’t know exactly how traditional antidepressants work. The body is a sort of black box, and we wish we knew what’s going on inside it, but we often don’t. A lot of researchers say, ‘Well, if neuroscience can’t tell us [exactly why psychedelics affect the brain the way they do], we need to focus on how they affect behaviour in the long run.’ That’s the next best thing we can do.
MH: Why might psychedelics be considered superior to existing antidepressants?
JCH: Some research shows them being successful in more than 50% of cases. Antidepressants can mess with your sleep and appetite, and they can cause weight gain. With psychedelics, the side effects seem to be much less far-reaching – whether that’s true is what’s being looked at now, but that is what’s appealing about them. Psychedelics are not physically addictive – but there are conversations, as with all drugs, about whether they are psychologically addictive. I’ve heard similar discussion around marijuana – that there’s no physical addiction but people love smoking weed every day and they do it because it makes them feel good. This is an important conversation to have and we need to be cautious about saying no one can get addicted.
MH: But people aren’t using psychedelics in the same way they might use them recreationally. It’s a new way of using them, isn’t it?
JCH: I think so, but it depends on who you talk to. Some people who never would’ve considered using psychedelics are now considering it in a therapeutic setting, with a therapist, or at the very least someone who isn’t under the influence of the drug while they are. Or maybe seeing a coach to help understand what happens to them during an experience and trying to interpret that in a therapeutic way. Then you have people who are self-medicating as maybe they were before, but now trying to be more introspective and set an intention. Then you have people who are microdosing, taking psilocybin and LSD in small doses, self-administered, and aren’t having a full-blown trip, but instead feel that the process calms them or helps with an ailment.
Much anecdotal evidence around microdosing talks about users who aren’t depressed, but instead do it to improve productivity or creativity. I have heard of some people who are prone to depression who feel that microdosing keeps that at bay. But the underlying theme for almost everyone who wants to try this is that it’s self-administered and illegal, unless you are in one of the small but increasing number of clinical trials.
MH: How important is the therapeutic component of potential psychedelic treatments?
JCH: With an Imperial study published in 2016, participants had therapists when they took psilocybin who were available 24 hours a day for weeks after. You need observers and scientists there to see what is happening, but also people there for safety, who understand what people might be going through when they take psychedelic drugs. How is therapy going to be operationalised if you can’t explain to people how they are going to feel during or after their experiences? There are a lot of training programmes trying to address that. They’re for licensed therapists but also for people without a background in therapy, because many people feel you don’t need to be a qualified therapist to ‘hold space’ for people during their experience. If neuroscience is finding it hard to explain what’s going on in the body with these drugs, the therapeutic aspect is going to be even harder to study.
MH: What is your understanding of how psychedelics work on the brain?
JCH: There are a few different theories. The most popular one concerns the default mode network. This idea says your brain has a default mode when it’s just hanging out and working as usual, and psychedelics disrupt that mode. You get shaken out of your usual thought patterns. A lot of theories come back to this idea, or similar ones, about psychedelics disrupting what your brain naturally does. It gets you out of your old ruts and your old thought patterns.
MH: Some critics say psychedelic research might be biased, that many researchers are just trying to prove what they feel to be true, with some of that belief based on personal use of psychedelics. Is that fair?
JCH: It’s hard to ascribe motive to anyone. Most scientists will have pet theories about their work and there are huge incentives in academia to find what you want to find, and this criticism is important to consider. A lot of people who are studying psychedelics have personal experience of them and those of us outside the field have to ask ourselves how that might influence what we’re looking at.
MH: But isn’t it true that in other trials, scientists wouldn’t necessarily have taken the drugs or have positive feelings towards them, other than hoping their discovery does what they want it to do?
JCH: This is definitely a sexier set of drugs than most. There’s a culture and pre-existing set of beliefs here. What’s interesting about the psychedelics world is seeing all of these different sectors of society come together. You’ve got the researchers, you’ve got the psychonauts who have been working with these drugs in an official or unofficial way for decades. You’ve got the business folks and the regular people who have just read about it and are interested in how this field could help them or someone they know. And everyone is in the same space, wondering about what makes for good evidence, who the ‘real’ experts are and whose opinion counts.
MH: Who stands out among the people you’ve spoken to for The Microdose?
JCH: One is Zach Skiles. He was in the US Marines, had PTSD when he got out of service and is now a clinical psychologist and researcher who has led some psychedelic retreats for veterans. His story exemplifies the direction in which a lot of research is going. In the US, individual states are funding research that helps veterans specifically, which is an interesting strategy politically. Conservative states such as Texas are doing that. I imagine that research can be applied to people beyond the veteran community who also have PTSD. Zach’s story is really moving and interesting, how he’s pivoted to make this his life’s work.
MH: What’s next for psychedelics?
JCH: There are so many elements to it all – the business side and research side – that it’s hard to say. There is a lot of hope riding on this, but there’s also strong initial research. It also makes for a tidy media story: this thing that’s been under our noses all along might have some use. Of course, native and indigenous people have known this for a long time, but the part of society that’s ‘discovering’ all this is very excited by its potential.
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