I NTEREST IN research investigating psychedelic drugs including psilocybin, ketamine, ibogaine, and LSD and their potential role in improving mental health has been heating up for a while. Now, with the signing of an executive order for the FDA to fast track review of these drugs, interest is at a fever pitch. This order is expected to lower barriers to researching these drugs and may even make some drugs eligible for the Right to Try Act.
A decade ago, using drugs like magic mushrooms, especially in a therapist’s office, seemed cringey, extreme, and not helpful for what patients were there for. Today…it’s complicated.
Tech bros and CEOs have been trumpeting their use of mushrooms (psilocybin) to optimize performance and improve emotional well-being, and new science is probing the mental health benefits of these and other psychedelics. The conversation got louder as MAHA championed for them being outside of Big Pharma’s hands (largely) and being “suppressed by the FDA,” according to Robert F. Kennedy, Jr. Meanwhile, plenty of people aren’t waiting for government approval before experimenting: About 8 million US adults reported using psychedelics in 2023 (often for fun), according to a RAND corporation survey. Now there are psychedelic happy hours, ibogaine retreats abroad, and chocolate candies for microdosing.
The medical community has been interested in psychedelics for a long time. Back in the 1940s, researchers were already trying to pick apart their mind-alerting effects.
When I was training to become a psychiatrist—not that long ago—I was taught that psychedelics (like psilocybin) might still help the types of patients in those early studies. But within the past five years, we have heard that tripping on shrooms—literally—might also help treat some of the more common mental health issues today, such as post-traumatic stress disorder (PTSD), major depression, and certain types of substance use disorders. Other psychedelics may be helpful to our mental wellness as well. In some cases, they may also be harmful.
“The promise of psychedelics is real. But these are profoundly novel and disruptive therapies, and they were bound to spark resistance and backlash, as they did in the 1960s,” says Michael Pollan, author of How to Change Your Mind.
So where are we now? Here’s your hallucination-free guide to what we know and what we don’t:
Psychedelics help…sometimes
DURING A SESSION with MDMA (midomafetamine) or psilocybin, a couple of helpful things are thought to be happening in your brain. First, the process of neuroplasticity is allowing your brain to form newer and stronger pathways. That enables your neurons (or brain cells) to communicate with each other better. Second, psychedelics also flood your brain with mood-boosting chemicals such as serotonin and dopamine, as well as hormones including oxytocin that allow you to feel calmer and experience a stronger sense of connection.
Regimen-wise, seeing a mental health boost from psychedelic treatment doesn’t always require a big investment of time. Some studies show that after just two doses of MDMA, people had reduced PTSD symptoms for up to 17 months. Other studies have found that just one or two doses of psilocybin can improve people’s depression for up to six weeks; two doses of it reduced alcohol intake by 83 percent.
When combined with talk therapy, psychedelics might open a “window” into the mind that could help you think differently about yourself in a way that promotes positive change.
Psychedelics have been voted up and voted down
AT THIS MOMENT, on the cusp of the FDA fast tracking research review, psychedelics are largely still illegal on the federal level as well as in most states. Psilocybin has been decriminalized in Colorado, psilocybin therapy is legal in Oregon, and last year, Missouri allowed the use of psilocybin for the medical treatment of conditions like PTSD and end-of-life care for people age 21 and older.
That doesn’t mean psychedelics are completely safe. In Massachusetts, voters shot down legalizing these drugs after news showing an increase in ER visits and fatal car accidents due to “drugged-driving.”
Potential safety issues were behind the FDA’s decision to deny approval for an MDMA-based drug that Lykos Therapeutics investigated to treat PTSD. While the research showed that 88 percent of people with PTSD got better, the FDA was concerned that MDMA may cause insomnia, anxiety, or heart rhythm problems. Psychedelics can also spike blood pressure and cause nausea and vomiting. Ibogaine has been associated with cardiac arrhythmias. And some, like MDMA, can potentially become addictive.
Until research is definitive, it will be hard to know where the risks and benefits lie. Consider this: A few years ago, while I was taking a break from my shift covering a detox unit, I caught a glimpse of a documentary about the supplement kratom that was playing in the physicians’ lounge; the show claimed that it might be the next potential cure for opioid addiction. That same night, I was treating patients who were actively detoxing from kratom, and the FDA later warned that it could have serious health consequences including addiction.
We need more options
MORE THAN 60 million American adults are dealing with symptoms of depression and/or anxiety, despite all the meds available. While SSRIs such as Prozac, Celexa, and Lexapro can be helpful, they don’t work well for about a third of people with depression. They also aren’t effective for about 40 percent of people who have PTSD, and there hasn’t been a new medication approved for PTSD since 2000.
With millions left struggling, scientists at institutions including Johns Hopkins reignited research in 2019 on psychedelics for conditions such as PTSD, major depression, and certain types of substance use disorders. That science builds on what we already knew: Building on that research that was started in the 1940s, by the 1960s, certain psychedelics were found to help terminally ill patients experience less physical pain and fear about death. New research is likely to turn up more benefits: one lab is even looking at whether psychedelics can help people break free of tobacco addiction.
Microdosing is a maybe
SOME RESEARCH SHOWS that microdosing with LDS or psilocybin may boost your mood (even if you aren’t depressed) or help you feel more creative and sociable. But other studies don’t report a noticeable effect on mental health. With adults in their 20s and 30s drinking less, some find microdosing happy hours to be a good way to have fun without the health risks of alcohol (or the hangover). Except there’s no conclusion yet about how safe microdosing actually is. Altered heart rhythms and bad trips can happen with psychedelics at ay dose.
What about ketamine?
WHILE KETAMINE OFTEN comes up in conversations about psychedelic medicine, technically it’s not a psychedelic. It’s part of a class of drugs called “dissociative anesthetics” that are used in certain surgical procedures. Yes, this was the substance found in Matthew Perry’s system after his death—but in extraordinary concentrations that you’d typically see only in general anesthesia.
However, for years, doctors have prescribed much lower doses of intravenous ketamine or ketamine lozenges, as off label treatments for conditions including depression or physical pain. This means that the FDA didn’t necessarily approve these forms of ketamine for such purposes, but there was enough research that some doctors believed the benefits potentially outweighed the risks. In 2019, the FDA approved a nasal-spray version of ketamine called esketamine for depression that hasn’t responded to typical antidepressants. (These are tough cases, and the spray helps up to 58 percent of people.) Note that ketamine might cause heart or respiratory problems, and it can be addictive so it’s important to only get it under the supervision of a licensed physician.
Gregory Scott Brown MD is a board-certified psychiatrist and Men’s Health advisor. He is an adjunct faculty member at the University of Houston College of Medicine, founder of The Brown Center & Clinics, and author of The Self-Healing Mind: An Essential Five-Step Practice to Overcoming Anxiety and Depression, and Revitalizing Your Life.
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